| 1. |
- Al-Adili, Lina, et al.
(author)
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Discrepancy in the evaluation of explicit and implicit nutrition care outcomes for patients at risk of malnutrition : A qualitative study
- 2022
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In: Journal of human nutrition and dietetics. - : John Wiley & Sons. - 0952-3871 .- 1365-277X. ; 35:3, s. 494-503
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Journal article (peer-reviewed)abstract
- BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition.METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes.RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure.CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.
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| 2. |
- Al-Adili, Lina, et al.
(author)
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Setting goals with patients at risk of malnutrition : A focus group study with clinical dietitians
- 2022
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In: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 105:7, s. 2103-2109
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Journal article (peer-reviewed)abstract
- Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition.Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes.Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically oriented goals and patients' personal goals.Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. Practice implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.
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| 3. |
- Fielding, R. A., et al.
(author)
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Effect of structured physical activity and nutritional supplementation on physical function in mobility-limited older adults : Results from the VIVE2 randomized trial
- 2017
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In: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 21:9, s. 936-942
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Journal article (peer-reviewed)abstract
- The interactions between nutritional supplementation and physical activity on changes in physical function among older adults remain unclear. The primary objective of this study was to examine the impact of nutritional supplementation plus structured physical activity on 400M walk capacity in mobility-limited older adults across two sites (Boston, USA and Stockholm, Sweden). All subjects participated in a physical activity program (3x/week for 24 weeks), involving walking, strength, balance, and flexibility exercises. Subjects were randomized to a daily nutritional supplement (150kcal, 20g whey protein, 800 IU vitamin D) or placebo (30kcal, non-nutritive). Participants were recruited from urban communities at 2 field centers in Boston MA USA and Stockholm SWE. Mobility-limited (Short Physical Performance Battery (SPPB) ae9) and vitamin D insufficient (serum 25(OH) D 9 - 24 ng/ml) older adults were recruited for this study. Primary outcome was gait speed assessed by the 400M walk. Results: 149 subjects were randomized into the study (mean age=77.5 +/- 5.4; female=46.3%; mean SPPB= 7.9 +/- 1.2; mean 25(OH)D=18.7 +/- 6.4 ng/ml). Adherence across supplement and placebo groups was similar (86% and 88%, respectively), and was also similar across groups for the physical activity intervention (75% and 72%, respectively). Both groups demonstrated an improvement in gait speed with no significant difference between those who received the nutritional supplement compared to the placebo (0.071 and 0.108 m/s, respectively (p=0.06)). Similar effects in physical function were observed using the SPPB. Serum 25(OH)D increased in supplemented group compared to placebo 7.4 ng/ml versus 1.3 ng/ml respectively. Results suggest improved gait speed following physical activity program with no further improvement with added nutritional supplementation.
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| 4. |
- Hedman, Sanna, et al.
(author)
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Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients
- 2016
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In: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 35:3, s. 692-698
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Journal article (peer-reviewed)abstract
- Background & aimsMalnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal.MethodsThis study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients.ResultsThe prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff.ConclusionPatients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.
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| 5. |
- Holt, Christina, et al.
(author)
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Salt
- 2014. - 2:1
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In: Livsmedelsvetenskap. - Lund : Studentlitteratur AB. - 9789144095677 ; , s. 345-350
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Book chapter (other academic/artistic)
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| 6. |
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| 7. |
- Liljeberg, Evelina, 1985-, et al.
(author)
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A qualitative exploration of dietitians' experiences of prescribing oral nutritional supplements to patients with malnutrition : A focus on shared tailoring and behaviour change support
- 2021
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In: Journal of human nutrition and dietetics. - : John Wiley & Sons. - 0952-3871 .- 1365-277X. ; 34:5, s. 858-867
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Journal article (peer-reviewed)abstract
- Background: Oral nutritional supplements (ONS) are commonly prescribed to patients with malnutrition. Dietitians have been suggested as preferred prescribers butgenerally lack ONS prescribing rights. How dietitians with prescribing rights experience their professional practice of prescribing ONS remains understudied. Thus, byexploring dietitians’ experiences of prescribing ONS, the present study aimed to obtain a deeper understanding of specific aspects that are of importance for dietitianswhen providing a nutrition therapy including ONS.Methods: Qualitative individual interviews were conducted with 13 dietitians prescribing ONS to free-living adult outpatients with malnutrition or at nutritional riskin the hospital or primary care setting. Systematic text condensation was used fordata analysis.Results: Two main categories signifying important aspects were identified and labelled: ‘Shared tailoring of the ONS prescription’ and ‘Supporting and facilitatingONS use’. First, the dietitians described tailoring the ONS prescription together withthe patient, having their acceptance as a prerequisite, and being flexible regardingproducts and amounts prescribed. Second, they described performing different communication strategies and organising of practical issues (e.g., ONS delivery and support from others) to support and facilitate patients’ ONS usage.Conclusions: The present study identifies patient involvement and the role of dietitians as behaviour change facilitators as two important aspects when dietitiansprescribe ONS. These findings allow for dietitians’ ideals and strategies on how toprescribe ONS to be made more visible, which can inform both clinical practice andclinical trials for future improvements in nutrition therapy to address malnutrition.
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| 8. |
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| 9. |
- Liljeberg, Evelina, 1985-, et al.
(author)
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'Between foods and medicines' : A qualitative interview study of patient experiences of the meaning and usage of oral nutritional supplements
- 2022
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In: Appetite. - : Elsevier. - 0195-6663 .- 1095-8304. ; 178
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Journal article (peer-reviewed)abstract
- The aim of this study was to deepen the understanding of what oral nutritional supplements mean to patients and how this meaning connects to supplement usage, by exploring patient experiences of such supplements. Qualitative interviews were conducted in June 2019–March 2020 with ten patients with malnutrition or at nutritional risk, prescribed oral nutritional supplements by dietitians. Data were thematically analysed using systematic text condensation. Two final categories were identified: ‘Oral nutritional supplements are a one-dimensional remedy’ and ‘Everyday oral nutritional supplement usage is regulated autonomously’. The patients described the meaning of oral nutritional supplements as nutrition. While the supplements could compensate for nutrients not eaten or be part of a helpful compensation strategy, they could not lessen the burden of altered eating. Supplement usage was described as dependent on the acceptance of taste and the priority given to nutrition in everyday life. Usage was greater when nutrients were perceived as needed, such as when striving for higher bodyweight or disease recovery. Usage was lower when a patient's own goals were not increased nutrient intake or bodyweight or when other activities were perceived as more important. Patient experiences indicated that oral nutritional supplements could serve as a remedy for malnutrition, but not for a situation of altered eating. Supplement usage was described as being regulated autonomously based on patient views on the importance of nutrition. Those views were diverse, highlighting the importance of supplement prescribers discussing treatment goals with each patient. A deeper understanding of the meaning of oral nutritional supplements and reasons for their usage from a patient perspective is crucial in order for healthcare to provide appropriate, effective nutrition therapy for malnutrition.
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