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Liu L, He C, Yang J, Chen W, Xie Y, Chen X. Development and Validation of a Nomogram for Predicting Nutritional Risk Based on Frailty Scores in Older Stroke Patients. Aging Clin Exp Res 2024; 36:112. [PMID: 38761298 PMCID: PMC11102373 DOI: 10.1007/s40520-023-02689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/27/2023] [Indexed: 05/20/2024]
Abstract
BACKGROUND In older stroke patients with frailty, nutritional deficiencies can amplify their susceptibility, delay recovery, and deteriorate prognosis. A precise predictive model is crucial to assess their nutritional risk, enabling targeted interventions for improved clinical outcomes. OBJECTIVE To develop and externally validate a nutritional risk prediction model integrating general demographics, physical parameters, psychological indicators, and biochemical markers. The aim is to facilitate the early identification of older stroke patients requiring nutritional intervention. METHODS This was a multicenter cross-sectional study. A total of 570 stroke patients were included, 434 as the modeling set and 136 as the external validation set. The least absolute shrinkage selection operator (LASSO) regression analysis was used to select the predictor variables. Internal validation was performed using Bootstrap resampling (1000 iterations). The nomogram was constructed based on the results of logistic regression. The performance assessment relied on the receiver operating characteristic curve (ROC), Hosmer--Lemeshow test, calibration curves, Brier score, and decision curve analysis (DCA). RESULTS The predictive nomogram encompassed seven pivotal variables: Activities of Daily Living (ADL), NIHSS score, diabetes, Body Mass Index (BMI), grip strength, serum albumin levels, and depression. Together, these variables comprehensively evaluate the overall health and nutritional status of elderly stroke patients, facilitating accurate assessment of their nutritional risk. The model exhibited excellent accuracy in both the development and external validation sets, evidenced by AUC values of 0.934 and 0.887, respectively. Such performance highlights its efficacy in pinpointing elderly stroke patients who require nutritional intervention. Moreover, the model showed robust goodness of fit and practical applicability, providing essential clinical insights to improve recovery and prognosis for patients prone to malnutrition. CONCLUSIONS Elderly individuals recovering from stroke often experience significant nutritional deficiencies. The nomogram we devised accurately assesses this risk by combining physiological, psychological, and biochemical metrics. It equips healthcare providers with the means to actively screen for and manage the nutritional care of these patients. This tool is instrumental in swiftly identifying those in urgent need of targeted nutritional support, which is essential for optimizing their recovery and managing their nutrition more effectively.
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Affiliation(s)
- Lei Liu
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Chunyu He
- Chengdu Medical College, Chengdu, 610083, Sichuan, China.
| | - Jiaxin Yang
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Wenbo Chen
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Yan Xie
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Xiaofang Chen
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
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Tangvik RJ, Skeie E, Haugen AS, Harthug S, Harris K. Is self-screening for 'at risk of malnutrition' feasible in a home setting? PLoS One 2024; 19:e0299305. [PMID: 38625912 PMCID: PMC11020964 DOI: 10.1371/journal.pone.0299305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/02/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Despite malnutrition being established as a well-known risk for postoperative complications, the lack of screening for nutritional risk remains a challenge. The aim of this study was to investigate whether self-screening for nutritional risk prior to surgery is feasible in a home setting and if it will increase number of patients screened for nutritional risk, and secondly, to compare their screening results with the "in-hospital assessments" conducted by healthcare professionals. MATERIALS AND METHODS This was a prospective study involving patients from six randomly selected surgical wards at two Norwegian hospitals as a part of the "Feasibility study of implementing the surgical Patient Safety Checklist the (PASC)". This checklist included a self-reported screening tool based on the Nutritional Risk Screening tool (NRS 2002) to identify "at risk of malnutrition" in patients that will undergo surgery the next 3 months or less. The original screening tool (NRS 2002) was used as a standard routine to identify "at risk of malnutrition" by healthcare professionals at hospital. The interrater reliability between these results was investigated using Fleiss multi rater Kappa with overall agreement and reported with Landis and Koch's grading system (poor, slight, fair, moderate, substantial, and almost perfect). RESULTS Out of 215 surgical patients in the home setting, 164 (76.7%) patients completed the self-reported screening tool. A total of 123 (57.2%) patients were screened in-hospital, of whom 96 (44.7%) prior to surgery and 96 (44.7%) were screened both at hospital (pre- and post-surgery) and at home. Self-screening at home improved malnutrition screening participation by 71.9% compared to hospital screening prior to surgery (165 (76.7%) and 96 (44.7%), respectively) and by 34.1% compared to pre- and postoperative in-hospital screening, 165 (76.7%) and 123 (57.2%), respectively). The degree of agreement between patients identified to be "at risk of malnutrition" by the self-reported screening tool and healthcare professionals was poor (κ = - 0.04 (95% CI: -0.24, 0.16), however, the degrees of agreement between the patients and healthcare professionals answers to the initial NRS 2002 questions "low BMI", "weight loss", and "reduced food intake" were almost perfect (κ = 1.00 (95% CI: 0,82, 1.18)), moderate (κ = 0.55 (95% CI: 0.34, 0.75)), and slight (κ = 0.08 (95% CI: - 0.10, 0.25) respectively. CONCLUSIONS Three out of four patients completed the self-screening form and the preoperative screening rate improved with 70%. Preoperatively self-screening in a home setting may be a feasible method to increase the number of elective surgical patients screened for risk of malnutrition. TRIAL REGISTRATION The trial is registered in ClinicalTrials.gov ID NCT03105713. https://classic.clinicaltrials.gov/ct2/show/NCT03105713.
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Affiliation(s)
- Randi J. Tangvik
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway
| | - Eli Skeie
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Health and Social Services, Kvam Municipality, Norheimsund, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion Acute and Critical Illness, OsloMet–Oslo Metropolitan University, Oslo, Norway
| | - Stig Harthug
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristin Harris
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Aktary ML, Dunn S, Sajobi T, O'Hara H, Leblanc P, McCormack GR, Caron-Roy S, Lee YY, Reimer RA, Minaker LM, Raine KD, Godley J, Downs S, Nykiforuk CIJ, Olstad DL. The British Columbia Farmers' Market Nutrition Coupon Program Reduces Short-Term Household Food Insecurity Among Adults With Low Incomes: A Pragmatic Randomized Controlled Trial. J Acad Nutr Diet 2024; 124:466-480.e16. [PMID: 37806435 DOI: 10.1016/j.jand.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The British Columbia Farmers' Market Nutrition Coupon Program (BC FMNCP) provides households with low incomes with coupons to purchase healthy foods from farmers' markets. OBJECTIVE To examine the impact of the BC FMNCP on the short-term household food insecurity, malnutrition risk, mental well-being, sense of community (secondary outcomes), and subjective social status (exploratory outcome) of adults with low incomes post-intervention and 16 weeks post-intervention. DESIGN Secondary analyses from a pragmatic randomized controlled trial conducted in 2019 that collected data at baseline, post-intervention, and 16 weeks post-intervention. PARTICIPANTS/SETTING Adults ≥18 years with low incomes were randomized to an FMNCP group (n = 143) or a no-intervention control group (n = 142). INTERVENTION Participants in the FMNCP group received 16 coupon sheets valued at $21 Canadian dollars (CAD)/sheet over 10 to 15 weeks to purchase healthy foods from farmers' markets and were eligible to participate in nutrition skill-building activities. MAIN OUTCOME MEASURES Outcomes included short-term household food insecurity (modified version of Health Canada's 18-item Household Food Security Survey Module), malnutrition risk (Malnutrition Universal Screening Tool), mental well-being (Warwick-Edinburgh Mental Well-Being Scale), sense of community (Brief Sense of Community Scale), and subjective social status (MacArthur Scale of Subjective Social Status community scale). STATISTICAL ANALYSIS Mixed-effects linear regression and multinomial logistic regression examined between-group differences in outcomes post-intervention and 16 weeks post-intervention. RESULTS The risk of marginal and severe short-term household food insecurity was lower among those in the FMNCP group compared with those in the control group (relative risk ratio [RRR] 0.15, P = 0.01 and RRR 0.16, P = 0.02) post-intervention, with sustained reductions in severe household food insecurity 16 weeks post-intervention (RRR 0.11, P = 0.01). No statistically significant differences were observed in malnutrition risk, mental well-being, sense of community, or subjective social status post-intervention or 16 weeks post-intervention. CONCLUSIONS The BC FMNCP reduced short-term household food insecurity but was not found to improve malnutrition risk or psychosocial well-being among adults with low incomes compared with a no-intervention control group.
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Hultink D, Souwer ETD, Bastiaannet E, Dekker JWT, Steup WH, Hamaker ME, Sonneveld DJA, Consten ECJ, Neijenhuis PA, Portielje JEA, van den Bos F. The prognostic value of a geriatric risk score for older patients undergoing emergency surgery of colorectal cancer: A retrospective cohort study. J Geriatr Oncol 2024; 15:101711. [PMID: 38310662 DOI: 10.1016/j.jgo.2024.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/24/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Emergency surgery of colorectal cancer is associated with high mortality rates in older patients. We investigated whether information on four geriatric domains has prognostic value for 30-day mortality and postoperative morbidity including severe complications. MATERIALS AND METHODS All consecutive patients aged 70 years or older who underwent emergency colorectal cancer surgery in six Dutch hospitals (2014-2017) were studied. Presence of geriatric risk factors was scored prior to surgery as either 0 (risk absent) or 1 (risk present) in each of four geriatric domains and summed up to calculate a sumscore with a value between 0 and 4. In addition, we separately investigated the use of a mobility aid. Primary outcome was 30-day mortality. Secondary outcomes were any postoperative complications and severe complications. Multivariable logistic regression model was used to evaluate the sumscore and outcomes. RESULTS Two hundred seven patients were included. Median age was 79.4 years. One hundred seventy-five patients (76%) presented with obstruction, 22 (11%) with a perforation, and 17 (8%) with severe anemia. Mortality rates were 2.9%, 13.6%, and 29.6% for patients with a sumscore of 0, 1-2, and 3-4 respectively, with odds ratio (OR) 4.8 [95% confidence interval (CI) 1.03-22.95] and OR 10.6 [95% CI 1.99-56.34] for a sumscore of 1-2 and 3-4 respectively. Use of a mobility aid was associated with increased mortality OR 8.0 [95% CI 2.74-23.43] and severe complications OR 2.31 [95% CI 1.17-4.55]. DISCUSSION This geriatric sumscore and the use of a mobility aid have strong association with 30-day mortality after emergency surgery of colorectal cancer. This could provide better insight into surgical risk and help select high-risk patients for alternative strategies.
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Affiliation(s)
- Daniëlle Hultink
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands.
| | - Esteban T D Souwer
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - W H Steup
- Department of Surgery, Haga Hospital, The Hague, the Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | | | - Esther C J Consten
- Department of Surgery, Meander Medisch Centrum, Amersfoort, the Netherlands
| | | | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Geriatric Medicine, University Medical Center Leiden, Utrecht, the Netherlands
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Morton M, Patterson J, Sciuva J, Perni J, Backes F, Nagel C, O'Malley DM, Chambers LM. Malnutrition, sarcopenia, and cancer cachexia in gynecologic cancer. Gynecol Oncol 2023; 175:142-155. [PMID: 37385068 DOI: 10.1016/j.ygyno.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023]
Abstract
Patients with gynecologic cancers are at risk for malnutrition, cancer cachexia, and sarcopenia. Accumulating data supports that malnourished patients with gynecologic cancer have worse overall survival, increased healthcare utilization and costs, and a higher incidence of postoperative complications and treatment toxicity than those who are not malnourished. Malnutrition is defined as insufficient energy intake, leading to altered body composition and subsequent impaired physical and cognitive function, and can result in sarcopenia and cachexia, defined as the loss of lean body mass and loss of body weight respectively. The etiology of cancer-related malnutrition is complex, resulting from a systemic pro-inflammatory state of malignancy with upregulation of muscle degradation pathways and metabolic derangements, including lipolysis and proteolysis, that may not respond to nutritional repletion alone. Numerous validated scoring systems and radiographic measures have been described to define and quantify the severity of malnutrition and muscle loss in both clinical and research settings. "Prehabilitation" and optimization of nutrition and functional status early in therapy may combat the development or worsening of malnutrition and associated syndromes and ultimately improve oncologic outcomes, but limited data exist in the context of gynecologic cancer. Multi-modality nutrition and physical activity interventions have been proposed to combat the biophysical losses related to malnutrition. Several trials are underway in gynecologic oncology patients to address these aims, but significant gaps in knowledge persist. Pharmacologic interventions and potential immune targets for combating cachexia related to malignancy are discussed in this review and may provide opportunities to target disease and cachexia. This article reviews currently available data regarding the implications, diagnostics, physiology, and intervention strategies for gynecologic oncology patients with malnutrition and its associated conditions.
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Affiliation(s)
- Molly Morton
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America.
| | - Jenna Patterson
- Department of Obstetrics and Gynecology; The Ohio State University Wexner Medical Center, 456 W 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Jessica Sciuva
- The Ohio State University College of Medicine; 370 W. 9(th) Ave, Columbus, OH 43210, United States of America
| | - Jaya Perni
- The Ohio State University; 281 W Lane Ave, Columbus, OH 43210, United States of America
| | - Floor Backes
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Christa Nagel
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - David M O'Malley
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Laura M Chambers
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
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Sobolewska-Włodarczyk A, Walecka-Kapica E, Włodarczyk M, Gąsiorowska A. Nutritional Status Indicators as a Predictor of Achieving Remission at Week 14 during Vedolizumab Therapy in Patients with Ulcerative Colitis: A Pilot Study. Nutrients 2023; 15:nu15010240. [PMID: 36615897 PMCID: PMC9824159 DOI: 10.3390/nu15010240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
Background: The loss of response or failure to achieve remission to vedolizumab in ulcerative colitis (UC) patients is currently a major clinical problem. Recently, Nutritional Risk Index (NRI), Controlling Nutritional Status (CONUT), and Malnutrition Universal Screening Tool (MUST) have been suggested as a new prognostic factor of UC activity. Here, we aimed at confirmation of hypotezis that NRI, CONUT and MUST may be used as inexpensive and efficient predictive biomarkers of response in UC patients treated with vedolizumab. Methods: This study was conducted in retrospective manner in 32 adult patients with UC of Caucasian origin (21 men and 11 women), who were qualified for 52-week therapy with vedolizumab and finished the 14-weeks from January 2020 to March 2022. Our study analyzed the 45 courses of vedolizumab therapy. Nutritional status indicators, i.e., the NRI, CONUT and MUST of each UC patient, were marked at the time of qualifying for biological treatment. Results: In our study, the MUST score was significantly lower in UC patients who positively achieved clinical remission at week 14 during vedolizumab induction therapy (0.33 ± 0.49 vs. 1.37 ± 0.83; p = 0.002). The analysis showed the lower baseline NRI and CONUT scores in patients with positive clinical remission at week 14 (NRI: 96.42 ± 4.29 vs. 101.41 ± 7.09; p = 0.024; CONUT: 1.00 ± 1.08 vs. 2.16 ± 1.46; p = 0.031). Conclusions: Nutritional status indicators (NRI, MUST and CONUT) may become valuable predictor of achieving remission at week 14 during vedolizumab therapy in UC patients.
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Affiliation(s)
| | - Ewa Walecka-Kapica
- Department of Gastroenterology, Medical University of Lodz, Pomorska Str. 251, 90-213 Lodz, Poland
| | - Marcin Włodarczyk
- Department of General and Oncological Surgery, Medical University of Lodz, Pomorska Str. 251, 90-213 Lodz, Poland
| | - Anita Gąsiorowska
- Department of Gastroenterology, Medical University of Lodz, Pomorska Str. 251, 90-213 Lodz, Poland
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Argillander T, van der Hulst H, van der Zaag-Loonen H, van Duijvendijk P, Dekker J, van der Bol J, Bastiaannet E, Verkuyl J, Neijenhuis P, Hamaker M, Schiphorst A, Aukema T, Burghgraef T, Sonneveld D, Schuijtemaker J, van der Meij W, van den Bos F, Portielje J, Souwer E, van Munster B. Predictive value of selected geriatric parameters for postoperative outcomes in older patients with rectal cancer – A multicenter cohort study. J Geriatr Oncol 2022; 13:796-802. [DOI: 10.1016/j.jgo.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/23/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
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Yıldız E, Arslan Ş, Çölkesen F, Sadi Aykan F, Evcen R, Kılınç M, Aytekin G. Evaluation of malnutrition risk and nutrition status in adult patients with common variable immunodeficiency. Nutr Clin Pract 2022; 37:1206-1214. [PMID: 34989028 DOI: 10.1002/ncp.10806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of this study is to determine the prevalence of malnutrition in outpatients with common variable immunodeficiency (CVID) and the utility of nutrition screening tools to detect malnutrition in these patients. METHODS Fifty outpatients with CVID were included in the study. Nutrition risk for each patient was evaluated using four nutrition screening tools: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), and Nutritional Risk Screening 2002 (NRS-2002). RESULTS According to MUST, MST, SNAQ, and NRS-2002, malnutrition risk was determined to be 48% (n = 24), 26% (n = 13), 20% (n = 10), and 20% (n = 10), respectively. Malnutrition was detected in 54% (n = 27) of the patients. It was found that MUST showed a better correlation in detecting malnutrition in outpatients with CVID (κ = 0.482, P = 0.001). MUST has a higher positive and negative predictive value than other nutrition screening tools (79% and 70%, respectively). In the multivariate logistic regression analysis, it was found that low serum immunoglobulin A (IgA) levels at diagnosis increased the risk of malnutrition by ∼15 times, and low CD19+ B-cell counts increased the risk by approximately eight times. CONCLUSION The prevalence of malnutrition in patients with CVID was found to be quite high, and there was a strong correlation between malnutrition and low CD19+ B-cell counts and low serum IgA levels. Given the high rate of malnutrition in patients with CVID, nutrition assessment is recommended rather than starting with nutrition screening.
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Affiliation(s)
- Eray Yıldız
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Şevket Arslan
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Çölkesen
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Sadi Aykan
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Recep Evcen
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Kılınç
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gökhan Aytekin
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Konya City Hospital, Konya, Turkey
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Arrieta F, Pedro-Botet J, Iglesias P, Obaya JC, Montanez L, Maldonado GF, Becerra A, Navarro J, Perez JC, Petrecca R, Pardo JL, Ribalta J, Sánchez-Margalet V, Duran S, Tébar FJ, Aguilar M. Diabetes mellitus and cardiovascular risk: an update of the recommendations of the Diabetes and Cardiovascular Disease Working Group of the Spanish Society of Diabetes (SED, 2021). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:36-55. [PMID: 34330545 DOI: 10.1016/j.arteri.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.
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Affiliation(s)
- Francisco Arrieta
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España.
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Juan Carlos Obaya
- Centro de Salud CHOPERA, Atención Primaria Alcobendas, Gdt Enfermedades Cardiovasculares Semfyc, Madrid, España
| | - Laura Montanez
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | | | - Antonio Becerra
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | - Jorge Navarro
- Hospital Clínico Universitario de Valencia, Gdt Diabetes Semfyc, Valencia, España
| | - J C Perez
- Centro de Salud Rincón de la Victoria, Atención Primaria, Málaga, España
| | - Romina Petrecca
- Unidad de Nutrición y dietética, Hospital de la Princesa, Madrid, España
| | - José Luis Pardo
- Centro de Salud Orihuela I. Médico de Familia, Atención Primaria Alicante, Alicante, España
| | - Josep Ribalta
- Universidad Rovira i Vigili, IISPV, CIBERDEM, Tarragona, España
| | | | - Santiago Duran
- Servicio de Endocrinología y Nutrición, Hospital Virgen de Valme, Sevilla, España
| | - Francisco Javier Tébar
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Manuel Aguilar
- Servicio de Endocrinología y Nutrición, Hospital Puerta del Mar, Cádiz, España
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Wang YC, Lee WY, Chou MY, Liang CK, Chen HF, Yeh SCJ, Yaung CL, Tsai KT, Huang JJ, Wang C, Lin YT, Lou SJ, Shi HY. Cost and Effectiveness of Long-Term Care Following Integrated Discharge Planning: A Prospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9111413. [PMID: 34828460 PMCID: PMC8621918 DOI: 10.3390/healthcare9111413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Little is known about the effects of seamless hospital discharge planning on long-term care (LTC) costs and effectiveness. This study evaluates the cost and effectiveness of the recently implemented policy from hospital to LTC between patients discharged under seamless transition and standard transition. A total of 49 elderly patients in the standard transition cohort and 119 in the seamless transition cohort were recruited from November 2016 to February 2018. Data collected from medical records included the Multimorbidity Frailty Index, Activities of Daily Living Scale, and Malnutrition Universal Screening Tool during hospitalization. Multiple linear regression and Cox regression models were used to explore risk factors for medical resource utilization and medical outcomes. After adjustment for effective predictors, the seamless cohort had lower direct medical costs, a shorter length of stay, a higher survival rate, and a lower unplanned readmission rate compared to the standard cohort. However, only mean total direct medical costs during hospitalization and 6 months after discharge were significantly (p < 0.001) lower in the seamless cohort (USD 6192) compared to the standard cohort (USD 8361). Additionally, the annual per-patient economic burden in the seamless cohort approximated USD 2.9–3.3 billion. Analysis of the economic burden of disability in the elderly population in Taiwan indicates that seamless transition planning can save approximately USD 3 billion in annual healthcare costs. Implementing this policy would achieve continuous improvement in LTC quality and reduce the financial burden of healthcare on the Taiwanese government.
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Affiliation(s)
- Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
| | - Wen-Ying Lee
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Hsueh-Fen Chen
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Chih-Liang Yaung
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
| | - Kang-Ting Tsai
- Department of Geriatrics and Center for Integrative Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Joh-Jong Huang
- Department of Health, Kaohsiung City Government, Kaohsiung 80251, Taiwan;
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
| | - Shi-Jer Lou
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Correspondence: (S.-J.L.); (H.-Y.S.); Tel.: +886-7-3211101 (ext. 2648) (H.-Y.S.)
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40604, Taiwan
- Correspondence: (S.-J.L.); (H.-Y.S.); Tel.: +886-7-3211101 (ext. 2648) (H.-Y.S.)
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11
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Souwer ETD, Bastiaannet E, Steyerberg EW, Dekker JWT, Steup WH, Hamaker MM, Sonneveld DJA, Burghgraef TA, van den Bos F, Portielje JEA. A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older. Cancers (Basel) 2021; 13:cancers13133110. [PMID: 34206349 PMCID: PMC8268502 DOI: 10.3390/cancers13133110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Older patients have an increased risk of morbidity and mortality after colorectal cancer (CRC) surgery. Existing CRC surgical prediction models have not incorporated geriatric predictors, limiting applicability for preoperative decision-making. The objective was to develop and internally validate a predictive model based on preoperative predictors, including geriatric characteristics, for severe postoperative complications after elective surgery for stage I-III CRC in patients ≥70 years. PATIENTS AND METHODS A prospectively collected database contained 1088 consecutive patients from five Dutch hospitals (2014-2017) with 171 severe complications (16%). The least absolute shrinkage and selection operator (LASSO) method was used for predictor selection and prediction model building. Internal validation was done using bootstrapping. RESULTS A geriatric model that included gender, previous DVT or pulmonary embolism, COPD/asthma/emphysema, rectal cancer, the use of a mobility aid, ADL assistance, previous delirium and polypharmacy showed satisfactory discrimination with an AUC of 0.69 (95% CI 0.73-0.64); the AUC for the optimism corrected model was 0.65. Based on these predictors, the eight-item colorectal geriatric model (GerCRC) was developed. CONCLUSION The GerCRC is the first prediction model specifically developed for older patients expected to undergo CRC surgery. Combining tumour- and patient-specific predictors, including geriatric predictors, improves outcome prediction in the heterogeneous older population.
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Affiliation(s)
- Esteban T. D. Souwer
- Department of Internal Medicine, Haga Hospital, 2545 AA Den Haag, The Netherlands
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.B.); (J.E.A.P.)
- Correspondence:
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.B.); (J.E.A.P.)
| | - Ewout W. Steyerberg
- Department of Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Jan Willem T. Dekker
- Department of Surgery, Reinier De Graaf Gasthuis, 2625 AD Delft, The Netherlands;
| | - Willem H. Steup
- Department of Surgery, Haga Hospital, 2545 AA Den Haag, The Netherlands;
| | - Marije M. Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands;
| | | | - Thijs A. Burghgraef
- Department of Surgery, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands;
| | - Frederiek van den Bos
- Department of Geriatric Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Johanna E. A. Portielje
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.B.); (J.E.A.P.)
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12
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Bullock AF, Greenley SL, Patterson MJ, McKenzie GAG, Johnson MJ. Patient, family and carer experiences of nutritional screening: a systematic review. J Hum Nutr Diet 2021; 34:595-603. [PMID: 33316101 PMCID: PMC8246934 DOI: 10.1111/jhn.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite recommendations for nutritional risk screening of all inpatients, outpatients and care home residents, as well as work to assess clinician's experiences and the validity of tools, little attention has been paid to the experiences of patients undergoing nutritional screening. This review aims to synthesise systematically the current evidence regarding nutritional risk screening with respect to the experiences and views of patients, their families and carers. METHODS A systematic search was performed in MEDLINE, Embase, PsychINFO, CINAHL, Web of Science and British Nursing Database (inception - July 2019); with screening terms related to malnutrition, screening tools and experience. Titles, abstracts and full-text papers were independently reviewed by two reviewers and then quality-appraised. Qualitative papers and quantitative surveys were included. A narrative review of surveys and a thematic framework synthesis of interviews were used to identify themes. RESULTS Nine studies, including five qualitative interview papers, were included. Qualitative and quantitative study results were combined using a matrix chart to allow comparison. Surveyed participants reported processes of nutritional screening as acceptable. Three key themes emerged from qualitative data: (i) experience of nutritional screening; (ii) misunderstanding of malnutrition: of causes, role of screening and poor self-perception of risk; and (iii) barriers to and opportunities for change. CONCLUSIONS Although the screening process is acceptable, patients' misunderstanding and poor knowledge regarding causes and consequences of malnutrition result in reduced risk perception and disbelief or disregard of nutritional screening results. Findings should inform policy and clinical practice, as well as highlight the known paucity of data regarding the effectiveness of screening on clinical outcomes.
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Affiliation(s)
- A. F. Bullock
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - S. L. Greenley
- Academy of Primary CareHull York Medical SchoolUniversity of HullHullUK
| | - M. J. Patterson
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - G. A. G. McKenzie
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - M. J. Johnson
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
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13
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Lewis C, O’Caoimh R, Patton D, O’Connor T, Moore Z, Nugent LE. Utilisation of a Suite of Screening Tools to Determine Adverse Healthcare Outcomes in an Older Frail Population Admitted to a Community Virtual Ward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5601. [PMID: 34073916 PMCID: PMC8197352 DOI: 10.3390/ijerph18115601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Risk stratification to assess healthcare outcomes among older people is challenging due to the interplay of multiple syndromes and conditions. Different short risk-screening tools can assist but the most useful instruments to predict responses and outcomes following interventions are unknown. We examined the relationship between a suite of screening tools and risk of adverse outcomes (pre-determined clinical 'decline' i.e., becoming 'unstable' or 'deteriorating' at 60-90 days, and institutionalisation, hospitalisation and death at 120 days), among community dwellers (n = 88) after admission to a single-centre, Irish, Community Virtual Ward (CVW). The mean age of patients was 82.8 (±6.4) years. Most were severely frail, with mean Clinical Frailty Scale (CFS) scores of 6.8 ± 1.33. Several instruments were useful in predicting 'decline' and other healthcare outcomes. After adjustment for age and gender, higher frailty levels, odds ratio (OR) 3.29, (p = 0.002), impaired cognition (Mini Mental State Examination; OR 4.23, p < 0.001), lower mobility (modified FIM) (OR 3.08, p < 0.001) and reduced functional level (Barthel Index; OR 6.39, p < 0.001) were significantly associated with clinical 'decline' at 90 days. Prolonged (>30 s) TUG times (OR 1.27, p = 0.023) and higher CFS scores (OR 2.29, p = 0.045) were associated with institutionalisation. Only TUG scores were associated with hospitalisation and only CFS, MMSE and Barthel scores at baseline were associated with mortality. Utilisation of a multidimensional suite of risk-screening tools across a range of domains measuring frailty, mobility and cognition can help predict clinical 'decline' for an already frail older population. Their association with other outcomes was less useful. A better understanding of the utility of these instruments in vulnerable populations will provide a framework to inform the impact of interventions and assist in decision-making and anticipatory care planning for older patients in CVW models.
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Affiliation(s)
- Clare Lewis
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Rónán O’Caoimh
- Clinical Sciences Institute, National University of Ireland Galway, Costello Road, H91 TK33 Galway City, Ireland;
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork City, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Tom O’Connor
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Linda E. Nugent
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
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14
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Kiss N, Loeliger J, Findlay M, Isenring E, Baguley BJ, Boltong A, Butler A, Deftereos I, Eisenhuth M, Fraser SF, Fichera R, Griffin H, Hayes S, Jeffery E, Johnson C, Lomma C, van der Meij B, McIntyre C, Nicholls T, Pugliano L, Skinner T, Stewart J, Bauer J. Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia. Nutr Diet 2020; 77:416-425. [PMID: 32803904 PMCID: PMC7540290 DOI: 10.1111/1747-0080.12631] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/30/2022]
Abstract
This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer‐related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence‐based guidelines, systematic reviews and meta‐analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as “at risk” of malnutrition or with a high‐risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment; people identified as “at risk” of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer‐related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer‐related malnutrition and sarcopenia should be individualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer‐related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenelle Loeliger
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Anna Boltong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Butler
- GP Liaison, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery Western Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition and Dietetics, Western Health, Melbourne, Victoria, Australia
| | - Michelle Eisenhuth
- Nutrition and Dietetics Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Fichera
- Nutrition and Dietetics Departments, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hayley Griffin
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Jeffery
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Catherine Johnson
- Gastrointestinal Cancer Service, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Chris Lomma
- Medical Oncology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Barbara van der Meij
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Dietetics and Food Services, Mater Health, Brisbane, Queensland, Australia
| | - Carolyn McIntyre
- School of Medical and Health Science, Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Tracey Nicholls
- Department of ENT Otolaryngology Head and Neck Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lina Pugliano
- Medical Oncology, Northern Cancer Institute, Sydney, New South Wales, Australia
| | - Tina Skinner
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Jane Stewart
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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15
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Nutritional status and interventions for patients with cancer - A systematic review. J Geriatr Oncol 2020; 12:6-21. [PMID: 32616384 DOI: 10.1016/j.jgo.2020.06.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Malnourishment is commonly seen in ageing, cancer and many chronic conditions, and is associated with poorer prognosis. AIM We set out to collect all currently available evidence on the association between nutritional status assessed with a validated screening tool and prognosis or course of treatment in older patients with cancer, and on the benefit of nutritional interventions in improving these outcomes. METHODS A systematic search in MEDLINE and EMBASE. RESULTS We included 71 studies on the association between nutritional status and outcome in (older) patients with cancer and 17 studies on the benefit of nutritional interventions in improving outcomes in this patient population. There is a significant association between nutritional status and increased intermediate- and long-term mortality (hazard ratio 1.87 (95% confidence interval 1.62-2.17). Those with poorer nutritional status were less likely to complete oncologic treatment according to plan and had higher health care consumption. Benefit of dietary interventions was limited although dietary counselling may lead to improved quality of life while nutritional support may lead to a decrease in post-operative complication rates. CONCLUSION Nutritional status is associated with poorer survival, decreased treatment completion and higher health care consumption and nutritional interventions are only able to negate these negatives outcome to a very limited degree.
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16
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Lewis C, O'Caoimh R, Patton D, O'Connor T, Moore Z, Nugent LE. Risk Prediction for Adverse Outcomes for Frail Older Persons with Complex Healthcare and Social Care Needs Admitted to a Community Virtual Ward Model. Clin Interv Aging 2020; 15:915-926. [PMID: 32606633 PMCID: PMC7320026 DOI: 10.2147/cia.s236895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/02/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose Population ageing is challenging healthcare systems with limited resources, necessitating the development of new care models to address the needs of older, frail community-dwellers. Community Virtual Wards (CVW) reduce adverse events in these patients. We examined the effect of an established CVW on pre-defined health trajectories (between “stable”, “deteriorating”, and “unstable” states) and characteristics that increased the likelihood of adverse healthcare outcomes (hospitalization, institutionalization and death). Patients and Methods We collected prospective data on frail patients admitted to a CVW in a single centre in Ireland. Relationships between risk scores, health states and adverse outcomes at 30, 60 and 90 days after admission were examined using multinomial regression analysis. Results In total, 88 community-dwellers, mean (±SD) age of 82.8 ±6.4 years, were included. Most were severely frail on the Rockwood Clinical Frailty Scale (mean 6.8/9 ±1.33). Reaching stability (“stable” state) within 30 days was a predictor for stability at 60 and 90 days and remaining at home. Stability was also associated with fewer care episodes (<2) (p=<0.001), a requirement for fewer healthcare professionals (HCP) (<7) (p<0.001) and lower risk of delirium (p<0.001). By contrast, being “unstable” at 60 days increased the numbers of HCP referrals (>7) and was predictive of more acute episodes (>2) and institutionalization or death (p<0.001). Predictors of adverse outcomes of either institutionalization or death included frailty status, function, mobility, nutrition, pressure ulcer risk and cognition. Conclusion A CVW model can provide a framework for monitoring and case management to support older people to remain at home or identify those at risk of institutional care. The use of defined health states helped to stratify those at lower or higher risk in an already high-risk frail population. Level of frailty, function, mobility, nutrition, pressure ulcer risks and cognition were predictive of remaining at home and reaching a level of stability or instability/deterioration and institutional care.
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Affiliation(s)
- Clare Lewis
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland Galway, Galway City H91 TK33, Ireland.,Mercy University Hospital, Cork City T12 WE28, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Linda E Nugent
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
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17
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Aktary ML, Caron-Roy S, Sajobi T, O'Hara H, Leblanc P, Dunn S, McCormack GR, Timmins D, Ball K, Downs S, Minaker LM, Nykiforuk CI, Godley J, Milaney K, Lashewicz B, Fournier B, Elliott C, Raine KD, Prowse RJ, Olstad DL. Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation. BMJ Open 2020; 10:e035143. [PMID: 32371514 PMCID: PMC7228519 DOI: 10.1136/bmjopen-2019-035143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts. METHODS AND ANALYSIS In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03952338.
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Affiliation(s)
- Michelle L Aktary
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Heather O'Hara
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Peter Leblanc
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gavin R McCormack
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- School of Architecture, Planning and Landscape, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Timmins
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Shauna Downs
- School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
| | - Katrina Milaney
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Fournier
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Charlene Elliott
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Communication Media and Film, University of Calgary, Calgary, Alberta, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Jl Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dana Lee Olstad
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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18
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Jager‐Wittenaar H, de Bats HF, Welink‐Lamberts BJ, Gort‐van Dijk D, van der Laan BFAM, Ottery FD, Roodenburg JLN. Self-Completion of the Patient-Generated Subjective Global Assessment Short Form Is Feasible and Is Associated With Increased Awareness on Malnutrition Risk in Patients With Head and Neck Cancer. Nutr Clin Pract 2020; 35:353-362. [PMID: 31134665 PMCID: PMC7078954 DOI: 10.1002/ncp.10313] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We aimed to assess feasibility of self-completion of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) by head and neck cancer patients, and to assess self-reported increased awareness regarding malnutrition risk after self-completion. METHODS Participants were randomized to complete the PG-SGA SF by paper or app. Feasibility was assessed by time needed to complete the PG-SGA SF, perceived difficulty, and help needed during completion. Participants were asked if they knew what malnutrition was (yes/no) and if they could define "malnutrition." They were also asked 9 questions on whether they perceived increased awareness of malnutrition risk after having completed the PG-SGA SF and 2 on their intention to change lifestyle habits. RESULTS Of all participants (n = 59; 65.9 ± 12.6 years; 73% male), 55% completed the PG-SGA SF paper version and 46% the Pt-Global app. Median time needed for self-completion of the PG-SGA SF was 2 minutes 41 seconds (interquartile range: 1 minute 49 seconds-3 minutes 50 seconds). Forty-eight percent needed help with completion, indicating acceptable feasibility. Participants who completed the Pt-Global app needed help significantly more often (66%; 21/32) than those who completed the PG-SGA SF paper version (26%; 7/27) (P = 0.005). All difficulty scores were excellent. For 7/9 questions on malnutrition risk awareness, >50% of the participants answered positively. CONCLUSION The results of this study show that self-completion of the PG-SGA SF by head and neck cancer patients is feasible and that awareness regarding malnutrition risk may increase after completing the PG-SGA SF.
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Affiliation(s)
- Harriët Jager‐Wittenaar
- Department of Maxillofacial SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied SciencesGroningenthe Netherlands
| | - Hester F. de Bats
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Bertine J. Welink‐Lamberts
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Dorienke Gort‐van Dijk
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Bernard F. A. M. van der Laan
- Department of Otorhinolaryngology/Head & Neck SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Faith D. Ottery
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied SciencesGroningenthe Netherlands
- Ottery & AssociatesLLCOncology Care ConsultantsDeerfieldIllinoisUSA
| | - Jan L. N. Roodenburg
- Department of Maxillofacial SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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Warnier RMJ, van Rossum E, van Kuijk SMJ, Magdelijns F, Schols JMGA, Kempen GIJM. Frailty screening in hospitalised older adults: How does the brief Dutch National Safety Management Program perform compared to a more extensive approach? J Clin Nurs 2019; 29:1064-1073. [PMID: 31856316 DOI: 10.1111/jocn.15148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/23/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the predictive properties of the brief Dutch National Safety Management Program for the screening of frail hospitalised older patients (VMS) and to compare these with the more extensive Maastricht Frailty Screening Tool for Hospitalised Patients (MFST-HP). BACKGROUND Screening of older patients during admission may help to detect frailty and underlying geriatric conditions. The VMS screening assesses patients on four domains (i.e. functional decline, delirium risk, fall risk and nutrition). The 15-item MFST-HP assesses patients on three domains of frailty (physical, social and psychological). DESIGN Retrospective cohort study. METHODS Data of 2,573 hospitalised patients (70+) admitted in 2013 were included, and relative risks, sensitivity and specificity and area under the receiver operating characteristic (AUC) curve of the two tools were calculated for discharge destination, readmissions and mortality. The data were derived from the patients nursing files. A STARD checklist was completed. RESULTS Different proportions of frail patients were identified by means of both tools: 1,369 (53.2%) based on the VMS and 414 (16.1%) based on the MFST-HP. The specificity was low for the VMS, and the sensitivity was low for the MFST-HP. The overall AUC for the VMS varied from 0.50 to 0.76 and from 0.49 to 0.69 for the MFST-HP. CONCLUSION The predictive properties of the VMS and the more extended MFST-HP on the screening of frailty among older hospitalised patients are poor to moderate and not very promising. RELEVANCE TO CLINICAL PRACTICE The VMS labels a high proportion of older patients as potentially frail, while the MFST-HP labels over 80% as nonfrail. An extended tool did not increase the predictive ability of the VMS. However, information derived from the individual items of the screening tools may help nurses in daily practice to intervene on potential geriatric risks such as delirium risk or fall risk.
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Affiliation(s)
- Ron M J Warnier
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Geriatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Integrated Care, Elderly Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Erik van Rossum
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Sander M J van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Fabienne Magdelijns
- Department of Internal Medicine, Geriatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Elia M, Cawood AL, Akbar T, Smith T. Nutritional self-screening in <1 min: Evaluation of a measuring station using sonic measurement of height. Nutrition 2019; 67-68:110529. [DOI: 10.1016/j.nut.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/23/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
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Mosli MH, Albeshri MA, Alsolami AA, Addas FA, Qazli AM, Alsahafi M, Jawa H, Alkhaldy A, Qari Y. Arabic translation and psychometric testing of the self-screening malnutrition universal screening tool in inflammatory bowel disease patients. Saudi Med J 2019; 40:828-835. [PMID: 31423521 PMCID: PMC6718852 DOI: 10.15537/smj.2019.8.24427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To translate and validate the malnutrition universal screening tool (MUST) for use in Arabic-speaking outpatients with inflammatory bowel disease (IBD). METHODS We translated the MUST into Arabic by using the Brislin back-translation method. This methodological study was performed between August 2016 and November 2017 on 143 outpatients with IBD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The patients must completed the self-administered (PSA) Arabic version of the MUST. Then, the health-care practitioners (HCPs) administered the Arabic MUST and performed standard patient clinical assessment. The nutrition risk was defined as low (MUST score=0), medium (MUST score=1), or high (MUST score greater than 1). The chance-corrected proportional agreement between the scores from the PSA and HCP-administered Arabic MUST was evaluated using Cohen's kappa coefficient. Internal consistency was evaluated using Cronbach's alpha statistic. RESULTS The overall agreement between the PSA and HCP-administered Arabic MUST was almost perfect (agreement=95.9%, expected agreement=72.4%, kappa=0.85, p less than 0.0001). The calculated Cronbach's alpha statistic for MUST scores in 15/143 (10%) patients was 0.79. The calculated Pearson's correlation coefficient between PSA and HCP-administered MUST scores was 0.93 (p less than 0.0001). CONCLUSIONS The PSA and HCP-administered Arabic MUST showed perfect agreement in outpatients with IBD.
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Affiliation(s)
- Mahmoud H Mosli
- Department of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Abstract
PURPOSE OF REVIEW Malnutrition is a common and under-recognized geriatric condition in older adults with cancer. This review describes the public health burden, malnutrition prevention, and the relationship among cancer cachexia, malnutrition, and sarcopenia. Finally, clinical practice recommendations on malnutrition and prevention are presented. RECENT FINDINGS Advanced age and cancer stage, frailty, dementia, major depression, functional impairment, and physical performance are important risk factors for malnutrition in older adults with cancer. The Mini Nutrition Assessment (MNA), Malnutrition Universal Screening Tool (MUST), and Patient Generated Subjective Global Assessment (PG-SGA) are the most commonly used assessment tools in older adults with cancer. In addition, malnutrition is independently associated with poor overall survival and quality of life, longer hospital stays, greater hospital cost, and hospital readmission. Comprehensive malnutrition prevention is required for improving the nutrition status among older adults with cancer.
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Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, Bardon L, de van der Schueren MAE, Corish CA. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2019; 24:1-13. [PMID: 29576345 DOI: 10.1016/j.clnesp.2018.02.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. METHODS A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated. RESULTS Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12-100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings. CONCLUSIONS Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.
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Affiliation(s)
- Lauren Power
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Deirdre Mullally
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Michelle Clarke
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marjolein Visser
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Laura Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marian A E de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
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Liljeberg E, Andersson A, Blom Malmberg K, Nydahl M. High Adherence to Oral Nutrition Supplements Prescribed by Dietitians: A Cross-Sectional Study on Hospital Outpatients. Nutr Clin Pract 2019; 34:887-898. [PMID: 30644591 PMCID: PMC6899765 DOI: 10.1002/ncp.10243] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to assess adherence to oral nutrition supplements (ONS) among hospital outpatients and to assess patient characteristics, experiences of ONS, and the characteristics of ONS prescriptions in clinical practice. Methods Hospital outpatients aged ≥18 years and prescribed ONS by a dietitian at a Swedish hospital were referred to the study from September 2016 to February 2017. Data were collected from structured telephone interviews, medical records, and a register of ONS delivered. Adherence to ONS was measured by dividing self‐reported intake of ONS (frequency question and 24‐hour recall question) by the amount prescribed and using the medication possession ratio (MPR). Results Of the 96 patients included (mean age 67 ± 13 years), 52% were male. The 2 most frequent medical diagnoses were malignancy and digestive system disease. Mean adherence to ONS was 93% measured by the frequency question, 87% measured by the 24‐hour recall question, and 76% according to MPR. The majority of the patients (83%) were prescribed 1–3 bottles of ONS/day. The average number of flavors of ONS delivered was 4.2. Before prescription, 69% of the patients had been allowed to taste the ONS and 92% had chosen the flavors to be prescribed. Over 75% liked the taste of the ONS and considered them to be good for their health. Conclusions Adherence to ONS was high in this population, which might be explained by the individual tailoring of ONS prescriptions by a dietitian, positive experiences of ONS, and the relatively young mean age of the participants.
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Affiliation(s)
- Evelina Liljeberg
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Andersson
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Karin Blom Malmberg
- Department of Clinical Nutrition, Uppsala University Hospital, Uppsala, Sweden
| | - Margaretha Nydahl
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Souwer ETD, Hultink D, Bastiaannet E, Hamaker ME, Schiphorst A, Pronk A, van der Bol JM, Steup WH, Dekker JWT, Portielje JEA, van den Bos F. The Prognostic Value of a Geriatric Risk Score for Older Patients with Colorectal Cancer. Ann Surg Oncol 2018; 26:71-78. [PMID: 30362061 PMCID: PMC6338720 DOI: 10.1245/s10434-018-6867-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION VMS is a Dutch risk assessment tool for hospitalized older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal surgery. METHODS All consecutive patients over age 70 years who underwent elective colorectal cancer surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival. RESULTS Five hundred fifty patients were included. Median age was 76.5 years, and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival, with hazard ratio (HR) of 1.9 [95% confidence interval (CI) 1.1-3.5; p = 0.03] and 8.7 (95% CI 4.0-19.2; p < 0.001), respectively. Sumscores were also associated with postoperative complications (intermediate sumscore OR 1.8; 95% CI 1.2-2.7; high sumscore OR 2.4; 95% CI 1.02-5.5). CONCLUSIONS This easy-to-use geriatric sumscore has strong associations with long-term outcome and morbidity after colorectal cancer surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision-making.
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Affiliation(s)
- E T D Souwer
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.
| | - D Hultink
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - A Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - J M van der Bol
- Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - W H Steup
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F van den Bos
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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Vázquez‐Sánchez MÁ, Valero‐Cantero I, Carrión‐Velasco Y, Castro‐López P, Suárez‐Cadenas E, Casals C. Applicability and Clinical Validity of Nursing Outcomes Classification in a Nursing Intervention of Nutritional Counseling for Patients With Malnutrition. Int J Nurs Knowl 2018; 30:168-172. [DOI: 10.1111/2047-3095.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | | | | | - Cristina Casals
- the Department of Teaching Physical EducationFine Arts and Music, Faculty of Educational SciencesUniversity of Cádiz Cádiz Spain
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Exocrine Pancreatic Insufficiency and Malnutrition in Chronic Pancreatitis: Identification, Treatment, and Consequences. Pancreas 2018; 47:1015-1018. [PMID: 30074926 PMCID: PMC6462188 DOI: 10.1097/mpa.0000000000001137] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the impact of exocrine pancreatic insufficiency (EPI) on chronic pancreatitis (CP) patients and to identify challenges with its diagnosis and treatment. METHODS Ninety-one patients with CP diagnosed with endoscopic ultrasound were identified and assessed for symptoms of EPI, fat-soluble vitamin levels, dual-energy x-ray absorptiometry scan T-scores, and treatment with pancreatic enzyme replacement therapy. All patients were also screened with the Malnutrition Universal Screening Test. RESULTS Exocrine pancreatic insufficiency was diagnosed in 84.6% (77/91) of patients based on symptoms of bloating, steatorrhea, or weight loss. Of these patients, 35.2% (19/54) had vitamin A deficiency, 62.5% (55/88) had vitamin D deficiency, and 17.7% (9/51) had vitamin E deficiency. Either osteopenia or osteoporosis was found in 68.9% (31/45). A medium or higher risk for malnutrition based on Malnutrition Universal Screening Test score of 1 or higher was found in 31.5% (28/89). Malnutrition Universal Screening Test score of 1 or higher was associated with an increased risk for osteopenia and osteoporosis on Fisher's exact test (P = 0.0037). CONCLUSIONS There is a high prevalence of fat-soluble vitamin deficiencies, osteopathy, and malnutrition in CP patients, which is underestimated due to a lack of effective diagnosis and suboptimal therapies for EPI.
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‘Self-screening’ for malnutrition with an electronic version of the Malnutrition Universal Screening Tool (‘MUST’) in hospital outpatients: concurrent validity, preference and ease of use. Br J Nutr 2018; 120:528-536. [DOI: 10.1017/s000711451800185x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractSelf-screening using an electronic version of the Malnutrition Universal Screening Tool (‘MUST’) has been developed but its implementation requires investigation. A total of 100 outpatients (mean age 50 (sd 16) years; 57 % male) self-screened with an electronic version of ‘MUST’ and were then screened by a healthcare professional (HCP) to assess concurrent validity. Ease of use, time to self-screen and prevalence of malnutrition were also assessed. A further twenty outpatients (mean age 54 (sd 15) years; 55 % male) examined preference between self- screening with paper and electronic versions of ‘MUST’. For the three-category classification of ‘MUST’ (low, medium and high risk), agreement between electronic self-screening and HCP screening was 94 % (κ=0·74, se 0·092; P<0·001). For the two-category classification (low risk; medium+high risk) agreement was 96 % (κ=0·82, se 0·085; P<0·001), comparable with the previously reported paper-based self-screening. In all, 15 % of patients categorised themselves ‘at risk’ of malnutrition (5 % medium, 10 % high). Electronic self-screening took 3 min (sd 1·2 min), 40 % faster than previously reported for the paper-based version. Patients found the tool easy or very easy to understand (99 %) and complete (98 %). Patients that assessed both tools found the electronic tool easier to complete (65 %) and preferred it (55 %) to the paper version. Electronic self-screening using ‘MUST’ in a heterogeneous group of hospital outpatients is acceptable, user-friendly and has ‘substantial to almost-perfect’ agreement with HCP screening. The electronic format appears to be as agreeable and often the preferred format when compared with the validated paper-based ‘MUST’ self-screening tool.
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Arrieta F, Iglesias P, Pedro-Botet J, Becerra A, Ortega E, Obaya JC, Nubiola A, Maldonado GF, Campos MDM, Petrecca R, Pardo JL, Sánchez-Margalet V, Alemán JJ, Navarro J, Duran S, Tébar FJ, Aguilar M, Escobar F. Diabetes mellitus y riesgo cardiovascular. Actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Riesgo Cardiovascular de la Sociedad Española de Diabetes (SED, 2018). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 30:137-153. [DOI: 10.1016/j.arteri.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/28/2018] [Accepted: 03/09/2018] [Indexed: 12/24/2022]
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Di Bella A, Blake C, Young A, Pelecanos A, Brown T. Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting. J Acad Nutr Diet 2018; 118:1065-1071. [PMID: 29398570 DOI: 10.1016/j.jand.2017.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/29/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prevalence of malnutrition in patients with cancer is reported as high as 60% to 80%, and malnutrition is associated with lower survival, reduced response to treatment, and poorer functional status. The Malnutrition Screening Tool (MST) is a validated tool when administered by health care professionals; however, it has not been evaluated for patient-led screening. OBJECTIVES This study aims to assess the reliability of patient-led MST screening through assessment of inter-rater reliability between patient-led and dietitian-researcher-led screening and intra-rater reliability between an initial and a repeat patient screening. DESIGN/PARTICIPANTS This cross-sectional study included 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia, in October 2016 (n=160 inter-rater reliability; n=48 intra-rater reliability measured in a separate sample). MAIN OUTCOME MEASUREMENTS Primary outcome measures were MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and a dietitian-researcher, patient test-retest screening, and patient acceptability. STATISTICAL ANALYSIS Percent and chance-corrected agreement (Cohen's kappa coefficient, κ) were used to determine agreement between patient-MST and dietitian-MST (inter-rater reliability) and MST completed by patient on admission to unit (patient-MSTA) and MST completed by patient 1 to 3 hours after completion of initial MST (patient-MSTB) (intra-rater reliability). RESULTS High inter-rater reliability and intra-rater reliability were observed. Agreement between patient-MST and dietitian-MST was 96%, with "almost perfect" chance-adjusted agreement (κ=0.92, 95% CI 0.84 to 0.97). Agreement between repeated patient-MSTA and patient-MSTB was 94%, with "almost perfect" chance-adjusted agreement (κ=0.88, 95% CI 0.71 to 1.00). Based on dietitian-MST, 33% (n=53) of patients were identified as being at risk for malnutrition, and 40% of these reported not seeing a dietitian. Of 156 patients who provided feedback, almost all reported that the MST was clear (92%), questions were easy to understand (95%), and completion time was ≤5 minutes (99%). CONCLUSION Patient-led screening with the MST is reliable and well accepted by patients. Patient-led screening in the cancer care ambulatory setting has the potential to improve patient autonomy and screening completion rates.
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Keetarut K, Zacharopoulou-Otapasidou S, Bloom S, Majumdar A, Patel PS. An evaluation of the feasibility and validity of a patient-administered malnutrition universal screening tool ('MUST') compared to healthcare professional screening in an inflammatory bowel disease (IBD) outpatient clinic. J Hum Nutr Diet 2017; 30:737-745. [PMID: 28585266 DOI: 10.1111/jhn.12481] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Malnutrition is common in inflammatory bowel disease (IBD) and is associated with poor health outcomes. Despite this, screening for malnutrition in the outpatient-setting is not routine and research in the area is limited. The present study aimed to evaluate whether agreement between malnutrition screening completed by patients and healthcare professionals (HCPs) could be achieved by comparing patient self-administered 'MUST' ('MUST'-P) with HCP administered 'MUST' ('MUST'-HCP) in a single tertiary IBD outpatient clinic. METHODS We conducted a feasibility and validity study on adult outpatients with IBD. We collected anthropometric, nutritional and clinical data from patients. All patients completed 'MUST'-P using a self-administered questionnaire, followed by 'MUST'-HCP. 'MUST'-P was timed and feedback on ease-of-use was obtained. The risk of malnutrition was classified as low (score = 0), medium (score = 1) and high (score ≥ 2) and agreement was tested using kappa statistics (κ). RESULTS Eighty patients were recruited (Crohn's disease: n = 49, ulcerative colitis: n = 29, unclassified: n = 2), with a mean (SD) age of 39.9 (15.1) years (51.2% were males). Seventy-one (92%) of patients found 'MUST'-P either easy or very easy. The mean (SD) time to complete 'MUST'-P was 3.1 (1.8) min (range 1-10 min). Sixty-eight (85%) of patients were at low risk of malnutrition when screened by the HCP. There was moderate agreement (κ = 0.486, P < 0.001) between 'MUST'-P and 'MUST'-HCP, with 100% agreement in scoring for medium- and high-risk categories. CONCLUSIONS The results of the present study suggests that self-screening using 'MUST' could be effectively used in an IBD outpatient clinic to identify those at medium and high risk of malnutrition. The patient friendly version of 'MUST' ('MUST'-P) was considered quick and easy to use by patients. Implementation of self-screening with 'MUST' could improve the nutritional management of IBD patients.
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Affiliation(s)
- K Keetarut
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - S Bloom
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Majumdar
- St Mary's University, Twickenham, London, UK
| | - P S Patel
- University College London Hospitals NHS Foundation Trust, London, UK
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Avelino-Silva TJ, Jaluul O. Malnutrition in Hospitalized Older Patients: Management Strategies to Improve Patient Care and Clinical Outcomes. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Payne D. Strategies to support prevention, identification and management of pressure ulcers in the community. Br J Community Nurs 2016; Suppl:S10-S18. [PMID: 27297572 DOI: 10.12968/bjcn.2016.21.sup6.s10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pressure ulcers are classified as serious incidents, cause pain and distress, and are a source of infection. Unlike patients in hospital, those in the community spend only a small amount of time with healthcare practitioners, so strategies are required to ensure they remain protected against pressure damage when community nurses are not with them. A risk assessment should be carried out to outline a patient's risks and used to develop a strategy for that person. Patients have different risks so prevention strategies need to be tailored individually. Strategies, which cover issues such as pressure-relieving equipment, mattress type, mobility aids and nutrition, should be monitored to ensure they continue to meet patients' needs, as their health, carers and other matters may change. Patients and their carers may need education on ulcers, including on myths, as it is essential they are involved.
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Affiliation(s)
- Drew Payne
- Community Staff Nurse, Whittington Health NHS
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Arrieta F, Iglesias P, Pedro-Botet J, Tébar FJ, Ortega E, Nubiola A, Pardo JL, Maldonado GF, Obaya JC, Matute P, Petrecca R, Alonso N, Sarabia E, Sánchez-Margalet V, Alemán JJ, Navarro J, Becerra A, Duran S, Aguilar M, Escobar-Jiménez F. [Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. Aten Primaria 2016; 48:325-36. [PMID: 26031458 PMCID: PMC6877822 DOI: 10.1016/j.aprim.2015.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/11/2015] [Indexed: 02/07/2023] Open
Abstract
The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.
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Affiliation(s)
- Francisco Arrieta
- Unidad Enfermedades Metabólicas del Adulto (CSUR), Servicio de Endocrinología y Nutrición Hospital Universitario Ramón y Cajal, IRYCIS, CIBEROBN, Madrid, España.
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Parc de Salut Mar, Barcelona, España
| | - Francisco Javier Tébar
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Emilio Ortega
- Servicio de Endocrinología y Nutrición, Hospital Clínic, IDIBAPS, CIBEROBN, Barcelona, España
| | - Andreu Nubiola
- Servicio Endocrinologia, Hospital ĹEsperit Sant, Sta. Coloma Gramenet, Barcelona, España
| | - Jose Luis Pardo
- Centro de Salud Orihuela I, Orihuela (Alicante), Alicante, España
| | | | | | - Pablo Matute
- Instituto Médico del Puerto de Santamaría, Cádiz, España
| | - Romina Petrecca
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Madrid, España
| | - Nuria Alonso
- Servicio de Endocrinología y Nutrición, Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - Elena Sarabia
- Profesora del Grado en Ciencias de la Actividad Física y del Deporte en Cardenal Spínola CEU, Sevilla
| | | | | | - Jorge Navarro
- Dirección Atención Primaria, IIS INCLIVA, CIBERESP, Valencia, España
| | - Antonio Becerra
- Servicio de Endocrinología y Nutrición Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - Santiago Duran
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Ntra. Sra. de Valme. Sevilla, España
| | - Manuel Aguilar
- Servicio de Endocrinología y Nutrición, Hospital Puerta del Mar, Cádiz, España
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Arrieta F, Iglesias P, Pedro-Botet J, Tébar FJ, Ortega E, Nubiola A, Pardo JL, Maldonado GF, Obaya JC, Matute P, Petrecca R, Alonso N, Sarabia E, Sánchez-Margalet V, Alemán JJ, Navarro J, Becerra A, Duran S, Aguilar M, Escobar-Jiménez F. Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 27:181-92. [DOI: 10.1016/j.arteri.2014.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 12/29/2022]
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Sandhu A, Mosli M, Yan B, Wu T, Gregor J, Chande N, Ponich T, Beaton M, Rahman A. Self-Screening for Malnutrition Risk in Outpatient Inflammatory Bowel Disease Patients Using the Malnutrition Universal Screening Tool (MUST). JPEN J Parenter Enteral Nutr 2015; 40:507-10. [PMID: 25632031 DOI: 10.1177/0148607114566656] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/20/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Malnutrition is common in patients with inflammatory bowel disease (IBD) and is associated with poor outcomes. Our aim is to determine if patient self-administered malnutrition screening using the malnutrition universal screening tool (MUST) is reliable by comparing patient scores with those derived from the healthcare practitioner (HCP), the gold standard. METHODS We conducted a prospective validation study at a tertiary Canadian academic center that included 154 adult outpatients with IBD. All patients with IBD completed a self-administered nutrition screening assessment using the MUST score followed by an independent MUST assessment performed by HCPs. The main outcome measure was chance-corrected agreement (κ) of malnutrition risk categorization. RESULTS For patient-administered MUST, the chance-corrected agreement κ (95% confidence interval [CI]) was 0.83 (0.74-0.92) when comparing low-risk and combined medium- and high-risk patients with HCP screening. Weighted κ analysis comparing all 3 risks groups yielded a κ (95% CI) of 0.85 (0.77-0.93) between patient and HCP screening. All patients were able to screen themselves. Overall, 96% of patients reported the MUST questionnaire as either very easy or easy to understand and to complete. CONCLUSION Self-administered nutrition screening in outpatients with IBD is valid using the MUST screening tool and is easy to use. If adopted, this tool will increase utilization of malnutrition screening in hectic outpatient clinic settings and will help HCPs determine which patients require additional nutrition support.
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Affiliation(s)
- Amindeep Sandhu
- Department of Medicine, Western University, London, Ontario, Canada
| | - Mahmoud Mosli
- Department of Medicine, Western University, London, Ontario, Canada Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Brian Yan
- Department of Medicine, Western University, London, Ontario, Canada
| | - Thomas Wu
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jamie Gregor
- Department of Medicine, Western University, London, Ontario, Canada
| | - Nilesh Chande
- Department of Medicine, Western University, London, Ontario, Canada
| | - Terry Ponich
- Department of Medicine, Western University, London, Ontario, Canada
| | - Melanie Beaton
- Department of Medicine, Western University, London, Ontario, Canada
| | - Adam Rahman
- Department of Medicine, Western University, London, Ontario, Canada Program of Experimental Medicine (POEM), Western University, London, Ontario, Canada Program of Experimental Medicine, Department of Medicine, Western University, London, Ontario, Canada.
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Leistra E, Langius JAE, Evers AM, van Bokhorst-de van der Schueren MAE, Visser M, de Vet HCW, Kruizenga HM. Validity of nutritional screening with MUST and SNAQ in hospital outpatients. Eur J Clin Nutr 2013; 67:738-42. [PMID: 23632750 DOI: 10.1038/ejcn.2013.85] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/14/2013] [Accepted: 03/25/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES The majority of hospital outpatients with undernutrition is unrecognized, and therefore untreated. There is a need for an easy and valid screening tool to detect undernutrition in this setting. The aim of this study was to determine the diagnostic accuracy of the MUST (Malnutrition Universal Screening Tool) and SNAQ (Short Nutritional Assessment Questionnaire) tools for undernutrition screening in hospital outpatients. METHODS In a large multicenter-hospital-outpatient population, patients were classified as: severely undernourished (body mass index (BMI) <18.5 (<65 years) or <20 ( ≥ 65 years) and/or unintentional weight loss >5% in the last month or >10% in the last 6 months), moderately undernourished (BMI 18.5-20 (<65 years) or 20-22 ( ≥ 65 years) and/or 5-10% unintentional weight loss in the last 6 months) or not undernourished. Diagnostic accuracy of the screening tools versus the reference method was expressed as sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). RESULTS Out of the 2236 outpatients, 6% were severely and 7% were moderately undernourished according to the reference method. MUST and SNAQ identified 9% and 3% as severely undernourished, respectively. MUST had a low PPV (Se=75, Sp=95, PPV=43, NPV=98), whereas SNAQ had a low Se (Se=43, Sp=99, PPV=78, NPV=96). CONCLUSIONS The validity of MUST and SNAQ is insufficient for hospital outpatients. While SNAQ identifies too few patients as undernourished, MUST identifies too many patients as undernourished. We advise to measure body weight, height and weight loss, in order to define undernutrition in hospital outpatients.
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Affiliation(s)
- E Leistra
- Dutch Malnutrition Steering Group, Amsterdam, The Netherlands.
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McGurk P, Jackson JM, Elia M. Rapid and reliable self-screening for nutritional risk in hospital outpatients using an electronic system. Nutrition 2013; 29:693-6. [DOI: 10.1016/j.nut.2012.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/19/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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