Global Assessment Tool Research Articles

Validation of the Italian version of Montreal Cognitive Assessment (MoCA) in routine clinical practice in community dweller older adults residing in the central area of Sicily

Abstract Background/Objective: The aim of the study was to examine Montreal Cognitive Assessment (MoCA) performance in subjects with normal global cognition according to the Mini Mental State Examination (MMSE) in routine clinical practice. Methods: This was a prospective, clinical validation study in 302 consecutive subjects, referring to our dementia centre for suspected cognitive impairment over a six-month period. The MMSE and the MoCA were administered within two hours of each other. Results: 184 (60.91%) of 302 evaluated subjects with a MMSE score between 26 and 30/30 had a pathological MoCA score (< 26). 112/184 (60.84%) patients with a MMSE score between 26 and 29/30 obtained MoCA scores below the norm; 72/184 (39.13%) patients with a 30/30 MMSE had a MoCA score below the norm. Recall (p <.0001) and attention (p<.0001) were the domains that differed significantly on the two screening instruments. Conclusion: The additional use of MoCA, as a global assessment tool for the initial screening process, has allowed the identification of patients with cognitive deficit, despite their performance at MMSE had been the norm. Keywords: MoCA, MMSE, Cognitive Screening Test.

THTP3.4 Performances measures in Robotic-Assisted Surgery- A Systematic Review

Abstract Background Robotic-Assisted Surgery (RAS) has seen a global rise in the past 30 years. Despite the increased adoption, there is no current standardised training curricula or measure of performance. The aim of this systematic review was to define the RAS metrics used to assess technical performance across the surgical specialities. Methods Using the PRISMA 2020 guidelines, Pubmed, Embase and the Cochrane Library were searched systematically for full texts published 31st January 2020 – 31st January 2022. All randomised controlled trials (RCTs) and observational studies were considered. Review articles and systematic reviews were excluded. The papers’ quality and bias score were assessed using the Newcastle Ottawa Score for the observational studies and Cochrane Risk Tool for the RCTs. Results The initial search yielded 1189 papers of which 74 were eligible. The majority were published in urology (45% n=33). 27 unique metrics were identified and categorised as “task based”, “procedural based”, “cognitive assessments” and “global assessments”. Global assessments were the most common category of assessment (n=12); the most frequently used was GEARs (Global Evaluative Assessment of Robotic Skills). Only 4 metrics (automated, Proficiency Based Progression (PBP), pupillary measures and time to completion) used quantitative measures to assess performance whilst the remaining relied upon Likert scales thereby creating variability amongst users. Conclusion There is wide variation in tools used to assess performance in RAS. The majority of tools are subjective which increases the risk of bias amongst users and therefore accuracy in the measure of performance. A validated, objective global assessment tool that utilises quantitative measures is required.

Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: a Randomized Controlled Trial

BackgroundIn super obesity, Roux-en-Y gastric bypass (RYGB) may be insufficient why some surgeons advocate biliopancreatic diversion with duodenal switch (BPD/DS), a more malabsorptive procedure. There is a paucity of evidence regarding results beyond 10 years, especially after BPD/DS. The aim of this randomized controlled trial was to compare the long-term outcome of BPD/DS, and RYGB in patients with super obesity, i.e., body mass index (BMI) > 50 kg/m2.MethodsThis is a 13- to 17-year follow-up study of a single-center, single-blinded randomized trial in which 47 patients (BMI > 48 and eligible for bariatric surgery) were randomized 1:1 to BPD/DS and RYGB (25 men, 24 BPD/DS, 39.1 ± 9.9 years, BMI 54.5 ± 6.1 kg/m2). The primary outcome was weight loss. The study was financed by Swedish governmental funding of clinical research (ALF). Trial registration number: ISRCTN10940791.ResultsThirty-four (18 BPD/DS) of the living 42 patients (81.0%) participated. BPD/DS resulted in higher BMI loss (20.4 ± 7.9 vs. 12.4 ± 8.6, p = .008) and higher percent of total body weight loss (37.5% ± 12.2 vs. 22.8% ± 14.8, p = .004). BPD/DS was associated with lower fasting glucose, glycated hemoglobin (HbA1c), and low-density lipoprotein (LDL) as well as lower hemoglobin. Adverse events were more common after BPD/DS (2.7 vs. 0.9 per patient, p = .004). The global assessment tool BAROS (Bariatric Analysis and Reporting Outcome System) demonstrated superior scores for BPD/DS (p = .047).ConclusionWhen compared to RYGB, BPD/DS results in superior weight loss and metabolic control as well as superior BAROS score, however, at the cost of more adverse events.Graphical

The combined effects of coping and pain interference on army readiness.

Chronic pain and associated interference with daily activities are common in the military and impact Force readiness. Chronic pain affects one-third of service members and is a leading cause of medical non-readiness (MNR) in the military. Research suggests that underlying psychological mechanisms related to trait coping styles and pain interference (PI) affect functional outcomes, but little research exists examining this relationship within an Army population. The purpose of this study was to examine the combined effects of PI and coping on U.S. Army soldier readiness by using annual well-being data from the Global Assessment Tool (GAT) and medical non-readiness (MNR) based on duty restriction records. The sample comprised 866,379 soldiers who completed the GAT between 2014 and 2017 with no duty restrictions at the time of baseline GAT completion; subjects were observed through 2018 for duty restrictions. Parametric survival regression models with a Weibull distribution predicted demographic-adjusted hazards of MNR by dichotomized PI (no PI/PI) and beneficial/non-beneficial use of GAT coping components (good coping, bad coping, catastrophizing-flexibility, and catastrophizing-hopelessness). Incident MNR was evaluated for all duty restrictions, and stratified by selected body systems (upper extremity, lower extremity, psychiatric). Among soldiers with PI, hazards were higher in those reporting non-beneficial coping styles (bad coping, hopelessness) and lower in those reporting beneficial coping styles (good coping, flexibility). Across all coping styles, PI/coping interactions were particularly strong for catastrophizing-hopelessness and when examining MNR from psychiatric conditions. These findings suggest some synergistic associations between pain and coping that may impact pain-related occupational disability. Coping skills may be an effective interventional target for chronic pain reduction/prevention within military programs, such as the Master Resilience Training Course offered to soldiers in the Army. Further research should assess whether early coping style interventions can reduce pain-related outcomes.

Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer

PurposeMalnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer.MethodsPatients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications.ResultsPre-operative malnutrition incidence was 40%. Malnourished patients had higher incidences of any type of complication (57% vs 44%, p = 0.013) and pressure injury (86% vs 14%, p = 0.011) compared to well-nourished patients. Well-nourished patients had a clinically important shorter median length of stay compared to malnourished patients (17.5 vs 20 days).ConclusionEarly identification and management of malnutrition is essential to minimize risk of post-operative complications and reduce length of stay and should be considered a key component of prehabilitation programs.

International study on the prevalence of malnutrition in centralized care for colorectal cancer patients.

Patients with different diseases may show signs of malnutrition both before and during the hospital stay. The presence of malnutrition may impact the recovery and length of stay and consequently the costs. Early identification of malnutrition is thus a critical factor. The objective of this multicenter study is to determine the prevalence of malnutrition in colorectal cancer centers. Another objective is to investigate possible consequences, such as complications or length of stay. In addition, the study aims to demonstrate the relevance of nutrition management in colorectal cancer centers. At the same time, relevant requirements clearly demanded by the Certification Commission for Certified Colorectal Cancer Centers are met through implementation of the study. Between 2019 and 2021, patients incolorectal cancer centers were examined in the preoperative phase. In addition to questions about patients' state of health and nutrition, the validated screening forms-Subjective Global Assessment (SGA) and Nutritional Risk Screening Tool 2002 (NRS 2002)-were used to assess malnutrition. The data were processed by univariate analysis. In total, data records of 3,102 patients were evaluated. The mean age of the participants was 68.5 ± 11.9 years, and their average body mass index (BMI) was 26.8 ± 5.3 kg/m2. The SGA questionnaire indicated that 23 % of the participants suffered from malnutrition and 38 % were at risk of malnutrition (NRS≥3). Malnutrition was found more frequently in patients with colorectal carcinomas than in patients with rectal carcinomas (53.1 vs. 32.1 %). The length of stay in hospital and the rate of complications were significantly higher when malnutrition was identified. Approximately one in three to four patients with a colorectal carcinoma has an increased risk of malnutrition. The two screening methods calculated a different prevalence (23 and 38 %). Any malnutrition that is present demonstrably has a significant impact both on the rate of complications and the length of stay and may therefore have a decisive influence on the costs. The results of this multicenter study underscore the need for systematic screening for malnutrition and at the same time should increase clinics awareness of the importance of establishing a nutrition management policy.

Peripheral parenteral nutrition: An evaluation of its use, safety and cost implications in a tertiary hospital setting

Malnutrition is a common challenge among hospitalised patients and its associatiation with poor patient health-related outcomes places a significant financial burden on the healthcare system. Total parenteral nutrition (TPN) is the primary means for providing nutrition to individuals in whom enteral feeding is not possible but is costly and requires invasive central venous access. Peripheral parenteral nutrition (PPN) provides a suitable option for early nutrition provision in select patients; however, its routine use has been limited by safety and tolerability concerns, with high rates of phlebitis reported in previous studies. The objectives of this study were to review the use, safety, and costs of PPN in an Australian tertiary hospital. A single-site, prospective observational study was conducted over 15 months in a tertiary hospital. 139 participants (87 male and 52 female) were enrolled in the study. Data collected assessed the indication for PPN initiation, compliance with the hospital's protocols for PPN, total fasting days, the proportion of the patient's total energy and protein requirements provided by PPN, the incidence of phlebitis and potential cost implications associated with the use of PPN. 139 patients (62.6% male), median age 62 years (IQR (interquartile range) 48-74) were enrolled. Most patients had an emergency admission (80.6%) under a general surgical team (84.2%). Forty-eight patients (34.5%) were malnourished, as assessed by the Subjective Global Assessment tool (SGA). Patients fasted for a median of 3 days (IQR 2-5) before PPN commencement, with a median duration of PPN use of 3 days (IQR 2-4). PPN provided an average of 61.6% of the patients' required caloric intake and 46.4% of protein requirements. Progression to TPN was observed in 34.5% of patients. There were low rates of complications with phlebitis observed in 3.7%, extravasation in 1.1%, and no patients developed septicaemia, despite suboptimal compliance with the recommended cannula management guidelines for PPN (66.4% compliant). The cost of PPN was estimated to be AUD$187 per patient day. PPN is an effective short-term nutrient delivery solution to facilitate early feeding with small numbers of patients requiring transition to TPN. PPN was safe with low rates of cannula complications. Costs were favourable, with potentially significant cost savings as compared with TPN.

Risk screening, nutrition assessment and associated factors of malnutrition among elderly inpatients in Hue University of Medicine and Pharmacy Hospital

Background: Undernutrition is a significant risk factor for mortality, complications, hospital infections, length of hospital stay, quality of life, and prognosis. Patients with proper nutrition will help prevent undernutrition, prevent the development of the disease, and improve the effectiveness of treatment. Nutrition is an integral part of the comprehensive treatment process. Nutritional risk screening is one criterion that shows the hospital’s nutritional care capacity. Assessing nutritional status plays an essential role in treating and recovering health. This study aims (1) to screen and assess the nutritional status of inpatients aged from 60 years old in Hue University Medicine and Pharmacy Hospital and (2) to identify some factors related to malnutrition. Methods: A cross-sectional study was carried out on 389 inpatients at two departments of internal medicine, Hue University of Medicine and Pharmacy Hospital, from 11/2020 - 03/2021. We used the mini nutritional assessment tool for screening nutrition risks. The subjective global assessment tool was used to assess nutritional status and questionnaires to understand some related factors. Results: There were 68.9% of patients at risk of malnutrition and 38.8% of patients had malnutrition. There were significant relationships between the nutrition status of patients with re-admitted status (p < 0.05), including diseases (p < 0.05), oral pathology (p < 0.05), decreased taste (p < 0.05). Conclusion: The prevalence of inpatients with nutritional risk in two departments of internal medicine was relatively high. It is necessary to conduct nutrition screening in all inpatients to improve the effectiveness of treatment and comprehensive care. Key words: malnutrition, inpatients, nutrition treatment, subjective global assessment tool, mini nutritional assessment tool.

Nutritional Assessment in Early Allogenic Hematopoietic Stem Cell Transplant Patients, a Cross-Sectional Study

Background Our study aims to comprehensively assess nutrition status and malnutritional prevalence in early allogenic hematopoietic stem cell transplant (allo-HSCT) patients. Methods This single-center, cross-sectional study included 171 patients within the 90 days post-transplantation (from September 2019 to April 2020). Data collected included demographic, 3 day 24-h diet record, a Patient-Generated Subjective Global Assessment (PG-SGA) tool, laboratory tests, anthropometric indices, and body composition. Results One hundred and seventy-one patients with a mean age of 37.8 ± 11.3 and a male to female ratio of 102 to 69 were included. According to PG-SGA, 115 (67.3%) indicated the critical need for nutritional intervention and symptom management (PG-SGA score > 9). Forty-three (43.3%) of patients had experienced insufficient intakes of energy according to a 24-h diet record. Our study found that 120 (70.2%) patients had a body fat percentage and high triacylglycerol (64.9%). Reduced free fat mass index and low hand-grip strength were found in 133 (77.78%) and 104 (60.81%), respectively. The prevalence of malnutrition was 24.6% and the prevalence of sarcopenia was 13.5%. Conclusion Although the prevalence was not high, this research has demonstrated a high risk of malnutrition and a lower muscle mass in early allo-HSCT. Furthermore, our study confirmed body composition assessment would be an excellent way to identify malnutrition precisely.

Mental Health and Public Health: Improving Mental Health and Well-being of Communities in the Modern World: A Pragmatic Approach Using the Global Mental Health Assessment Tool/PC

The World Health Organization report of 2022 on mental health highlights the slow progress in reducing the treatment gap for people with mental illness worldwide. It emphasizes that everyone should participate in improving the mental health and well-being of the communities. The governments should put their act together and all agencies should work in coordination to address the mental health needs of their population. They should also focus on mental health promotion, early intervention, and prevention of suicide. The Mental Health Action Plan 2013–2030 outlines the importance of leadership and governance for mental health in providing comprehensive, integrated, and responsive mental health and social care services in community-based settings. Stigma, human resource shortages, fragmented service delivery models, and poor commitment of authorities for mental health are some of the factors for the ongoing service gap in mental health. Providing mental health knowledge and assessment skills to frontline workers, supporting frontline workers by mental health specialists using their leadership skills, and fully utilizing mobile and Internet technology in providing education and training as well as providing services could bring down the treatment gap of mental disorders worldwide. The Global Mental Health Assessment Tool for Primary Care and General Health Setting (GMHAT/PC)-based training package has been developed and successfully implemented in training frontline health workers in different parts of the word. The authors propose that this may be a pragmatic way to integrate mental health in public health by skilling frontline workers in assessing mental health along with physical health and by providing holistic care.

P200 The relationship between patient and physician global assessment in patients with anti-neutrophil cytoplasmic antibody associated vasculitis

Abstract Background/Aims Patients with anti-neutrophil cytoplasmic antibody associated vasculitis (AAV) often have reduced health-related quality of life (HRQoL) as assessed by the SF-36 questionnaire. Global assessment provides a patient and physician’s view on the patient’s overall health and wellbeing. The aim of this project was to examine the level of agreement between the patient and physician global assessment (PtGA and PhGA) in patients with AAV. Methods Patients attending our dedicated tertiary vasculitis clinic were recruited into this prospective study. PtGA and PhGA scores, out of 100, were assessed via a visual analog scale, with higher scores representing better health. SF-36 assessed HRQoL. Discordance was defined as an absolute difference of ≥ 20 between PhGA and PtGA. Active disease was defined as a BVAS of ≥ 1. Results Ninety-seven patients (mean age 58 years, 46% male) participated. Forty-three (44%) patients had active disease. The majority (88%) were on immunosuppressive therapy with renal (79.4%), lung (42.3%) and sino-nasal (40.2%) being the most commonly involved systems. The mean (SD) PtGA and PhGA was 63.4 (22.2) and 60.8 (24.8) respectively (t = 2.63, p = 0.0049). Mean (SD) PtGA in active versus inactive disease was 59 (22.8) and 66 (21.5) respectively (t = 1.49, p = 0.07). PhGA scores were higher than PtGA in 44 patients with an overall mean difference of + 13.7 (95% confidence interval [CI] 9.97, 17.46, p < 0.001). PtGA scores were higher than PhGA in 48 patients (mean difference +17.9, 95% CI 22.6, 13.3, p < 0.001). Scores were discordant in 26 patients, with PhGA>PtGA (negatively discordant) in 10 (38%). Mean (SD) PhGA in discordant patients versus non-discordant patients was 47.5 (24.7) versus 65.7 (23.1) respectively (t = 1.71, p = 0.001). Mean (SD) age in positively discordant versus negatively discordant patients was 58.8 (17.3) versus 69.1 (8) respectively (t = 1.71, p = 0.026). The percentage of patients with active disease (n=number of patients) in positively discordant versus negatively discordant patients was 50% (n = 8) versus 30% (n = 3) respectively (p = 0.008). Bland-Altman plots showed no systematic bias as global scores increased. Conclusion Overall, physicians did not overestimate patients' global health when using the global assessment tool. Discordance rates were 26%, within which physicians were likelier to assess the patient's global health as lower than patients did themselves. Positively discordant patients (PhGA<PtGA) were likelier to have active disease and were younger on average. Disclosure A. Bhonsle: None. T. Coughlan: None. R. Graven: None. P. Bussa: None. M. Gingold: None. K. Polkinghorne: None. J. Ryan: None. A. Kitching: None.

Assessing the Efficacy of Mental Health Assessment Training for Accredited Social Health Activists Workers in Rural India: A Pilot Study.

Background Mental health issues are a major concern in rural India, but the lack of trained professionals limits access to care. In this pilot study, we evaluated the efficacy of a mental health assessment training program for Accredited Social Health Activists (ASHA) in rural Maharashtra, India. Aim and objective To conduct a pilot study to evaluate the feasibility and potential efficacy of Mental Health Assessment Training by using the Global Mental Health Assessment Tool-Primary Care Marathi Android version (GMHAT/PC-M) on ASHA workers in the Wardha district to identify mental health problems. Methods The study enrolled 12 ASHA workers from two rural health centers in Maharashtra. The workers completed a pretest and then received training in mental health assessment using the GMHAT/PC Marathi Android version. Mental health knowledge and global mental health assessment tool checklist scale scores were assessed on day seven, month one, and month three after training. Results The ASHA workers had a mean age of 42.2 years and a mean experience of 9.6 years. The majority were Hindus (50%), with the remaining workers being Buddhist. Of the 12 workers, only four had prior mental health training. Mental health knowledge and global mental health assessment tool checklist scale score significantly improved from the pretest to day seven (p<0.001), and the scores continued to improve at month one and month three with a 0.001 level of significance. At the end of the study, the mean mental health knowledge score was 15.2 (out of 20), and the mean global mental health assessment tool checklist scale score was 55.5 (out of 60). Conclusion Our pilot study demonstrated the effectiveness of a mental health assessment training program for ASHA workers in rural Maharashtra, India, using the GMHAT/PC Marathi Android version. The training program improved the mental health knowledge and GMHAT checklist scale of the ASHA workers, suggesting that such programs can help bridge the gap in mental health care in rural areas. Further studies with larger sample sizes and longer follow-up periods are needed to confirm the effectiveness of this training program.

Faculty Perception of Student Engagement in Online Anatomy Laboratory Courses During the COVID-19 Pandemic.

When the social distancing guidelines, as a result of the COVID-19 pandemic, caused universities to close campuses, there was a rapid shift in the course delivery methods of human gross anatomy laboratory sessions. Courses were delivered online, and this change created new challenges for anatomy faculty to engage students effectively. This profoundly impacted student-instructor interactions, the quality of the learning environment, and successful student outcomes. Because of the importance of student interaction and engagement for hands-on laboratory courses like anatomy, which rely on cadaver dissections and in-person learning communities, as well as the novel opportunity, this qualitative study sought to explore the faculty perspectives of transitioning their in-person laboratory sessions online and unearth their experience with student engagement in this new teaching format. The Delphi technique was used to explore this experience in two rounds of qualitative inquiry using questionnaires and semi-structured interviews, and thematic analysis was used to analyze the data, identifying codes and building themes. The study utilized indicators of student engagement in online courses to formulate four themes: instructor presence, social presence, cognitive presence, and reliable technology design and access. These were constructed based on the factors faculty used to maintain engagement, new challenges they faced, and strategies deployed to overcome these challenges and engage students in the new learning format. These are supported by strategies such as using video and multimedia, ice-breaker activities, chat and discussion features, immediate and personalized feedback, and virtual meeting via synchronous sessions. These themes highlight important lessons that faculty designing online anatomy laboratory courses can use to guide their course design, and institutions and instructional design faculty can use to inform best practices and faculty development efforts. Additionally, the study calls for further research to design a standardized and global assessment tool that measures student engagement in the online learning environment.

Validation of AND/ASPEN pediatric malnutrition diagnosis in children admitted to medical wards in two tertiary hospitals in Malaysia.

Identification and management of malnutrition among pediatric hospitalized patients is critical for improved clinical outcomes and recovery. This study investigated the use of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (AND/ASPEN) pediatric malnutrition diagnosis in comparison with the Subjective Global Nutritional Assessment (SGNA) tool and single anthropometric indicators (weight, height, body mass index, and mid-upper arm circumference) among hospitalized children. A cross-sectional study was conducted among 260 children admitted to general medical wards. SGNA and anthropometric measurements were used as references. Kappa agreement, diagnostic values, and area under the curve (AUC) were analyzed to evaluate the diagnostic ability of the AND/ASPEN malnutrition diagnosis tool. Logistic binary regression was performed to determine the predictive ability of each malnutrition diagnosis tool on the length of hospital stay. The AND/ASPEN diagnosis tool detected the highest malnutrition rate (41%) among the hospitalized children in comparison with the reference methods. This tool demonstrated fair specificity of 74% and sensitivity of 70% compared with the SGNA. It obtained a weak agreement in determining the presence of malnutrition by kappa (0.06-0.42) and receiver operating characteristic curve analysis (AUC = 0.54-0.72). The use of the AND/ASPEN tool obtained an odds ratio of 0.84 (95% CI, 0.44-1.61; P = 0.59) in predicting the length of hospital stay. The AND/ASPEN malnutrition tool is an acceptable nutrition assessment tool for hospitalized children in general medical wards.

Impact of Hearing Loss and Rehabilitation on the Psychological Well-Being of the Elderly

Purpose: Hearing loss in the elderly is a common disorder which range from an undetectable degree of disability to profound alteration in the ability to function in society. Hence, this study was undertaken to assess the impact of hearing loss and rehabilitation on the psychological well-being of the elderly.Method: Patients above 60 years complaining of hearing loss were evaluated for the otoscopic examination, audiological assessment, psychological assessment Hearing Handicap Inventory for the Elderly Screening (HHIE-S) version, and Global Mental Health Assessment (GMHA) tool. Data was statistically analyzed to determine the relationship between the hearing loss and psychological affection and the benefit after use of hearing aids and rehabilitation.Results: A total of 60 males and 50 females were taken into consideration. HHIE-S showed a significant relation with the severity of hearing loss in the initial assessment and also after remedial measures. GMHA also showed a significant statistical relationship with the severity of hearing loss after initial assessment and after remedial measures.Conclusion: The significant relation of HHIE-S and GMHA with the severity of hearing loss suggest that as the hearing loss increases there is a higher probability of an individual having psychological affection causing the social and emotional situational adjustments producing depression and anxiety. It is also concluded that early remedial measures provide substantial improvement in their quality of life.

Patient and Physician Global Assessments of Disease Status in Systemic Sclerosis.

Global assessments of disease by both patients and physicians are widely used in clinical studies of systemic sclerosis (SSc). They are commonly secondary end points in randomized controlled trials (RCTs) and are considered important items in composite measures of treatment response. A comprehensive literature review was conducted of the formats, wording, and clinimetric properties of the patient global assessment of disease status (PtGA) and physician global assessment of disease status (PhGA) used in RCTs of SSc. Marked heterogeneity was found in the wording and measurement scales of the global assessments applied in RCTs. These instruments were not developed using rigorous methodology and have not been fully validated. There is a pressing need for standardization and validation of patient and physician global assessment tools in SSc to enable universal application of these measures across RCTs in SSc.

Utility of Subjective Global Nutritional Assessment Tool for the Assessment of Malnutrition in Pediatric Patients with Chronic Liver Disease.

Approximately 30% of children with chronic liver disease (CLD) are malnourished. However, proper assessment of their nutritional status is difficult. The subjective global nutritional assessment (SGNA) is a comprehensive approach that uses nutrition-focused history and examination, followed by grading of malnourishment. We aimed to study the prevalence of malnutrition in children with CLD using the SGNA tool. This cross-sectional observational study included patients aged <18 years with CLD. Nutritional assessments were recorded using SGNA tool. Conventional anthropometric measurements were performed and corroborated with nutritional status using SGNA tool. A total of 85 children with CLD and mean age of 62 months were enrolled in this study. The prevalence of malnourished children according to SGNA was 34%; 22% were moderately malnourished and 12% were severely malnourished. We found statistically significant differences in anthropometric parameters among the three groups. A moderate degree of agreement was found between SGNA and weight-for-age (W/A) (p=0.020), mid-upper arm circumference (MUAC) (p<0.001), and triceps skin-fold thickness (TSF)-for-age (p=0.029). Furthermore, a fair degree of agreement was found between height-for-age (H/A) (p=0.001) and weight-for-height (W/H) (p<0.001). The sensitivity of W/A for detecting malnutrition was 93%, H/A was 90%, MUAC was 86%, and TSF was 88%. The sensitivity was much lower for W/H and body mass index for age (55% for both). In our study, more than one-third of children with CLD were malnourished. Nutritional assessment using SGNA is a reliable method for evaluating nutritional status and is significantly correlated with common anthropometric measurements.

Nutritional Assessment of Adult Patients Undergoing Maintenance Hemodialysis in the Gaza Strip

Malnutrition is a common condition in patients undergoing hemodialysis (HD), and it is associated with increased morbidity and mortality. The main objective of the study was to evaluate the nutritional status of patients on maintenance HD. After applying eligibility criteria, 141 HD patients attending major governmental dialysis centers were randomly recruited in this cross-sectional study and assessed for nutritional status using the Patient-Generated Subjective Global Assessment (PG-SGA) tool. The PG-SGA categorizes patients as well-nourished, moderately malnourished, and severely malnourished. Different anthropometric measurements, laboratory investigations, blood pressure measurements, and 24-h dietary recall were collected from each patient. According to PG- SGA results, 78% of patients were moderately malnourished and 22% of patients were severely malnourished. The mean body mass index was 27.8 kg/m2, and 5.7% of patients were underweight. There were significant differences in the mid-upper arm muscle circumference (P = 0.020) between the PG-SGA groups. The total energy and protein intake were significantly (P &lt;0.001) less than the recommended dietary intake by 1268.9 kcal and 41.4 g, respectively. The albumin level in 37.6% of patients was less than the normal level, and the results indicated that there were significant differences in serum iron (P = 0.022) between the moderately and severely malnourished patients. The results of this study indicated that all HD patients were suffering from different degrees of malnutrition and, unfortunately, most of their energy and nutrient intake was far less than the requirements, which might be the reason why they face nutritional and health risks.

Effect of a Personalized Enteral Nutrition Protocol on the Postoperative Nutritional Status in Patients Who Underwent Oral Cancer Surgery

Differences in the implementation of the perioperative nutrition guidelines and pathways by caregivers lead to differences in enteral nutrition provided to the patients. This study investigated the effect of a personalized enteral nutrition protocol on the postoperative nutritional status of patients who underwent oral cancer surgery at Zhejiang Ningbo NO. 2 Hospital. Those who underwent surgery between July 2017 and October 2018 received routine enteral nutrition based on the Nutritional Risk Screening 2002 (routine group), while those between November 2018 and August 2021 received personalized enteral nutrition based on the Patient-Generated Subjective Global Assessment tool (personalized group). Seventy patients completed the study (routine group, n = 34; personalized group, n = 36). After surgery, the personalized group exhibited significantly greater improvements in serum albumin levels (P < 0.01) (on the 7th and 10th day) and hand grip strength (P < 0.01), higher self-care ability (P < 0.01), lower incidence of gastrointestinal reactions during enteral feeding (P < 0.05), and shorter hospital stay (P < 0.05) than the routine group. Therefore, a personalized enteral nutrition program might improve the postoperative nutritional status, shorten the hospital stay, and accelerate postoperative recovery in patients who underwent oral cancer surgery.

Influence of interdisciplinary frailty screening on perioperative complication rates in elderly ovarian cancer patients: results of a retrospective observational study

PurposeFrailty is a frequent and underdiagnosed multidimensional age-related syndrome, involving decreased physiological performance reserves and marked vulnerability against major stressors. To standardize the preoperative frailty assessment and identify patients at risk of adverse surgical outcomes, commonly used global health assessment tools were evaluated. We aimed to assess three interdisciplinary preoperative screening assessments to investigate the influence of frailty status with in-hospital complications irrespective of surgical complexity and radicality in older women with ovarian cancer (OC).MethodsPreoperative frailty status was examined by the G8 geriatric screening tool (G8 Score-geriatric screening), Eastern Cooperative Oncology Group performance status (ECOG PS-oncological screening), and American Society of Anesthesiologists Physical Status System (ASA PS-anesthesiologic screening). The main outcome measures were the relationship between perioperative laboratory results, intraoperative surgical parameters and the incidence of immediate postoperative in-hospital complications with the preoperative frailty status.Results116 consecutive women 60 years and older (BMI 24.8 ± 5.2 kg/m2) with OC, who underwent elective oncological surgery in University Medical Center Mainz between 2008 and 2019 were preoperatively classified with the selected global health assessment tools as frail or non-frail. The rate of preoperative anemia (hemoglobin ≤ 12 g/dl) and perioperative transfusions were significantly higher in the G8-frail group (65.9% vs. 34.1%; p = 0.006 and 62.7% vs. 41.8%, p = 0.031; respectively). In addition, patients preoperatively classified as G8-frail exhibited significantly more postoperative clinical in-hospital complications (27.8% vs. 12.5%, p = 0.045) independent of chronological age and BMI. In contrast, ECOG PS and ASA PS did not predict the rates of postoperative complications (all p values > 0.05). After propensity score matching, the complication rate in the G8-frail cohort was approximately 1.7 times more common than in the G8-non-frail cohort.ConclusionPreoperative frailty assessment with the G8 Score identified elderly women with OC recording a significantly higher rate of postoperative in-hospital complications. In G8-frail patients, preoperative anemia and perioperative transfusions were significantly more recorded, regardless of chronological age, abnormal BMI and surgical complexity. Standardized preoperative frailty assessment should be added to clinical routine care to enhance risk stratification in older cancer individuals for surgical patient-centered decision-making.