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.

Co-design of a cancer nutrition care pathway by patients, carers, and health professionals: the CanEAT pathway.

PURPOSE: Limited practical resources exist to guide optimal nutrition care for patients, carers, and health professionals (HPs). This study aimed to co-design a cancer nutrition care pathway to guide and improve the provision of consistent, evidence-based care with consumers and HPs. METHODS: This study utilised an experienced-based co-design (EBCD) approach over five stages. Stage 1 involved stakeholder engagement and a literature review. Stage 2 included a survey and focus groups with patients/carers. Co-design workshops were conducted within stage 3, key stakeholder consultation within stage 4, and the finalisation and dissemination of the cancer nutrition care pathway formed stage 5. Results of stages 3 to 5 are the focus of this paper. RESULTS: Two co-design workshops were held with patients, carers, and HPs (n = 32 workshop 1; n = 32 workshop 2), who collectively agreed on areas of focus and key priorities. Following this, a consultation period was completed with patients, carers, and HPs (n = 45) to refine the pathway. The collective outcome of all study stages was the co-design of a cancer nutrition care pathway (the CanEAT pathway) defining optimal cancer nutrition care that combines evidence-based practice tips into a centralised suite of resources, tools, and clinical guidance. CONCLUSION: The CanEAT pathway was co-designed by patients, carers, and HPs. The EBCD approach is a meaningful way to develop targeted improvements in cancer care. The CanEAT pathway is freely available to guide and support patients, carers, and HPs to aid the implementation of optimal nutrition care into clinical practice.

Data-Driven Design Strategies to Address Crowding and Boarding in an Emergency Department: A Discrete-Event Simulation Study.

OBJECTIVE: To address prolonged lengths of stay (LOS) in a Level 1 trauma center, we examined the impact of implementing two data-driven strategies with a focus on the physical environment. BACKGROUND: Crowding in emergency departments (EDs) is a widely reported problem leading to increased service times and patients leaving without being seen. METHODS: Using ED historical data and expert estimates, we created a discrete-event simulation model. We analyzed the likely impact of initiating care and boarding patients in the hallway (hallway care) instead of the exam rooms and adding a dedicated triage space for patients who arrive by emergency medical services (EMS triage) to decrease hallway congestion. The scenarios were compared in terms of LOS, time spent in exam rooms and hallway spaces, service time, blocked time, and utilization rate. RESULTS: The hallway care scenario resulted in significantly lower LOS and exam room time only for EMS patients but when implemented along with the EMS triage scenario, a significantly lower LOS and exam room time was observed for all patients (EMS and walk-in). The combination of two simulated scenarios resulted in significant improvements in other flow metrics as well. CONCLUSIONS: Our findings discourage boarding of admitted patients in ED exam rooms. If space limitations require that admitted patients be placed in ED hallways, designers and planners should consider enabling hallway spaces with features recommended in this article. Alternative locations for boarding should be prioritized in or out of the ED. Our findings also encourage establishing a triage area dedicated to EMS patients in the ED.

Assessment of readiness to prevent type 2 diabetes in a population of rural women with a history of gestational diabetes.

INTRODUCTION: Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes mellitus. Given the rapidly increasing prevalence of diabetes globally, there is an urgent need to develop preventative strategies and to identify high risk populations who would most benefit from diabetes prevention. OBJECTIVE: To investigate readiness to prevent diabetes in a cohort of rural women with a recent history of GDM. SETTING: Women with a recent history of GDM in regional and rural Victoria, Australia. METHODS: All women who had attended a regional diabetes centre in the past 14 months (June 2004 to July 2005) for treatment of GDM, were surveyed by mail. Variables measured included readiness to engage in physical activity and weight management as measured by the transtheoretical model of behaviour change, and perception of diabetes risk. RESULTS: Of the 53 women who completed the survey (mean age 32.5 years), 58% were classified as in pre-action for activity and 75% in pre-action for weight loss. Highest prevalence of pre-action for both activity and weight loss was among women with more than two children, high BMI, and those not engaged in paid work. Eighty-five percent of women in pre-action for activity were also in pre-action for weight loss. Neither physical activity nor weight loss behaviour was influenced by baby age. Nearly all respondents agreed that regular exercise, healthy diet and healthy weight, were very important to prevent diabetes, and the majority of respondents were optimistic about preventing type 2 diabetes mellitus. However, just under half (43%) of the total cohort were not engaged in any diabetes risk reduction behaviour. CONCLUSION: The prevalence of physical activity and weight loss behaviour was found to be low in a rural population of women with a history of GDM, despite a high awareness of diabetes prevention strategies. Future planning for diabetes prevention will need to target this knowledge-behaviour gap. In addition to child care services and partner support, programs designed to target ambivalence to behaviour change, including structured stage-matched interventions, may have success in this vulnerable and high risk group.

Tina Keller's analyses with C. G. Jung and Toni Wolff, 1915-1928.

This historical essay documents the clinical practices of C. G. Jung and Toni Wolff with their analysand Tina Keller, a Swiss physician and psychotherapist, during the formative years of analytical psychology (1915-1928). The topic is investigated through an examination of primary documents, largely unpublished, in English and German, based on Keller's autobiographical writings. It presents biographical information on Keller's life and details of her analyses with Jung and Wolff, emphasizing the technique of active imagination and describing the clinical practices of Jung and Wolff in Keller's analyses.