Malnutrition in community-dwelling older people: lessons learnt using a new procedure

This article reports the implementation of a new procedure for screening and treatment of malnutrition in a community NHS trust in England. The barriers and facilitators to implementation were assessed with staff from Integrated Community and Older People's Mental Health teams. Data from interviews and surveys were collected at baseline, 2 months after initial training and 16 months after initial training as well as following deployment of a nutrition lead to embed new developments for nutritional care. The adoption of the procedure made screening and treatment of malnutrition simpler and more likely to be actioned. The benefit of a nutrition lead and local nutrition champions to support and empower staff (avoiding reliance on training alone) was shown to drive change for nutritional care across the community. Prioritisation and commitment of leadership at the organisational level are needed to embed and sustain malnutrition screening and treatment in routine practice

Implementing professional behaviour change in teams under pressure: results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project).

OBJECTIVES: To evaluate the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and to identify factors promoting or inhibiting its implementation as a routine aspect of care. DESIGN: Prospective process evaluation using mixed methods with pre/post-implementation measures. SETTING AND PARTICIPANTS: Community teams (nursing and allied health professionals) within a UK National Health Service Community Trust. 73 participants were recruited, of which 32 completed both pre-implemetation and post-implementation surveys. MAIN OUTCOME MEASURES: NoMAD survey for pre-post-intervention measures; telephone interviews exploring participant experiences and wider organisational/contextual processes. METHODS: Data prior to implementation of training, baseline (T0-survey and telephone interview) and 2 months following training (T1-follow-up survey). Quantitative data described using frequency tables reporting team type, healthcare provider role group and total study sample; analysis using Wilcoxon rank-sum (subgroup comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using normalisation process theory. RESULTS: High support for nutrition screening and treatment indicated by participants. Concerns expressed around logistical, organisational and specialist dietetic support. Pre-post-training measures indicated a positive impact of training on knowledge of the new procedure; however, most implementation measures saw no significant changes between time points or between subgroups (training participants vs non-participants). Implementation barriers included the following: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance and lack of access to dietetic support. CONCLUSION: Greater support necessary to support implementation in relation to monitoring of training completion, and organisational support for nutrition screening and treatment activity. Recommended changes to implementation design are as follows: appointment of a key person to support and monitor procedure compliance; adoption of training as an e-learning module within the existing organisational platform to increase participation in changeable working conditions

Los lenguajes controlados y la documentación técnica : mejorando la traducibilidad

Los lenguajes controlados pueden suponer una estrategia efectiva para mejorar los procesos de traducción, modificando el texto origen para que se adapte a una serie de reglas que mejoran su traducibilidad. El artículo analiza el concepto de lenguaje controlado y revisa las diferentes áreas de control y su tipología, para después realizar un breve repaso al origen y evolución de estos si stemas lingüísticos. A continuación explora qué papel representan los lenguajes controlados en el proceso de redacción y traducción de documentación técnica. Por último, se centra en la relación entre lenguajes controlados y traducción y, más en concreto, la traducción automática, haciendo especial hincapié en las reglas más efectivas para la mejora de la traducibilidad.Els llenguatges controlats poden suposar una estratègia efectiva per a millorar els processos de traducció, modificant el text origen perquè s'adapte a una sèrie de regles que milloren la seua traduïbilitat. L'article analitza el concepte de llenguatge controlat i revisa les diferents àrees de control i la seua tipologia, per a després realitzar un breu repàs a l'origen i evolució d'estos sistemes lingüístics. A continuació explora quin paper representen els llenguatges controlats en el procés de redacció i traducció de documentació tècnica. Finalment, es centra en la relació entre llenguatges controlats i traducció i, més concretament, traducció autom àtica, fent especial insistència en les regles més efectives per a la millora de la traduïbilitat.Controlled languages can be an effective strategy to improve translation processes, pre-editing the source text to conform to a set of rules to improve its translatability. This article analyses the concept of controlled language and reviews the different control areas and their typology. Further, it reviews the origin and evolution of these linguistic systems and explores the role controlled languages play in the process of writing and translating technical documentation. Finally, it focuses on the relationship between controlled language and translation and, more specifically, machine translation, with particular emphasis on the rules aimed at improving translatability

A Mixed Blessing: Market-Mediated Religious Authority in Neopaganism

This research explores how marketplace dynamics affect religious authority in the context of Neopagan religion. Drawing on an interpretivist study of Wiccan practitioners in Italy, we reveal that engagement with the market may cause considerable, ongoing tensions, based on the inherent contradictions that are perceived to exist between spirituality and commercial gain. As a result, market success is a mixed blessing that can increase religious authority and influence, but is just as likely to decrease authority and credibility. Using an extended case study method, we propose a theoretical framework that depicts the links between our informants’ situated experiences and the macro-level factors affecting religious authority as it interacts with market-mediated dynamics at the global level. Overall, our study extends previous work in macromarketing that has looked at religious authority in the marketplace) and how the processes of globalization are affecting religion

Identifying older people at risk of malnutrition and treatment in the community: prevalence and concurrent validation of the Patients Association Nutrition Checklist with ‘MUST’

BackgroundDespite policy guidance and quality standards, the majority of older adults with or at risk of malnutrition living in the community still remain under‐detected and under‐treated by health and social care professionals. The present study aimed to evaluate the concurrent validity of the Patients Association Nutrition Checklist against the ‘Malnutrition Universal Screening Tool’ (‘MUST’).MethodsThis cross‐sectional study involved 312 older adults recruited from 21 lunch and social groups. All participants were screened as per standard methodology for ‘MUST’. For the Patients Association Nutrition Checklist, they provided information about signs of unintentional weight loss in the past 3–6 months, experiencing loss of appetite or interest in eating. Chance‐corrected agreement (κ) was assessed.ResultsMean (SD) age of participants was 79.6 (8.3) years and body mass index was 27.8 (5.6) kg m–2. The majority (n = 197; 63%) were living alone. Using ‘MUST’, the overall prevalence of malnutrition was 9.9% (n = 31) comprising 6.7% at medium risk and 3.2% at high risk. There were 21.8% of participants (n = 68) rated at risk of overall malnutrition by the Patients Association Nutrition Checklist. Moderate agreement was observed between the two tools (κ = 0.47, P < 0.001).ConclusionsThe Patients Association Nutrition Checklist has potential for early identification of malnutrition risk, attributed to unintentional weight loss and appetite changes with signposting to basic dietary advice and appropriate support. Further work is required to understand how this tool could be effectively used by stakeholders including volunteers, community workers and home care staff