Enhancing the provision of cancer nutrition information to support care through experience-based co-design: a mixed-methods study.

PURPOSE: Nutrition is essential within cancer care, yet patient and carer access to nutrition care and information is variable. This study aimed to (1) investigate patient and carer access and perceptions, and health professional views and practices, relating to cancer nutrition information and care; and (2) co-design interactive resources to support optimal nutrition care. METHODS: Patients and carers completed a survey regarding access to nutrition care and information. Seven multidisciplinary health service teams were invited to participate in a survey and focus group to assess barriers and enablers in nutrition practices. Focus groups were recorded, transcribed and thematically analyzed. Eligible patients, carers, and health professionals were invited to four virtual workshops utilizing experience-based co-design methods to identify nutrition priority areas and design resources. Workshop participant acceptability of the resources was measured. RESULTS: Of 104 consumer survey respondents (n = 97 patients, n = 7 carers), 61% agreed that it "took too much time to find evidence-based nutrition and cancer information", and 46% had seen a dietitian. Thirty-four of 38 health professionals completed the survey and 30 participated in a focus group, and it was identified the greatest barriers to delivering nutrition care were lack of referral services, knowledge or skill gaps, and time. Twenty participants (n = 10 patients and carers, n = 10 health professionals) attended four workshops and co-designed a suite of 46 novel resources rated as highly acceptable. CONCLUSION: Improved communication, training, and availability of suitable resources could improve access to and support cancer nutrition information and care. New, co-designed cancer nutrition resources were created and deemed highly acceptable to patients, carers, and health professionals.

Visual and spectrophotometric observations related to histology in a small sample of bruises from cadavers.

Spectrophotometry has been investigated as a means to estimate the age of bruises as experiments have indicated that it can be used to detect the presence of degradation products of hemoglobin (bilirubin and hemosiderin). However, there is no data relating spectrophotometric observations to histological findings in bruises of human skin. A small number of bruises in human cadavers were studied by spectrophotometry. The average first derivative value at 490 nm was more negative in bruises with stainable iron (hemosiderin) than in those without, confirming that spectrophotometry observations can indicate the presence of degradation products of hemoglobin in the skin. This confirms spectrophotometry may be a useful tool for estimating the age of bruises.

Use of reflectance spectrophotometry and colorimetry in a general linear model for the determination of the age of bruises.

Bruises can have medicolegal significance such that the age of a bruise may be an important issue. This study sought to determine if colorimetry or reflectance spectrophotometry could be employed to objectively estimate the age of bruises. Based on a previously described method, reflectance spectrophotometric scans were obtained from bruises using a Cary 100 Bio spectrophotometer fitted with a fibre-optic reflectance probe. Measurements were taken from the bruise and a control area. Software was used to calculate the first derivative at 490 and 480 nm; the proportion of oxygenated hemoglobin was calculated using an isobestic point method and a software application converted the scan data into colorimetry data. In addition, data on factors that might be associated with the determination of the age of a bruise: subject age, subject sex, degree of trauma, bruise size, skin color, body build, and depth of bruise were recorded. From 147 subjects, 233 reflectance spectrophotometry scans were obtained for analysis. The age of the bruises ranged from 0.5 to 231.5 h. A General Linear Model analysis method was used. This revealed that colorimetric measurement of the yellowness of a bruise accounted for 13% of the bruise age. By incorporation of the other recorded data (as above), yellowness could predict up to 32% of the age of a bruise-implying that 68% of the variation was dependent on other factors. However, critical appraisal of the model revealed that the colorimetry method of determining the age of a bruise was affected by skin tone and required a measure of the proportion of oxygenated hemoglobin, which is obtained by spectrophotometric methods. Using spectrophotometry, the first derivative at 490 nm alone accounted for 18% of the bruise age estimate. When additional factors (subject sex, bruise depth and oxygenation of hemoglobin) were included in the General Linear Model this increased to 31%-implying that 69% of the variation was dependent on other factors. This indicates that spectrophotometry would be of more use that colorimetry for assessing the age of bruises, but the spectrophotometric method used needs to be refined to provide useful data regarding the estimated age of a bruise. Such refinements might include the use of multiple readings or utilizing a comprehensive mathematical model of the optics of skin.