Original article
Vol. 155 No. 1 (2025)
Implementation of evidence-based clinical nutrition: Usability of the new digital platform clinicalnutrition.science
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Cite this as:
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Swiss Med Wkly. 2025;155:3764
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Published
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06.01.2025
Summary
AIM OF THE STUDY: Malnutrition is a common and complex challenge in inpatient and outpatient settings, associated with increased risk of morbidity and mortality. Its management is often neglected, despite strong evidence of the benefits of adequate nutritional therapy. We introduced clinicalnutrition.science (https://clinicalnutrition.science/en/), a digital platform that provides healthcare professionals with easy online access to evidence and streamlines the nutritional care process. The aim of this study was to assess the usability and to validate improvements in nutritional management when the digital platform is used by healthcare professionals.
METHODS: The usability study, conducted from 28 September to 16 November 2023, involved 56 healthcare professionals from the University Hospital of Bern and the Cantonal Hospital of Aarau. In an adapted cross-over study design, participants completed key steps of nutritional management for a simulated hepatology and oncology case both with and without the clinicalnutrition.science platform. Usability was assessed using the validated Healthcare Systems Usability Scale questionnaire, supplemented by collection of demographic data. Subgroup analysis was performed for recommended protein and energy intakes by different professional representatives.
RESULTS: Clinicalnutrition.science achieved a good overall usability score of 71.8%. Use of the platform significantly improved the protein intake recommendation (p = 0.03; median 96.5 and 80.0 g/d) and the basal metabolic rate estimate (p <0.01; median 1420.8 and 1755.5 kcal/d) of the simulated oncology case. The variance in protein and energy intake recommendations, basal metabolic rate estimation and energy deficit estimation was reduced by using the digital platform. These improvements were achieved without increasing the time required to complete key steps in nutritional management for the two patient cases (median between 10.5 and 15.0 minutes; p = 0.09 and p = 0.67) and without prior training on the platform. There was no effect on the malnutrition detection rate, the selection of an appropriate nutritional product or the identification of the most appropriate guideline.
CONCLUSIONS: The use of clinicalnutrition.science improved evidence-based clinical practice in prescribing personalised nutritional therapy and increased the accuracy of both protein and energy intake recommendations, without increasing the time taken to complete key steps in the nutritional management process.
References
- Schuetz P, Seres D, Lobo DN, Gomes F, Kaegi-Braun N, Stanga Z. Management of disease-related malnutrition for patients being treated in hospital. Lancet. 2021 Nov;398(10314):1927–38. doi: https://doi.org/10.1016/S0140-6736(21)01451-3
- Bundesamt für Statistik. Patient/innen, Hospitalisierungen. 2021; Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/gesundheitswesen/spitaeler/patienten-hospitalisierungen.html
- Cawood AL, Elia M, Sharp SK, Stratton RJ. Malnutrition self-screening by using MUST in hospital outpatients: validity, reliability, and ease of use. Am J Clin Nutr. 2012 Nov;96(5):1000–7. doi: https://doi.org/10.3945/ajcn.112.037853
- Álvaro Sanz E, Garrido Siles M, Rey Fernández L, Villatoro Roldán R, Rueda Domínguez A, Abilés J. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: early intervention protocol. Nutrition. 2019 Jan;57:148–53. doi: https://doi.org/10.1016/j.nut.2018.05.021
- Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017 Feb;36(1):49–64. doi: https://doi.org/10.1016/j.clnu.2016.09.004
- Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet. 2019 Jun;393(10188):2312–21. doi: https://doi.org/10.1016/S0140-6736(18)32776-4
- Deutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, et al.; NOURISH Study Group. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016 Feb;35(1):18–26. doi: https://doi.org/10.1016/j.clnu.2015.12.010
- Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, et al. ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr. 2023 Sep;42(9):1545–68. doi: https://doi.org/10.1016/j.clnu.2023.06.023
- Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr. 2020 Dec;39(12):3533–62. doi: https://doi.org/10.1016/j.clnu.2020.09.001
- Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: clinical Nutrition in cancer. Clin Nutr. 2021 May;40(5):2898–913. doi: https://doi.org/10.1016/j.clnu.2021.02.005
- Ghorayeb A, Darbyshire JL, Wronikowska MW, Watkinson PJ. Design and validation of a new Healthcare Systems Usability Scale (HSUS) for clinical decision support systems: a mixed-methods approach. BMJ Open. 2023 Jan;13(1):e065323. doi: https://doi.org/10.1136/bmjopen-2022-065323
- Aubert CE, Fankhauser N, Marques-Vidal P, Stirnemann J, Aujesky D, Limacher A, et al. Patterns of multimorbidity in internal medicine patients in Swiss university hospitals: a multicentre cohort study. Swiss Med Wkly. 2019 Jun;149:w20094. doi: https://doi.org/10.4414/smw.2019.20094
- Google. Google Forms. 2023 05. [January 2024]; Available from: https://docs.google.com/forms
- R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2023.
- Wickham H. ggplot2: Elegant graphics for data analysis. 2016, New York: Springer-Verlag. 11-31.
- Gross, J. and U. Ligges, nortest: Tests for Normality. R package version, 2015. 1(4).
- Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1):1–48. doi: https://doi.org/10.18637/jss.v067.i01
- Fox J, Weisberg S. An R companion to applied regression. 3rd ed. Sage publications; 2018.
- Fisher RA. Statistical methods for research workers. Breakthroughs in statistics: Methodology and distribution. Springer; 1970. pp. 66–70.
- Sobotka L. Basics in clinical nutrition. 5th ed. Galen; 2020.[S.l.].
- Cano N, Fiaccadori E, Tesinsky P, Toigo G, Druml W, Kuhlmann M, et al.; DGEM (German Society for Nutritional Medicine); ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: adult renal failure. Clin Nutr. 2006 Apr;25(2):295–310. doi: https://doi.org/10.1016/j.clnu.2006.01.023
- Fiaccadori E, Sabatino A, Barazzoni R, Carrero JJ, Cupisti A, De Waele E, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021 Apr;40(4):1644–68. doi: https://doi.org/10.1016/j.clnu.2021.01.028
- Bischoff SC, Cuerda C, Barazzoni R. Practical guidelines and apps for improvement of guideline implementation. Clin Nutr. 2020 Oct;39(10):2943–4. doi: https://doi.org/10.1016/j.clnu.2020.07.031
- Aeberhard C, Birrenbach T, Joray M, Mühlebach S, Perrig M, Stanga Z. Simple training tool is insufficient for appropriate diagnosis and treatment of malnutrition: A pre-post intervention study in a tertiary center. Nutrition. 2016 Mar;32(3):355–61. doi: https://doi.org/10.1016/j.nut.2015.09.012
- Reber E, Messmer Ivanova A, Cadisch P, Stirnimann J, Perrig M, Roten C, et al. Does multifaceted nutritional education improve malnutrition management? Nutrition. 2020 Oct;78:110810. doi: https://doi.org/10.1016/j.nut.2020.110810
- Wyatt JC, Wyatt SM. When and how to evaluate health information systems? Int J Med Inform. 2003 Mar;69(2-3):251–9. doi: https://doi.org/10.1016/S1386-5056(02)00108-9
- Imoberdorf R, Meier R, Krebs P, Hangartner PJ, Hess B, Stäubli M, et al. Prevalence of undernutrition on admission to Swiss hospitals. Clin Nutr. 2010 Feb;29(1):38–41. doi: https://doi.org/10.1016/j.clnu.2009.06.005