An Intervention to Debunk Facts vs. Myths in Intermittent Fasting: A Quality Improvement Project

Intermittent fasting (IF) is gaining popularity as an eating regimen to promote health and optimize wellbeing. IF is the voluntary avoidance of food over a period and is not a diet, but an eating behavior (Teong et al., 2021). Despite the increased emphasis on obesity and diet-related diseases, IF education remains lacking in formal training programs and can influence HCC’s attitudes and behaviors when engaging in IF dialogue with patients in clinical settings. Evidence suggests that IF is beneficial for weight loss and has been shown to have positive effects on the brain, heart, liver, muscles, intestines, blood, and various other systems. IF has also been shown to reduce risk factors associated with the development and progression of type II diabetes, neurological disorders, and cancers. Additionally, IF may boost the effectiveness of certain medical and cancer treatments (Armutcu, 2019; Phillips, 2019). The main objective is to determine if an evidence-based education program on intermittent fasting will change healthcare clinicians’ knowledge, attitudes, confidence level, perception of knowledge, and behavior in communicating with adult patients about IF. The presentation aims to fill the knowledge gaps with pertinent evidence-based information, debunk common IF myths, and provide effective communication strategies to help improve HCCs knowledge, attitudes, confidence, and behavior of IF in clinical practice settings. The study is a quasi-experimental, pre-test post-test quality improvement (QI) project including 20 HCCs working at the practice site. Potential participants were identified by snow-ball samplings of various units/clinics at the site. Descriptive statistics were used to analyze the data. Results from the project indicate that mean knowledge scores compared from baseline to post-education increased, 6.8 (s.d. 3.77) and 12.65 (s.d. 4.83), respectively. Based on the current evidence and the results from this quality-improvement project, HCC education helps improve knowledge, confidence, perceptions, and behaviors of IF in clinical practice settings to promote safe and effective communication with patients

Conceptualizing Community Buy-in and Its Application to Urban Farming

Supporters of urban farming — a type of urban agriculture that emphasizes income generation — view it as a productive use of vacant land, increasing access to fresh produce and contributing to local economies. Yet its viability depends on gaining "community buy-in" (i.e., the acceptance and active support of local residents). While recognized as important to the success of socially oriented programs, information is lacking regarding effective processes for gaining community buy-in. Through participant observation at urban farms and interviews with urban farmers, neighborhood leaders, city residents, and key stakeholders in Baltimore, Maryland, we explored the perceived importance of community buy-in for urban farming, as well as the barriers, facilitators, and strategies for gaining such buy-in. Findings reveal consensus regarding the importance of buy-in, justified by farms' vulnerability to vandalism and the need to align farm services with local residents' desires. Barriers to buy-in include unfamiliarity of residents with urban farming, concerns about negative impacts on the neighborhood, and perceptions of urban farms as "outsider projects." Buy-in is facilitated by perceived benefits such as access to fresh produce, improvement of degraded lots, employment and educational opportunities, the creation of community centers, and community revitalization. Strategies urban farmers use to gain community support followed three main phases: (1) gaining entry into a neighborhood; (2) introducing the idea for an urban farm; and (3) engaging the neighborhood in the urban farm. We make recommendations based on these three phases to assist urban farmers in gaining community buy-in and discuss themes that can be applied to community buy-in processes more broadly

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London