Merrilyn Banks - Academia.edu (original) (raw)

Papers by Merrilyn Banks

Research paper thumbnail of Understanding Initiation of Nutrition Support in Patients with Head and Neck Cancer (Hnc) and Adherence to Recommendations-A Patient Perspective

Asia-pacific Journal of Clinical Oncology, 2016

Research paper thumbnail of Adult malnutrition, nutritional interventions and outcomes in Singapore: a scoping review of local studies for the past 20 years

Proceedings of Singapore Healthcare, 2020

Background:There is currently no review published on the prevalence and incidence of malnutrition... more Background:There is currently no review published on the prevalence and incidence of malnutrition in Singapore across various populations, or what interventions or policies are in place for preventing/treating malnutrition.Objectives:This review aims to determine the: (a) incidence and prevalence of malnutrition in the community, and in acute, intermediate and long-term care facilities; (b) interventions implemented for screening, assessing and treating/preventing malnutrition; (c) specific clinical populations investigated for malnutrition or nutritional therapy; and (d) implications of malnutrition and effectiveness of treating malnutrition or using nutritional therapy in Singapore.Methods:A structured search strategy was applied to available electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, the Cochrane Library and Google Scholar) using selected search terms, with additional reports and grey literature identified using iterative searches.Results:Forty-two articles were found,...

Research paper thumbnail of Nutrition Screening Practices in Australian Health-Care, Facilities: A Decade Later

Nutrition & Dietetics, 2011

Research paper thumbnail of Dietary intake of patients with inflammatory bowel disease aligns poorly with traditional Mediterranean diet principles

Nutrition & Dietetics

AIM Previous research has shown that individuals with inflammatory bowel disease avoid specific f... more AIM Previous research has shown that individuals with inflammatory bowel disease avoid specific food items, such as fibre rich foods, in order to manage symptoms. Dietary fibre and the traditional Mediterranean diet are both associated with reduced mucosal and systemic inflammation, gut barrier integrity, and microbiota diversity. There is limited data on the diet composition of individuals with inflammatory bowel disease. The aim of this study was to evaluate how it compares to the traditional Mediterranean diet and national dietary guidelines. METHODS Outpatients with inflammatory bowel disease were recruited to the study between February and August 2019. Demographic and medical information was obtained for consenting participants. All participants completed a dietary assessment of usual intake (24-h diet recall and 17-point ready reckoner) from which a Mediterranean diet adherence score was calculated. Dietary intake of core food groups was compared to the recommended number of serves outlined in the Australian Guide to Healthy Eating. RESULTS 100 participants were recruited. The mean Mediterranean diet adherence score was 5.1 ± 1.3 (maximum 14 points), 4% of participants scored ≥9 (commonly agreed criteria for Mediterranean diet adherence). Participants also consumed considerably less grains and vegetables than national dietary guidelines recommendations. CONCLUSIONS The diet of outpatients with inflammatory bowel disease did not align with Mediterranean diet characteristics. Participants consumed significantly less grains and vegetables than national guidelines, suggesting a low fibre intake. These findings suggest that dietary interventions focusing on improving the diet of individuals with inflammatory bowel disease to align with Mediterranean diet characteristics are warranted.

Research paper thumbnail of Additional file 1 of Engaging hospitalised patients in their nutrition care using technology: development of the NUTRI-TEC intervention

Additional file 1: Figure S1. Project timeline with System Development Life Cycle stages.

Research paper thumbnail of A detailed feeding algorithm improves delivery of nutrition support in an intensive care unit

Critical Care and Resuscitation, 2010

To determine whether a detailed feeding algorithm improved nutrition support of critically ill pa... more To determine whether a detailed feeding algorithm improved nutrition support of critically ill patients compared with a standard feeding protocol. Pre- and post-intervention comparison of nutrition commencement and nutritional adequacy in intensive care unit patients receiving enteral or parenteral nutrition until length of stay (LOS) exceeded 30 days, oral intake resumed, the patient was discharged from the ICU or the patient died. The study was conducted at the Royal Brisbane & Women's Hospital, a tertiary hospital with 27 ICU beds, in 2005 (pre-intervention) and 2007 (post-intervention). A detailed feeding algorithm that included commencement of nutrition support, progression to goal nutrition rates and management of gastric residual volumes. Time to commencement of nutrition support; time to reach goal nutrition rate; nutritional adequacy over ICU stay. No demographic differences between pre- (n=42) and post-implementation (n=41) patient groups were observed. Implementation ...

Research paper thumbnail of Do skeletons in the hospital closet still exist? What so they eat?

One aim of the Australasian Nutrition Care Day Survey (ANCDS) was to explore dietary intake and n... more One aim of the Australasian Nutrition Care Day Survey (ANCDS) was to explore dietary intake and nutritional status of acute care hospital patients. Dietitians from 56 hospitals in Australia and New Zealand completed a 24-hour nutritional status and dietary intake audit of 3000 adult patients. Participants were evaluated for nutritional risk using the Malnutrition Screening Tool (MST). Those ‘at risk’ underwent nutritional assessment using Subjective Global Assessment (SGA). Dietitians observed participants’ dietary intake at each main meal and recorded mid-meal intake via participant interviews. Intakes were recorded as 0%, 25%, 50%, 75%, or 100% of that offered for each meal during the 24-hour audit. Preliminary results for 1550 participants (males = 853; females = 697), age = 64 ± 17 years and BMI = 27 ± 7 kg/m2. Fifty-five percent (n = 853) of the participants had BMI > 25 kg/m2. The MST identified 41% (n = 636) ‘at risk’ for malnutrition. Of those ‘at risk’, 70% were assessed as malnourished resulting in an overall malnutrition prevalence of 30% (25% moderately malnourished, 5% severely malnourished). One-quarter of malnourished participants (n = 118) were on standard hospital diets without additional nutritional support. Fifty percent of malnourished patients (n = 235) and 40% of all patients (n = 620) had an overall 24-hour food consumption of ≤50% during the 24-hour audit. The ANCDS found that skeletons in the hospital closet continue to exist and that acute care patients continue to have suboptimal dietary intake. The ANCDS provides valuable insight into gaps in existing nutrition care practices.

Research paper thumbnail of Evaluation of a novel pre‐treatment model of nutrition care for patients with head and neck cancer receiving chemoradiotherapy

Nutrition & Dietetics, 2021

Research paper thumbnail of Erratum: A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients (Nutrition and Dietetics (2008) vol. 65 (162-167))

Research paper thumbnail of Economic analysis of malnutrition and pressure ulcers in Queensland hospitals and residential aged care facilities

Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up... more Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up to 50% or more) and in free living individuals with severe or multiple disease (>10%) (Stratton et al., 2003). Published Australian studies indicate similar results (Beck et al., 2001, Ferguson et al., 1997, Lazarus and Hamlyn, 2005, Middleton et al., 2001, Visvanathan et al., 2003), but are generally limited in number, with none conducted across multiple centres or in residential aged care facilities. In Australia, there is a general lack of awareness and recognition of the problem of malnutrition, with currently no policy, standards or guidelines related to the identification, prevention and treatment of malnutrition. Malnutrition has been found to be associated with the development of pressure ulcers, but studies are limited. The consequences of the development of pressure ulcers include pain and discomfort for the patient, and considerable costs associated with treatment and incr...

Research paper thumbnail of Ongoing pH testing to confirm nasogastric tube position before feeding to reduce the risk of adverse outcomes in adult and paediatric patients: A systematic literature review

Clinical Nutrition ESPEN, 2021

BACKGROUND & AIMS There is no agreed gold standard method to confirm nasogastric tube positio... more BACKGROUND & AIMS There is no agreed gold standard method to confirm nasogastric tube position before every use. However, many global guidelines recommend testing the pH of gastric aspirates obtained from an NGT before each use. This study aims to determine whether ongoing pH testing has been shown to reduce adverse events. Secondary aims are to determine how frequently aspirates can be obtained, and how often pH correctly confirms ongoing NGT tip position. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and protocol was published on PROSPERO. Keywords were used to search PubMed, Embase, CENTRAL, CINAHL and MEDLINE. Article assessment for inclusion was completed by two independent authors and risk of bias was assessed using ROBINS-I. RESULTS The systematic search and review methodology was followed due to wide variety and high risk of bias in the included studies. One full study and five abstracts met inclusion criteria for the primary aim. The full article contained one instance where pH testing and external NGT length together identified a misplaced NGT. The abstracts identified missed or delayed feeds and medications, and frequent unnecessary X-rays, as negative outcomes of ongoing pH testing. Ten full studies and one conference abstract addressed the secondary aims, but the studies varied widely which prevented meta-analysis and made it difficult to draw conclusions. CONCLUSIONS This review confirmed that ongoing pH testing is based on expert opinion due to limited evidence. More primary research is required to determine the clinical impact of ongoing pH testing to confirm NGT position.

Research paper thumbnail of Patient and carer experience of nutrition care throughout treatment for head and neck cancer: a systematic qualitative review and thematic synthesis

Supportive Care in Cancer, 2020

Nutrition care plays a critical role in the provision of best practice care to head and neck canc... more Nutrition care plays a critical role in the provision of best practice care to head and neck cancer (HNC) patients, with carers playing an important role in supporting patients to maintain nutrition intake. This qualitative systematic review investigated patient and carer experience of nutrition care throughout and beyond HNC treatment. Five databases were systematically searched for qualitative studies reporting on patient and carer experience of nutrition care throughout HNC. Twenty-five studies including 435 patients and 46 carers were identified, revealing three themes: information and support in the healthcare setting, enteral feeding challenges and management, and life outside hospital. Findings highlight the importance of providing individualised person-centred nutrition care to patients with HNC and their carers. Further qualitative research is needed to inform healthcare professionals about the needs of patients and carers to provide appropriate support throughout the treatment trajectory across and between different treatment modalities.

Research paper thumbnail of Development of a new tool to monitor and identify inadequate oral intake in hospital

Nutrition & Dietetics, 2021

BACKGROUND There is a need for quick and easy methods to monitor nutritional intake in hospital a... more BACKGROUND There is a need for quick and easy methods to monitor nutritional intake in hospital and identify patients with poor intake. Food record charts are often used in clinical practice, with low levels of accuracy and completion. This study aims to describe the development and evaluate the performance of a new tool to estimate energy and protein intake and identify poor nutritional intake amongst adult hospital patients. METHODS Ninety trays were sampled and assessed independently using the new tool 'Meal Intake Points' and a weighed (reference) method. The performance was tested by measuring association (Spearman's correlation), agreement (proportion of meals within specified limits of reference method), and sensitivity and specificity to identify poor energy and protein intake. RESULTS This new tool achieved very strong association for energy estimates (r = .91) and strong association for protein estimates (r = .86). Estimates for energy and protein were within 450 kJ and 4.5 g of the reference method in 77.8% and 62.2% of meals, respectively. It also displayed excellent performance as a screening tool (sensitivity 100%; specificity 76%-80%). Minor revision of the original tool was needed to optimise performance. CONCLUSIONS Meal Intake Points accurately estimates energy and protein intake and identifies patients with poor nutritional intake, providing a clinically relevant tool for use in hospitals to monitor intake and identify patients for proactive nutrition support. Further validation studies are needed to determine its performance in clinical practice and whether it is useful in predicting hospital-acquired malnutrition.

Research paper thumbnail of Exploring the Impact of Obesity on Health Care Resources and Coding in the Acute Hospital Setting: A Feasibility Study

Healthcare, 2020

Obesity is costly, yet there have been few attempts to estimate the actual costs of providing hos... more Obesity is costly, yet there have been few attempts to estimate the actual costs of providing hospital care to the obese inpatient. This study aimed to test the feasibility of measuring obesity-related health care costs and accuracy of coding data for acute inpatients. A prospective observational study was conducted over three weeks in June 2018 in a single orthopaedic ward of a metropolitan tertiary hospital in Queensland, Australia. Demographic data, anthropometric measurements, clinical characteristics, cost of hospital encounter and coding data were collected. Complete demographic, anthropometric and clinical data were collected for all 18 participants. Hospital costing reports and coding data were not available within the study timeframe. Participant recruitment and data collection were resource-intensive, with mobility assistance required to obtain anthropometric measurements in more than half of the participants. Greater staff time and costs were seen in participants with obe...

Research paper thumbnail of Underreporting of Obesity in Hospital Inpatients: A Comparison of Body Mass Index and Administrative Documentation in Australian Hospitals

Healthcare, 2020

Despite its high prevalence, there is no systematic approach to documenting and coding obesity in... more Despite its high prevalence, there is no systematic approach to documenting and coding obesity in hospitals. This study aimed to determine the prevalence of obesity among inpatients, the proportion of obese patients recognised as obese by hospital administration, and the cost associated with their admission. A cross-sectional study was undertaken in three hospitals in Queensland, Australia. Inpatients present on three audit days were included in this study. Data collected were age, sex, height, and weight. Body mass index (BMI) was calculated in accordance with the World Health Organization’s definition. Administrative data were sourced from hospital records departments to determine the number of patients officially documented as obese. Total actual costing data were sourced from hospital finance departments. From a combined cohort of n = 1327 inpatients (57% male, mean (SD) age: 61 (19) years, BMI: 28 (9) kg/m2), the prevalence of obesity was 32% (n = 421). Only half of obese patie...

Research paper thumbnail of Allied health primary contact services: results of a 2-year follow-up study of clinical effectiveness, safety, wait times and impact on medical specialist out-patient waitlists

Australian Health Review, 2020

ObjectiveLong specialist out-patient waitlists are common in public health facilities, but not al... more ObjectiveLong specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists.MethodUsing a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists.ResultsIn all, 10634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models.ConclusionsAllied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics.What is known about this topic?Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists.What does this paper add?This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed.What are the implications for practitioners?Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation.

Research paper thumbnail of Nutrition Support and the Gastrointestinal Microbiota: A Systematic Review

Journal of the Academy of Nutrition and Dietetics, 2020

BACKGROUND Low microbial diversity or altered microbiota composition is associated with many dise... more BACKGROUND Low microbial diversity or altered microbiota composition is associated with many disease states. In the treatment of many conditions, enteral (EN) or parenteral (PN) nutrition is frequently required. OBJECTIVE This systematic review aimed to identify and evaluate the evidence of the effect of EN vs PN on the gastrointestinal microbiota. METHOD A comprehensive systematic literature search of 5 databases was completed to review studies published until February 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized in completion of the review with the Academy of Nutrition and Dietetics quality criteria checklist and Grading of Recommendations Assessment, Development and Evaluation to evaluate the included studies. The review was registered on PROSPERO (CRD42018091328). Studies were eligible for inclusion if participants were older than 3 years, patients received either EN, PN or both, with some patients receiving each mode of nutrition support. The main outcome was any assessment of the gastrointestinal microbiota, including diversity or taxa abundance. RESULTS Eleven articles (n = 367 patients) met the inclusion criteria and were evaluated. Seven studies (n = 237) reported greater abundance of Proteobacteria with the provision of PN compared to EN; 6 studies (n = 172) reported lower Firmicutes and 5 studies (n = 155) lower Bacteroidetes. In 7 studies (n = 282), microbial diversity was lower with provision of PN than EN. The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low. CONCLUSIONS Provision of PN may lead to greater abundance of Proteobacteria and reduced microbial diversity; however, there is limited literature on this topic and additional research is warranted to improve understanding of the impact of EN vs PN on the microbiota.

Research paper thumbnail of Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial

Journal of Wound Care, 2016

Research paper thumbnail of Nutrition support during allogeneic stem cell transplantation: evidence versus practice

Supportive Care in Cancer, 2020

Purpose Enteral (EN) or parenteral nutrition (PN) is frequently required during allogeneic haemat... more Purpose Enteral (EN) or parenteral nutrition (PN) is frequently required during allogeneic haematopoietic progenitor cell transplantation (HPCT), however there is limited consensus on the appropriate mode and timing of nutrition support commencement. This study aimed to investigate current nutrition support practices in Australian allogeneic transplant units and explore barriers and enablers to the use of EN and PN. Methods All Australian adult allogeneic HPCT units were eligible to participate. A survey tool was developed, and phone interview with each unit dietitian was completed to explore current nutrition support and perceived barriers and enablers to provision of nutrition care. Results A total of 12 (100%) units agreed to participate. Six (50%) units reported using PN as standard care and six use EN routinely for one or more conditioning regimens. All units using EN place feeding tubes proactively with tolerance of EN reported at 50–95%. The most frequently reported barriers to the use of EN include perception of poor EN tolerance, medical team preference for PN, gastrointestinal symptoms and thrombocytopenia. Reported barriers to the use of PN include fluid overload, elevated liver enzymes, patient apprehension about PN commencement, medical team uncertainty if PN is required and patients approaching engraftment. Conclusion There is wide variation in the mode and timing of nutrition support provided to patients undergoing allogeneic HPCT. Clinical guidelines should be updated to reflect recent findings on EN use and incorporate strategies to optimise EN tolerance. This will assist in standardising practice and facilitate evidence-based nutrition care.

Research paper thumbnail of Engaging hospitalised patients in their nutrition care using technology: development of the NUTRI-TEC intervention

BMC Health Services Research, 2020

Background Nutrition is vital for health and recovery during hospitalisation, however most patien... more Background Nutrition is vital for health and recovery during hospitalisation, however most patients fail to meet minimum dietary requirements and up to 50% of patients are malnourished in hospital. When patients participate in nutrition care, their dietary intakes are improved. Advances in health information technology (HIT) have broadened the ways by which patients can participate in care. Our team has developed an innovative, HIT-based intervention (called NUTRI-TEC; engaging patients in their nutrition care using technology), facilitating patient participation in their nutrition care in hospital. This paper aims to describe the systematic and iterative process by which the intervention was developed. Methods NUTRI-TEC development was informed by the Medical Research Council guidance for developing complex interventions and underpinned by theoretical frameworks and concepts (i.e. integrated knowledge translation and patient participation in care), existing evidence and a rigorous ...

Research paper thumbnail of Understanding Initiation of Nutrition Support in Patients with Head and Neck Cancer (Hnc) and Adherence to Recommendations-A Patient Perspective

Asia-pacific Journal of Clinical Oncology, 2016

Research paper thumbnail of Adult malnutrition, nutritional interventions and outcomes in Singapore: a scoping review of local studies for the past 20 years

Proceedings of Singapore Healthcare, 2020

Background:There is currently no review published on the prevalence and incidence of malnutrition... more Background:There is currently no review published on the prevalence and incidence of malnutrition in Singapore across various populations, or what interventions or policies are in place for preventing/treating malnutrition.Objectives:This review aims to determine the: (a) incidence and prevalence of malnutrition in the community, and in acute, intermediate and long-term care facilities; (b) interventions implemented for screening, assessing and treating/preventing malnutrition; (c) specific clinical populations investigated for malnutrition or nutritional therapy; and (d) implications of malnutrition and effectiveness of treating malnutrition or using nutritional therapy in Singapore.Methods:A structured search strategy was applied to available electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, the Cochrane Library and Google Scholar) using selected search terms, with additional reports and grey literature identified using iterative searches.Results:Forty-two articles were found,...

Research paper thumbnail of Nutrition Screening Practices in Australian Health-Care, Facilities: A Decade Later

Nutrition & Dietetics, 2011

Research paper thumbnail of Dietary intake of patients with inflammatory bowel disease aligns poorly with traditional Mediterranean diet principles

Nutrition & Dietetics

AIM Previous research has shown that individuals with inflammatory bowel disease avoid specific f... more AIM Previous research has shown that individuals with inflammatory bowel disease avoid specific food items, such as fibre rich foods, in order to manage symptoms. Dietary fibre and the traditional Mediterranean diet are both associated with reduced mucosal and systemic inflammation, gut barrier integrity, and microbiota diversity. There is limited data on the diet composition of individuals with inflammatory bowel disease. The aim of this study was to evaluate how it compares to the traditional Mediterranean diet and national dietary guidelines. METHODS Outpatients with inflammatory bowel disease were recruited to the study between February and August 2019. Demographic and medical information was obtained for consenting participants. All participants completed a dietary assessment of usual intake (24-h diet recall and 17-point ready reckoner) from which a Mediterranean diet adherence score was calculated. Dietary intake of core food groups was compared to the recommended number of serves outlined in the Australian Guide to Healthy Eating. RESULTS 100 participants were recruited. The mean Mediterranean diet adherence score was 5.1 ± 1.3 (maximum 14 points), 4% of participants scored ≥9 (commonly agreed criteria for Mediterranean diet adherence). Participants also consumed considerably less grains and vegetables than national dietary guidelines recommendations. CONCLUSIONS The diet of outpatients with inflammatory bowel disease did not align with Mediterranean diet characteristics. Participants consumed significantly less grains and vegetables than national guidelines, suggesting a low fibre intake. These findings suggest that dietary interventions focusing on improving the diet of individuals with inflammatory bowel disease to align with Mediterranean diet characteristics are warranted.

Research paper thumbnail of Additional file 1 of Engaging hospitalised patients in their nutrition care using technology: development of the NUTRI-TEC intervention

Additional file 1: Figure S1. Project timeline with System Development Life Cycle stages.

Research paper thumbnail of A detailed feeding algorithm improves delivery of nutrition support in an intensive care unit

Critical Care and Resuscitation, 2010

To determine whether a detailed feeding algorithm improved nutrition support of critically ill pa... more To determine whether a detailed feeding algorithm improved nutrition support of critically ill patients compared with a standard feeding protocol. Pre- and post-intervention comparison of nutrition commencement and nutritional adequacy in intensive care unit patients receiving enteral or parenteral nutrition until length of stay (LOS) exceeded 30 days, oral intake resumed, the patient was discharged from the ICU or the patient died. The study was conducted at the Royal Brisbane & Women's Hospital, a tertiary hospital with 27 ICU beds, in 2005 (pre-intervention) and 2007 (post-intervention). A detailed feeding algorithm that included commencement of nutrition support, progression to goal nutrition rates and management of gastric residual volumes. Time to commencement of nutrition support; time to reach goal nutrition rate; nutritional adequacy over ICU stay. No demographic differences between pre- (n=42) and post-implementation (n=41) patient groups were observed. Implementation ...

Research paper thumbnail of Do skeletons in the hospital closet still exist? What so they eat?

One aim of the Australasian Nutrition Care Day Survey (ANCDS) was to explore dietary intake and n... more One aim of the Australasian Nutrition Care Day Survey (ANCDS) was to explore dietary intake and nutritional status of acute care hospital patients. Dietitians from 56 hospitals in Australia and New Zealand completed a 24-hour nutritional status and dietary intake audit of 3000 adult patients. Participants were evaluated for nutritional risk using the Malnutrition Screening Tool (MST). Those ‘at risk’ underwent nutritional assessment using Subjective Global Assessment (SGA). Dietitians observed participants’ dietary intake at each main meal and recorded mid-meal intake via participant interviews. Intakes were recorded as 0%, 25%, 50%, 75%, or 100% of that offered for each meal during the 24-hour audit. Preliminary results for 1550 participants (males = 853; females = 697), age = 64 ± 17 years and BMI = 27 ± 7 kg/m2. Fifty-five percent (n = 853) of the participants had BMI > 25 kg/m2. The MST identified 41% (n = 636) ‘at risk’ for malnutrition. Of those ‘at risk’, 70% were assessed as malnourished resulting in an overall malnutrition prevalence of 30% (25% moderately malnourished, 5% severely malnourished). One-quarter of malnourished participants (n = 118) were on standard hospital diets without additional nutritional support. Fifty percent of malnourished patients (n = 235) and 40% of all patients (n = 620) had an overall 24-hour food consumption of ≤50% during the 24-hour audit. The ANCDS found that skeletons in the hospital closet continue to exist and that acute care patients continue to have suboptimal dietary intake. The ANCDS provides valuable insight into gaps in existing nutrition care practices.

Research paper thumbnail of Evaluation of a novel pre‐treatment model of nutrition care for patients with head and neck cancer receiving chemoradiotherapy

Nutrition & Dietetics, 2021

Research paper thumbnail of Erratum: A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients (Nutrition and Dietetics (2008) vol. 65 (162-167))

Research paper thumbnail of Economic analysis of malnutrition and pressure ulcers in Queensland hospitals and residential aged care facilities

Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up... more Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up to 50% or more) and in free living individuals with severe or multiple disease (>10%) (Stratton et al., 2003). Published Australian studies indicate similar results (Beck et al., 2001, Ferguson et al., 1997, Lazarus and Hamlyn, 2005, Middleton et al., 2001, Visvanathan et al., 2003), but are generally limited in number, with none conducted across multiple centres or in residential aged care facilities. In Australia, there is a general lack of awareness and recognition of the problem of malnutrition, with currently no policy, standards or guidelines related to the identification, prevention and treatment of malnutrition. Malnutrition has been found to be associated with the development of pressure ulcers, but studies are limited. The consequences of the development of pressure ulcers include pain and discomfort for the patient, and considerable costs associated with treatment and incr...

Research paper thumbnail of Ongoing pH testing to confirm nasogastric tube position before feeding to reduce the risk of adverse outcomes in adult and paediatric patients: A systematic literature review

Clinical Nutrition ESPEN, 2021

BACKGROUND & AIMS There is no agreed gold standard method to confirm nasogastric tube positio... more BACKGROUND & AIMS There is no agreed gold standard method to confirm nasogastric tube position before every use. However, many global guidelines recommend testing the pH of gastric aspirates obtained from an NGT before each use. This study aims to determine whether ongoing pH testing has been shown to reduce adverse events. Secondary aims are to determine how frequently aspirates can be obtained, and how often pH correctly confirms ongoing NGT tip position. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and protocol was published on PROSPERO. Keywords were used to search PubMed, Embase, CENTRAL, CINAHL and MEDLINE. Article assessment for inclusion was completed by two independent authors and risk of bias was assessed using ROBINS-I. RESULTS The systematic search and review methodology was followed due to wide variety and high risk of bias in the included studies. One full study and five abstracts met inclusion criteria for the primary aim. The full article contained one instance where pH testing and external NGT length together identified a misplaced NGT. The abstracts identified missed or delayed feeds and medications, and frequent unnecessary X-rays, as negative outcomes of ongoing pH testing. Ten full studies and one conference abstract addressed the secondary aims, but the studies varied widely which prevented meta-analysis and made it difficult to draw conclusions. CONCLUSIONS This review confirmed that ongoing pH testing is based on expert opinion due to limited evidence. More primary research is required to determine the clinical impact of ongoing pH testing to confirm NGT position.

Research paper thumbnail of Patient and carer experience of nutrition care throughout treatment for head and neck cancer: a systematic qualitative review and thematic synthesis

Supportive Care in Cancer, 2020

Nutrition care plays a critical role in the provision of best practice care to head and neck canc... more Nutrition care plays a critical role in the provision of best practice care to head and neck cancer (HNC) patients, with carers playing an important role in supporting patients to maintain nutrition intake. This qualitative systematic review investigated patient and carer experience of nutrition care throughout and beyond HNC treatment. Five databases were systematically searched for qualitative studies reporting on patient and carer experience of nutrition care throughout HNC. Twenty-five studies including 435 patients and 46 carers were identified, revealing three themes: information and support in the healthcare setting, enteral feeding challenges and management, and life outside hospital. Findings highlight the importance of providing individualised person-centred nutrition care to patients with HNC and their carers. Further qualitative research is needed to inform healthcare professionals about the needs of patients and carers to provide appropriate support throughout the treatment trajectory across and between different treatment modalities.

Research paper thumbnail of Development of a new tool to monitor and identify inadequate oral intake in hospital

Nutrition & Dietetics, 2021

BACKGROUND There is a need for quick and easy methods to monitor nutritional intake in hospital a... more BACKGROUND There is a need for quick and easy methods to monitor nutritional intake in hospital and identify patients with poor intake. Food record charts are often used in clinical practice, with low levels of accuracy and completion. This study aims to describe the development and evaluate the performance of a new tool to estimate energy and protein intake and identify poor nutritional intake amongst adult hospital patients. METHODS Ninety trays were sampled and assessed independently using the new tool 'Meal Intake Points' and a weighed (reference) method. The performance was tested by measuring association (Spearman's correlation), agreement (proportion of meals within specified limits of reference method), and sensitivity and specificity to identify poor energy and protein intake. RESULTS This new tool achieved very strong association for energy estimates (r = .91) and strong association for protein estimates (r = .86). Estimates for energy and protein were within 450 kJ and 4.5 g of the reference method in 77.8% and 62.2% of meals, respectively. It also displayed excellent performance as a screening tool (sensitivity 100%; specificity 76%-80%). Minor revision of the original tool was needed to optimise performance. CONCLUSIONS Meal Intake Points accurately estimates energy and protein intake and identifies patients with poor nutritional intake, providing a clinically relevant tool for use in hospitals to monitor intake and identify patients for proactive nutrition support. Further validation studies are needed to determine its performance in clinical practice and whether it is useful in predicting hospital-acquired malnutrition.

Research paper thumbnail of Exploring the Impact of Obesity on Health Care Resources and Coding in the Acute Hospital Setting: A Feasibility Study

Healthcare, 2020

Obesity is costly, yet there have been few attempts to estimate the actual costs of providing hos... more Obesity is costly, yet there have been few attempts to estimate the actual costs of providing hospital care to the obese inpatient. This study aimed to test the feasibility of measuring obesity-related health care costs and accuracy of coding data for acute inpatients. A prospective observational study was conducted over three weeks in June 2018 in a single orthopaedic ward of a metropolitan tertiary hospital in Queensland, Australia. Demographic data, anthropometric measurements, clinical characteristics, cost of hospital encounter and coding data were collected. Complete demographic, anthropometric and clinical data were collected for all 18 participants. Hospital costing reports and coding data were not available within the study timeframe. Participant recruitment and data collection were resource-intensive, with mobility assistance required to obtain anthropometric measurements in more than half of the participants. Greater staff time and costs were seen in participants with obe...

Research paper thumbnail of Underreporting of Obesity in Hospital Inpatients: A Comparison of Body Mass Index and Administrative Documentation in Australian Hospitals

Healthcare, 2020

Despite its high prevalence, there is no systematic approach to documenting and coding obesity in... more Despite its high prevalence, there is no systematic approach to documenting and coding obesity in hospitals. This study aimed to determine the prevalence of obesity among inpatients, the proportion of obese patients recognised as obese by hospital administration, and the cost associated with their admission. A cross-sectional study was undertaken in three hospitals in Queensland, Australia. Inpatients present on three audit days were included in this study. Data collected were age, sex, height, and weight. Body mass index (BMI) was calculated in accordance with the World Health Organization’s definition. Administrative data were sourced from hospital records departments to determine the number of patients officially documented as obese. Total actual costing data were sourced from hospital finance departments. From a combined cohort of n = 1327 inpatients (57% male, mean (SD) age: 61 (19) years, BMI: 28 (9) kg/m2), the prevalence of obesity was 32% (n = 421). Only half of obese patie...

Research paper thumbnail of Allied health primary contact services: results of a 2-year follow-up study of clinical effectiveness, safety, wait times and impact on medical specialist out-patient waitlists

Australian Health Review, 2020

ObjectiveLong specialist out-patient waitlists are common in public health facilities, but not al... more ObjectiveLong specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists.MethodUsing a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists.ResultsIn all, 10634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models.ConclusionsAllied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics.What is known about this topic?Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists.What does this paper add?This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed.What are the implications for practitioners?Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation.

Research paper thumbnail of Nutrition Support and the Gastrointestinal Microbiota: A Systematic Review

Journal of the Academy of Nutrition and Dietetics, 2020

BACKGROUND Low microbial diversity or altered microbiota composition is associated with many dise... more BACKGROUND Low microbial diversity or altered microbiota composition is associated with many disease states. In the treatment of many conditions, enteral (EN) or parenteral (PN) nutrition is frequently required. OBJECTIVE This systematic review aimed to identify and evaluate the evidence of the effect of EN vs PN on the gastrointestinal microbiota. METHOD A comprehensive systematic literature search of 5 databases was completed to review studies published until February 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized in completion of the review with the Academy of Nutrition and Dietetics quality criteria checklist and Grading of Recommendations Assessment, Development and Evaluation to evaluate the included studies. The review was registered on PROSPERO (CRD42018091328). Studies were eligible for inclusion if participants were older than 3 years, patients received either EN, PN or both, with some patients receiving each mode of nutrition support. The main outcome was any assessment of the gastrointestinal microbiota, including diversity or taxa abundance. RESULTS Eleven articles (n = 367 patients) met the inclusion criteria and were evaluated. Seven studies (n = 237) reported greater abundance of Proteobacteria with the provision of PN compared to EN; 6 studies (n = 172) reported lower Firmicutes and 5 studies (n = 155) lower Bacteroidetes. In 7 studies (n = 282), microbial diversity was lower with provision of PN than EN. The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low. CONCLUSIONS Provision of PN may lead to greater abundance of Proteobacteria and reduced microbial diversity; however, there is limited literature on this topic and additional research is warranted to improve understanding of the impact of EN vs PN on the microbiota.

Research paper thumbnail of Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial

Journal of Wound Care, 2016

Research paper thumbnail of Nutrition support during allogeneic stem cell transplantation: evidence versus practice

Supportive Care in Cancer, 2020

Purpose Enteral (EN) or parenteral nutrition (PN) is frequently required during allogeneic haemat... more Purpose Enteral (EN) or parenteral nutrition (PN) is frequently required during allogeneic haematopoietic progenitor cell transplantation (HPCT), however there is limited consensus on the appropriate mode and timing of nutrition support commencement. This study aimed to investigate current nutrition support practices in Australian allogeneic transplant units and explore barriers and enablers to the use of EN and PN. Methods All Australian adult allogeneic HPCT units were eligible to participate. A survey tool was developed, and phone interview with each unit dietitian was completed to explore current nutrition support and perceived barriers and enablers to provision of nutrition care. Results A total of 12 (100%) units agreed to participate. Six (50%) units reported using PN as standard care and six use EN routinely for one or more conditioning regimens. All units using EN place feeding tubes proactively with tolerance of EN reported at 50–95%. The most frequently reported barriers to the use of EN include perception of poor EN tolerance, medical team preference for PN, gastrointestinal symptoms and thrombocytopenia. Reported barriers to the use of PN include fluid overload, elevated liver enzymes, patient apprehension about PN commencement, medical team uncertainty if PN is required and patients approaching engraftment. Conclusion There is wide variation in the mode and timing of nutrition support provided to patients undergoing allogeneic HPCT. Clinical guidelines should be updated to reflect recent findings on EN use and incorporate strategies to optimise EN tolerance. This will assist in standardising practice and facilitate evidence-based nutrition care.

Research paper thumbnail of Engaging hospitalised patients in their nutrition care using technology: development of the NUTRI-TEC intervention

BMC Health Services Research, 2020

Background Nutrition is vital for health and recovery during hospitalisation, however most patien... more Background Nutrition is vital for health and recovery during hospitalisation, however most patients fail to meet minimum dietary requirements and up to 50% of patients are malnourished in hospital. When patients participate in nutrition care, their dietary intakes are improved. Advances in health information technology (HIT) have broadened the ways by which patients can participate in care. Our team has developed an innovative, HIT-based intervention (called NUTRI-TEC; engaging patients in their nutrition care using technology), facilitating patient participation in their nutrition care in hospital. This paper aims to describe the systematic and iterative process by which the intervention was developed. Methods NUTRI-TEC development was informed by the Medical Research Council guidance for developing complex interventions and underpinned by theoretical frameworks and concepts (i.e. integrated knowledge translation and patient participation in care), existing evidence and a rigorous ...