Many nutrition interventions and innovations are supported by strong evidence; however, their adoption, implementation, and long‐term sustainability in real‐world healthcare settings too frequently remain a challenge. Implementation science offers methodologies to equip practitioners with tools to identify and address the contextual factors that influence implementation success in health settings (e.g., adoption, implementation, sustainability). Among the various frameworks and theories used in implementation science, the Consolidated Framework of Implementation Research (CFIR) is one of the most widely used. The CFIR synthesizes constructs from multiple behavioral and implementation theories into a comprehensive tool that can be used to systematically assess the barriers and facilitators that influence implementation outcomes. The framework enables practitioners and researchers to identify context‐specific implementation determinants and to design tailored implementation strategies across diverse contexts and settings. Given its adaptability, the CFIR is highly relevant to the field of nutrition and dietetics to support sustained adoption and delivery of nutrition innovations (e.g., screening tools, educational programs, quality improvement initiatives); but it is relatively underutilized in nutrition practice. This article provides an overview of the CFIR and illustrates how it can be used to guide the implementation of nutrition innovations in clinical practice through two pragmatic case studies. We highlight the potential of the CFIR to be used as a guiding framework to advance the adoption, implementation, and sustainability of nutrition innovations and improve nutrition care and patient outcomes.

BackgroundExcessive fasting for tests and procedures within the hospital setting remains commonplace, despite clear evidence of the benefits related to reduced fasting. There is minimal research addressing the issue of prolonged preoperative fasting. The aim of this study was to undertake a pre/post implementation study using multifaceted interventions to reduce excessive fasting on acute surgical wards within a quaternary hospital in Sydney, Australia, using the behavior change wheel (BCW) framework.MethodsThe BCW was used to identify key strategies to address barriers to implementing evidence‐based fasting guidelines. A pre/post implementation study using multifaceted interventions to reduce excessive fasting on acute surgical wards was implemented over a 3‐month period. The primary outcome was preoperative fasting time in hours. Clinician interviews were conducted to assess the benefit of each of the interventions within the study.ResultsOn completion of preimplementation data collection, strategies were implemented including ward education, guideline promotion, patient stories, patient‐facing flyers, and audit and feedback. There was no significant difference between fasting times pre and post intervention. Clinician interviews showed increased awareness and increased confidence.ConclusionThis pre/post implementation study was unable to significantly reduce fasting times, but did show increased clinician awareness and a trend towards improved patient‐reported outcomes. Future research needs to ensure a larger sample size, as well as incorporating emerging strategies such as “sip‐to‐send” or “think‐drink.”

BackgroundHyperglycemia is a complication of parenteral nutrition (PN), which can be exacerbated in patients with obesity. Limited data exist on glycemic control in this population. This study aims to evaluate the association of obesity and body mass index (BMI) classification with glycemic control in patients who are critically ill initiated receiving PN.MethodsThis is a retrospective study of patients who are critically ill receiving PN from January 2013 to February 2024. The primary outcome was glycemic control in patients with BMI ≥ 30 kg/m2 or BMI < 30 kg/m2 based on hyperglycemic episodes, peak blood glucose, and insulin requirements on the first and second days of therapy. Multivariate analyses were conducted for the occurrence of a hyperglycemic episode. The secondary outcome was to determine the association of BMI classification with glycemic control.ResultsThe study included 220 patients with BMI ≥ 30 kg/m2 (n = 91) and BMI < 30 kg/m2 (n = 129). The BMI < 30 kg/m2 group received more total dextrose (1.58 vs 2.36 mg/kg/min; P < 0.0001). There was no difference in the primary outcome during day 1 of PN, but there were increased hyperglycemic episodes (P = 0.0478) and insulin requirements in the BMI ≥ 30 kg/m2 group on day 2 (P = 0.0226). The only difference in the secondary outcome was insulin requirements on day 2 (P = 0.0453).ConclusionPatients who are critically ill with BMI ≥ 30 kg/m2 receiving PN received more conservative dextrose infusion rates yet experienced more hyperglycemic episodes and required more insulin on day 2. However, obesity and BMI classification were not independently associated with hyperglycemic episodes within the first 2 days of PN initiation.

BackgroundThe 2019 Enhanced Recovery After Cardiac Surgery (ERACS) guidelines presented perioperative recommendations to optimize treatment for patients undergoing cardiac surgery (CS). However, the guidelines have not established postoperative nutrition recommendations. Limited studies have analyzed oral intakes after CS, but to our knowledge, none have done so in an ERACS pathway. The main objective of this study was to evaluate the adequacy of postoperative oral intakes, including adherence to oral nutrition supplements (ONSs).MethodsThis was an observational prospective study. Postoperative oral intakes were analyzed from postoperative day (POD) 1 to 4, using direct observation of meal plates provided by the hospital. ONSs consumption was evaluated from POD2 to POD4. Adherence to other ERACS recommendations, including nutrition optimization before surgery, was recorded.ResultsForty‐three patients were included in this study. Nutrition optimization before CS was offered to three (7%) patients. Forty‐one (95%) patients resumed oral intakes on POD1. Mean oral calorie and protein intakes from POD2 to POD4 were 1088 ± 437 kcal and 0.8 ± 0.3 g/kg, respectively; however, 17 (41%) patients had calorie and protein intakes ≥70% of their estimated requirements. On POD2, ONSs consumption contributed 35% ± 19% and 38% ± 20% of calorie and protein intake, respectively. There was a significant decrease in ONSs consumption starting on POD3.ConclusionWithin an ERACS pathway and with the contribution of ONSs, 41% of patients achieved sufficient oral intakes within the first 4 days after CS. The optimization of ONSs adherence on postoperative oral intakes should be further studied.

BackgroundThe administration of home parenteral nutrition improves quality of life for patients with intestinal failure, thus fostering their will to actively participate to social activities. Nevertheless, sports participation can be risky for patients with a central venous catheter (CVC). Despite literature thoroughly proving the positive impact of sports on motor‐psychosocial development, no consistent evidence assessing its role on central‐line complications is available. This study aimed to report the European centers' approach to children with intestinal failure on home parenteral nutrition and interested in playing sports, further assessing complications and how to prevent them.Materials and MethodsA questionnaire focusing on children with intestinal failure regarding physical activity was circulated to 20 centers. Questions assessed the centers' policy for CVC management, the sports‐related recommendations for patients on home parenteral nutrition and complication rates.ResultsSixteen (80%) centers filled in the questionnaire. Twelve centers reported not to have a standardized formal protocol for catheter care during sports. All centers encouraged patients to perform mild/moderate exercise, whereas high‐contact sports were allowed by one center only. Specific dressings were suggested to protect the vascular access device, especially for water sports. Only one sports‐related complication (rupture) was reported.ConclusionThis survey emphasizes that sports should not be restricted in patients with intestinal failure and represents a blueprint for sports‐related recommendations for these patients. Prospective studies assessing complication rates are advisable to ensure an improved access to sports for these patients.

BackgroundThis study aimed to understand the collective impact of trace elements, vitamins, cholesterol, and prealbumin on patient outcomes in the intensive care unit (ICU) using an advanced artificial intelligence (AI) model for mortality prediction.MethodsData from ICU patients (December 2016 to December 2021), including serum levels of trace elements, vitamins, cholesterol, and prealbumin, were retrospectively analyzed using AI models. Models employed included category boosting (CatBoost), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and multilayer perceptron (MLP). Performance was evaluated using area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F1‐score. The performance was evaluated using 10‐fold crossvalidation. The SHapley Additive exPlanations (SHAP) method provided interpretability.ResultsCatBoost emerged as the top‐performing individual AI model with an AUROC of 0.756, closely followed by LGBM, MLP, and XGBoost. Furthermore, the ensemble model combining these four models achieved the highest AUROC of 0.776 and more balanced metrics, outperforming all models. SHAP analysis indicated significant influences of prealbumin, Acute Physiology and Chronic Health Evaluation II score, and age on predictions. Notably, the ratios of selenium to age and low‐density lipoprotein to total cholesterol also had a notable impact on the models' output.ConclusionThe study underscores the critical role of nutrition‐related parameters in ICU patient outcomes. Advanced AI models, particularly in an ensemble approach, demonstrated improved predictive accuracy. SHAP analysis offered insights into specific factors influencing patient survival, highlighting the need for broader consideration of these biomarkers in critical care management.

BackgroundIn February 2022, an infant formula recall and closing of a major manufacturing center exacerbated a nationwide shortage initiated by COVID‐19–related supply chain disruptions. The effects were far‐reaching, impacting families and healthcare providers across the US.MethodsA 19‐item web survey was developed to better understand how the infant formula shortage impacted healthcare provider practices, resources needed and those already used, and patient health, including malnutrition. Subjective data on providers' experience were also collected.ResultsTwo hundred forty‐one providers responded, primarily registered dietitians (94%) practicing in inpatient/academic hospitals in urban and metropolitan areas. Practice adjustments included increases in patient education (100%), communication with pharmacies/durable medical equipment companies (65%), and visit durations (28%). Feeding adjustments by caregivers included new infant formula (99%), toddler (55%) or homemade (23%) formula, cow's milk (46%) or milk alternatives (32%), formula dilution (41%), and early food introduction (14%). Providers indicated an increase in malnutrition (33%), related diagnoses (including failure to thrive [31%] and deceleration in z score [27%]), and associated symptoms. Of the providers who reported malnutrition and related diagnoses, 93% also reported caregiver feeding practices that are generally not recommended.ConclusionProviders made practice adjustments to mitigate the consequences associated with formula unavailability and misuse yet saw an increase in malnutrition and related diagnoses or symptoms. Subjectively, providers reported frustration that greater workloads did not result in improved outcomes, contributing to burnout. These data underscore the essentiality of supporting healthcare providers as they guide families in safe infant feeding practices.

BackgroundPostoperative pancreatic fistula (POPF) remains one of the most severe complications after pancreatic surgery. The methods for predicting pancreatic fistula are limited. We aimed to investigate the predictive value of body composition parameters measured by preoperative bioelectrical impedance analysis (BIA) on the development of POPF.MethodsA total of 168 consecutive patients undergoing pancreatic surgery from March 2022 to December 2022 at our institution were included in the study and randomly assigned at a 3:2 ratio to the training group and the validation group. All data, including previously reported risk factors for POPF and parameters measured by BIA, were collected. Risk factors were analyzed by univariable and multivariable logistic regression analysis. A prediction model was established to predict the development of POPF based on these parameters.ResultsPOPF occurred in 41 of 168 (24.4%) patients. In the training group of 101 enrolled patients, visceral fat area (VFA) (odds ratio [OR] = 1.077, P = 0.001) and fat mass index (FMI) (OR = 0.628, P = 0.027) were found to be independently associated with POPF according to multivariable analysis. A prediction model including VFA and FMI was established to predict the development of POPF with an area under the receiver operating characteristic curve (AUC) of 0.753. The efficacy of the prediction model was also confirmed in the internal validation group (AUC 0.785, 95% CI 0.659–0.911).ConclusionsPreoperative assessment of body fat distribution by BIA can predict the risk of POPF after pancreatic surgery.