Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Health Science, University of Southampton, Southampton, UK.
School of Health Sciences, University of Southampton, UK.
Clin Nutr. 2022 Mar;41(3):661-672. doi: 10.1016/j.clnu.2022.01.009. Epub 2022 Jan 13.
BACKGROUND & AIMS: The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation.
A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool.
The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n = 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n = 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n = 89/104) of statements reached consensus, whereas in round-two 12.5% (n = 13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised.
The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.
Remote Malnutrition Application（R-MAPP）是在 COVID-19 大流行期间开发的，旨在为在社区工作的医疗保健专业人员（HCP）提供支持，以完成远程营养评估，并为营养护理提供实用指导。本研究的目的是将 R-MAPP 改编为适用于儿童的版本，即 Pediatric Remote Malnutrition Application（Pedi-R-MAPP），并提供一种结构化的方法来完成作为技术启用护理服务（TECS）咨询一部分的营养重点评估。
完成了十个步骤：1）修改成人 R-MAPP 的许可，2）文献检索以告知 Pedi-R-MAPP 内容，3）Pedi-R-MAPP 草案，4）使用 TECS 对 HCP 实践进行国际调查，5）邀请营养专家参与修改后的 Delphi 流程，6）第一次利益相关者会议以商定工具的目的/草案，7）第一轮在线调查，8）从调查中删除有共识的陈述，9）第二轮在线调查，用于没有共识的陈述，10）第二次利益相关者会议，最终确定 Pedi-R-MAPP 营养意识工具。
463 名 HCP 完成了国际调查，其中 55%为儿科医生，38%为营养师，7%为护士/其他。当 HCP 被要求回顾过去 12 个月时，营养师（n=110）报告说，每 10 次预约中有 5.7±10.6 次是亲自完成的；而儿科医生（n=182）报告说，每 10 次预约中有 7.5±7.0 次是亲自进行的（p<0.0001），其余的都是通过 TECS 咨询完成的。总体而言，确定了 74 篇文章，并用于开发 Pedi-R-MAPP，其中包括使用红绿灯系统的彩色编码建议；绿色、琥珀色、红色和紫色。有 18 名参与者同意参与 Delphi 共识，并完成了两轮修改后的 Delphi 调查。在第一次会议上就拟议工具的目的和草案部分达成了一致。在第一轮在线调查中，86%（n=89/104）的陈述达成共识，而在第二轮中，12.5%（n=13/104）的陈述没有达成共识。在第二次专家会议上，对有争议的陈述进行了讨论，直到达成一致意见，并最终确定了 Pedi-R-MAPP。
使用修改后的 Delphi 共识开发了 Pedi-R-MAPP 营养意识工具。该工具旨在通过提供一种结构化的方法来完成远程营养重点评估，并确定随访频率以及可能需要亲自评估的儿童，从而支持 COVID-19 大流行快速推动的技术转型。
