Engaging Patients in Trainee Evaluations in Clinical Nutrition: a Pilot Intervention.

BACKGROUND: Health professions trainee feedback rarely includes the patient voice, despite patients being experts in their own experience. Research supports including the patient voice; however, literature on the value of in-practice patient feedback is lacking. ACTIVITY: A form was designed and implemented for patients to evaluate dietetic interns teaching a group class. Interns were surveyed to provide feedback. RESULTS: Interns reported finding the feedback valuable and unique. The evaluations were felt to be credible. DISCUSSION: Results support engaging patients in feedback for dietetic interns. Research should address different contexts, competencies other than communication and professionalism, and the impact to patients.

Enteral Nutrition Support Reduces the Necessity of Total Parenteral Nutrition to Reach Patient-Specific Caloric Goals Postpancreaticoduodenectomy.

OBJECTIVES: Pancreaticoduodenectomy (PD) is associated with significant rates of postoperative complications. Although there is evidence that enteral nutrition support (ENS) may reduce postoperative sepsis, the true value of ENS in the abrogation of septic complications remains controversial. The aim of our study is to investigate the postoperative outcome of patients post-PD with and without ENS. METHODS: Using our prospective institutional database, we identified 202 patients from 2001 through 2009 who underwent PD. Of the 202 patients, 121 matched our inclusion criteria. In total, 67 of 121 (55.4%) patients received ENS, whereas 54 (44.6%) patients had no ENS and served as controls. Postoperative morbidity and mortality were recorded and analyzed. RESULTS: No significant differences were found in the postoperative morbidity of the patients. The anastomotic leak rate was 13% in both the ENS and control groups (P = 0.846). There was no difference in mortality within the two groups (4% vs 5%, P = 0.881). Significantly more patients in the control group received total parenteral nutrition (P = 0.033). CONCLUSIONS: ENS is not associated with lower rates of postoperative morbidity and mortality. It does, however, reduce the necessity of additional total parenteral nutrition to reach patient-specific caloric goals.

The Experiences of Patients With Advanced Head and Neck Cancer With a Percutaneous Endoscopic Gastrostomy Tube: A Qualitative Descriptive Study.

Background: While the percutaneous endoscopic gastrostomy (PEG) tube has become an established part of the management regimen for patients with head and neck cancer (HNCA) with impaired nutrition and functional status, limited research has explored the impact and experiences of living with a PEG tube from the patient's perspective. This qualitative study serves as a follow-up investigation undertaken to describe the experiences of patients with advanced HNCA living with a PEG tube. Materials and Methods: Eligible patients from convenience sampling were invited to participate until data saturation was reached. In-depth interviews were conducted with consenting participants. Qualitative descriptive design guided the content analysis of the interview transcripts. Results: Of the 49 patients invited, a total of 15 participants' interviews were transcribed and analyzed. Each interview was 15-90 minutes in length. Four of 22 content codes were chosen to describe the overarching ideas of the progressive experience of a patient's journey from the initial decision-making process around tube insertion through to its removal. Difficulty swallowing and weight loss emerged as primary factors for PEG tube insertion, and all participants became accustomed to living with the tube. Resuming a complete oral diet was a gradual transition. All participants recognized the value of the tube, and most acknowledged its necessity for their survival. Conclusions: Results describe the overall PEG tube experience as a dichotomy. While there were issues with the PEG tube, all participants found the tube to be beneficial. This study provides invaluable insight from a practice perspective.

Role of the nutrition professional in high-risk obstetrics inpatient teams.

Beyond the management of gestational diabetes and weight control, limited literature exists on nutritional management in high-risk pregnancies. This study is a starting point for understanding the role of the registered dietitian (RD) in high-risk obstetrics (HRO) inpatient teams. Demographic information was gathered on Ontario HRO inpatient units and patient characteristics, and the RD's role in this setting was explored. Representatives from all six HRO units in Ontario completed a questionnaire. Five of the HRO units had an RD on the team. The RDs stated that their primary role in the unit involved providing nutrition education and support, screening patients for nutritional risk, and writing vitamin and mineral orders. This was the first study in which RDs' role in HRO inpatient units was examined. Existing literature supports the role of good nutrition in preventing and treating the conditions seen in HRO units; however, RDs' specific role remains unclear. Future studies are needed to analyze the effect of nutrition on these HRO conditions, and to support the development of best practice guidelines.

The experience of head and neck cancer patients with a percutaneous endoscopic gastrostomy tube at a Canadian cancer center.

BACKGROUND: Many patients with advanced head and neck cancer become unable to obtain sufficient nutrition and hydration orally, leading to considerable weight loss and compromised clinical outcomes. The percutaneous endoscopic gastrostomy (PEG) tube is ideal for this population who require longer term nutrition support due to the effects of cancer treatment. Although clinical experts at the Odette Cancer Centre (OCC) report positive patient feedback with PEG tubes, there is debate in the literature regarding the associated quality of life (QoL). The study objective was to learn about the experience of patients living with a PEG tube. MATERIALS AND METHODS: A neutral questionnaire with closed- and open-ended questions was developed, tested, and used to collect data. Quantitative data were analyzed using descriptive statistics to determine whether the patients' experiences were positive/neutral or negative. Qualitative data were assessed for common themes, and frequency was counted. RESULTS: Of the 51 participants, 84% felt the PEG tube had a positive/neutral effect on their QoL. Ninety percent felt that the PEG tube was "very much" or "quite a bit" worthwhile. In addition, 96% would recommend it to another patient. The 11 questions reflecting domains of QoL affected by living with a PEG tube were answered positively or neutrally at least 71% of the time. CONCLUSION: Results indicate that the patient experience with the PEG tube is generally positive or neutral, thus demonstrating a different outcome than recent literature. This study will help improve understanding regarding the experience of living with a PEG tube from the patient perspective.

Solution-focused counselling in Canadian outpatient dietetic practice.

PURPOSE: The use of solution-focused counselling (SFC) in dietetics was examined to determine the demand for an SFC teaching tool for registered dietitians. METHODS: A cross-sectional web-based survey was conducted within the Dietitians of Canada cardiology, eating disorders, and consulting networks, with dietitians who practised in an outpatient setting. Dietitians were surveyed on the seven core components of SFC. RESULTS: Responses (n=58) were received from dietitians practising in seven provinces, who tended to be younger (mean age=44) and who had practised for a mean of 15 years. The entire sample reported use of at least four of the seven core components of SFC. All respondents were interested in receiving a counselling teaching tool for dietitians. CONCLUSIONS: All respondents were using components of SFC in their outpatient practices. The efficaciousness of SFC in dietetic practice has yet to be determined.