Feasibility, acceptability and cost efficiency of using webinars to deliver first-line patient education for people with Irritable Bowel Syndrome as part of a dietetic-led gastroenterology service in primary care.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. International research suggests dietary intervention as a first-line approach, although dietetic services are struggling to cope with demand. Digital technology may offer a solution to deliver appropriate patient education. The present study aimed to assess the feasibility, acceptability and cost efficiency of using webinars to deliver first-line IBS advice to patients as part of a dietetic-led gastroenterology service in primary care. METHODS: Patients were directed to an IBS First Line Advice webinar on a specialist NHS website. Data were collected from patients pre- and post-webinar use using an online survey. RESULTS: In total, 1171 attendees completed the pre-webinar survey and 443 completed the post-webinar survey. Attendees ranged from under 17 years to over 75 years. Of the attendees, 95% found the webinar easy to access and 91% were satisfied with the content of the webinar. Those with excellent or good knowledge rose from 25% pre-webinar to 67% post-webinar, and confidence in managing their condition improved for 74% of attendees. Using the webinars led to a 44% reduction in referrals for one-to-one appointments with a specialist dietitian in the first year of use. The value of the clinical time saved is estimated at £3593 per annum. The one-off cost of creating the webinar was £3597. CONCLUSIONS: The use of webinars is a feasible, acceptable and cost-efficient way of delivering first-line patient education to people suffering with Irritable Bowel Syndrome as part of a dietetic-led gastroenterology service in primary care.

The contribution of ascitic fluid to body weight in patients with liver cirrhosis, and its estimation using girth: a cross-sectional observational study.

BACKGROUND: There is a high prevalence of malnutrition among people with decompensated liver disease. Standard nutritional screening tools use weight and body mass index (BMI) to identify risk, although these are difficult to measure for those with ascites, often secondary to liver cirrhosis. Dietetic guidance suggests adjusting for ascitic weight by 2.2-14 kg, although there is a lack of evidence to substantiate these values. The present study aimed to measure the contribution of ascitic fluid weight and compare this with the current guidance, as well as to examine whether girth circumference can be used to estimate ascitic weight. METHODS: A cross-sectional, observational study was conducted over 13 weeks. Participants attending for paracentesis were weighed, their girths measured, and BMI was calculated pre- and post-paracentesis. Fluid removed via paracentesis was recorded. Ethical approval was received (IRAS project ID: 218747). RESULTS: Eighteen participants underwent paracentesis. The range of ascitic fluid drained was 3.8-19 L [mean (SD) = 8.7 (3.7) L]. Weight difference between pre- and post-paracentesis was in the range 4.5-20 kg [mean (SD) = 8.7 (3.9) kg]. Ascitic fluid weight is shown to be higher in each category (minimal, moderate, severe ascites) than the current guidance values. Weight difference was greater than 14 kg in 11% (n = 2) of participants. A strong, statistically significant relationship (rho = 0.68, P ≤ 0.01) between ascitic weight and pre-paracentesis girth was found. An equation was formulated to enable the estimation of ascitic fluid from pre-paracentesis girth. CONCLUSIONS: Current dietetic guidance should be re-evaluated to reflect the greater weight differences identified. Measuring girth pre-paracentesis may help to inform dry weight estimation. Further research is required to verify the accuracy of estimating ascitic weight from pre-paracentesis girth.

Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study.

BACKGROUND: Critically ill patients lose up to 2% of muscle mass per day. We assessed the feasibility of administering a leucine-enriched essential amino acid (L-EAA) supplement to mechanically ventilated trauma patients with the aim of assessing the effect on skeletal muscle mass and function. METHODS: A randomised feasibility study was performed over six months in intensive care (ICU). Patients received 5 g L-EAA five times per day in addition to standard feed (L-EAA group) or standard feed only (control group) for up to 14 days. C-reactive protein, albumin, IL-6, IL-10, urinary 3-MH, nitrogen balance, protein turnover ([1-13C] leucine infusion), muscle depth change (ultrasound), functional change (Katz and Barthel indices) and muscle strength Medical Research Council (MRC) sum score to assess ICU Acquired Weakness were measured sequentially. RESULTS: Eight patients (9.5% of screened patients) were recruited over six months. L-EAA doses were provided on 91/124 (73%) occasions. Inflammatory and urinary marker data were collected; serial muscle depth measurements were lacking due to short length of stay. Protein turnover studies were performed on five occasions. MRC sum score could not be performed as patients were not able to respond to the screening questions. The Katz and Barthel indices did not change. L-EAA delivery was achievable, but meaningful functional and muscle mass outcome measures require careful consideration in the design of a future randomised controlled trial. CONCLUSION: L-EAA was practical to provide, but we found significant barriers to recruitment and measurement of the chosen outcomes which would need to be addressed in the design of a future, large randomised controlled trial. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN79066838 . Registered on 25 July 2012.

Post-exercise hypotension and skeletal muscle oxygenation is regulated by nitrate-reducing activity of oral bacteria.

Post-exercise hypotension (PEH) is a common physiological phenomenon leading to lower blood pressure after acute exercise, but it is not fully understood how this intriguing response occurs. This study investigated whether the nitrate-reducing activity of oral bacteria is a key mechanism to trigger PEH. Following a randomized, double blind and crossover design, twenty-three healthy individuals (15 males/8 females) completed two treadmill trials at moderate intensity. After exercise, participants rinsed their mouth with antibacterial mouthwash to inhibit the activity of oral bacteria or a placebo mouthwash. Blood pressure was measured before, 1h and 2 h after exercise. The microvascular response to a reactive hyperaemia test, as well as blood and salivary samples were taken before and 2 h after exercise to analyse nitrate and nitrite concentrations and the oral microbiome. As expected, systolic blood pressure (SBP) was lower (1 h: -5.2 ±â€¯1.0 mmHg; P < 0.001); 2 h: -3.8 ±â€¯1.1 mmHg, P = 0.005) after exercise compared to baseline in the placebo condition. This was accompanied by an increase of circulatory nitrite 2 h after exercise (2h: 100 ±â€¯13 nM) compared to baseline (59 ±â€¯9 nM; P = 0.013). Additionally, an increase in the peak of the tissue oxygenation index (TOI) during the reactive hyperaemia response was observed after exercise (86.1 ±â€¯0.6%) compared to baseline levels (84.8 ±â€¯0.5%; P = 0.010) in the placebo condition. On the other hand, the SBP-lowering effect of exercise was attenuated by 61% at 1 h in the recovery period, and it was fully attenuated 2 h after exercise with antibacterial mouthwash. This was associated with a lack of changes in circulatory nitrite (P > 0.05), and impaired microvascular response (peak TOI baseline: 85.1 ±â€¯3.1%; peak TOI post-exercise: 84.6 ±â€¯3.2%; P > 0.05). Diversity of oral bacteria did not change after exercise in any treatment. These findings show that nitrite synthesis by oral commensal bacteria is a key mechanism to induce the vascular response to exercise over the first period of recovery thereby promoting lower blood pressure and greater muscle oxygenation.

Potentially modifiable determinants of malnutrition in older adults: A systematic review.

BACKGROUND & AIMS: Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. METHODS: A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. RESULTS: Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. CONCLUSION: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly ageing population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.

Changes in physical activity, weight and wellbeing outcomes among attendees of a weekly mass participation event: a prospective 12-month study.

BACKGROUND: Mass participation events are recognized as a way of engaging low-active individuals in health-enhancing physical activity, but there is a need to investigate the sustained effects on behaviour and health. This study aimed to examine changes in self-reported physical activity, weight and wellbeing over 12 months in participants of parkrun, a weekly mass participation 5 km running event. METHODS: New parkrun registrants (n = 354) completed self-reported measures of physical activity, weight, happiness and stress, at registration, 6 months and 12 months. Objective data on attendance and fitness (i.e. run dates and finishing times) were obtained from the parkrun database. RESULTS: Overall physical activity levels were high at baseline, but significantly increased over the first 6 months, before declining. By 12 months, weekly physical activity was 39 min higher than baseline. Significant reductions in body mass index were observed over 12 months, with a weight loss of 1.1% in the whole sample, and 2.4% among overweight participants. Modest increases in happiness and decreases in perceived stress were recorded. Run times suggested a 12% improvement in fitness during the study. CONCLUSION: Significant changes in weight, fitness and wellbeing outcomes indicate the public health benefits of regular participation in parkrun.

Future Dietitian 2025: informing the development of a workforce strategy for dietetics.

BACKGROUND: Healthcare is changing and the professions that deliver it need to adapt and change too. The aim of this research was to inform the development of a workforce strategy for Dietetics for 2020-2030. This included an understanding of the drivers for change, the views of stakeholders and recommendations to prepare the profession for the future. METHODS: The research included three phases: (i) establishing the context which included a literature and document review (environmental scan); (ii) discovering the profession and professional issues using crowd-sourcing technology; and (iii) articulating the vision for the future using appreciative inquiry. RESULTS: The environmental scan described the current status of the dietetic profession, the changing healthcare environment, the context in which dietitians work and what future opportunities exist for the profession. The online conversation facilitated by crowd-sourcing technology asked the question: 'How can dietitians strengthen their future role, influence and impact?' Dietitians and interested stakeholders (726 and 109, respectively) made 6130 contributions. Seven priorities were identified and fed into the appreciative inquiry event. The event bought together 54 dietitians and analysis of the discussions generated five themes: (i) professional identity; (ii) strong foundations-creating structure and direction for the profession; (iii) amplifying visibility and influence; (iv) embracing advances in science and technology; and (v) career advancement and emerging opportunities. CONCLUSIONS: A series of recommendations were made for the next steps in moving the workforce to a new future. The future for dietetics looks bright, embracing technology, as well as exploring different ways of working and new opportunities, as this dynamic profession continues to evolve.

Using judgement analysis to identify dietitians' referral prioritisation for assessment in adult acute services.

BACKGROUND/OBJECTIVES: Dietitians need to prioritise referrals in order to manage their work load. Novice dietitians may not receive training on prioritisation and could be helped with an evidence-based, effective decision-making training tool. To develop such a tool, it is necessary to understand how experts make prioritisation decisions. This study aimed to model expert decision-making policy for prioritising dietetic referrals in adult acute-care services. METHODS/SUBJECTS: Social judgement theory was used to model expert decision-making policy. Informational cues and cue levels were identified. A set of case scenarios that replicated dietetic referrals in adult acute services were developed using fractional factorial design approach. Experienced dietitians were asked to make prioritisation decisions on case scenarios. A model was derived using multiple regression analysis to elicit the weighting given to cues and cue levels by the experts when making prioritisation decisions. RESULTS: Six cues and 21 cue levels were identified, and 60 unique case scenarios were created. Fifty experienced dietitians made decisions on these case scenarios. The 'reason for referral' and 'biochemistry picture' were the two most influential cues, and 'weight history' was the least significant. 'Nutritional status', 'presenting complaint' and 'previous food intake' had similar weightings. In all, 95.7% of the variability in the experts' average judgement (adjusted R2=0.93) was predicted by the 6 cues. CONCLUSIONS: A model for referral prioritisation in adult acute services described experienced dietitians' decision-making policy. This can be used to develop training materials that may increase the effectiveness and quality of prioritisation judgements.European Journal of Clinical Nutrition advance online publication, 23 August 2017; doi:10.1038/ejcn.2017.123.

Does body mass index impact on muscle wasting and recovery following critical illness? A pilot feasibility observational study.

BACKGROUND: Critical illness is associated with muscle loss, weakness and poor recovery. The impact that illness and the ensuing metabolic response has on obese patients is not known. Objectives were to test if obese patients lose less muscle depth compared to non-obese patients; if a reduction in muscle depth was associated with reduced strength and recovery; and to assess the feasibility of these methods with a range of body mass index's (BMI). METHODS: A prospective observational pilot study of muscle depth in critically ill patients categorised by BMI was performed. Muscle depth changes were assessed by ultrasound on study days 1, 3, 5, 7, 12 and 14. Strength was measured via handgrip dynamometry and Medical Research Council (MRC) sum score on waking and at discharge from the intensive care unit. Level of dependency was measured with the Barthel index. RESULTS: 44 critically ill patients; 17 had normal BMI, 10 were overweight and 17 were obese. The three groups did not differ in baseline characteristics, except obese patients had significantly greater initial muscle depth. Muscle depth loss was similar between the BMI groups at each of the time points. Handgrip and MRC sum score were only possible in a small number of patients because of reduced alertness and weakness. Majority were deemed fully dependent based on the Barthel index. CONCLUSIONS: Obese patients lost muscle depth in a comparable manner to non-obese patients, suggesting that BMI may not prevent muscle depth loss. It was not possible to determine the effect on strength because the clinical condition of patients precluded reliable measurements.

Impact of supplementation with amino acids or their metabolites on muscle wasting in patients with critical illness or other muscle wasting illness: a systematic review.

Muscle wasting during critical illness impairs recovery. Dietary strategies to minimise wasting include nutritional supplements, particularly essential amino acids. We reviewed the evidence on enteral supplementation with amino acids or their metabolites in the critically ill and in muscle wasting illness with similarities to critical illness, aiming to assess whether this intervention could limit muscle wasting in vulnerable patient groups. Citation databases, including MEDLINE, Web of Knowledge, EMBASE, the meta-register of controlled trials and the Cochrane Collaboration library, were searched for articles from 1950 to 2013. Search terms included 'critical illness', 'muscle wasting', 'amino acid supplementation', 'chronic obstructive pulmonary disease', 'chronic heart failure', 'sarcopenia' and 'disuse atrophy'. Reviews, observational studies, sport nutrition, intravenous supplementation and studies in children were excluded. One hundred and eighty studies were assessed for eligibility and 158 were excluded. Twenty-two studies were graded according to standardised criteria using the GRADE methodology: four in critical care populations, and 18 from other clinically relevant areas. Methodologies, interventions and outcome measures used were highly heterogeneous and meta-analysis was not appropriate. Methodology and quality of studies were too varied to draw any firm conclusion. Dietary manipulation with leucine enriched essential amino acids (EAA), ß-hydroxy-ß-methylbutyrate and creatine warrant further investigation in critical care; EAA has demonstrated improvements in body composition and nutritional status in other groups with muscle wasting illness. High-quality research is required in critical care before treatment recommendations can be made.

Exploring the public health potential of a mass community participation event.

BACKGROUND: The role of mass participation sports events in encouraging regular physical activity is under-researched. This study explored the public health potential of parkrun, a UK-wide network of free weekly timed 5-km runs in public parks. METHODS: A total of 7308 adult participants of parkrun self-reported demographic characteristics, current physical activity and the perceived impact of involvement. Objective data on attendance and 5-km performance were available from the central parkrun database. RESULTS: At registration 25.3% of participants described themselves as non-runners, with this group including the highest proportions of females (53.8 versus 48.9% for the total sample), overweight/obese (45.2 versus 33.2%) and those with a limiting disability (6.1 versus 4.3%). The initial non-runners had the largest increase in 5-km performance (15.8 versus 10.2%), and were more likely to report health-related benefits. More regular attendance was positively associated with perceived benefits. Middle-aged and older adults were well represented overall (60.9 and 14.3% of the sample, respectively). CONCLUSIONS: Preliminary evidence suggests that parkrun is attractive to non-runners, with women, older adults and overweight people well represented. The observed fitness improvements and perceived benefits indicate the scope for investigating the effectiveness of parkrun as a cost-effective community-based intervention for improving public health.

Gastrointestinal hormones: the regulation of appetite and the anorexia of ageing.

Loss of appetite is frequently observed during ageing, termed the 'anorexia of ageing'. Ageing is associated with the inability to appropriately increase food intake after under-eating in the short- and long-term. Older people also report lower feelings of hunger and increased feelings of satiety and fullness. Gastrointestinal peptide hormones are a major part of the appetite regulatory system and are released in response to nutritional stimuli. They can be classified as: anorexigenic (satiety) [e.g. peptide tyrosine tyrosine (PYY), glucagon-like peptide-1, pancreatic polypeptide, oxyntomodulin and cholecystokinin (CCK)] or orexigenic (hunger) (e.g. ghrelin). Although the control of appetite is not fully understood, it is clear that these hormones play an important role, and may influence the development and treatment of obesity and under-nutrition. The literature shows a consistent finding that there is a loss of appetite in those aged over 65 years, although how this loss is mediated is not yet clear. Some evidence suggests that with advancing age there is an increase in satiety hormones, such as CCK and PYY, and a decrease in the hunger hormone, ghrelin. However, not all studies agree, emphasising the need for more in-depth research to clarify age-related changes. This knowledge will enable us to develop therapies to help prevent under-nutrition during ageing. This review explores how age influences gastrointestinal appetite hormones in humans, as well as how this may contribute to the development of age-related malnutrition.

Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients.

BACKGROUND: Malnutrition is a common problem in hospitalised inpatients, resulting in a range of negative clinical, patient-centred and economic sequelae. Protected mealtimes (PM) aim to enhance the quality of the mealtime experience and maximise nutrient intake in hospitalised patients. The present study aimed to measure mealtime environment, patient experience and nutrient intake before and after the implementation of PM. METHODS: PM were implemented in a large teaching hospital through a range of different approaches. Direct observations were used to assess ward-level mealtime environment (e.g. dining room use, removal of distractions) (40 versus 34 wards) and individual patient experience (e.g. assistance with eating, visitors present) (253 versus 237 patients), and nutrient intake was assessed with a weighed food intake at lunch (39 versus 60 patients) at baseline and after the implementation of PM, respectively. RESULTS: Mealtime experience showed improvements in three objectives: more patients were monitored using food/fluid charts (32% versus 43%, P = 0.02), more were offered the opportunity to wash hands (30% versus 40%, P = 0.03) and more were served meals at uncluttered tables (54% versus 64%, P = 0.04). There was no difference in the number of patients experiencing mealtime interruptions (32% versus 25%, P = 0.14). There was no difference in energy intake (1088 versus 837 kJ, P = 0.25) and a decrease in protein intake (14.0 versus 7.5 g, P = 0.04) after PM. CONCLUSIONS: Only minor improvements in mealtime experience were made after the implementation of PM and so it is not unexpected that macronutrient intake did not improve. The implementation of PM needs to be evaluated to ensure improvements in mealtime experience are made such that measurable improvements in nutritional and clinical outcomes ensue.

Identifying the factors that influence energy deficit in the adult intensive care unit: a mixed linear model analysis.

BACKGROUND: Critically ill patients frequently receive inadequate nutrition support as a result of under- or overfeeding. Malnutrition in intensive care unit (ICU) patients is associated with increased morbidity and mortality. The present study aimed to identify the significant factors that influence energy deficit in the ICU. METHODS: ICU patients with a length of stay of ≥3 days were studied for 30 days over two consecutive years at a large university teaching hospital. Fifty-six Patients were studied, with a total of 530 records of feeding days. Information was collected for: day when feed initiated, age, gender, length of stay, Acute Physiological and Chronic Health Evaluation score (APACHE II), fed within 24 h, speciality, type of ventilation, feeding route, outcome (survived/died), diarrhoea (yes/no), aspirate volume, dietitian observed nutritional status (malnourished/not), sedation, estimated energy requirements and energy received. Mixed linear models for longitudinal data were used with energy deficit (energy received - energy requirements) as the dependent variable. RESULTS: Factors that were found to have a significant association with energy deficit were: day feeding was initiated (P<0.001), whether fed within 24 h (P<0.001) and whether sedated (P<0.001). Furthermore, three combined effects were found: ventilation mode and aspirate volume (P<0.007), fed within 24 h and ventilation mode (P<0.001), fed within 24 h and sedation (P<0.017). CONCLUSIONS: The number of days after feeding was initiated, initiation of feeding within 24 h and sedation have been identified as factors that predict energy deficit during ICU stay. Efforts to initiate feeding as soon as possible and minimise interruptions to feeding may reduce energy deficits in these vulnerable patients.

Validity, reliability and acceptability of the Imperial Nutritional Screening System (INSYST): a tool that does not require the body mass index.

BACKGROUND: Nutritional screening tools are central to identifying malnourished patients, but their efficacy is often reduced as a result of difficulties in obtaining height for body mass index (BMI) calculations. The present study aimed to evaluate the validity, reliability and acceptability of the Imperial Nutritional Screening System (INSYST); a tool that does not require the BMI. METHODS: Patients were screened by the researcher within 72 h of admission using INSYST I & II, Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA), including taking height and weight. Routine INSYST data, completed by nursing staff, were subsequently collected. At risk and malnourished patients were combined for statistical analysis. Inter-tool and inter-rater agreement (kappa, kappa) was evaluated. Sensitivity and specificity were calculated. Nurses were timed using INSYST. Acceptability, including ease and speed of use, was evaluated. RESULTS: Kappa (agreement) scores (all P < 0.001) were substantial for INSYST I versus MUST and MNA (kappa = 0.73 and kappa = 0.76, respectively) and moderate for INSYST II (both kappa = 0.53). The sensitivity of INSYST I and II was high (95-100%), whereas specificity was lower (65-83%). The agreement between dietitian and nurse for INSYST I was substantial kappa = 0.77 and that for INSYST II was fair kappa = 0.39 (both P

Evaluation of attendance and weight loss in an intensive weight management clinic compared to standard dietetic care.

BACKGROUND: With increasing rates of obesity, the effectiveness of weight reduction programmes come under increasing scrutiny. This nonrandomized study aimed to review the effectiveness of two weight loss clinics in terms of percent and rate of weight loss, and attendance. METHODS: Data were collected on consecutive obese patients, attending either an intensive weight management clinic (IWMC) or a general dietetic outpatient clinic. The IWMC had a structured approach with six once-a-month appointments, a signed agreement to attend, an initial screening of readiness to change and consistent advice from one dietitian. The general clinic was less structured, had more ad hoc follow up and did not guarantee one dietitian. RESULTS: Seventy percent of patients referred were female [mean (SD) age 48 (14.2) years]. Thirty-three percent (103/313) of all patients referred did not book an appointment. Of those attending with a body mass index > or = 32 kg m(-2), 55% were seen in the general and 45% in the intensive clinic, but only 19% and 53%, respectively, completed the programmes. The total amount and rate of weight loss did not differ significantly between clinics. However, analysis using the last recorded weight revealed a median weight reduction of 1.8% (interquartile range = -5.6-0) at the median rate of -0.4 kg month(-1) (-1-0) in the intensive clinic, compared to no overall weight loss in the general clinic (P < or = 0.001). CONCLUSIONS: A more structured approach and initial screening of readiness to change is likely to achieve better weight loss results and therefore will comprise a better use of dietetic time than including obese patients in general clinics.

The effectiveness of targeted feeding assistance to improve the nutritional intake of elderly dysphagic patients in hospital.

BACKGROUND: Dysphagic older patients are prescribed texture modified food or fluids as treatment. The present study aimed to determine whether targeted feeding assistance using trained volunteers increased oral intake in elderly dysphagic patients. METHOD: Individualized feeding assistance was given to patients who were diagnosed with dysphagia by a speech and language therapist. Data were collected between 08.00 h and 16.00 h and compared with previously collected data from dysphagic patients who received no targeted feeding assistance. RESULTS: The group with targeted assistance (n = 16) had higher intakes of energy and protein from both meals and supplements combined compared to the controls (n = 30); mean difference = 2327 kJ (554 kcal) (95% CI = 1294-3360 kJ; P < 0.001) and 28 g protein (95% CI = 13-41 g; P = 0.01). The assisted group ate more from meals only; mean difference = 1336 kJ (318 kcal) (95% Cl = 517-2155 kJ; P = 0.002) and 6 g of protein (95% Cl = 2-26 g; P = 0.02); and from nutritional supplements only, median difference = 1205 kJ (287 kcal) (95% CI = 613-1273 kJ; P = 0.0002) and 15 g protein (95% CI 6.9-15 g; P < 0.0001). CONCLUSION: Nutritional intake can be improved by targeted feeding assistance in hospitalized elderly dysphagic patients on texture modified diets.

Does a new steam meal catering system meet patient requirements in hospital?

BACKGROUND: It has been consistently observed that a significant proportion of hospital inpatients are malnourished and many actually develop malnutrition in hospital. The NHS provides over 300 million meals each year at a cost of pound 500 million, yet there is relatively little research evaluating how well different catering systems provide for the needs of hospital inpatients. AIM: The aim of the study was to: (i) evaluate whether a new steam meal catering system (Steamplicity) enables patients in theory to meet their energy requirements in hospital and (ii) compare energy and protein intake using Steamplicity with a traditional bulk cook-chill system. METHODS: Patients not at nutritional risk had their food intake at one lunchtime assessed. Energy intake was compared with the patients' energy requirements and energy and protein intake were compared with previous data from a bulk system. RESULTS: Fifty-seven patients had a median daily energy requirement of 7648 kJ (1821 kcal) [inter-quartile range (IQR): 6854-9164 kJ]. Assuming 30% [2293 kJ (546 kcal)] should be supplied by the lunch meal the average intake of 1369 kJ (326 kcal) fell short by 40%. Patients served meals from Steamplicity ate less energy [1369 kJ versus 1562 kJ (326 kcal versus 372 kcal) P = 0.04] but similar protein (18 g versus 19 g P = 0.34) to the bulk system. The largest difference was the energy provided by the dessert since the bulk system served more hot high-calorie desserts. CONCLUSIONS: Patient intakes did not meet their estimated requirements. The patients in this study were eating well and not at nutritional risk, thus patients with a poor appetite will be even less likely to meet their nutritional requirements. Steamplicity meals result in a lower energy intake than meals from a bulk cook-chill system, but similar protein intakes.

Evaluation of paladai cup feeding in breast-fed preterm infants compared with bottle feeding.

This pilot study developed an appropriate procedure to evaluate the paladai cup compared to bottle feeding in preterm infants, using weighed napkins and video analysis to assess amount of spillage, volume consumed, time taken and physiological stability. Paladai results demonstrated increased spillage, increased feed times with more stress cues.

Vulnerable patients with a fractured neck of femur: nutritional status and support in hospital.

BACKGROUND AND AIM: Malnutrition has serious consequences for recovery and increases the risk of complications in hospital patients. Fractured neck of femur (NOF) patients may be particularly at risk because of their old age and frail state of health. We conducted an observational study to evaluate the nutritional state and the nutritional support, which was provided to this group during their stay in hospital. METHODS: Twenty-five consecutive people admitted to an orthopaedic ward with a fractured NOF at Charing Cross Hospital, London were recruited. Anthropometric measures, biochemical indices, 3 days dietary intake and dietetic referral rates were collected. RESULTS: Patients had a significantly lower body mass index (BMI) compared with the mean BMI for sex and age in an elderly UK population (21.97 +/- 1.06 versus 26.73 +/- 0.03 kg m(-2); P < 0.005). They took just 58.6% of their energy requirements in hospital (4219 +/- 319 versus 7199 +/- 202 kJ mean(-1) daily intake over 3 days in week 2). Using the hospitals own nutritional risk assessment tool 56% of patients were found to be at risk of malnutrition on admission, which increased to 68% after 2-3 weeks. Of these 64% were referred to a dietitian and were given nutritional supplements. Nutritional assessment revealed that their nutritional status worsened during stay. CONCLUSIONS: This group of patients with fractured NOF is likely to be malnourished on admission and to show a rapid deterioration in its nutrition status during admission. Energy needs were not met in up to 50% of patients. These results reinforce the need to screen, supplement and monitor fractured NOF patients.