Zoe E. Davidson

Background: Reflective practice is a core competency for all healthcare professionals however, ensuring valuable assessment of this key skill is challenging; especially in the age of generative artificial intelligence (AI). The use of a programme‐level approach to develop this capability is proposed as a potential way to support development and assessment of reflection in health professions education. Approach: A cross‐disciplinary team of experienced health professions educators came together to develop a framework for assessing reflection in the age of AI. Consisting of three domains, three levels of expertise and artefacts of learning, the framework was informed by relevant healthcare competency standards, existing literature and programmatic assessment principles. Evaluation: We sought to evaluate the perceived usefulness of the framework through educators and student feedback. Educators across multiple healthcare disciplines were invited to provide feedback via survey at a faculty education showcase where the proposed framework was presented. Students were invited to provide feedback in a dedicated focus group. A total of 13 participants accepted the invitation ( n = 9 educators completed the survey, n = 4 students participated in the focus group), providing qualitative and quantitative data. Thematic analysis was used to analyse the qualitative responses. The quantitative data were used for demographic purposes. Implications: Evaluation of the perceived usefulness of the framework suggests that a programme‐level approach to assessing reflection, which considers moments of reflection as data points in the ongoing development of reflective practice, could support skill development and meaningful reflection in the age of AI. Further evaluation of the framework is advised.

Objective To explore families’ experiences participating in a 10-week web-based lifestyle programme for school-aged children with overweight or obesity. Design A qualitative study using inductive analysis of semi-structured interview data. Setting Victoria, Australia. Participants Families (children aged 7–13 years with overweight or obesity—body mass index ≥85th percentile—and accompanying parent) recruited for a randomised controlled trial that evaluated the effectiveness of the web-based programme and who received the programme (n=102 children/85 families) were invited to participate in a semi-structured interview at 3 months post-programme. Intervention Families received a 10-week family-focused electronic health (e-Health; web-based) lifestyle programme with health coaching sessions—an evidence-based programme adapted from its in-person, group-based counterpart. Results A total of 28 families, including 34 children (eight siblings) and mostly mothers, shared their experiences. 10 themes were identified on family members’ experiences and aligned with the socioecological model: intrapersonal—knowledge development on healthy living; experiences and stigma related to overweight, obesity or weight; engaging with structural features of the web-based programme, interpersonal—family dynamic; connections with others (non-healthcare professionals) outside of home; relationship with healthcare professionals, environmental/institutional—impact of COVID-19 lockdowns; health-promoting environments; promotion of and access to overweight or obesity management programmes; web-based programme as part of a larger or established system. Each theme highlighted factors that influenced programme uptake and engagement. Conclusions Valuable insights were gained on ways to better adapt e-Health (web-based) lifestyle programmes for children with overweight or obesity. Families perceived advantages in a web-based lifestyle programme and highly regarded humanised features and elements comparable to conventional in-person programmes. Further research is needed to explore the perspectives of families from diverse populations, fathers and families who decline participation in the follow-up period. Web-based lifestyle programmes that incorporate contemporary e-Health technologies, including responsive AI, also warrant further investigation to maximise programme benefits. Trial registration number ACTRN12621001762842.

Achievement of optimal nutritional status within the first 1000 days of life for a child with cystic fibrosis (CF) is of paramount importance, with an emphasis on favorable early life growth trajectories that best optimize pulmonary and extrapulmonary health. The ‘first 1000 days’ framework emphasizes that environmental, sociocultural and nutritional exposures during this period can have life-long consequences for physical, cognitive, social and emotional health and development. Optimal nutrition encompasses not just physical growth, but the provision of nutrients and optimal feeding throughout the preconception, pregnancy and first 1000-day period to ensure lifelong healthy development and aging. For children with CF (cwCF), the first 1000 days is marred by a myriad of complications, exposing a unique nutritional fragility within this critical developmental window. Conversely, as life expectancy increases for people with CF (pwCF), overnutrition is becoming increasingly prevalent and the widespread uptake of disease-modifying drugs challenges clinicians to take a nuanced and personalized approach to lifelong nutritional care. This review explores early disease manifestations of CF and their impact on early life growth and nutrition in the modern era of CF. This review also considers how we might theoretically view early life nutrition in CF from a lens which takes into consideration well-known frameworks such as ‘the first 1000 days’ and ‘developmental origins of health and disease’.

This case series aimed to observe the impact of a single-stage ultramarathon (50–100 km) on gastrointestinal integrity, systemic immune responses, and exercise-associated gastrointestinal symptoms in 3 adolescent (aged 12–15 y) competitors. Body mass, venous and finger-prick blood samples and fecal samples were taken before and after the race for analysis of exercise-induced body mass loss, plasma osmolality, plasma intestinal fatty acid binding protein, soluble CD14, and C-reactive protein, total and differential leukocyte counts, and fecal bacterial alpha-diversity. Gastrointestinal symptom incidence were recorded before, during, immediately after, and 24 h after the race. Food and fluid intake were recorded for the 48 h before the race and each hour during the race. Body mass decreased in Youth 1 (−0.4%) and Youth 3 (−0.9%) and increased in Youth 2 (+0.5%) from before to after the race. No youth competitor met carbohydrate intake recommendations in the lead-up to (2.8–5.1 g·kg ^–1 ·d ^–1 ) or during the race (24–26 g·h ^–1 ). Pre- to post-race plasma intestinal fatty acid binding protein and C-reactive protein concentrations increased in the youth competitors, but was of no clinical significance (≤657 pg·mL ^–1 and ≤3.36 micrograms·mL ^–1 , respectively). A pre- to postrace change in plasma soluble CD14 of clinical relevance was observed in Youth 3 (1.5 micrograms·mL ^–1 ), but not Youth 1 (−0.1 micrograms·mL ^–1 ). Total and differential leukocyte counts increased beyond the normal reference range in Youth 1 and Youth 2, but not Youth 3. The incidence and severity of gastrointestinal symptoms were low at all timepoints in the competitors. Large intra- and interindividual responses to ultramarathon events observed in this case series suggest that adolescent ultramarathon runners require individually tailored nutrition support.

Background/objectives: Overweight and obesity in adolescents is a significant public health concern, yet limited interventions exist in Australia to promote healthy behavior change in families and young people. This retrospective, real-world evaluation aimed to describe the impact of an 8-week e-Health program (Think, Eat And Move, [TEAM]) on anthropometric, behavioral and wellbeing outcomes in adolescents. Methods: Eligible TEAM program participants were aged 13–17 years, resided in Central or Eastern Sydney, Australia, had overweight/obesity, were at risk of or had a chronic health condition and/or required healthy lifestyle support. Retrospective program data were used to assess the impact of TEAM on weight, height and BMI z-score, dietary intake, physical activity and wellbeing indices. Results: Of 567 registered participants, 313 completed the TEAM program and were included in the analysis (median age 14.4 years, 56.2% female). The median (interquartile range) BMI z-score reduced from 1.8 (1.4–2.2) pre-program to 1.6 (1.1–2.1) post-program (p < 0.001, n = 262). Significant improvements in health behaviors following the program were observed, including increased consumption of fruit, vegetables and water; reduced consumption of confectionery and take-away foods; increased days of physical activity; and reduced sedentary time. Significant positive changes were also observed in knowledge and wellbeing measures. Conclusions: Adolescents completing the TEAM program demonstrated clinically important changes in anthropometry and improved nutrition and physical activity behaviors. E-Health modalities for promoting behavior change should be considered in public health strategies for adolescents.

Background: Vitamin C deficiency (VCD) is common in adult inpatients in high‐income countries and is associated with moderate to severe frailty, cognitive impairment, and scurvy signs and symptoms. However, clinical practice associated with vitamin C status has not been explored in this setting. This study aims to describe current vitamin C clinical practices and explore barriers and enablers that influence nutrition care delivered to adult hospitalized patients within routine clinical practice. Method: This study was conducted across General Medicine units at a tertiary health service in Melbourne, Australia. Using an explanatory, sequential mixed methods design, data across each stage of the Nutrition Care Process (NCP) was triangulated from three phases involving analysis of clinical guidelines, file review data of patients with VCD ( n = 100) according to plasma vitamin C levels, and focus groups informed by the Theoretical Domains Framework. Results: Triangulated data revealed that barriers to vitamin C nutrition care include infrequent assessment, influenced by environmental factors, beliefs about consequences, clinical priority, and healthcare professionals' (HCPs') knowledge. Enablers include strong belief in nutrition care capability and belief that vitamin C nutrition care is within HCPs' roles. Low suspected VCD diagnosis and low intervention and discharge planning rates were also observed. The single vitamin C clinical guideline lacked detail across specific stages of the NCP. Conclusion: Limited vitamin C nutrition care potentially occurs in adult inpatients, hindered predominantly by assessment barriers. To achieve improvements in clinical practice, a theoretically driven implementation strategy targeted to healthcare systems, clinician behavior, and national quality standards is required.

Background: Facioscapulohumeral muscular dystrophy (FSHD) is a rare, progressive muscle disease with no available disease‐modifying therapy. Creatine monohydrate (CrM) has been shown to improve muscle strength in individuals with muscular dystrophies but has not been tested in young people with FSHD. This study aimed to explore the efficacy of CrM on motor function in children with FSHD.Methods: In a randomized placebo‐controlled double‐blind crossover trial, powdered CrM at a dose of 100 mg/kg/day (maximum 10 g daily) was compared with placebo in two 12‐week treatment periods with a 6‐week washout between crossover arms. The primary outcome measure was the Motor Function Measure for Neuromuscular Disease (MFM‐32) with secondary outcomes assessing safety, endurance, strength, patient‐reported outcome measures, and muscle morphology measurements as assessed by whole‐body magnetic resonance imaging (MRI).Results: Thirteen children were enrolled (mean (standard deviation, SD) 12.2 (2.67) years of age) and 11 patients completed both trial treatment periods. In an intention‐to‐treat analysis, no clinically meaningful difference was seen between treatment groups as measured by the mean difference in MFM‐32 (0.19, 95% confidence interval (CI) −0.71 to 1.08). However, there was an improvement in 6‐minute walk distance of 27.74 m (95% CI −1.41 to 56.88) and trends to improvement in the FSHD‐Composite Outcome Measure for Pediatrics (FSHD‐COM Peds), 10 meter walk/run, and in MRI measures. There were no serious adverse events. Serum creatinine increased by a mean 12.63 μmol/L (95% CI 1.14 to 24.12) post‐CrM treatment, though this was presumed to reflect increased creatinine production. No participants discontinued CrM due to adverse events.Conclusion: CrM is safe and well tolerated in children with FSHD. Although CrM had no effect on motor function as measured by the MFM‐32 compared with placebo, there were trends toward improvement in the 6‐minute walk distance and other secondary outcome measures. This study confirms the feasibility of conducting clinical trials in children with FSHD. Further assessment of the efficacy of CrM in pediatric FSHD is warranted in a larger randomized controlled clinical trial. Future studies may benefit from stratifying population cohorts according to functional ability or by MRI fat infiltration measurements.

Background/Objectives: Assessment of vitamin C status rarely occurs in hospital patients within high-income countries on the assumption that vitamin C deficiency (VCD) is rare, and evidence on prevalence, risk factors, and clinical outcomes of VCD is limited. This study aimed to describe the prevalence of VCD, characteristics of patients with VCD, and identify risk factors and clinical outcomes associated with VCD status in adult hospitalised patients. Methods: This retrospective observational study included adult inpatients from five metropolitan hospitals within a single public health service in Australia which provides tertiary, acute, and sub-acute care, over a 3.5-year period. Non-fasting vitamin C levels were examined for the prevalence of VCD, defined as p < 0.001) and male gender (OR 1.47, 95% CI 1.17–1.86, p = 0.001) were associated with VCD. VCD was not associated with clinical outcomes including in-hospital death, hospital or intensive care unit LOS, or hospital-acquired complications. Conclusions: VCD exists within adult hospital patients in high-income countries, and early, targeted detection of VCD in this setting is warranted. Further research is needed to explore the impact of VCD on hospital clinical outcomes.