{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T10:00:23Z","timestamp":1789639223964,"version":"4.0.0"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nut in Clin Prac"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged fasting before surgery remains common despite guidelines recommending liquid fasting for 2\u2009h and solid fasting for 6\u2009h preoperatively. Consuming carbohydrate\u2010rich drinks until 2\u2009h before surgery improves patient well\u2010being and reduces postoperative complications and insulin resistance. Given the persistence of implementation barriers, including logistical challenges and insufficient patient education, this study aimed to implement drinking up to 2\u2009h before elective orthopedic surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Grol and Wensing implementation approached was followed in a before\u2010after study conducted at a Dutch academic orthopedic ward (April 2023 to May 2024), after approval by the Scientific Ethical Committee. Current practices and barriers were assessed, and tailored strategies were developed using implementation theory and taxonomies to develop implementation strategies for the identified factors, followed by integration and evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Implementation included dissemination, patient\u2010oriented, organizational, educational, and risk prevention strategies. A total of 39 patients participated in the initial analysis and 48 patients participated in the evaluation. Preoperative fasting from liquids significantly reduced from 8:20\u2009h (IQR: 4:42\u201312:19\u2009h) to 4:38\u2009h (IQR: 2:58\u20136:12) by informing patients about the importance of drinking up to 2\u2009h before surgery and to 2:45\u2009h (IQR: 2:21\u20133:26) by facilitating drinking lemonade after admission when surgery would start in \u22652\u2009h. Patients' comfort improved regarding thirst, whereas no effect was found for other symptoms. Adverse events, including postponement of surgeries and pulmonary aspirations, during surgery did not occur while accepting &gt;1\u2009h of fasting at the start of surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Scalable implementation strategies for patient education on fasting and coordinated provision of lemonade reduced fasting duration among elective orthopedic patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ncp.70052","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T08:05:27Z","timestamp":1760515527000},"page":"1538-1551","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Drink lemonade! Implementation of drinking 2\u2009h before elective orthopedic surgery to reduce prolonged fasting"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0404-2332","authenticated-orcid":false,"given":"Ingrid M. S.","family":"Heijnen","sequence":"first","affiliation":[{"name":"Centre for Trauma, Reconstructive Surgery and Movement, Radboud University Medical Centre Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin F.","family":"Dierselhuis","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Radboud University Medical Centre Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maartje M. S.","family":"Frijlink","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Radboud University Medical Centre Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8568-5496","authenticated-orcid":false,"given":"Selma C. W.","family":"Musters","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam UMC location University of Amsterdam  the Netherlands"},{"name":"Cancer Center Amsterdam, Treatment and quality of life Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2811-4176","authenticated-orcid":false,"given":"Getty J. Huisman\u2010de","family":"Waal","sequence":"additional","affiliation":[{"name":"Centre for Trauma, Reconstructive Surgery and Movement, Radboud University Medical Centre Nijmegen the Netherlands"},{"name":"IQ health, Radboud University Medical Centre Nijmegen the Netherlands"},{"name":"Department of Surgery Radboud University Medical Centre Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9467-8434","authenticated-orcid":false,"given":"Harm H. J.","family":"van Noort","sequence":"additional","affiliation":[{"name":"Department of Surgery Radboud University Medical Centre Nijmegen the Netherlands"},{"name":"Centre for Abdominal and Pelvine Care, Radboud University Medical Centre Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"issue":"4","key":"e_1_2_7_2_1","article-title":"Preoperative fasting for adults to prevent perioperative complications","author":"Brady M","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e3283495ba1"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001452"},{"key":"e_1_2_7_5_1","unstructured":"Dutch Society of Anaesthesiology (NVA) Dutch Society for Surgery (NVVH).Perioperative Nutrition Policy Guideline. Richtlijnendatabase. 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