Measuring the quality of Hospital Food Services: Development and reliability of a Meal Quality Audit Tool.

AIM: To develop and test the reliability of a Meal Quality Audit Tool (MQAT) to audit the quality of hospital meals to assist food service managers and dietitians in identifying areas for improvement. METHODS: The MQAT was developed using expert opinion and was modified over time with extensive use and feedback. A phased approach was used to assess content validity and test reliability: (i) trial with 60 dietetic students, (ii) trial with 12 food service dietitians in practice and (iii) interrater reliability study. Phases 1 and 2 confirmed content validity and informed minor revision of scoring, language and formatting of the MQAT. To assess reliability of the final MQAT, eight separate meal quality audits of five identical meals were conducted over several weeks in the hospital setting. Each audit comprised an 'expert' team and four 'test' teams (dietitians, food services and ward staff). Interrater reliability was determined using intra-class correlation analysis. RESULTS: There was statistically significant interrater reliability for dimensions of Temperature and Accuracy (P < 0.001) but not for Appearance or Sensory. Composition of the 'test' team appeared to influence results for Appearance and Sensory, with food service-led teams scoring higher on these dimensions. 'Test' teams reported that MQAT was clear and easy to use. CONCLUSIONS: MQAT was found to be reliable for Temperature and Accuracy domains, with further work required to improve the reliability of the Appearance and Sensory dimensions. The systematic use of the tool, used in conjunction with patient satisfaction, could provide pertinent and useful information regarding the quality of food services and areas for improvement.

Encouraging family engagement in the rehabilitation process: a rehabilitation provider's development of support strategies for family members of people with traumatic brain injury.

PURPOSE: After a moderate to severe traumatic brain injury, it is widely recommended that family members be actively engaged in the client's rehabilitation journey because evidence suggests that this is associated with better outcomes. The ability of family members to fully engage in rehabilitation may be hindered by the barriers (logistical and psychological) they encounter. However, rehabilitation services can facilitate family engagement through a person-centred approach that provides support to remove barriers. Limited published guidance exists regarding practical and effective methods for delivering such support. This paper describes how one rehabilitation service has developed an eight-tiered approach. KEY MESSAGES AND IMPLICATIONS: Family support is provided by explicit structuring of services to include (i) early engagement, (ii) meeting cultural needs, (iii) keeping families together, (iv) actively listening, (v) active involvement, (vi) education, (vii) skills training, and (viii) support for community re-integration. Implementation of these support strategies are individualised based on the expressed needs of each family. Families report a high level of satisfaction with the service. CONCLUSION: A practice-based quality improvement model identified challenges, implemented changes, and observed/evaluated the results to successfully develop a multifaceted strategy for supporting families, thereby encouraging their engagement in rehabilitation. Ongoing refinements and evaluation are planned.

Citicoline (Cognizin) in the treatment of cognitive impairment.

Pharmacological treatment of cerebrovascular disorders was introduced at the beginning of the 20th Century. Since then, a multitude of studies have focused on the development of a consensus for a well defined taxonomy of these disorders and on the identification of specific patterns of cognitive deficits associated with them, but with no clear consensus. Nevertheless, citicoline has proved to be a valid treatment in patients with a cerebrovascular pathogenesis for memory disorders. A metanalysis performed on the entire database available from the clinical studies performed with this compound confirms the experimental evidence from the animal studies which have repeatedly described the multiple biological actions of citicoline in restoring both the cell lipid structures and some neurotransmitter functions.