The strength of the relationship between the six contextual factors and research utilization by nurses is still largely unknown as (a) few studies were found of sufficient quality because of methodological limitations and (b) the results in reviewed studies were mixed. More robust methods in future work would yield a better understanding of the full impact of contextual factors on nurses' use of research.

The objective of this study was to provide data on malnutrition prevalence in hospitals, nursing homes and home-care organisations in The Netherlands in a nationally representative sample, and to assess the factors such as age, sex, time since admission, ward type and disease for identifying patients at high risk of malnutrition. A cross-sectional, multi-centre design with a standardised questionnaire was used to measure the prevalence of malnutrition. Nutritional status was assessed by BMI, undesired weight loss and nutritional intake. In this study, 12 883 patients were included. The prevalence of malnutrition was the highest in hospitals (23·8 %), followed by home-care organisations (21·7 %) and nursing homes (19·2 %). Logistic regression analysis revealed no association with age, time since admission and ward type. Being female was associated with malnutrition only in nursing homes. Blood diseases, gastrointestinal tract diseases, infection, chronic obstructive pulmonary disease, dementia and cancer were the factors associated with malnutrition in hospitals. Dementia was associated with malnutrition in nursing homes, while gastrointestinal tract diseases, diabetes mellitus and cancer were the associated factors in home care. This study shows that malnutrition is still a substantial problem in hospitals, nursing homes and home care in The Netherlands. Malnutrition is a problem for more than one in five patients. Despite growing attention to the problem, more continued alertness is required. Malnutrition continues to be an important and under-recognised problem in all health-care settings. Malnutrition can encompass both over-and undernutrition as well as deficiencies or imbalances of specific nutrients (1) . In this study, malnutrition is described as a state of undernutrition.The first national survey of malnutrition conducted in 2001 by the dietitians in The Netherlands included 7606 patients, and indicated that approximately 12 % appeared to be malnourished and 13 % at risk of malnutrition in hospitals, nursing homes and home-care organisations (2) . Since then, no other large-scale studies of malnutrition prevalence have been performed in The Netherlands.Comparisons of malnutrition prevalence in patients hospitalised in different European countries reveal that this fluctuates from 20 to 60 % (3) . European studies specifically related to the elderly report prevalence ranging from 22 % in Germany up to 84 % in Ireland (4,5) . Stratton et al.showed that disease-related malnutrition occurs in hospitals (10-60 %), nursing homes (50 % or more) and among individuals living independently (.10 %). These prevalence rates for malnutrition fluctuate extensively, as they depend on how malnutrition is operationalised (7 -9) . As no worldwide consensus on the elements of malnutrition operationalisation has yet been reached, it is very difficult to find a uniform operationalisation covering different patient groups, diseases and settings. It is thus difficult to compare the prevalence rates of malnutrition across diffe...

Insight into the barriers for implementation and tailoring implementation strategies to these barriers improves the implementation.