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Assessment and management of nutritional challenges in children’s cancer care: A survey of current practice in the United Kingdom. Eur J Oncol Nurs 2010; 14:439-46. [DOI: 10.1016/j.ejon.2010.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 04/19/2010] [Accepted: 04/22/2010] [Indexed: 11/23/2022]
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53
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Velasco C, García E, Rodríguez V, Frias L, Garriga R, Alvarez J, García-Peris P, León M. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 2010; 65:269-74. [PMID: 21081958 DOI: 10.1038/ejcn.2010.243] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools. SUBJECTS/METHODS Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the χ(2)-test to assess differences between the tests and the κ statistic to assess agreement between the tests. RESULTS The study sample comprised 400 patients (159 women, 241 men), mean age 67.3 (16.1) years. The prevalence of patients at nutritional risk with the NRS-2002, MUST, SGA and MNA was 34.5, 31.5, 35.3 and 58.5%, respectively. Statistically significant differences were observed between the four nutritional screening tools (P<0.001). The agreement between the tools was quite good except for the MNA (MNA-SGA κ=0.491, NRS-2002-SGA κ=0.620 and MUST-SGA κ=0.635). Patients at nutritional risk developed more complications during admission and had an increased length of stay. CONCLUSIONS The prevalence of nutritional risk in hospitalized patients was high with all the tools used. The best agreement between the tools was for NRS-2002 with SGA and MUST with SGA. At admission, NRS-2002 and MUST should be used to screen for nutritional status.
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Affiliation(s)
- C Velasco
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, c/Doctor Esquerdo no. 46, Madrid, Spain.
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Tsai AC, Chang TL, Wang YC, Liao CY. Population-Specific Short-Form Mini Nutritional Assessment with Body Mass Index or Calf Circumference Can Predict Risk of Malnutrition in Community-Living or Institutionalized Elderly People in Taiwan. ACTA ACUST UNITED AC 2010; 110:1328-34. [DOI: 10.1016/j.jada.2010.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 12/04/2009] [Indexed: 10/19/2022]
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55
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FREW E, SEQUEIRA J, CANT R. Nutrition screening process for patients in an acute public hospital servicing an elderly, culturally diverse population. Nutr Diet 2010. [DOI: 10.1111/j.1747-0080.2010.01422.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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56
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Beckwith S, Dickinson A, Kendall S. Exploring understanding of the term nursing assessment: a mixed method review of the literature. Worldviews Evid Based Nurs 2010; 7:98-110. [PMID: 19958471 DOI: 10.1111/j.1741-6787.2009.00178.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Much skilled nursing practice is described by words that at face value appear low-tech and self-explanatory. Despite being intrinsic to practice, the term "nursing assessment" has few operational definitions. Evidence-based practice and the quality agenda makes it imperative that this term is well understood. OBJECTIVES To contribute to the evidence base and facilitate a greater understanding of assessment of patients as carried out by nurses through exploring the research question: How is the term "nursing assessment" used in the current health care literature? DESIGN The review process, synthesised from the work of Greenhalgh et al. (2005), Clancy (2002), Egger et al. (2001), identified and assessed the quality of articles, text books, the grey literature, policy documents and databases. Glaser's Grounded Theory (GT) method was utilised to analyse the concept of "assessment" as exemplified within the included studies. METHODS The focus for this mixed-method review is the health care literature between 1990 and 2005. Studies were identified, screened and assessed for methodological quality and data were extracted and recorded. Analysis of the included studies was facilitated using a GT approach. Possible tensions when using a mixed-method research design are acknowledged and briefly discussed. RESULTS Of the 32,602 instances initially identified, 329 articles, policy documents and book extracts were closely read and after further screening, 120 articles and 12 policy documents and book extracts were analysed. Seven overlapping categories were identified, with "judicial" or "judgement making" identified as the core category. CONCLUSIONS Hierarchies of nursing practice, government policies and inter-professional agendas cause barriers to meaningful assessment. Informal and formal assessments and screening processes are often conflated, resulting in confusion regarding the scope and nature of the process. Differences between the rhetoric of placing the patient at the heart of the assessment process and practice have been identified.
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Affiliation(s)
- Sue Beckwith
- Centre for Research in Primary and Secondary Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
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57
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A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr 2010; 104:751-6. [DOI: 10.1017/s0007114510001121] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59 % of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47 % were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (κ = 0·46) and inter-rater reliability (κ = 0·53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.
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58
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Söderhamn U, Flateland S, Jessen L, Söderhamn O. Norwegian version of the Nutritional Form for the Elderly: sufficient psychometric properties for performing institutional screening of elderly patients. Nutr Res 2010; 29:761-7. [PMID: 19932864 DOI: 10.1016/j.nutres.2009.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 10/09/2009] [Accepted: 10/12/2009] [Indexed: 11/17/2022]
Abstract
The objective of this study was to test if the Norwegian version of the nutritional screening instrument entitled Nutritional Form for the Elderly (NUFFE-NO) demonstrates sufficient evidence of reliability and validity, including sensitivity and specificity, when applied to a select group of elderly hospital patients. The hypothesis was that NUFFE-NO has sufficient psychometric properties to be used as a screening instrument. The model used for the testing procedure was designed to test reliability (homogeneity and stability) and validity (criterion-related, concurrent validity, and construct validity) including sensitivity and specificity in a cross-sectional study. One-hundred fifty-eight patients were interviewed using the nutritional screening instruments NUFFE-NO and Mini Nutritional Assessment (MNA). They were interviewed once again (using NUFFE-NO) 2 to 4 days afterward. Background variables were collected. Data from the patients' records were collected regarding the nutritional screening instrument Nutrition Risk Screening 2002. Anthropometric measurements were performed. A Cronbach alpha coefficient of .77 was obtained. A majority of the items showed good or very good agreement in a test-retest. A high correlation coefficient (as a measurement of concurrent validity) was estimated between NUFFE-NO and MNA. The NUFFE-NO could separate groups with expected high and low scores, which supported construct validity. Calculated sensitivity and specificity values for NUFFE-NO, with MNA as a criterion and receiver operating characteristic curves with areas 0.79 and 0.80, showed appropriate cutoff points for measuring low, medium, and high risk for undernutrition. In conclusion, NUFFE-NO was shown to have sufficient psychometric properties for performing an institutional screening of elderly hospital patients.
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Affiliation(s)
- Ulrika Söderhamn
- University of Agder, Faculty of Health and Sport, Arendal, Norway.
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59
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Kralik D. Editorial: What are the issues of nutrition for people living with chronic illness? ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01049.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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60
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Hafsteinsdóttir TB, Mosselman M, Schoneveld C, Riedstra YD, Kruitwagen CLJJ. Malnutrition in hospitalised neurological patients approximately doubles in 10 days of hospitalisation. J Clin Nurs 2010; 19:639-48. [DOI: 10.1111/j.1365-2702.2009.03142.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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61
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Leuenberger M, Kurmann S, Stanga Z. Nutritional screening tools in daily clinical practice: the focus on cancer. Support Care Cancer 2010; 18 Suppl 2:S17-27. [DOI: 10.1007/s00520-009-0805-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 12/15/2009] [Indexed: 02/07/2023]
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62
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Nutrition: what do nurses know and do – a pilot evaluation of nursing staff's knowledge, awareness and practice. Proc Nutr Soc 2010. [DOI: 10.1017/s0029665110004593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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63
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Meijers JMM, van Bokhorst-de van der Schueren MAE, Schols JMGA, Soeters PB, Halfens RJG. Defining malnutrition: mission or mission impossible? Nutrition 2009; 26:432-40. [PMID: 19954929 DOI: 10.1016/j.nut.2009.06.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 03/04/2009] [Accepted: 06/19/2009] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Although screening for malnutrition in health care has expanded enormously, a gold standard for the optimal definition and operationalism of malnutrition is still lacking. This report reflects expert opinions on the elements of the definition and operationalism of malnutrition and is meant to trigger further debate within the nutritional societies. METHODS A Delphi study was performed consisting of three phases. After a literature review (phase 1), questions for a semistructured interviews (phase 2) were formulated. Subsequently, the results of these semistructured interviews were used to develop the final list of elements (for defining and operationalism of malnutrition). In phase 3 (final phase), experts were asked to provide written feedback regarding the ranking of elements concerning the importance of these elements. RESULTS Twenty-two experts (response 73.3%) were included in the final phase of this Delphi study. No overall agreement could be reached. The elements deficiencies of energy or protein and decrease in fat-free mass were most often mentioned to be particularly important in defining malnutrition. Elements mentioned to be important in operationalism of malnutrition were involuntary weight loss, body mass index, and no nutritional intake. Opinions on cutoff points regarding these elements differed strongly among experts. CONCLUSION This study shows that there is no full agreement among experts on the elements defining and operationalism of malnutrition. The results of this study may fuel the discussion within the nutritional societies, which will most ideally lead to an international consensus on a definition and operationalism of malnutrition.
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Affiliation(s)
- Judith M M Meijers
- Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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64
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Tsai AC, Chang TL, Chen JT, Yang TW. Population-specific modifications of the short-form Mini Nutritional Assessment and Malnutrition Universal Screening Tool for elderly Taiwanese. Int J Nurs Stud 2009; 46:1431-8. [DOI: 10.1016/j.ijnurstu.2009.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 04/21/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
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65
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Govig B, de Souza R, Levitan EB, Crookston D, Kestens Y, Mendivil CO, Mittleman MA. The eating assessment table-an evidence-based nutrition tool for clinicians: background, description, future of tool. Crit Pathw Cardiol 2009; 8:55-6, 57-62. [PMID: 19491570 PMCID: PMC4354859 DOI: 10.1097/hpc.0b013e31819a4441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The complex relationships between health and dietary components and patterns have been intensely studied. Researchers have developed various tools, such as food diaries and food frequency questionnaires, to help understand relationships between dietary components and health, and have developed indexes such as the Alternative Healthy Eating Index, and the revised Dietary Quality Index, to help understand relationships between dietary patterns and health. These tools have greatly enhanced our understanding, but they are too costly and cumbersome to use in routine clinical practice.This article gives a brief overview of the features and advantages of existing tools, and describes a new self-administered tool (the Eating Assessment Table) that retains many of the advantages of existing research tools, but which is simple enough to be used in clinical practice.The background and design of this tool are described as well as a mechanism for guiding the evolution of future versions of this tool. Forms for using this tool in clinical and research settings are supplied in English, French, and Spanish.
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Affiliation(s)
- Bert Govig
- Coalition for the Acquisition of Sound Habits, McGill University, Harvard School of Public Health, Sault Saint-Marie, Ontario, Canada.
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66
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Porter J, Raja R, Cant R, Aroni R. Exploring issues influencing the use of the Malnutrition Universal Screening Tool by nurses in two Australian hospitals. J Hum Nutr Diet 2009; 22:203-9. [DOI: 10.1111/j.1365-277x.2008.00932.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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67
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Odencrants S, Ehnfors M, Ehrenberg A. Nutritional status and body composition among persons with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1365-2702.2008.01008.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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68
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Nutritional assessment interpretation on 22 007 Spanish community-dwelling elders through the Mini Nutritional Assessment test. Public Health Nutr 2009; 12:82-90. [DOI: 10.1017/s136898000800195x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractObjectivesTo evaluate the prevalence of undernutrition among community-dwelling elderly people in Spain using the Mini Nutritional Assessment (MNA) and to analyse its distribution according to age, gender and residence region.DesignCross-sectional study assessing the nutritional status of elderly persons through both the short form and the full version of the MNA test.SettingPharmacy offices across the whole country (Spain) were enrolled to recruit participants.SubjectsA total of 22 007 participants (8014 men and 13 993 women), aged ≥65 years, assessed during the last two months of 2005.ResultsAccording to MNA screening, 4·3 % subjects were classified as undernourished (MNA score <17) and 25·4 % were at risk of undernutrition (MNA score ≥17 to ≤23·5). The MNA short form correlated strongly with the full MNA version (r = 0·85). MNA total score was significantly higher in men than in women (25·4 (sd 3·7) v. 24·6 (sd 3·9); P < 0·001) and lower in the oldest than in the youngest subjects (P < 0·001) in both genders. According to regional distribution, the best nutritional status was found in elderly from the north of Spain excluding the north-west area.ConclusionsFemale gender, older age and living in the south half or north-west of the country were associated with higher rates of undernutrition among community-dwelling elderly persons in Spain.
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69
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Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition Assessment in Critically Ill Patients. Nutr Clin Pract 2008; 23:635-41. [DOI: 10.1177/0884533608326137] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hulya Sungurtekin
- From the Department of Anesthesiology and Reanimation, and the Department of General Surgery, Pamukkale University, Denizli, Turkey
| | - Ugur Sungurtekin
- From the Department of Anesthesiology and Reanimation, and the Department of General Surgery, Pamukkale University, Denizli, Turkey
| | - Ozlem Oner
- From the Department of Anesthesiology and Reanimation, and the Department of General Surgery, Pamukkale University, Denizli, Turkey
| | - Demet Okke
- From the Department of Anesthesiology and Reanimation, and the Department of General Surgery, Pamukkale University, Denizli, Turkey
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70
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Persenius MW, Hall-Lord ML, Bååth C, Larsson BW. Assessment and documentation of patients’ nutritional status: perceptions of registered nurses and their chief nurses. J Clin Nurs 2008; 17:2125-36. [DOI: 10.1111/j.1365-2702.2007.02202.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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71
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Chima CS, Dietz-Seher C, Kushner-Benson S. Nutrition Risk Screening in Acute Care: A Survey of Practice. Nutr Clin Pract 2008; 23:417-23. [DOI: 10.1177/0884533608321137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cinda S. Chima
- From Family and Consumer Sciences, University of Akron, Akron,
Ohio
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72
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Odencrants S, Ehnfors M, Ehrenberg A. Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease. J Clin Nurs 2008; 17:1771-8. [DOI: 10.1111/j.1365-2702.2008.02292.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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73
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How Other Assessment Tools Measure Up to the Mini Nutritional Assessment. Am J Nurs 2008. [DOI: 10.1097/01.naj.0000310335.85927.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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74
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Affiliation(s)
- Carol L Delville
- University of Texas at Austin, School of Nursing, Austin, TX, USA
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75
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The ability of the DETERMINE checklist to predict continued community-dwelling in rural, white women. JOURNAL OF NUTRITION FOR THE ELDERLY 2007; 25:41-59. [PMID: 18032215 DOI: 10.1300/j052v25n03_04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study evaluated the ability of the DETERMINE checklist to predict continued community-dwelling in rural elderly women. Using a stratified random sample (N = 249) of white women aged 65-94, in-home interviews were completed at baseline and a telephone interview at 3 years. Overall higher total DETERMINE checklist scores negatively predicted continued community-dwelling (p = 0.0005). Lower risk scores indicated continued community-dwelling, while mid-range scores were inconclusive. Regression analysis for each age bracket showed that total DETERMINE checklist scores was most predictive of those aged 75-84 (p = 0.0037). The DETERMINE checklist may be a useful tool to identify those with increased risk of losing independence.
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76
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Söderhamn U, Bachrach-Lindström M, Ek AC. Nutritional screening and perceived health in a group of geriatric rehabilitation patients. J Clin Nurs 2007; 16:1997-2006. [PMID: 17331091 DOI: 10.1111/j.1365-2702.2006.01805.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES (i) To perform a nutritional screening using the Nutritional Form For the Elderly and relate the results to perceived health in a group of geriatric rehabilitation patients; and (ii) to compare the screening results and nurses' nutritional notes in the nursing documentation. BACKGROUND Undernutrition is an under-recognized problem among older patients. Using a screening instrument is a way to detect patients at risk for undernutrition. DESIGN A cross-sectional study conducted in Sweden. METHODS A sample of 147 geriatric rehabilitation patients was consecutively included and was interviewed with the screening instrument, questions about background variables, perceived health and health-related issues. Higher screening scores indicate higher risk for undernutrition. Parametric and nonparametric statistical tests were used. When nurses' nutritional notes in the nursing documentation were corresponding to the content in any of the response alternatives for each screening item, the notes were marked as existent. RESULTS The screening results showed that 55% of the patients were at medium risk and 14% at high risk for undernutrition. Patients in perceived ill health had higher screening scores than those in perceived good health. Associations were also found between receiving help, perceiving helplessness, not being active and not feeling satisfied and higher screening scores. The content of nine of 15 items in the instrument was mentioned in a number of nursing records. CONCLUSIONS The prevalence of older patients at medium or high risk for undernutrition was high. To be at high risk for undernutrition was associated with perceived ill health. Nurses' nutritional notes in the nursing documentation showed deficiencies, indicating that all patients at medium or high risk for undernutrition were not identified. RELEVANCE TO CLINICAL PRACTICE The results suggest that nurses need a screening instrument to highlight older nutritional at-risk patients in need of further awareness and investigation.
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Affiliation(s)
- Ulrika Söderhamn
- Division of Nursing Science, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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77
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Abstract
Malnutrition ranges from 20% to 80% in oncology patients. Malnutrition has been associated with reduced response to treatment, survival, and quality of life. Therefore, screening for malnutrition in patients with cancer is recommended by clinical practice groups including the Oncology Nursing Society. Nurses are in an ideal position to carry out nutrition screening. Three nutrition screening tools that have been recommended for use with oncology patients by the Oncology Nursing Society are critically evaluated. The Patient Generated-Subjective Global Assessment has demonstrated diagnostic value in oncology patients at risk of malnutrition or who are malnourished.
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Affiliation(s)
- Catherine Kubrak
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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78
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Malnutrition in acute care patients: A narrative review. Int J Nurs Stud 2007; 44:1036-54. [DOI: 10.1016/j.ijnurstu.2006.07.015] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Revised: 07/12/2006] [Accepted: 07/13/2006] [Indexed: 01/15/2023]
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79
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Quick-and-easy nutritional screening tools to detect disease-related undernutrition in hospital in- and outpatient settings: A systematic review of sensitivity and specificity. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.eclnm.2007.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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80
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Fulbrook P, Bongers A, Albarran JW. A European survey of enteral nutrition practices and procedures in adult intensive care units. J Clin Nurs 2007; 16:2132-41. [PMID: 17331100 DOI: 10.1111/j.1365-2702.2006.01841.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The aim of this survey was to gain an overview of enteral nutrition practices and procedures of European adult intensive care units and to describe current trends. BACKGROUND Currently, little is known about nutritional practices in European intensive care units and whether they match existing guidelines. DESIGN Survey. METHODS A 51-item questionnaire about nutritional assessment and enteral feeding was distributed to 383 intensive care units in 20 countries. RESULTS A total of 380 (99.2%) questionnaires were returned. Most intensive care units (86.5%, n = 320/370) did not use a nutritional risk score and 35.8% (n = 133/371) conducted daily assessments of nutritional status; body weight and serum albumin were the commonest measures. Checking the position of the feeding tube using auscultation of injected air was widespread (72.6%, n = 275/373). Most units used a clinical protocol and under half were supported by a nutritional support team. CONCLUSION There are some variations in enteral nutrition practices across European intensive care units. Involvement of nurses in performing nutritional assessments or developing clinical protocols was minimal. The use of outdated procedures for checking feeding tube placement is a concern. There is scope for further development of nutrition guidelines in European units. RELEVANCE TO CLINICAL PRACTICE This study is relevant to all nurses working in critical care areas. The findings suggest that when an intensive care unit is supported by a nutritional support team it is more likely that a nutritional score will be used and nutritional assessments will be made daily. Many intensive care practices do not conform to international guidelines for enteral feeding. Nutritional assessment and the use of nutritional risk scores are areas that would benefit from further application in intensive care. This study may provide an impetus for intensive care units to review their nutrition assessment practices and to advance evidence-based guidelines, developed by multi-professional teams, which ensure the safe and effective management of patients receiving enteral nutrition.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing & Midwifery, Australian Catholic University, McAuley at Banyo Campus, Brisbane, QLD, Australia.
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81
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Abstract
Hospital-based malnutrition continues to be an important comorbidity affecting clinical outcomes. Knowledge of performing an appropriate nutrition assessment and implementing a rational nutrition therapy should be part of any patient's hospital plan of care. Familiarity with nutrition assessment scoring systems and nutrition assessment tools should be part of any gastroenterologist's expertise. Assessment of a patient's caloric and protein needs should be part of any hospital patient's clinical evaluation.
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Affiliation(s)
- Mark H DeLegge
- Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas Street, 210 Clinical Science Building, Charleston, SC 29425, USA.
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Prochaska JD, Sharkey JR, Ory MG, Burdine JN. Assessing healthful eating among community dwelling rural older adults using self-reported fruit and vegetable consumption via a community-wide mail-out health status assessment. ACTA ACUST UNITED AC 2007; 25:101-12. [PMID: 17182469 DOI: 10.1300/j052v25n02_07] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This project assessed fruit and vegetable intakes among rural older adults on a regional mail-out community health assessment. Over 95% of respondents answered questions regarding fruit and vegetable consumption. Rural older adults in this sample were willing to respond to questions regarding their fruit and vegetable intake; yet they were not likely to be meeting minimum recommended intakes of these foods. Including questions about dietary healthfulness on such an assessment may provide key stakeholders and policymakers a clearer understanding of their community's overall health status.
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Affiliation(s)
- John D Prochaska
- Department of Social and Behavioral Health, Texas A&M University System Health Science Center, College Station, TX 77843-1266, USA
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84
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Abstract
AIM This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed. BACKGROUND The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools. METHODS A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk. RESULTS Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically. CONCLUSIONS As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.
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Affiliation(s)
- Sue M Green
- School of Nursing and Midwifery, University of Southampton, Southampton, UK.
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85
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Bennett PN, Breugelmans L, Meade A, Parkhurst D. A Simple Nutrition Screening Tool for Hemodialysis Nurses. J Ren Nutr 2006; 16:59-62. [PMID: 16414443 DOI: 10.1053/j.jrn.2005.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To assess the reliability of a nurse-performed nutrition screening tool (NST) for hemodialysis (HD) patients to identify nutritionally at-risk patients. DESIGN Tool reliability assessment. SETTING AND PARTICIPANTS The setting was nine non-hospital private (n = 3) and public (n = 6) HD units in Australia (two rural and seven metropolitan). Participants were 112 HD patients. RESULTS A total of 112 HD patients (male = 65, female = 47) from 9 non-hospital HD units in Australia (seven metropolitan and two rural) were screened with the NST and the outcome of dietitian referral compared with Standard Dietitians Assessment. The mean age of patients was 57.6 years. Overall, the NST showed a sensitivity of 0.84 (range, 0.71 to 0.94; P < .05) and a specificity of 0.9 (range, 0.82 to 0.98; P < .05). The NST was more sensitive (sensitivity, 0.93 [range, 0.87 to 0.99; P < .05]) and was more specific for men (specificity, 0.92 [range, 0.85 to 0.99; P < .05]). Specificity was very strong in metropolitan patients (specificity, 0.94 [range, 0.87 to 1.01; P < .05]). CONCLUSIONS The tool was more sensitive and specific than the NST previously reported by the same investigators. The tool is particularly specific in that it screens those patients not requiring dietitian intervention. The use of this tool may benefit HD units that do not have on-site or regular dietetic support to prioritize patients needing dietitian intervention.
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Affiliation(s)
- Paul N Bennett
- Flinders University of South Australia, Adelaide, South Australia.
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Eberhardie C. Assessment of eating skills and the nutritional process in neurological disability. ACTA ACUST UNITED AC 2005. [DOI: 10.12968/bjnn.2005.1.4.19916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christine Eberhardie
- St George's, University of London, Grosvenor Wing, Cranmer Terrace, London SW17 0RE
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Abstract
Up to 85% of all patients with cancer develop clinical malnutrition, which negatively affects patients' response to therapy, increases the incidence of treatment-related side effects and can decrease survival. Early identification of patients who are malnourished or at risk of malnutrition can promote recovery and improve prognosis. In addition, early nutritional intervention is cost effective, as it reduces complication rates and length of hospital stay. The development and use of screening and assessment tools is essential for effective nutritional intervention and management of patients with cancer. Nutritional screening aims to identify patients who are malnourished or at significant risk of malnutrition. Patients identified through screening require referral to a dietician or specialist in nutrition for an in-depth nutritional assessment, involving examination of medical, dietary, psychological and social history, physical examination, anthropometry and biochemical testing. Interventions initiated after nutritional assessment should be tailored to the individual and take into consideration the patient's prognosis. Nutritional care is a fundamental aspect of nursing practice and nurses are ideally placed to play an essential role in the early detection and screening of malnutrition in patients with cancer.
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