Rationale The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self‐perceived knowledge, attitudes, and barriers to nutrition practice of final‐year medical students. Methods Eighty‐five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close‐ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. Results A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand‐alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0–150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students’ average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients’ health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition‐related issues. Conclusions Positive attitude and interest in nutrition among final‐year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.

SUMMARYRationalePrognosis and outcomes of gastrointestinal fistulas (GIF) might depend upon the operational characteristics of the hospital containing and caring for the patients.ObjectiveTo assess how selected operational characteristics of the hospital participating in the exercises of the “Fistula Day” Project (FDP) influence upon prognosis and outcomes of GIF.Study designCohort-type study. Enrolled patients were followed for 60 days. Three cross-sectional examinations were made during the completion of the exercises of the FDP, namely, upon admission of the patient in the study, and 30 and 60 days after admission.Study serieSeventy-six hospitals of Latin America (13 countries) and Europe (4).MethodsAssociations between survival of the patient, prolongation of hospital stay, and (likely) spontaneous closure of the fistula, on one hand; and selected operational characteristics of the participating hospital, on the other; were assessed.ResultsSpecialties hospitals prevailed. Most of the hospitals assisted between 1 – 2 GIF patients a month. Participating hospitals distributed evenly regarding the number of beds. Most of the hospitals had an intensive care unit. Similarly, three-quarters of the hospitals had a multidisciplinary unit dedicated to clinical and hospital nutrition. However, a unit dedicated to the management of intestinal failure and/or postoperative fistulas was present only in a fifth of them. Experience of the physician attending GIF was rated between “Expert” and “High” in one third of the hospitals. Number of hospitals beds associated with increased survival of GIF patients (χ2 = 5.997; p = 0.092), prolonged hospital stay (χ2 = 7.885; p < 0.05), and higher rate of spontaneous closure of the fistula (χ2 = 11.947; p < 0.05). In addition, rate of spontaneous closure of the fistula was (marginally) higher among patients assisted by a hospital unit specialized on intestinal failure (χ2 = 3.610; p = 0.0574). On the other hand, survival of the patient was dependent (also marginally) upon the number of patients assisted in a month (χ2 = 5.934; p = 0.0514).ConclusionsIt is likely number of hospital beds to determine prognosis and outcomes of GIF. Other operational characteristics of the hospital might exert a marginal influence upon survival of the patient and the likely spontaneous closure of the fistula.

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Introduction: The "Fistula Day" multicontinent, multinational, multicentered project has revealed a 14.7 % mortality rate in patients assisted for gastrointrestinal fistulas (GIF) in Latin American and European hospitals. Mortality associated with GIF might be explained for the clinical-surgical condition of the patient, the operational characteristics of the hospital, and the surgical practices locally adopted in the contention, treatment and resolution of GIF. Objective: To assess the influence of surgical practices adopted in the hospital upon GIF outcomes. Study design: Cohort-type study. Three cross-sectional examinations were done during the completion of the exercises of the "Fistula Day" project: on admission in the study serie, and at 30 and 60 days after admission. Study serie: One hundred seventy seven patients (Males: 58.2 %; Average age: 51.0 ± 16.7 years; Ages ≥ 60 years: 36.2 %) assisted in 76 hospitals of Latin America (13 countries) and Europe (4). Methods: Surgical practices adopted in the management of GIF were documented such as the use of computerized axial tomography (CAT) and oral ingestion of contrast for examination of the fistula path, the use of open abdomen and devices for temporary closure of the abdominal wall, the administration of somatostatin and analogs for promoting the closure of the fistula, reoperation for fistula closure, and admission in the ICU. Results: Usage rate of surgical practices was as follows: CAT + oral use of contrast: 39.5 %; Use of open abdomen: 31.1 %; Use of somatostatin and analogs: 22.6 %; Admission in the hospital ICU: 31.6 %; and Surgery for GIF closure: 33.9 %; respectively. Surgical practices were more frequently used in the treatment and containment of enteroathmosferic fistulas (EAF). Surgical practices adopted by participating hospitals did not imply a higher rate of GIF closure, but were associated instead with a higher mortality and prolongation of hospital stay. Conduction of surgical practices was independent from the guidelines followed by the medical teams in the management of GIF. Availability of surgical practices, and access of medical teams to them, were independent from the operational characteristics of the surveyed hospital. It is to be noticed the existence of a hospital unit dedicated to intestinal failure translated to a lower use of the techniques for open abdomen and temporary closure of the abdominal wall, which, in turn, translated to a higher likelihood of GIF spontaneous closure. Conclusions: Currently, the adoption of surgical practices for containment and resolution of GIF does not result in a higher GIF closure rate. It is likely the existence of a hospital unit specialized in the management of intestinal failure might bring about a higher rate of non-surgical closure of GIF.

Debido a la alta incidencia de diferentes patologías oncológicas a nivel mundial y mortalidad relacionada a ellas resulta fundamental conocer formas de prevenir sus complicaciones que muchas veces son decisivas en la sobrevida del paciente. Esto lo evidencia la relación de un 30 % de las muertes por cáncer asociado a cinco factores de riesgo comportamentales y alimentarios. Ya que éstos pueden ser prevenidos, es urgente ahondar en conocimientos al respecto. Actualmente varios estudios confirman la vital importancia del estado nutricional de los pacientes con cáncer y su impacto positivo en la evolución de la enfermedad. Un diagnóstico e intervención nutricional tempranos aseguran múltiples beneficios, reducción de complicaciones, recuperaciones más rápidas, reducción de estancia hospitalaria, mejor tolerancia a los esquemas terapéuticos, entre otros.Existen varias herramientas para realizar un correcto cribado nutricional. En este artículo se describirán el Método del Nutritional Risk Screening 2002 y Valoración Global Subjetiva generada por el Paciente.