Vanessa M. Carter

Aim: This study explored the perceptions of former Culturally and Linguistically Diverse (CALD) hospital patients and carers regarding the role and meaning of hospital food during hospitalisation and recovery. Methods: Using a descriptive qualitative design guided by a social constructionist approach, four focus groups ( n = 28) were conducted with participants from Asian, Mediterranean, Arabic, and Indian Subcontinent communities at a major Australian metropolitan health service. Purposively recruited participants included former inpatients or caregivers who discussed their experiences in face‐to‐face focus groups. Results: Thematic analysis revealed three key themes: (1) Familiar food as a source of comfort in an unfamiliar environment, (2) Cultural traditions as wisdom for health and healing, and (3) Food as a contributor to physical recovery. Findings highlight the multifaceted role of culturally appropriate hospital food beyond basic nutrition, including its ability in supporting emotional well‐being, cultural identity, and physical healing when feeling already vulnerable amid the unfamiliar daily activities of hospital wards. Conclusions: Hospital food plays an important role in comfort, cultural identity, and recovery for CALD patients. Culturally responsive food services may enhance patient experiences, support recovery, and contribute to more equitable healthcare delivery.

Background: Malnutrition is independently associated with poor outcomes in colorectal cancer (CRC) surgery including increased complications and length of stay (LOS). The purpose of this study was to identify changes to perioperative nutritional management and surgical outcomes post implementation of an enhanced recovery after surgery (ERAS) protocol.Methods: Data on LOS and adherence to the ERAS protocol, including preoperative fasting time, nutritional assessment and supplementation was prospectively collected for the pre‐ERAS group who underwent surgery for CRC between February and August 2019. The post‐ERAS group involved a retrospective analysis of prospectively collected data of patients who underwent surgery between October 2019 and July 2020.Results: One hundred and thirty patients were included, (Pre‐ERASn = 42, Post‐ERASn = 88). A reduction in time to first solid intake by 1 day (P = 0.010), time to first bowel action (P = 0.007) and incidence of nausea (P < 0.001) was seen in the post‐ERAS group. Provision of postoperative oral supplements increased from 33.3% to 70.5% (P < 0.001) in the post‐ERAS group. Thirteen post‐ERAS patients had a ≥ 70% adherence to the ERAS protocol and this subgroup had an associated reduction in LOS, 6.5 (4) days to 5 (3),P = 0.020.Conclusion: Implementation of the ERAS protocol improved perioperative patient care and outcomes. Early feeding was associated with reduced gastrointestinal symptoms without an increase in complications. Adherence to ERAS was associated with a reduction in LOS. Further research is required to evaluate the role of preoperative nutritional screening and intervention within an ERAS protocol.

Background: Implementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR). Methods: This was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4–8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data. Results: Qualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points). Conclusions: The nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication.

Background: Malnutrition and low muscle mass are independently associated with poor outcomes in colorectal cancer (CRC). However, tools to identify low muscle mass are limited in the clinical setting. We investigated the ability of existing malnutrition screening and assessment tools to identify low muscle mass assessed by computed tomography (CT). Secondary aims were to determine the feasibility of CT analysis and handgrip strength (HGS).Methods and Analysis: An exploratory study of patients who underwent curative surgery for CRC between February and September 2019. Nutrition tools used included body mass index (BMI), Malnutrition Screening Tool (MST), and Patient‐Generated Subjective Global Assessment (PG‐SGA). Muscle mass was determined by preoperative CT image at the third lumbar vertebral level (L3), and muscle strength was determined by HGS dynamometry. Fisher's exact and Mann‐Whitney U tests were used to compare results of nutrition tools with CT muscle assessment.Results: In total, 57 patients were included. MST classified 18 patients (32%) as at risk of malnutrition, and PG‐SGA classified 10 patients (17%) as malnourished. Fifty‐one (90%) CT scans were analysable and 21 (47%) had low muscle mass. Of those with low muscle mass, PG‐SGA classified 22 patients (92%) as well nourished and MST classified 17 patients (71%) as not being at nutrition risk. No tool was able to identify CT‐diagnosed low muscle mass. Inability to complete HGS was associated with malnutrition (P = .001).Conclusion: In this cohort, nutrition screening and assessment tools did not identify CT‐diagnosed low muscle mass. Feasible tools to identify low muscle mass in the clinical setting are required.

Background: In some studies HIV infection confers approximately two-fold higher risk of cardiac events compared with the general population. C-reactive protein (CRP) is a well-characterised biomarker of cardiac events in the general population and is also elevated in patients with HIV infection. The aim of this study was to determine the predictive value of CRP for cardiac events in HIV-infected individuals. Methods: We retrospectively analysed CRP levels in stored plasma samples from HIV-infected patients who did or did not experience a coronary event in a case-controlled manner. All CRP measurements were performed using a high-sensitivity assay (hs-CRP). Results: Of the study participants with samples available, we found slightly elevated hs-CRP levels in the cardiac cases (median 3.5, IQR 1.6–14.4, n = 23) compared with controls (median 2.6, IQR1.2–8.3, n = 49) which were shown to not be statistically significant P = 0.20. Analysis of CRP as a binary variable (=5 mg L–1) was also not statistically significant (OR: 1.32, 95% CI 0.48–3.63). Conclusions: CRP levels may indicate elevated risk of future cardiac events, however this must be interpreted with caution due to the generalised elevation of CRP during HIV infection. CRP has no predictive value for atherosclerosis, and further research is required to improve early prediction of cardiovascular disease in HIV infection.

Background: Hypertriglyceridaemia is a recognised metabolic abnormality in HIV-infected people, increasing in severity in people treated with highly active antiretroviral therapy (HAART). An alternative treatment for hypertriglyceridaemia in non-HIV-infected populations is omega-3 fatty acid supplementation. This study aimed to compare the effectiveness of omega-3 fatty acid supplementation and placebo in lowering fasting triglyceride levels in HIV-infected patients on HAART. Methods: A placebo-controlled, randomised, double-blind trial in participants on stable HAART with fasting triglycerides of >3.5 mm to 10.0 mm using 9 g of omega-3 fatty acids versus placebo (olive oil) after a 6-week lead in on dietary therapy. Results: Eleven patients were enrolled. The mean triglyceride level for the population decreased from 5.02 mm at baseline to 4.44 mm (–11.6%) after dietary intervention and 3.37 mm (–32.9%) after the 8-week treatment period. In the omega-3 fatty acid arm of the study, triglycerides fell from 5.34 mm to 5.02 mm (–6%) after dietary intervention and to 2.30 mm (–56.9%) after the treatment period. In the placebo arm of the study, triglycerides fell from 4.77 mm to 4.05 mm (–15.1%) after dietary intervention and to 4.08 mm (–14.5%) after the treatment period. Using the random effects model, a statistically significant effect on triglycerides of omega-3 fatty acid versus placebo was found (?2 = 6.04, P = 0.0487). The estimated difference between groups for change in mean triglycerides over 8 weeks was –2.32 mm (95% CI –4.52, –0.12 mm). Conclusions: Omega-3 fatty acids are likely to be an effective treatment for hypertriglyceridaemia in HIV-infected males on HAART.