Evaluation of a Structured Nutrition Competence Program for Dietitian Assistants

OBJECTIVE

To explore the perspectives of dietitian assistants in a tertiary teaching hospital in Sydney, Australia, following the implementation of a formal competence and professional development program.

METHODS

All currently employed dietitian assistants at a tertiary teaching hospital in Sydney were eligible to participate. Semi-structured interviews were undertaken by two student dietitians. Transcripts were returned to participants for interviewee transcript review and further clarification of information. Transcripts were qualitatively described.

RESULTS

A total of 9 dietitian assistants participated in interviews in October 2019. The average age of participants was 45.11 yrs (range 29-59) and 90% were female (n=8). The average length of employment was 197 months (range 3-516). Three themes emerged including: (a) new job satisfaction, (b) positive influence of the dietitian assistant educator, and (c) challenges of new processes and responsibilities.

CONCLUSION

A supported structured competence and professional development program has provided dietitian assistants with new skills and renewed job satisfaction. Further research should consider the impact of the newly developed skills of dietitian assistants on patient care and outcome measures.

Preoperative Nutrition Status and Postoperative Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

BACKGROUND

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex surgery to treat peritoneal surface malignancy (PSM). PSM and gastrointestinal (GI) resection from CRS can lead to significant GI symptoms and malnutrition. There is limited research into the nutrition status of this patient group and the impact of malnutrition on morbidity.

OBJECTIVE

This study aims to determine if preoperative malnutrition, assessed using the Subjective Global Assessment (SGA), is associated with postoperative morbidity and increased length of stay (LOS) in patients undergoing CRS/HIPEC for PSM.

METHODS

This study prospectively assessed the nutritional status of patients undergoing CRS/HIPEC using a validated nutrition assessment tool. Preoperative clinical symptoms, Peritoneal Cancer Index (PCI), intraoperative blood transfusions, operative time, GI resections, postoperative morbidity, and LOS, as well as pre- and postoperative nutritional interventions, were recorded. The impact of preoperative nutritional status was assessed in relation to postoperative complications and hospital LOS.

RESULTS

The study included 102 participants; 34 patients (33%) were classified as malnourished (SGA = B or C). Preoperative weight loss (15% vs. 74%; p ≤ 0.001) and the presence of clinical symptoms (18% vs. 47%; p = 0.002) were significantly higher in malnourished patients. While PCI, intraoperative blood transfusions, and GI resections were independent predictors of morbidity, malnutrition was significantly associated with infectious complications and LOS. For each grade of worsening malnutrition, LOS increased by an average of 7.65 days.

CONCLUSIONS

Preoperative malnutrition is prevalent in patients undergoing CRS/HIPEC and postoperative morbidity is common. Malnutrition is linked to LOS and plays a role in postoperative outcomes such as infection. Clear pre- and postoperative nutrition pathways are needed to optimize nutrition support and postoperative recovery.