Background: Nutrition and nutritional care are essential for optimal outcomes, and, therefore of importance for patients with chronic limb threatening ischemia (CLTI) given their high risk of complications. However, insight is lacking in how healthcare professionals directly involved in the care of patients with CLTI perceive nutritional care, as well as in the perceived barriers and facilitators regarding optimal nutritional care. Methods: In this qualitative study with a phenomenological approach, 3 online focus groups were conducted with various healthcare professionals directly involved in the care of patients with CLTI. Sample size was guided by information power. Focus group recordings were transcribed verbatim, and reflexive thematic analysis was performed. Results: Seventeen healthcare professionals participated, including vascular surgeons, fellows in vascular surgery, a medical doctor and researcher, nurse specialized in wound care, general nurse, physical therapists, dietitians, and nutrition assistants. Four themes were generated: (1) nutritional care is crucial for optimal clinical outcomes and a healthy life, (2) insufficient attention to undernutrition and nutritional care by healthcare professionals, (3) patient-related factors challenge healthcare professionals in providing nutritional care, and (4) need for optimizing the organizational process related to nutritional care. Perceived barriers regarding nutritional care included knowledge deficits, nutritional care not being part of the healthcare professionals’ routine, missing tools to identify undernutrition, patient-related factors, and time constraints. Facilitators regarding nutritional care included more scientific evidence regarding the effect of nutritional care on clinical outcomes and optimization of organizational processes related to nutritional care. Conclusions: Healthcare professionals perceive nutritional care as important for optimal outcomes, but nutritional care is not routinely implemented in the care of patients with CLTI. This lack of implementation of nutritional care may be due to the barriers perceived in various domains. The findings of this study stress the need to optimize nutritional care, with the aim of improving outcomes in the CLTI population.
Objective: Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake.Methods: In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed.Results: Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake.Conclusion: Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI.
Onduidelijk is of en hoe kan worden voorkomen dat geldezels hun rekening beschikbaar stellen aan criminelen. In Nederland wordt geëxperimenteerd met interventies voor geldezels door Halt en de Reclassering. Zo krijgen de vaak jonge daders een weerbaarheidstraining of moeten zij zelf voorlichting geven op scholen (Reclassering, 2019). Om een goede interventie te ontwikkelen is het belangrijk om zicht te krijgen op het probleem dat de interventie probeert te verhelpen. Het is bekend dat het voor effectieve interventies belangrijk is dat de interventie aansluit bij de risico’s en behoeften van de doelgroep (Andrews et al., 1990; van der Laan, 2004). Er is op dit moment echter weinig tot geen empirisch onderzoek verricht naar karakteristieken van geldezels en de problematiek die een rol speelt bij deze doelgroep (Leukfeldt & Jansen, 2015). Dit onderzoek is een eerste aanzet om te voorzien in die leemte. Het huidige onderzoek heeft tot doel om meer inzicht te krijgen in effectieve interventies die de gemeente Haarlem kan inzetten om te voorkomen dat geldezels meewerken met cybercriminele netwerken. Om dat te kunnen bereiken zal allereerst inzicht moeten worden verkregen in kenmerken van geldezels en de problematiek die bij deze doelgroep een rol speelt. Vervolgens zal een inventarisatie worden gemaakt van bestaande of mogelijke interventies voor geldezels. Op basis van de kenmerken van de geldezels en de informatie over interventies kan vervolgens een interventie specifiek gericht op geldezels worden ontwikkeld en uitgevoerd worden in Haarlem. Dat zal gebeuren na afronding van dit rapport. De interventie zal door de onderzoekers worden geëvalueerd om achter mogelijke werkzame en nietwerkzame elementen van de interventie te komen. De volgende onderzoeksvraag staat tijdens het onderzoek centraal: Wat zijn kenmerken van geldezels, wat is de rol van geldezels in het cybercriminele netwerk en welke mogelijke interventies sluiten daarbij aan?
