The study illuminates that some neuro-oncology patients' have spiritual needs that could be met by nurses. Spiritual needs include supportive family relationships, emotional support, loneliness, religious needs, need to talk, reassurance, anxiety, solitude, denial, plans for the future, thoughts about meaning of life, end of life decisions and discussion of beliefs. The implications of the findings of this study are that nurses need to be aware and respond to these spiritual needs.

Background Altering the temporal distribution of energy intake (EI) and introducing periods of intermittent fasting (IF) exert important metabolic effects. Restricting EI to earlier in the day [early time-restricted feeding (eTRF)] is a novel type of IF. Objectives We assessed the chronic effects of eTRF compared with an energy-matched control on whole-body and skeletal muscle insulin and anabolic sensitivity. Methods Sixteen healthy males (aged 23 ± 1 y; BMI 24.0 ± 0.6 kg·m−2) were assigned to 2 groups that underwent either 2 wk of eTRF (n = 8) or control/caloric restriction (CON:CR; n = 8) diet. The eTRF diet was consumed ad libitum and the intervention was conducted before the CON:CR, in which the diet was provided to match the reduction in EI and body weight observed in eTRF. During eTRF, daily EI was restricted to between 08:00 and 16:00, which prolonged the overnight fast by ∼5 h. The metabolic responses to a carbohydrate/protein drink were assessed pre- and post-interventions following a 12-h overnight fast. Results When compared with CON:CR, eTRF improved whole-body insulin sensitivity [between-group difference (95% CI): 1.89 (0.18, 3.60); P = 0.03; η2p = 0.29] and skeletal muscle uptake of glucose [between-group difference (95% CI): 4266 (261, 8270) μmol·min−1·kg−1·180 min; P = 0.04; η2p = 0.31] and branched-chain amino acids (BCAAs) [between-group difference (95% CI): 266 (77, 455) nmol·min−1·kg−1·180 min; P = 0.01; η2p = 0.44]. eTRF caused a reduction in EI (∼400 kcal·d−1) and weight loss (−1.04 ± 0.25 kg; P = 0.01) that was matched in CON:CR (−1.24 ± 0.35 kg; P = 0.01). Conclusions Under free-living conditions, eTRF improves whole-body insulin sensitivity and increases skeletal muscle glucose and BCAA uptake. The metabolic benefits of eTRF are independent of its effects on weight loss and represent chronic adaptations rather than the effect of the last bout of overnight fast. This trial was registered at clinicaltrials.gov as NCT03969745.

BackgroundSpiritual needs of cancer patients should be assessed and discussed by healthcare professionals. Neurosurgical nurses need to be able to assess and support neuro-oncology patients with their spiritual needs from diagnosis and throughout their hospital stay.MethodsData were collected through questionnaires using a Critical Incident Technique (CIT) from neurosurgical nurses, findings were analysed using thematic analysis.ResultsNurses reported some awareness of their patients’ spiritual needs during their stay on neurosurgical units although some used expressions approximating what could be described as spiritual needs. Patients’ spiritual needs were identified as: need to talk about spiritual concerns, showing sensitivity to patients’ emotions, responding to religious needs; and relatives’ spiritual needs included: supporting them with end of life decisions, supporting them when feeling being lost and unbalanced, encouraging exploration of meaning of life, and providing space, time and privacy to talk. Participants appeared largely to be in tune with their patients’ spiritual needs and reported that they recognised effective strategies to meet their patients’ and relatives’ spiritual needs. However, the findings also suggest that they don’t always feel prepared to offer spiritual support for neuro-oncology patients.ConclusionsThere is a need for healthcare professionals to provide spiritual care for neuro-oncology patients and their relatives. Although strategies were identified that nurses can use to support patients with spiritual needs further research is required to explore how effective nurses are at delivering spiritual care and if nurses are the most appropriate professionals to support neuro-oncology patients with spiritual care.

The version presented here may differ from the published version. If citing, you are advised to consult the published version for pagination, volume/issue and date of publication Title: Reduced skeletal muscle protein balance and sarcopenia in paediatric Crohn's disease patients in remission.

The insulin-mediated increase in forearm carnitine balance with carbohydrate consumption was acutely blunted by a carbohydrate+protein beverage, which suggests that carbohydrate+protein could inhibit chronic muscle carnitine accumulation.

Key points The trajectory, magnitude and localisation of metabolic perturbations caused by immobilisation (IMM) are unresolved. Forearm glucose uptake (FGU) in response to glucose feeding was determined in healthy men before and during 72 h of forearm IMM, and the same measurements were made in the non‐IMM contralateral limb at baseline and 72 h. In a similar study design, FGU and forearm lipid uptake were determined after a high fat mixed‐meal (HFMM) in IMM and non‐IMM limbs. FGU was reduced by 38%, 57% and 46% following 24, 48 and 72 h IMM, respectively, but was unchanged in the non‐IMM limb. A similar FGU response to IMM was observed after a HFMM, and forearm lipid uptake was unchanged. A sizeable reduction in FGU occurs in just 24 h of IMM, which is sustained thereafter and specific to the IMM limb, making unloading per se the likely rapid driver of dysregulation. Abstract The trajectory and magnitude of metabolic perturbations caused by muscle disuse are unknown yet central to understanding the mechanistic basis of immobilisation‐associated metabolic dysregulation. To address this gap, forearm glucose uptake (FGU) was determined in 10 healthy men (age 24.9 ± 0.6 years, weight 71.9 ± 2.6 kg, BMI 22.6 ± 0.6 kg/m2) during a 180 min oral glucose challenge before (0) and after 24, 48 and 72 h of arm immobilisation, and before and after 72 h in the contralateral non‐immobilised arm (Study A). FGU was decreased from baseline at 24 h (38%, P = 0.04), 48 h (57%, P = 0.01) and 72 h (46%, P = 0.06) of immobilisation, and was also 63% less than the non‐immobilised limb at 72 h (P = 0.002). In a second study, FGU and forearm lipid uptake were determined in nine healthy men (age 22.4 ± 1.3 years, weight 71.4 ± 2.8 kg, BMI 22.6 ± 0.8 kg/m2) during a 420 min mixed‐meal challenge before (0) and after 24 and 48 h of arm immobilisation and before and after 72 h in the contralateral non‐immobilised arm (Study B). FGU responses were similar to Study A, and forearm lipid uptake was unchanged from pre‐immobilisation in both arms over the study. A sizeable decrement in FGU in response to glucose feeding occurred within 24 h of immobilisation that was sustained and specific to the immobilised limb. Increasing lipid availability had no additional impact on the rate or magnitude of these responses or on lipid uptake. These findings highlight a lack of muscle contraction per se as a fast‐acting physiological insult to FGU.

Purpose. Type 2 diabetes mellitus (T2DM) is poorly managed in the Caribbean region; therefore, conducting an assessment on the content and quality of clinical guidelines could assist guideline developers in detecting and addressing information gaps. Hence, this study aimed to benchmark and compare the clinical guidelines for T2DM management from the Caribbean to guidelines developed internationally and by high-income countries. Methods. Seven T2DM management clinical guidelines were a priori selected from international and high-income country-specific clinical guidelines and then compared to the country-specific T2DM management clinical guidelines of the Caribbean region. Two reviewers independently assessed content (using a previously piloted data extraction form) and quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results. The Caribbean clinical guideline was found to contain similar levels of T2DM management topics when compared to international and high-income country-specific clinical guidelines; however, one country-specific clinical guideline from New Zealand was found to have substantially lower levels of content. The clinical guideline from the Caribbean was found to be of low quality and could not be used in practice; however, only three comparator clinical guidelines were found to be of high quality and could be recommended for use in clinical practice. A further three comparator clinical guidelines could be used in practice with minor modifications. Conclusion. Although the T2DM management clinical guidelines from the Caribbean region contained high levels of content with regards to relevant topics, it was of insufficient quality to be used in clinical practice. Therefore, an alternative high-quality clinical guideline, as identified within this study, should be adopted and used within the Caribbean region to manage T2DM until a high-quality region-specific clinical guideline can be developed.

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