Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/10⁸ cells. Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P = 0.015) and using excessive amounts of alcohol and tobacco (P = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33–13.86; P = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05–8.19, P = 0.031) (n = 160). VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. Open Science Framework (https://doi.org/10.17605/OSF.IO/AJGHX).

While allied health plays a central role in healthcare, workforce challenges are straining the sector. Challenges are shaped by population changes, emerging models of care, and educational limitations, and were exacerbated by COVID-19. This study aimed to identify drivers of recruitment and retention for allied health clinicians in an Australian metropolitan setting. Identifying and addressing these factors is essential to the design and implementation of tailored, evidence-informed workforce strategy and policy. This cross-sectional, online survey explored workplace attraction, job seeking behaviours, and workplace perceptions. 29 Likert-scale statements informed by the existing literature examined factors influencing allied health retention. Allied health employees from a single Australian metropolitan health network were invited to participate. Descriptive statistics, logistic regression, and deductive content analysis were undertaken. 42.6% (n = 593) of those invited participated in the survey, with 45.7% (n = 271) of participants having been with the organisation for six or more years. 35% (n = 197) of respondents to a question about intention to leave agreed that they aimed to leave their current role within six months. Variables associated with intention to leave were not feeling a sense of satisfaction with their role (odds ratio [OR] 1.51, 95% CI 1.22–1.85), not being recognised and rewarded by the team manager (OR 1.37, 95% CI 1.12–1.67), not working in the preferred clinical area (OR 1.56; 95% CI 1.25–1.95), and feeling burned out by the job (OR 1.44; 95% CI 1.16–1.78). Qualitative findings support the centrality of aspects of the job (job characteristics), the organisational context (rewards offered; climate; organisational support) and person-context interface (peer/group relations; work-life conflict) to attraction, retention, and attrition in roles. This study identifies factors affecting recruitment, retention, and attrition of allied health professionals in a metropolitan setting. Findings are impacted by the personal and professional effects of the COVID-19 pandemic response. Results provide a baseline upon which the impact of interventions can be measured, while informing the prioritisation and design of tailored workforce strategies. Further, findings may inform local policy responses to improve the allied health workforce and ensure excellent care for the community.

Background: Adults with intellectual and developmental disabilities (IDDs) have higher healthcare needs, but experience difficulties accessing preventative healthcare. Despite this inequity, models of care that address barriers and provide customized treatment are limited, exacerbating vulnerabilities and poorer health outcomes. This study describes the development of a procedural model of care (PMOC) for adults with intellectual and developmental disabilities, and evaluates the sedation tier, exploring procedure and sedation outcomes.Methods: Development of the PMOC was informed by current evidence and themes identified in stakeholder consultation and literature. A retrospective cohort study evaluated the sedation option within the model, conducted at a community‐based disability service in Melbourne, Australia. All records over a 14‐month period were included. Descriptive statistics and univariate logistic regression analysis were used to analyze data.Results: The PMOC includes assessment, intervention, and evaluation tiers. Intervention options range from least to most invasive, culminating in the sedation level (mild; oral psychoactive, moderate; midazolam and nitrous oxide, high; general anesthetic). A total of 127 adults with IDDs received procedures under sedation; median age was 26 years, 61% lived with family, and 81% had multiple disabilities. A total of 197 procedures were referred to CDDH, including immunization (61%) and oral health reviews (23%), and resulted in 98% completion rate. Mild (n = 36) and moderate (n = 95) sedation were used for 67% of procedures. The PMOC correctly predicted 91% of sedation requirements. Living with family (OR 2.211, 95% CI 1.001–4.885, p = 0.05); immunization (OR 7.935, 95% CI 4.025–15.644, p <0.001); and multiple disabilities (OR 3.064, 95% CI 1.123–8.362, p = 0.029) were associated with mild, moderate and high sedation options, respectively.Conclusions: Models of care offering individualized interventions can support adults with IDDs to receive preventative procedures. Demographic variables may be able to predict sedation requirements. Wider application of this model may reduce health inequity within this vulnerable population.

Background/Objectives: Assessment of vitamin C status rarely occurs in hospital patients within high-income countries on the assumption that vitamin C deficiency (VCD) is rare, and evidence on prevalence, risk factors, and clinical outcomes of VCD is limited. This study aimed to describe the prevalence of VCD, characteristics of patients with VCD, and identify risk factors and clinical outcomes associated with VCD status in adult hospitalised patients. Methods: This retrospective observational study included adult inpatients from five metropolitan hospitals within a single public health service in Australia which provides tertiary, acute, and sub-acute care, over a 3.5-year period. Non-fasting vitamin C levels were examined for the prevalence of VCD, defined as <11.4 µmol/L. Multivariate regression models were used to identify risk factors and clinical outcomes associated with VCD. Results: The prevalence of VCD was 22.9% (n = 1791), comprising 23.2% (n = 1717) and 16.2% (n = 74) within acute and sub-acute settings, respectively. VCD prevalence was high in acute setting subgroups including patients with malnutrition (30%, n = 611) and patients admitted to ICU during hospitalisation (37.3%, n = 327). Malnutrition (OR 1.50, 95% CI 1.19–1.91, p < 0.001) and male gender (OR 1.47, 95% CI 1.17–1.86, p = 0.001) were associated with VCD. VCD was not associated with clinical outcomes including in-hospital death, hospital or intensive care unit LOS, or hospital-acquired complications. Conclusions: VCD exists within adult hospital patients in high-income countries, and early, targeted detection of VCD in this setting is warranted. Further research is needed to explore the impact of VCD on hospital clinical outcomes.

Aim: To investigate enablers and barriers to providing home enteral nutrition care and the use of blended tube feeding for adult clients. Methods: An explanatory sequential mixed‐methods study mapped to the Theoretical Domains Framework, comprising a national cross‐sectional web‐based survey, descriptive qualitative analysis of focus groups, and triangulation of quantitative and qualitative data. The target population was dietitians operating in all work environments with adult clients in patient‐facing roles. Results: 23 enablers and 24 barriers were identified for the provision of home enteral nutrition and blended tube feeding. Home enteral nutrition enablers: clinical guideline familiarity, confidence in troubleshooting, capacity for home visits, and access to peer support. Barriers centered on time constraints, complex funding arrangements, and an unclear scope of practice, particularly in relation to advanced procedures and community‐based roles. Blended tube feeding enablers: patient and caregiver enthusiasm, alignment with person‐centred care, peer encouragement, and the availability of written resources. Barriers included limited clinician training, inconsistent messaging between hospital and community sectors, and restrictive or absent organizational policy. Awareness of best practice guidelines emerged as a shared enabler between home enteral nutrition care and blended tube feeding use, while the lack of targeted university education and post‐graduate clinical support was the only common barrier across both. Conclusions: This novel study offers insights into dietitians' experiences in home enteral nutrition care and blended tube feeding use. Tailored strategies must address the unique barriers in home enteral nutrition and blended tube feeding to improve the quality and consistency of care for tube‐fed adults.