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Fisher R, Martyn K, Romano V, Smith A, Stennett R, Ayyad S, Ray S. Improving the assessment of older adult's nutrition in primary care: recommendations for a proactive, patient-centred and aetiology approach. BMJ Nutr Prev Health 2023; 6:402-406. [PMID: 38618534 PMCID: PMC11009540 DOI: 10.1136/bmjnph-2023-000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Rebecca Fisher
- NHS London Procurement Partnership, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kathy Martyn
- School of Sport and Health Science, University of Brighton, Brighton, UK
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
| | | | - Alison Smith
- Hertfordshire and West Essex Integrated Care Board, Hertfordshire, UK
| | | | - Sally Ayyad
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
- School of Biomedical Sciences, Ulster University, Coleraine, UK
- Fitzwilliam College, University of Cambridge, Cambridge, UK
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2
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Jose J, Louri N, Al Jabbar N, Dey N, Showaiter M, Al Mannai M, Ebrahim F. A Pilot Study To Compare Nutrition Screening Tools: Customized Nutrition Screening Tool for Burn Patients (Nstb) and Malnutrition Universal Screening Tool (Must). ANNALS OF BURNS AND FIRE DISASTERS 2022; 35:265-271. [PMID: 38680630 PMCID: PMC11041966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/15/2021] [Indexed: 05/01/2024]
Abstract
Nutrition screening is an initial procedure in which the risk of malnutrition is identified. It plays a role in and can incur costs to health systems and patients. A customized nutrition screening tool for burn patients (NSTB) was formulated and the nutritional risk score of 22 patients from a burn unit in Bahrain using NSTB and MUST was compared. The samples selected were adult patients aged 18 years or over; pregnant and mentally retarded patients were excluded. Mean age of the total sample was 29.40, and 90.9% were male. Mean BMI was 26.96. The mean and SD for NSTB was 2.18±1.65, and for MUST 2.0±0.0. A difference in the nutritional screening risk score of the same group of patients was observed. In the MUST group, 100% patients were classified as high risk, while in the NSTB group 50% patients were classified as high risk, 36.36% as moderate risk and 13.63% as low risk respectively. The variability of the risk score in the NSTB group helps prioritize the patients based on high, medium, and low risk, whereas MUST categorizes all patients as high risk. A unique screening tool for burns will be more effective in determining risk patients due to tailor-made characteristics. Even though the data sample is small, the difference gives scope for extensive study.
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Affiliation(s)
- J. Jose
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services, Bahrain
- Department of Dietetics, Bahrain Defence Force Royal Medical Services, Bahrain
| | - N.A. Louri
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services, Bahrain
| | - N. Al Jabbar
- Department of Dietetics, Bahrain Defence Force Royal Medical Services, Bahrain
| | - N. Dey
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services, Bahrain
| | - M. Showaiter
- Department of Dietetics, Bahrain Defence Force Royal Medical Services, Bahrain
| | - M. Al Mannai
- Department of Dietetics, Bahrain Defence Force Royal Medical Services, Bahrain
| | - F.K. Ebrahim
- Department of Nursing, Bahrain Defence Force Royal Medical Services, Bahrain
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Brunner S, Mayer H, Qin H, Breidert M, Dietrich M, Müller Staub M. Interventions to optimise nutrition in older people in hospitals and long-term care: Umbrella review. Scand J Caring Sci 2021; 36:579-598. [PMID: 34212419 PMCID: PMC9545538 DOI: 10.1111/scs.13015] [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: 12/19/2020] [Revised: 05/13/2021] [Accepted: 06/05/2021] [Indexed: 12/01/2022]
Abstract
Background Inpatients have a high need for protein‐energy intake because of increased physical stress metabolism due to illnesses. Protein‐energy undernutrition in older patients increases the risk of complications such as falls, pressure ulcers and even death. An overview of effective interventions addressing this complex issue of malnutrition in older people is missing. Aims To give an overview of effective interventions to optimise nutrition in older people in hospitals and long‐term care. Design An umbrella review, according to the Joanna Briggs Institute and PRISMA statement, was conducted in April 2020. Methods A systematic search of publications from 2010 until 2020 was conducted in CINAHL, PubMed and Cochrane Database. Included were studies reporting nutrition interventions that involved nurses or the interprofessional team in optimising older hospitalised people's nutrition. Excluded were studies investigating the effects of parenteral nutrition, certain food supplements or tube feeding and research from intensive, community or palliative care. Components of interventions were classified according to the intervention Nutrition management: Patients’ assistance, patients’ instruction, foodservice, environment for meals and nutrient‐dense snacks. Findings Included were 13 reviews from 19 countries of the continents Asia, Australia, Europe and North America from hospitals and long‐term care settings. An interprofessional food promoting culture, including staff training as part of a multi‐component measure, has shown to be a successful element in implementing activities of Nutrition Management. Conclusion Several studies synthesised that optimising nutrition in older people in hospitals and long‐term care is achievable. Interventions were effective if—on a meta‐level—staff training was addressed as part of a multi‐component measure to reach an interprofessional food promoting culture. Implications for practice Interventions to optimise older people's nutrition have to consider an interprofessional food promoting culture, including staff training about the importance of nutrition, patients’ assistance and an appropriate environment for meals.
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Affiliation(s)
- Silvia Brunner
- City Hospital Waid and Triemli, Tièchestrasse, Zürich, Switzerland.,University Vienna, A, Alser Strasse, Vienna, Austria.,TU Munich, Munich, Germany
| | - Hanna Mayer
- University Vienna, A, Alser Strasse, Vienna, Austria
| | - Hong Qin
- University Vienna, A, Alser Strasse, Vienna, Austria
| | - Matthias Breidert
- City Hospital Waid and Triemli, Tièchestrasse, Zürich, Switzerland.,TU Munich, Munich, Germany
| | - Michael Dietrich
- City Hospital Waid and Triemli, Tièchestrasse, Zürich, Switzerland.,University Zurich, Zürich, Switzerland
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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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5
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Wright M, Southcott E, MacLaughlin H, Wineberg S. Clinical practice guideline on undernutrition in chronic kidney disease. BMC Nephrol 2019; 20:370. [PMID: 31619185 PMCID: PMC6796390 DOI: 10.1186/s12882-019-1530-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023] Open
Affiliation(s)
| | | | | | - Stuart Wineberg
- Patient Representative, c/o The Renal Association, Bristol, UK
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6
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Use of an electronic malnutrition screening tool in a hospital setting: effects on knowledge, attitudes and perceived practices of healthcare staff. Br J Nutr 2019; 120:150-157. [PMID: 29947326 DOI: 10.1017/s0007114518001447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Malnutrition risk screening is essential for the adequate identification and treatment of malnourished hospitalised patients. The aim of this study was to determine the effect of the use of an electronic malnutrition screening tool on the knowledge, attitudes and perceived practices (KAP) of a pool of nurses, nurses' aides and physicians. A controlled study using a pre-test-post-test design was carried out in two Austrian hospitals. The hospital that was assigned to the intervention group used the Graz malnutrition screening tool. The hospital that was assigned to the control group received no intervention. To collect data, a questionnaire was filled out by the study participants at baseline (T0) and 1 month after the implementation (T1) to assess KAP. All data were analysed using descriptive statistics, χ 2 tests, Wilcoxon signed-rank tests and Student's t tests. A total of 269 nurses, nurses' aides and physicians participated in the study and completed the questionnaires at T0, and 190 people at T1. The sum score for the KAP questionnaire changed significantly after the implementation of the malnutrition screening tool in the intervention group (P<0·001), but not in the control group. The use of a valid and reliable malnutrition screening tool effectively improved the KAP of healthcare staff. The KAP described here are essential for providing successful nutritional care in malnourished patients, and improving these factors may result in improved patient outcomes. To attain these outcomes, stakeholders, as well as members of all professions involved in multidisciplinary nutritional care, must invest significant efforts.
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Harris PS, Payne L, Morrison L, Green SM, Ghio D, Hallett C, Parsons EL, Aveyard P, Roberts HC, Sutcliffe M, Robinson S, Slodkowska-Barabasz J, Little PS, Stroud MA, Yardley L. Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis. BMC FAMILY PRACTICE 2019; 20:100. [PMID: 31307402 PMCID: PMC6631945 DOI: 10.1186/s12875-019-0983-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 06/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions. METHOD A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers. RESULTS Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals' reservations about prescribing oral nutritional supplements. CONCLUSION The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face. REVIEW REGISTRATIONS PROSPERO: CRD42017071398 . The review protocol was registered retrospectively.
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Affiliation(s)
- Philine S Harris
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Liz Payne
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.,Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Sue M Green
- Bournemouth University, Bournemouth House B236, 19 Christchurch Road, Bournemouth, BH1 3LH, UK
| | - Daniela Ghio
- Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Claire Hallett
- Friarsgate Surgery, Stockbridge Road, Winchester, SO22 6EL, UK
| | - Emma L Parsons
- Wessex Academic Health Science Network and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Level E Centre Block, Mailpoint 807, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Michelle Sutcliffe
- Community Dietetic Department, Southampton NHS Treatment Centre, Royal South Hampshire Hospital, Brintons Terrace, Southampton, SO14 0YG, UK
| | - Siân Robinson
- AGE Research Group, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Paul S Little
- Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Michael A Stroud
- Gastroenterology and Clinical Nutrition, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.,Centre for Academic Primary Care and School of Psychological Science, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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8
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Roberts HC, Lim SER, Cox NJ, Ibrahim K. The Challenge of Managing Undernutrition in Older People with Frailty. Nutrients 2019; 11:E808. [PMID: 30974825 PMCID: PMC6521101 DOI: 10.3390/nu11040808] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022] Open
Abstract
Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation.
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Affiliation(s)
- Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Stephen E R Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
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Walther F, Kuester D, Schmitt J. Impact of Complex Quality-Interventions on Patient Outcome: A Systematic Overview of Systematic Reviews. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019884182. [PMID: 31746255 PMCID: PMC6868575 DOI: 10.1177/0046958019884182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023]
Abstract
Quality of care and the increasing strategies to its promotion, especially in inpatient settings, led to the question which quality-interventions work best and which do not. The aim was to summarize and critically appraise the evidence on the effects of structure- and/or process-related quality-interventions on patient outcome in predominantly controlled and inpatient settings. A systematic overview of systematic reviews after electronic searches in Medline, Embase, Cinahl, and PsycINFO, supplemented by hand search and expert survey, was conducted. From a total of 1559 identified records, 37 reviews fulfilled the inclusion criteria. 26 reviews assessed process-related quality-interventions, 6 structure-related quality-interventions, and 5 combined structure- and process-related quality-interventions. In all, 19 reviews reported pooled effect estimates (meta-analysis). Based on the evidence of this systematic overview, stroke units and pathways can be recommended. Although patient-relevant improvements for interprofessional approaches and discharge planning have been reported, pooled effect estimated evidence are currently missing for these and other quality-interventions.
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Affiliation(s)
- Felix Walther
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Denise Kuester
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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10
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Eglseer D, Schoberer D, Halfens R, Lohrmann C. The impact of using a malnutrition screening tool in a hospital setting: a mixed methods study. Eur J Clin Nutr 2018; 73:284-292. [PMID: 30323176 DOI: 10.1038/s41430-018-0339-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/29/2018] [Accepted: 09/26/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition risk screening represents a crucial starting point for the successful management of malnourished patients. This study was conducted to (1) examine the effect of the use of a malnutrition screening tool on process indicators of nutritional care and (2) explore healthcare professionals' perceptions and opinions regarding this tool. METHODS A mixed methods design was used. A controlled pretest-posttest study was conducted to carry out quantitative analyses, and semi-structured, qualitative interviews were held. Quantitative data were analysed with descriptive statistics, Chi-squared tests, Student's t-tests and Kruskal-Wallis H tests, using SPSS 23. Qualitative data were analysed by performing a qualitative content analysis using MAXQDA 12. Two comparable hospitals participated in the study, representing one intervention group (IG) and one control group (CG). The Graz Malnutrition Screening Tool (GMS) was implemented and used in the IG for at least 1 month, while the CG received no intervention. RESULTS The use of the screening tool positively correlated with significant improvements in the process indicators of nutritional care after 1 month, in terms of the number of nutritional interventions and the frequency of documentation of the diagnosis and the patient's weight and height. The content of the interviews revealed that nearly all professionals involved perceived the overall screening process positively. Few barriers were identified. CONCLUSIONS The results of this study show that the use of a screening tool has a positive, short-term impact on the hospital's process quality of nutritional care. Ongoing efforts are required to sustainably maintain these positive changes. During this process, positive attitudes, nomination of motivated 'opinion-leaders' and concerted management support are helpful facilitators.
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Affiliation(s)
- Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria.
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Ruud Halfens
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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11
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Guan C, Niu H. Frailty assessment in older adults with chronic obstructive respiratory diseases. Clin Interv Aging 2018; 13:1513-1524. [PMID: 30214171 PMCID: PMC6120513 DOI: 10.2147/cia.s173239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The number of patients with chronic obstructive pulmonary disease (COPD) has been rising with continued exposure to environmental risk factors and aging of populations around the world. Frailty is a geriatric syndrome with a decline in physiological reserve and often coexists with chronic diseases such as COPD. Frailty is an independent risk factor for the development and progression of COPD, and COPD can lead to frailty; treating one might improve the other. Thus, there is an increasing interest in the assessment of frailty in patients with COPD. Furthermore, early identification and assessment of frailty in patients with COPD may affect the choice of intervention and improve its effectiveness. Based on the current literature, the intent of this review was to summarize and discuss frailty assessment tools used for COPD patients and the relevant clinical practices for predicting outcomes. We ascertain that using suitable frailty assessment tools could facilitate physicians to screen and stratify physically frail patients with COPD. Screening appropriately targeted population can achieve better intervention outcomes and pulmonary rehabilitation among frail COPD patients.
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Affiliation(s)
- Chunyan Guan
- Department of Geriatrics, Sheng Jing Hospital, China Medical University, Shenyang, People's Republic of China,
| | - Huiyan Niu
- Department of Geriatrics, Sheng Jing Hospital, China Medical University, Shenyang, People's Republic of China,
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12
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Kang MC, Kim JH, Ryu SW, Moon JY, Park JH, Park JK, Park JH, Baik HW, Seo JM, Son MW, Song GA, Shin DW, Shin YM, Ahn HY, Yang HK, Yu HC, Yun IJ, Lee JG, Lee JM, Lee JH, Lee TH, Yim H, Jeon HJ, Jung K, Jung MR, Jeong CY, Lim HS, Hong SK. Prevalence of Malnutrition in Hospitalized Patients: a Multicenter Cross-sectional Study. J Korean Med Sci 2018; 33:e10. [PMID: 29215819 PMCID: PMC5729651 DOI: 10.3346/jkms.2018.33.e10] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.
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Affiliation(s)
- Min Chang Kang
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ji Hoon Kim
- Department of Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Je Hoon Park
- Department of Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jong Kyung Park
- Division of Colorectal Surgery, Department of Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong Hoon Park
- Department of Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Hyun Wook Baik
- Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Jeong Meen Seo
- Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Geun Am Song
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Dong Woo Shin
- Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yeon Myung Shin
- Division of Gastrointestinal Surgery, Department of Surgery, Kosin University College of Medicine, Gospel Hospital, Busan, Korea
| | - Hong Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Han Kwang Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Chul Yu
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Ik Jin Yun
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Myeong Lee
- Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Hwa Lee
- Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea
| | - Tae Hee Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Haejun Yim
- Department of Burn Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Jeong Jeon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyuwhan Jung
- Department of Surgery, Jeju National University Hospital, Jeju, Korea
| | - Mi Ran Jung
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Chi Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Hee Sook Lim
- Department of Food and Nutrition, Yeonsung University, Anyang, Korea
| | - Suk Kyung Hong
- Division of Acute Care Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Hyeda A, Costa ÉSMD. Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome. EINSTEIN-SAO PAULO 2017; 15:192-199. [PMID: 28767918 PMCID: PMC5609616 DOI: 10.1590/s1679-45082017gs4002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022] Open
Abstract
Objective To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). Methods It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. Results We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Conclusion Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died.
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Affiliation(s)
- Adriano Hyeda
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Instituto Superior de Administração e Economia, Fundação Getúlio Vargas, Curitiba, PR, Brazil
| | - Élide Sbardellotto Mariano da Costa
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Instituto Superior de Administração e Economia, Fundação Getúlio Vargas, Curitiba, PR, Brazil
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14
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Keller H, Laur C, Valaitis R, Bell J, McNicholl T, Ray S, Murphy J, Barnes S. More-2-Eat: evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care. BMC Nutr 2017. [DOI: 10.1186/s40795-017-0127-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci 2017; 12:3. [PMID: 28057024 PMCID: PMC5216570 DOI: 10.1186/s13012-016-0538-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS Study design: overview of reviews. DATA SOURCE MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). STUDY SELECTION two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. DATA EXTRACTION AND SYNTHESIS two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). RESULTS Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. CONCLUSIONS Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- College of Pharmacy, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Kathryn M Sibley
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Halvorsen K, Eide HK, Sortland K, Almendingen K. Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes. BMC Nurs 2016; 15:70. [PMID: 27980452 PMCID: PMC5134106 DOI: 10.1186/s12912-016-0193-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/28/2016] [Indexed: 01/04/2023] Open
Abstract
Background Nutritional care is a basic human right for all people. Nevertheless, undernourishment is known to be a frequent and serious health care problem among elderly hospitalized patients in Western Europe. Nutritional documentation contributes to ensuring proper nutritional treatment and care. Only a few studies have explored how nurses document nutritional care in hospitals, and between hospitals and nursing homes. Available research suggests that documentation practices are unsatisfactory. The aim of this study was to explore how nurses document nutritional treatment and care for elderly patients in hospitals and how nurses and undergraduate nurses communicate information about patients’ nutritional status when elderly patients are transferred between hospital and nursing homes. Methods A qualitative study was conducted using a phenomenological-hermeneutic approach. Data was collected in focus group interviews with 16 nurses in one large university hospital, and 11 nurses and 16 undergraduate nurses in five nursing homes associated with the university hospital. Participants from the university hospital represented a total of seven surgical and medical wards, all of which transferred patients to the associated nursing homes. The catchment area of the hospital and the nursing homes represented approximately 10% of the Norwegian population in heterogenic urban and rural municipalities. Data were coded and analysed thematically within the three contexts: self-understanding, critical common sense, and theoretical understanding. Results The results were summarized under three main themes 1) inadequate documentation of nutritional status on hospital admission, 2) inadequate and unsystematic documentation of nutritional information during hospital stay, 3) limited communication of nutritional information between hospital and nursing homes. The three main themes included seven sub-themes, which reflected the lack of nutritional screening and unsystematic documentation on admission and during hospital stay. Further the sub-themes elucidated poor exchange of information between hospital and nursing homes regarding the nutritional status of patients. Conclusion Overall, the documentation of nutritional treatment and care for elderly patients was inadequate in the hospital and between health care settings. Inappropriate documentation can create a negative nutritional spiral that leads to increased risk of severe health related complications for elderly patients. Moreover, it hinders nutritional follow-up across health care settings. Electronic supplementary material The online version of this article (doi:10.1186/s12912-016-0193-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristin Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Helene Kjøllesdal Eide
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway ; Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Sortland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Patel C, Omer E, Diamond SJ, McClave SA. Can Nutritional Assessment Tools Predict Response to Nutritional Therapy? Curr Gastroenterol Rep 2016; 18:15. [PMID: 26936031 DOI: 10.1007/s11894-016-0488-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traditional tools and scoring systems for nutritional assessment have focused solely on parameters of poor nutritional status in the past, in an effort to define the elusive concept of malnutrition. Such tools fail to account for the contribution of disease severity to overall nutritional risk. High nutritional risk, caused by either deterioration of nutritional status or greater disease severity (or a combination of both factors), puts the patient in a metabolic stress state characterized by adverse outcome and increased complications. Newer scoring systems for determining nutritional risk, such as the Nutric Score and the Nutritional Risk Score-2002 have created a paradigm shift connecting assessment and treatment with quality outcome measures of success. Clinicians now have the opportunity to identify high risk patients through their initial assessment, provide adequate or sufficient nutrition therapy, and expect improved patient outcomes as a result. These concepts are supported by observational and prospective interventional trials. Greater clinical experience and refinement in these scoring systems are needed in the future to optimize patient response to nutrition therapy.
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Affiliation(s)
- Chirag Patel
- Department of Medicine, University of Louisville School of Medicine, 550 S. Jackson St, Louisville, KY, 40205, USA
| | - Endashaw Omer
- Department of Medicine, University of Louisville School of Medicine, 550 S. Jackson St, Louisville, KY, 40205, USA
| | - Sarah J Diamond
- Division of Gastroenterology and Hepatology, Oregon Health Sciences University, Portland, OR, USA
| | - Stephen A McClave
- Department of Medicine, University of Louisville School of Medicine, 550 S. Jackson St, Louisville, KY, 40205, USA.
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Richardson M, Garner P, Donegan S. Cluster Randomised Trials in Cochrane Reviews: Evaluation of Methodological and Reporting Practice. PLoS One 2016; 11:e0151818. [PMID: 26982697 PMCID: PMC4794236 DOI: 10.1371/journal.pone.0151818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/04/2016] [Indexed: 12/02/2022] Open
Abstract
Objective Systematic reviews can include cluster-randomised controlled trials (C-RCTs), which require different analysis compared with standard individual-randomised controlled trials. However, it is not known whether review authors follow the methodological and reporting guidance when including these trials. The aim of this study was to assess the methodological and reporting practice of Cochrane reviews that included C-RCTs against criteria developed from existing guidance. Methods Criteria were developed, based on methodological literature and personal experience supervising review production and quality. Criteria were grouped into four themes: identifying, reporting, assessing risk of bias, and analysing C-RCTs. The Cochrane Database of Systematic Reviews was searched (2nd December 2013), and the 50 most recent reviews that included C-RCTs were retrieved. Each review was then assessed using the criteria. Results The 50 reviews we identified were published by 26 Cochrane Review Groups between June 2013 and November 2013. For identifying C-RCTs, only 56% identified that C-RCTs were eligible for inclusion in the review in the eligibility criteria. For reporting C-RCTs, only eight (24%) of the 33 reviews reported the method of cluster adjustment for their included C-RCTs. For assessing risk of bias, only one review assessed all five C-RCT-specific risk-of-bias criteria. For analysing C-RCTs, of the 27 reviews that presented unadjusted data, only nine (33%) provided a warning that confidence intervals may be artificially narrow. Of the 34 reviews that reported data from unadjusted C-RCTs, only 13 (38%) excluded the unadjusted results from the meta-analyses. Conclusions The methodological and reporting practices in Cochrane reviews incorporating C-RCTs could be greatly improved, particularly with regard to analyses. Criteria developed as part of the current study could be used by review authors or editors to identify errors and improve the quality of published systematic reviews incorporating C-RCTs.
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Affiliation(s)
- Marty Richardson
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Donegan
- Department of Biostatistics, Block F Waterhouse Building, University of Liverpool, Liverpool, United Kingdom
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Reim D, Friess H. Feeding Challenges in Patients with Esophageal and Gastroesophageal Cancers. Gastrointest Tumors 2016; 2:166-77. [PMID: 27403411 DOI: 10.1159/000442907] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/01/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients undergoing treatment for esophagogastric or esophageal cancer are exposed to a considerably high risk of malnutrition due to early obstruction of the gastrointestinal passage. Presently most of the patients undergo modern multimodal therapies which require chemoradiation or chemotherapy ahead of surgery. Therefore reconstruction of the obstructed gastrointestinal passage is considerably delayed. Surgery as the only curative option after neoadjuvant treatment is the mainstay of therapy in this setting. However, many patients are at risk for the development of postoperative complications associated with the complexity of the surgical procedure. Therefore enteral feeding as a prerequisite to avoid malnutrition represents a special therapeutic challenge. SUMMARY This review describes the recent literature on the incidence and influence of perioperative malnutrition on oncologic outcome, measures to determine patients at risk, possible strategies to reduce or avoid malnutrition by supportive enteral/parenteral nutrition, implementation of the enhanced recovery after surgery programs and feeding routes, but also surgical and adjuvant procedures in the curative and palliative setting for patients undergoing treatment for gastroesophageal cancers. KEY MESSAGES Appropriate identification of patients at risk is crucial to avoid malnutrition. Early nutritional interventions during multimodal/neoadjuvant treatment may be beneficial for weight loss reduction although the evidence is not conclusive. Pouch reconstructions during surgery should be applied in order to increase quality of life and eating capacity. Reduction of postoperative complications could provide potential benefits. In palliative patients, insertion of self-expanding metal stents can reduce dysphagia and improve quality of life, but does not prolong overall survival. Further evidence is required to determine the value of the procedures and measures described in this review. PRACTICAL IMPLICATIONS Nutritional risk scoring should be performed for every gastroesophageal cancer patient. Sophisticated reconstruction methods and early recovery programs should be enforced to reduce perioperative starvation periods. Self-expanding metal stents should be used for palliative patients.
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Affiliation(s)
- Daniel Reim
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Chen LY, Liu LK, Hwang AC, Lin MH, Peng LN, Chen LK, Lan CF, Chang PL. Impact of Malnutrition on Physical, Cognitive Function and Mortality among Older Men Living in Veteran Homes by Minimum Data Set: A Prospective Cohort Study in Taiwan. J Nutr Health Aging 2016; 20:41-7. [PMID: 26728932 DOI: 10.1007/s12603-016-0674-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the prevalence of malnutrition and its impact on mortality, functional decline and cognitive impairment among elder residents in long-term care settings. DESIGNS A prospective cohort study. SETTINGS Two veteran homes in Taiwan. PARTICIPANTS A total of 1,248 male residents aged equal or more than 65 years. MEASUREMENTS Charlson's comorbidity index (CCI), Minimum data set (MDS), resident assessment protocols (RAP), Activity of daily living-Hierarchy scale, Cognitive Performance Scale, MDS Social engagement scale. RESULTS The mean age of participants is 83.1 ± 5.1 years, and the prevalence of malnutrition was 6.1%. Inadequate dietary content (57.9%) and unintentional weight loss (31.6%) account for the majority of malnutrition identified by MDS tool. Higher 18-month mortality rate (25% vs. 14.2%), higher baseline CCI (median 1 vs. 0), and higher baseline sum of RAP triggers (median 8.5 vs. 5) were noted among residents with malnutrition. Furthermore, malnutrition was shown predictive for functional decline (OR: 3.096, 95% CI: 1.715-5.587) and potential cognitive improvement (OR: 2.469, 95% CI: 1.188-5.128) among survivors after adjustment for age, body mass index and CCI. CONCLUSION Malnutrition among elder men residing in veteran homes was associated with multimorbidities and higher care complexity, and was predictive for mortality and functional decline.
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Affiliation(s)
- L-Y Chen
- Liang-Kung Chen, MD, PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2nd, Shih-Pai Rd. Taipei, Taiwan 11217, Tel: +886-2-28757830, Fax: +886-2-28757711, E-mail:
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Charani E, Gharbi M, Hickson M, Othman S, Alfituri A, Frost G, Holmes A. Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study. BMJ Open 2015; 5:e006092. [PMID: 25838504 PMCID: PMC4390734 DOI: 10.1136/bmjopen-2014-006092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Patient weight is a key measure for safe medication management and monitoring of patients. Here we report the recording of patient's body weight on admission in three hospitals in West London and its relationship with the prescription of antibiotic drugs where it is essential to have the body weight of the patient. METHODS A prospective cross-sectional study was conducted in three teaching hospitals in West London. Data were collected during March 2011-September 2011 and July 2012-August 2012, from adult admissions units, medical and surgical wards. Data from each ward were collected on a single day to provide a point prevalence data on weight recording. Patient medication charts, nursing and medical notes were reviewed for evidence of weight and height recording together with all the medication prescribed for the patients. An observational study collecting data on the weight recording process was conducted on two randomly selected wards to add context to the data. RESULTS Data were collected on 1012 patients. Weight was not recorded for 46% (474) of patients. Eighty-nine patients were prescribed a narrow therapeutic antibiotic, in 39% (35/89) of these weight was not recorded for the patient. Intravenous vancomycin was the most commonly prescribed antibiotic requiring therapeutic monitoring. In total 61 patients were receiving intravenous vancomycin and of these 44% (27/61) did not have their weight recorded. In the observational study, the most frequently identified barrier to weight not being recorded was interruptions to the admission process. CONCLUSIONS Despite the clinical importance of body weight measurement it is poorly recorded in hospitalised patients, due to interruptions to the workflow and heavy staff workloads. In antibiotics a correct, recent patient weight is required for accurate dosing and to keep drugs within the narrow therapeutic index, to ensure efficacy of prescribing and reduce toxicity.
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Affiliation(s)
- Esmita Charani
- Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK
| | - Myriam Gharbi
- Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK
| | - Mary Hickson
- Therapy Services, Imperial College Healthcare NHS Trust, London, UK
| | - Shokri Othman
- National Institute of Health Research/Wellcome Trust Imperial Clinical Research Facility Imperial College Healthcare NHS Trust, London, UK
| | - Aisha Alfituri
- National Institute of Health Research/Wellcome Trust Imperial Clinical Research Facility Imperial College Healthcare NHS Trust, London, UK
| | - Gary Frost
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Alison Holmes
- Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK
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Lee L, Heckman G, Molnar FJ. Frailty: Identifying elderly patients at high risk of poor outcomes. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:227-231. [PMID: 25767167 PMCID: PMC4369632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To help family physicians better recognize frailty and its implications for managing elderly patients. SOURCES OF INFORMATION PubMed-MEDLINE was searched from 1990 to 2013. The search was restricted to English-language articles using the following groups of MeSH headings and key words: frail elderly, frail, frailty; aged, geriatrics, geriatric assessment, health services for the aged; and primary health care, community health services, and family practice. MAIN MESSAGE Frailty is common, particularly in elderly persons with complex chronic conditions such as heart failure and chronic obstructive pulmonary disease. Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. While there is currently a lack of consensus as to how best to assess and diagnose frailty in primary care practice, individual markers of frailty such as low gait speed offer a promising feasible means of screening for frailty. Identification of frailty in primary care might provide an opportunity to delay the progression of frailty through proactive interventions such as exercise, and awareness of frailty can guide appropriate counseling and anticipatory preventive measures for patients when considering medical interventions. Recognition of frailty might also help identify and optimize the management of coexisting conditions that might contribute to or be affected by frailty. Further research should be directed at identifying feasible and effective ways to appropriately assess and manage these vulnerable patients at the primary care level. CONCLUSION Despite its importance, little attention has been given to the concept of frailty in family medicine. Frailty is easily overlooked because its manifestations can be subtle, slowly progressive, and thus dismissed as normal aging; and physician training has been focused on specific medical diseases rather than overall vulnerability. For primary care physicians, recognition of frailty might help them provide appropriate counseling to patients and family members about the risks of medical interventions.
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Affiliation(s)
- Linda Lee
- Family physician at the Centre for Family Medicine Family Health Team in Kitchener, Ont, and Associate Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
| | - George Heckman
- Schlegel Research Chair in Geriatric Medicine and Associate Professor in the Faculty of Applied Health Sciences at the University of Waterloo in Ontario
| | - Frank J Molnar
- Medical Director of the Regional Geriatric Program of Eastern Ontario and Assistant Professor in the Department of Medicine at the University of Ottawa in Ontario
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Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: a randomized controlled trial. Int J Nurs Stud 2015; 52:904-12. [PMID: 25698120 DOI: 10.1016/j.ijnurstu.2015.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nutritional status is associated with physical functioning in older people. Protein-energy malnutrition can limit functional performance. OBJECTIVES This study examined the effectiveness of a "need-based intervention" on improving the physical functioning of older adults living in nursing homes. DESIGN A 24-week randomized, double-blind, controlled trial. SETTINGS A privately managed geriatric nursing home in Taiwan. PARTICIPANTS Ninety-two persons who were ≥65 years old, ≤25 kg/m(2), >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding. METHODS Qualified participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each participant in the intervention group would receive a 50 g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24 kg/m(2). The supplement contained 9.5 g protein, 250 kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two "at risk" conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t-test and by the Generalized Estimating Equations controlled for nutritional status. RESULTS The intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all p<0.05) according to the Generalized Estimating Equations. CONCLUSIONS "Need-based intervention" can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated. We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage.
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Keller H, Allard JP, Laporte M, Davidson B, Payette H, Bernier P, Jeejeebhoy K, Duerksen DR, Gramlich L. Predictors of dietitian consult on medical and surgical wards. Clin Nutr 2014; 34:1141-5. [PMID: 25510874 DOI: 10.1016/j.clnu.2014.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/04/2014] [Accepted: 11/14/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIM Guidelines promote dietitian consult (DC) for nutrition support. In Canada, dietitians are involved in the assessment of malnutrition and provide specialized dietary counseling. It is unknown however, what leads to a DC for patients fed orally. This study identifies independent predictors for a DC and determines what is the proportion of malnourished patients seeing a dietitian. METHODS The Canadian Malnutrition Task Force conducted a prospective cohort study in medical and surgical wards of 18 Canadian hospitals. 947 patients who did not receive enteral or parenteral nutrition were analyzed. At admission, subjective global assessment (SGA), body mass index, patient demography were collected. During hospitalization clinical data, including dietary intake and presence of a DC were obtained. Multivariate logistic regression was completed with dietitian consult ≤ 3 days and 4 + days as the outcome variables. RESULTS The prevalence of malnutrition (SGA B + C) was 45%. Dietitians were consulted for 23% of patients, and of these consults 44% were well nourished (SGA-A), 37% were mildly/moderately malnourished (SGA-B), and 19% were severely malnourished (SGA-C). DC missed 75% of the SGA-B and 60% of SGA-C patients. Predictors of consultation within 3 days of hospitalization were: renal diet (OR 5.75) modified texture diet (OR 5.38), metabolic diagnosis (3.91), ONS use pre-admission (OR 2.33), severe malnutrition (SGA-C, OR 1.88) and age (OR 0.98). Predictors for 4 + days were: dysphagia (OR 11.4), a new medical diagnosis (OR 2.3), severe malnutrition (OR 2.17), constipation (OR 2.16), more than one diagnosis (OR 1.8), antibiotic use (OR 1.6), and male gender (OR 1.6). Consuming < 50% of food in the first week was not a predictor as only 19% of those with low intake had a DC at 4 + days. CONCLUSIONS Overall predictors of DC were appropriate but SGA B and C patients and those eating <50% were missed. Screening at admission with algorithms of care that include referral to the dietitian are needed to improve the process of nutrition care.
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Affiliation(s)
- Heather Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue, West Waterloo, ON, N2L 3G1, Canada.
| | - Johane P Allard
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, ON, M5G 2C4 Canada
| | - Manon Laporte
- Reseau de sante Vitalite Health Network, Campbellton Regional Hospitals, 189 Lily Lake Road, PO Box 880, Campbellton, NB, E3N 3H3, Canada
| | | | - Helénè Payette
- Université de Sherbrooke, Research Center on Aging, CSSS-IUGS, 1036, Belvedere Street, Sherbrooke, QC, J1H 4C4, Canada
| | - Paule Bernier
- Jewish General Hospital, 3755 ch Cote Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Khursheed Jeejeebhoy
- Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Donald R Duerksen
- Department of Medicine, Division of Gastroenterology, C5120 409 Tache Avenue, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada
| | - Leah Gramlich
- University of Alberta, Division of Gastroenterology, Room 214, Community Services Centre, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
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Abstract
The Malnutrition Universal Screening Tool (MUST) is frequently cited as a simple screening tool for malnutrition. However, anecdotally, it seems that not all staff find it simple to use. If staff do not find MUST simple to complete, then screening is less likely to be completed accurately. Accurate completion of MUST is essential for malnutrition to be identified and treated, otherwise the nutritional needs of patients with unrecognised malnutrition may be neglected. The use of simplified versions of body mass index score, weight loss score and ulna-length charts together with ongoing training and support may help to improve accurate MUST completion. Audit of MUST completion must consider the accuracy of completion rather than completion alone. Therefore, those auditing MUST completion require a good understanding of the tool. This article draws on the author's own significant experience with applying the MUST tool and synthesises this with evidence from the literature to demonstrate the potential barriers to effective MUST implementation.
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Affiliation(s)
- Alison Smith
- Prescribing Support Dietitian, Medicines Management Team, Aylesbury Vale CCG and Chiltern CCG; Nutrition Advisory Group for Older People (NAGE), British Dietetic Association
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26
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Cost effectiveness of breast cancer screening using mammography; a systematic review. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:347-57. [PMID: 23785673 PMCID: PMC3684720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/09/2013] [Indexed: 11/02/2022]
Abstract
BACKGROUND Breast cancer is the leading cause of malignancy among women. Screening using mammography is proposed as an effective intervention for reducing early deaths due to breast cancer. We conducted a systematic review to assess the cost-effectiveness of such screening programs. We searched Medline, Scopus and Google Scholar and complemented it by other searches using sensitive search terms from 1993-2010. We screened the titles and abstracts, assessed the full texts of the remaining studies, and extracted data to a pre-designed data extraction sheet. Studies were categorized according to the age groups of the target population. We used narrative synthesis approaches for analyzing the data. Twenty-eight articles met the minimum inclusion criteria, mostly from high income settings. All studies used secondary data, and a variety of modeling techniques, age groups, screening intervals and outcome measures. Cost per life year gained, ranging from $1,634 (once at the age of 50 in India) to $65,000 (extending the lower age limit of screening to 40 Australian study), was the most commonly used outcome measure. Biennial screening test for those aged 50-70 years seems to be the most cost-effective option ($2685). Biennial screening for aged 50-70 years is the most cost-effective option among alternative scenarios. Screening those aged less than 50 is not recommended. Further studies in low-income and middle-income countries, and cost effectiveness studies along with randomized trials are required. To improve the comparability of the findings, future studies should include biennial screening in 50-70 age groups as an alternative strategy.
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