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PurposeHaematopoietic stem cell transplantation (HSCT) is potentially lifesaving. However, it comes with negative consequences such as impaired physical functioning, fatigue and poor quality of life. The aim of this systematic review and meta-analysis is to determine the effect of exercise and nutrition interventions to counteract negative consequences of treatment and improve physical functioning in patients receiving HSCT.MethodsThis systematic review and meta-analysis included randomised controlled trials from three electronic databases between 2009 and 2020. The trials included adult patients receiving HSCT and an exercise or nutrition intervention. Study selection, bias assessment and data extraction were independently performed by two reviewers. Physical functioning outcomes were meta-analysed with a random-effects model.ResultsThirteen studies were included using exercise interventions (n = 11) and nutrition interventions (n = 2); no study used a combined intervention. Meta-analysis of the trials using exercise intervention showed statistically significant effects on 6-min walking distance (standardised mean difference (SMD) 0.41, 95% CI: 0.14–0.68), lower extremity strength (SMD 0.37, 95% CI 0.12–0.62) and global quality of life (SMD 0.27, 95% CI: 0.08–0.46).ConclusionOur physical functioning outcomes indicate positive effects of exercise interventions for patients receiving HSCT. Heterogeneity of the exercise interventions and absence of high-quality nutrition studies call for new studies comparing different types of exercise studies and high quality studies on nutrition in patients with HSCT.

Background Integrating care for (risk of) malnutrition and sarcopenia in primary care is challenging, as limited physical proximity among healthcare professionals hinders collaboration. Both health conditions are common in community-dwelling older adults and are associated with significant declines in physical functioning, independence, and quality of life. Healthcare professionals tend to manage malnutrition and sarcopenia separately, leading to missed opportunities for early (risk) identification and coordinated care. An interprofessional care pathway can provide an evidence-based, structured framework to support such integration. Therefore, we aimed to co-design an interprofessional care pathway for addressing (risk of) malnutrition or sarcopenia in community-dwelling older adults within the Dutch primary care context. Methods We applied a design-oriented approach using the Double Diamond model to guide the development process across the discover, define, and develop phases. Methods included persona development and validation, desk research, patient journey mapping, service blueprinting, and prototyping. In addition, we introduced an interprofessional visualisation combining elements of the patient journey map and service blueprint to represent both front-stage and back-stage care processes along a timeline. The data were analysed iteratively. Results Thirteen healthcare professionals, including district nurses, dietitians, physiotherapists, general practice assistants, dementia case managers, general practitioners, and a geriatric specialist, participated in the co-design process. The process comprised three in-person sessions and two online follow-up meetings. In addition, one community-dwelling older adult was interviewed. The co-design process resulted in a prototype interprofessional care pathway that offers a structured workflow for detecting, screening, and managing (risk of) malnutrition and sarcopenia. The pathway addresses interprofessional, person-centred, and integrated care by a designated point of contact, shared treatment plans, continuous interprofessional communication, shared decision-making, clearly defined roles, and regular team evaluation. The pathway includes practical tools such as detection cards, templates and formats for task allocation, work agreements, and team evaluation. Conclusion This study presents a co-designed prototype of an interprofessional care pathway to address (risk of) malnutrition and sarcopenia in community-dwelling older adults. Future research should evaluate its feasibility in daily primary care practice.

Multimodal prehabilitation programs to improve physical fitness before surgery often include nutritional interventions. This study evaluates the efficacy of and adherence to a nutritional intervention among colorectal and esophageal cancer patients undergoing the multimodal Fit4Surgery prehabilitation program. The intervention aims to achieve an intake of ≥1.5 g of protein/kg body weight (BW) per day through dietary advice and daily nutritional supplementation (30 g whey protein). This study shows 56.3% of patients met this goal after prehabilitation. Mean daily protein intake significantly increased from 1.20 ± 0.39 g/kg BW at baseline to 1.61 ± 0.41 g/kg BW after prehabilitation (p < 0.001), with the main increase during the evening snack. BW, BMI, 5-CST, and protein intake at baseline were associated with adherence to the nutritional intervention. These outcomes suggest that dietary counseling and protein supplementation can significantly improve protein intake in different patient groups undergoing a multimodal prehabilitation program.

Malnutrition and sarcopenia impact the physical health and quality of life of community-dwelling older adults. Managing these conditions requires integrating nutritional and exercise interventions delivered by professionals from diverse backgrounds. Interprofessional collaboration holds promise for providing integrated, person-centered care to older adults. However, to tailor such care, it is essential to understand the needs and wishes of older adults, which remain underexplored. This study aimed to understand the needs and wishes of community-dwelling older adults regarding interprofessional treatment for (risk of) malnutrition and sarcopenia. We conducted a grounded theory study. Data collection involved semi-structured interviews and focus groups with community-dwelling older adults who are undergoing treatment or have been treated for (risk of) malnutrition and/or sarcopenia. We systematically analyzed the data using open, axial, and selective coding and developed a conceptual model. Interviews and focus groups were conducted with 18 older adults. Three selective codes were identified: 1) older adults need to be involved in their interprofessional treatment, 2) older adults need healthcare professionals to be well-informed about their interprofessional treatment, and 3) older adults need collaboration amongst involved healthcare professionals in interprofessional treatment. Our conceptual model addresses the needs and wishes of older adults in relation to interprofessional collaboration. Older adults' needs highlight what is missing, while their wishes offer ways to fulfill these needs. Older adults' need for involvement in interprofessional treatment can be met by engaging them actively in healthcare decisions and as partners to healthcare professionals. The need for well-informed healthcare professionals can be fulfilled by ensuring accessible healthcare information, the prevention of conflicting advice, and the prevention of repeating medical history. Finally, the need for collaboration among healthcare professionals can be fulfilled by healthcare professionals communicating openly and directly and working closely together.

As our global population ages, malnutrition and sarcopenia are increasingly prevalent. Given the multifactorial nature of these conditions, effective management of (risk of) malnutrition and sarcopenia necessitates interprofessional collaboration (IPC). This study aimed to understand primary and social care professionals' barriers, facilitators, preferences, and needs regarding interprofessional management of (risk of) malnutrition and sarcopenia in community-dwelling older adults. We conducted a qualitative, Straussian, grounded theory study. We collected data using online semi-structured focus group interviews. A grounded theory data analysis was performed using open, axial, and selective coding, followed by developing a conceptual model. We conducted five online focus groups with 28 professionals from the primary and social care setting. We identified five selective codes: 1) Information exchange between professionals must be smooth, 2) Regular consultation on the tasks, responsibilities, and extent of IPC is needed; 3) Thorough involvement of older adults in IPC is preferred; 4) Coordination of interprofessional care around the older adult is needed; and 5) IPC must move beyond healthcare systems. Our conceptual model illustrates three interconnected dimensions in interprofessional collaboration: professionals, infrastructure, and older adults. Based on insights from professionals, interprofessional collaboration requires synergy between professionals, infrastructure, and older adults. Professionals need both infrastructure elements and the engagement of older adults for successful interprofessional collaboration.

Clinical research shows that nutritional intervention is necessary to prevent malnutrition in head and neck cancer patients undergoing radiotherapy. The objective of the present study was to assess the value of individually adjusted counselling by a dietitian compared to standard nutritional care (SC). A prospective study, conducted between 2005 and 2007, compared individual dietary counselling (IDC, optimal energy and protein requirement) to SC by an oncology nurse (standard nutritional counselling). Endpoints were weight loss, BMI and malnutrition (5 % weight loss/month) before, during and after the treatment. Thirty-eight patients were included evenly distributed over two groups. A significant decrease in weight loss was found 2 months after the treatment (P = 0·03) for IDC compared with SC. Malnutrition in patients with IDC decreased over time, while malnutrition increased in patients with SC (P = 0·02). Therefore, early and intensive individualised dietary counselling by a dietitian produces clinically relevant effects in terms of decreasing weight loss and malnutrition compared with SC in patients with head and neck cancer undergoing radiotherapy.

Background: Surgery for complex primary and metastatic colorectal cancer (CRC), such as liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), in academic settings has led to improved survival but is associated with complications up to 75%. Prehabilitation has been shown to prevent complications in non-academic hospitals. This pilot study aimed to determine the feasibility and potential efficacy of a multimodal prehabilitation program in patients undergoing surgery in an academic hospital for complex primary and metastatic CRC. Methods: All patients awaiting complex colorectal surgery, liver resection, or HIPEC from July 2019 until January 2020 were considered potentially eligible. Feasibility was measured by accrual rate, completion rate, adherence to the program, satisfaction, and safety. To determine potential efficacy, postoperative outcomes were compared with a historical control group. Results: Sixteen out of twenty-five eligible patients (64%) commenced prehabilitation, and fourteen patients fully completed the intervention (88%). The adherence rate was 69%, as 11 patients completed >80% of prescribed supervised trainings. No adverse events occurred, and all patients expressed satisfaction with the program. The complication rate was significantly lower in the prehabilitation group (37.5%) than the control group (70.2%, p = 0.020). There was no difference in the type of complications. Conclusion: This pilot study illustrates that multimodal prehabilitation is feasible in the majority of patients undergoing complex colorectal cancer, liver resection, and HIPEC in an academic setting.

Background/Objectives Additional strategies should be applied to optimize hospital food services, in order to increase the number of patients with adequate protein intake at mealtimes. Therefore, we aim to specify the differences in protein intake per mealtime between the traditional three meals a day food service (TMS) and a novel six times a day food service containing protein-rich food items, FoodforCare (FfC). Subjects/Methods This was a post-hoc analysis of a prospective cohort study comparing the TMS (July 2015 − May 2016; n  = 326) to FfC (January 2016 − December 2016; n  = 311) in adult hospitalized patients. Results Protein intake (g) was higher with FfC at all mealtimes ( p  < 0.05) except for dinner (median [IQR] at breakfast: 17 [6.5–25.7] vs. 10 [3.8–17]; 10:00 a.m.: 3.3 [0.3−5.3] vs. 1 [0−2.2]; lunch: 17.6 [8.4−25.8] vs. 13 [7−19.4]; 2:30 p.m.: 5.4 [0.8–7.5] vs. 0 [0–1.8]; 7:00 p.m.: 1 [0–3.5] vs. 0 [0–1.7]; 9:00 p.m.: 0 [0–0.1] vs. 0 [0–0]). At dinner, protein intake was highest for both food services (20.9 g [8.4–24.1] vs. 20.5 g [10.5–27.8]). Conclusions Implementation of a high-frequency food service can improve protein intake at mealtimes during the day and might be a strategy to increase the number of patients with adequate protein intake.

The aims of this study were to examine the diagnostic accuracy of the Malnutrition Universal Screening Tool (MUST) and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF) for detecting malnutrition in chronic kidney disease (CKD), study individual contributions of MUST and PG-SGA screening items to the explained variance in nutritional status (NS), and examine whether the PG-SGA-SF score, in combination with one of the items of the clinician's part of the cPG-SGA, can be used as a valid and compact nutrition assessment tool in patients with CKD. This was a cross-sectional observational study with 123 patients with CKD who were screened for malnutrition risk by MUST and PG-SGA-SF. NS was determined by complete PG-SGA. Overall accuracy was calculated by the receiver operating curve area under the curve (ROC-AUC). Explained variance of individual screening items was assessed by Nagelkerke's R2, total explained variance was assessed by the increase of R2 after addition of items in manual stepwise forward selection. Of the patients, 44% were malnourished, which was detected by MUST in 24% and by PG-SGA-SF in 78%. Items “body mass index (BMI)” and “no food intake” of the MUST together explained only 3.7% of the variance in NS, whereas the item “nutrition impact symptoms” (NIS) of the PG-SGA-SF explained 57%. Total explained variance in NS by MUST and PG-SGA-SF were 15% and 74%, respectively. The PG-SGA-SF combined with the “metabolic stress” item explained most (87%) and had a sensitivity of 94% to detect malnutrition. Most malnourished patients with CKD failed to be identified with the MUST, whereas the PG-SGA-SF detected the majority of them with the screening item “NIS” having the highest individual contribution to the explained variance in NS. Combination of PG-SGA-SF with the item “metabolic stress” had the highest overall accuracy to detect malnutrition. •Many malnourished patients with chronic kidney disease were not identified with the Malnutrition Universal Screening Tool.•The Patient-Generated Subjective Global Assessment Short Form has a high accuracy and is a simple screening method in daily practice.•For the Malnutrition Universal Screening Tool, body mass index and no food intake combined explained 3.7% of variance in nutritional status.•For the Patient-Generated Subjective Global Assessment Short Form, nutrition impact symptoms explained 57% of variance in nutritional status.

•The new food service (NFS) was introduced to the hemodialysis department of the Radboud University Medical Center, which provides patients several small protein-rich meals with special care for presentation and aroma•NFS significantly improved protein and energy intake, but no increase in symptomatic hypotensive events was observed compared with the old food service•Improvements were also seen in all aspects of patient satisfaction•Mean ± standard deviation protein intake was 26.2 ± 11.4 (old food service) and 31.2 ± 13.1 g (NFS) Radboud University Medical Center introduced a new food service (NFS) to the hemodialysis (HD) department, which contains several small protein-rich foods and adheres to the Dutch dietary HD guidelines. The objectives were to investigate whether the NFS improves protein and energy intake compared with the old food service (OFS), the number of symptomatic hypotensive events (SHEs), and patient satisfaction. This was a prospective cohort (pilot) study of 25 adult patients with HD at the Radboud University Medical Center between August 2018 and February 2019. Differences in protein and energy intake over time by repeated measurements of the OFS and NFS were evaluated by linear mixed models with adjustments for confounders. SHEs, defined as a systolic drop >20 mmHg between two blood pressure measurements and 1) temporary or permanent stop ultrafiltration, 2) nausea, or 3) dizziness were collected. Patient satisfaction was determined by means of a self-developed questionnaire. Protein and energy intake for the OFS and NFS differed significantly. Mean ± standard deviation for protein intake was 26 ± 11 g and 31 ± 13 g, respectively, and for energy intake 603 ± 218 kcal and 724 ± 244 kcal, respectively. No increase in SHEs occurred between the food services (2 SHEs at OFS vs 1 SHE at NFS). OFS patient satisfaction was graded 6.7 ± 2.3 and NFS was graded 7.3 ± 1.7. NFS resulted in increased protein and energy intake and patient satisfaction, but no increase in SHEs was observed.