Global Leadership Research Articles

Global Power Shift and Foreign Policy Choices for Pakistan

The shifting global order suggests arrival of the world away from the U.S.-led liberal unipolar order. The rise of the rest, notably, the Chinese vision reflected in its Belt and Road Initiative (BRI) has defied the U.S. global hegemony. For example, China’s growing wealth and power, Russia’s resurge and belligerence, Europe’s pursuit for strategic autonomy, India’s rise and its strategic balancing, turmoil in the Middle East and its inclination to Asia suggest a world slipping away from the U.S.-led hegemonic liberal order. The U.S., which once was a lead player, is unlikely to play its global leadership role to manage global governance alone, and even not China is yet close to replacing it. Thus, the argument is that the U.S. global hegemony is waning while the world has entered a new era of bumpier multipolarity with several interdependencies. Consequently, the balancers, not the hedgers and/ or bandwagoners will capitalize on the new world order. Pakistan’s security in this context, is inextricably linked to the global and regional evolving order, which demands the contours of its foreign policy centred on a balancing act.

Ultrasound-based upper limb muscle thickness is useful for screening low muscularity during intensive care unit admission: A retrospective study

Malnutrition is associated with poor outcomes. Muscle mass is an important malnutrition indicator included in Global Leadership Initiative on Malnutrition (GLIM) criteria. Although bioelectrical impedance analysis and dual-energy X-ray absorptiometry are common muscle mass assessment methods, they are unreliable during intensive care unit (ICU) admission due to the influence of dynamic fluid changes. We hypothesized that ultrasound-based upper limb muscle assessment would be useful for assessing muscularity at ICU admission. We retrospectively analyzed prospectively obtained ultrasound data from patients admitted to an ICU. We excluded patients without computed tomography (CT) imaging of the third lumbar vertebra within 2 days of ICU admission. Primary outcomes were the diagnostic utility of ultrasound-based upper limb muscle thickness for assessing low muscularity by CT. Low muscularity was defined as a skeletal muscle index of 36.0cm2/m2 for males and 29.0cm2/m2 for females at the cross-sectional area of the third lumbar vertebrae. Secondary outcomes of this study included the relationships between upper limb muscle thickness and biceps brachii muscle cross-sectional area, quadriceps femoris thickness, rectus femoris cross-sectional area. Among 64 patients assessed by ultrasound, 52 had CT examination records and were included in the analysis. The mean age was 70±13 years, and the mean body mass index was 23.3±4.2kg/m2. Upper limb muscle thickness had the discriminative power to assess low muscularity at an area under the curve of 0.77 (95% CI [confidence interval], 0.63-0.91); the cutoff value (26.8cm) had 84.6% sensitivity and 66.7% specificity. The upper limb muscle index had the discriminative power to assess low muscularity at an area under the curve of 0.80 (95% CI, 0.68-0.93); the cutoff value (9.9mm/m2) had 76.9% sensitivity and 71.8% specificity. Upper limb muscle thickness was correlated with upper limb muscle cross-sectional area, quadriceps femoris muscle thickness, rectus femoris muscle cross-sectional area (r=0.39-0.76, p<0.01, n=52). Ultrasound-based upper limb muscle thickness assessments can screen for low muscularity upon ICU admission.

Ideologeme of Justice and Anticolonial Discourse as Justification for Türkiey’s Foreign Policy

The article critically examines how Türkiey justifies its proactive foreign policy through the concept of justice. The study analyzes Turkish discourse, blending Islamic teachings with an anticolonial stance, to characterize the understanding of justice. Initially used to legitimize opposition against secular elites, justice now serves as a tool for global leadership, mediation in conflicts involving Muslims, and regional focus on post-Ottoman states. It counters political opponents, gains negotiating advantages in EU accession talks, supports aspirations for a UN Security Council seat, and extends military presence beyond the region. The study concludes that justice grants moral legitimacy to Türkiye’s foreign policy decisions, particularly resonating with Muslim audiences.Rooted in Islamist principles and an anticolonial discourse, Türkiye positions itself as a just leader opposing historical oppression by the West. The concept of justice is crucial in shaping Türkiye’s foreign policy, establishing its authority as a just and moral actor internationally. By leveraging justice, Türkiye aims to assert leadership, mediate conflicts, and prioritize historically significant regions. Understanding the ideologeme of justice provides insights into Türkiye’s strategic decision-making and its aspiration for a just and influential role globally.

How does culture influence a Country's travel and tourism competitiveness? A longitudinal frontier study on 39 countries

The greater competitiveness of a firm improves the chances of its success. Likewise, countries are constantly attempting to improve their travel and tourism competitiveness to attract global tourists. In this study, we present a theoretical framework linking the culture of a country and its travel and tourism competitiveness. We adopted the theoretical foundation of global leadership and organizational behavior effectiveness (GLOBE) cultural values and practices to examine the panel effects of culture on competitiveness. We conducted a longitudinal study by using secondary data of 39 countries from 2011 to 2021. Results show that the culture of a country influence its travel and tourism competitiveness. Furthermore, we provide empirical evidence by performing longitudinal frontier analysis to determine which GLOBE model, that is, cultural practices or cultural values, is appropriate for future studies. Findings of this longitudinal study contribute to the novel understanding of competitiveness and culture.

US - China Competition for Global Leadership - An Alternative Perspective

This article investigates China’s prospects of assuming a global leadership role in a postAmerican world. It disputes the position of a growing group of American scholars who strongly defend America’s lead role in global politics and advance the argument that there is no alternative to US leadership of the current world order. On the contrary, this article argues that the sense of a relative decline in US power, exacerbated by China’s rise as a gigantic economic power in recent years, threatens to displace the US as the global leader. It concludes that Beijing may not, however, aim to redesign and reconstruct a new world order altogether, as its interests are best served within the framework of the existing post-war world order. In other words, China’s selfinterests would dictate it to lead the world while maintaining the basic structure of the USengineered post-war world order

OPENING THE DOOR TO NEW LEVELS OF LEADERSHIP

AbstractThe author, a global executive leadership coach, speaker, and author, writes about how she first met Frances Hesselbein as did many other leaders, through the pioneering executive coach Marshall Goldsmith. “Even though I’d been advocating for a more empathetic approach when coaching executives,” the author writes, “it was as if Frances brought into sharp focus something that had until then remained fuzzy, broadening and elevating my understanding of leadership to a spiritual level. With a few words, she had just unlocked a door in my mind.” The author’s tribute to Frances concludes: “She made everyone feel seen and heard, putting her ego aside to light a spark in others. The spark she lit in me profoundly shaped my perspective on leadership and my coaching practice. My hope is that I’m in turn unlocking doors for othersࣧdoors to becoming the best version of themselves.”

Anthropometric measures and physical examination could be used to assess phenotypic GLIM (Global leadership initiative on malnutrition) criteria in heart failure patients

Background and aimsThe assessment of muscle mass using technology-based methods is less commonly performed when applying the Global Leadership Initiative on Malnutrition (GLIM) criteria due to the lack of skilled clinical nutrition practitioners and/or equipment. Based on the predictive validity of poor health outcomes and feasibility in clinical practice, this study aimed to analyze whether the measurement of calf circumference (CC), mid-upper arm circumference (MAC), and the physical examination could be used as substitutes for muscle mass assessment, as well as handgrip strength (HGS) used as a substitution when applying the GLIM criteria in hospitalized HF patients. Methods and resultsFrom June 2022 to January 2023, a single-center prospective study including 216 patients was performed. Additionally, covariates were identified by a directed acyclic graph. The multivariate logistic regression analysis was also used to analyze and compare the association between poor health outcomes and malnutrition (based on 5 types of GLIM criteria). Cohen-kappa coefficient and TELOS-feasibility score were calculated. The prevalence of malnutrition ranged from 35.2% to 42.6%, depending on the tool used. After adjusting for covariates, malnutrition assessed using CC, MAC, or physical examination within the GLIM criteria was independently associated with poor clinical outcomes (90-day HF-related readmission or all-cause mortality and prolonged hospital stay) but not with HGS. ConclusionCC, MAC and results from physical examination but not HGS may serve as a substitutive metric of muscle mass contained in the GLIM criteria to diagnose malnutrition and predict poor clinical outcomes among HF patients. Registration numberThis study was registered at Chinese Clinical Trial Registry.(ChiCTR2200057876) on 20 Mar. 2022.

Leadership competencies developed during a short-term domestic study tour: An exploration of participants’ perceptions

As short-term study abroad tours seek to develop globally competent leaders within the agricultural industry, the rich diversity present within the United States has led to the inception of short-term domestic study tours. To improve how global leadership competencies are developed among adolescent participants, understanding competencies gained during short-term international and domestic cultural immersion trips is vital. This case study analysis sought to explore state FFA officer perceptions of leadership competencies developed through participation in the National FFA Organization’s International Leadership Seminar for State Officers (ILSSO) which pivoted to a domestic study tour for 2022. The findings indicate participants perceived agricultural exposure and networking with peers as the development of leadership competencies. Participants also expressed perspective shifts around agricultural production methods and varied cultural experiences in the state of California. Recommendations include designing leadership curriculum for both short-term abroad and domestic tours with a framework grounded in leadership theory and replicating this study to compare findings in various contexts. Similar studies should also be conducted to assess outcomes of leadership development programs designed by the National FFA Organization.

Culture and Corporate Decarbonization Efforts: A Time-Varying Analysis and Topology Approach

This study examines the influence of culture on corporate responses to climate change. Given the inherent uncertainty associated with climate change, cultural values, as a non-market force, are expected to impact corporate’s decision making regarding decarbonization.To investigate this, a sample of large firms from 23 societies participating in the Carbon Disclosure Project (CDP) survey was analyzed, along with cultural measures assessed by the Global Leadership and Organizational Behavior Effectiveness (GLOBE) study. The findings of this study reveal that cultural values have diverse effects on corporate decarbonization efforts. Specifically, a preference for avoiding uncertainty and a future-oriented perspective tend to foster decarbonization, while a strong focus on performance appears to hinder such efforts. Additionally, the relationship between culture and decarbonization demonstrates a time-varying characteristic, indicating the influence of culture on carbon performance is contingent upon the evolution of carbon-related institutions over the study period.

Analysis of the United Arab Emirates' contribution to the sustainable development goals with a focus on global health and climate change

PurposeThe world is confronted by various current development challenges, including global health security and climate change. The rapid growth of these challenges warned all nations regardless of their development or geographical position. As an emerging international power, the United Arab Emirates (UAE) was among these nations and is viewed as a proactive key actor.Design/methodology/approachThis review was conducted as a thematic synthesis from 27 studies, reports and publications along with authors' insights. Using MS Word and Excel programs, three stages of data exploration, extraction and synthesis and analysis were applied. Data gathering, analysis and thematization and compilation.FindingsThe UAE is giving significant attention to global health and climate change. Over the past 20 years, multipolicies, strategies and bodies were developed to lead the national, regional and global SDGs. Global health and climate change became the most two notable priorities on the government agenda and its strategic thinking is that both priorities can no longer be overlooked. Nationally, the UAE has made significant economic, scientific, social and health growth. Building a resilient and world-class healthcare system was one of six national priorities of the achieved UAE National Agenda 2021. Globally, UAE has proved its global health leadership by ensuring lasting and collective multilateral partnerships and collaborations that led to remarkable achievements in global health and climate change. Examples on the global scale: partnership with the World Health Organization (WHO) to target billions of people of the world's population and ensure they get Universal Healthcare Coverage (UHC) without financial hardship, the partnership between UAE and Bill and Melinda Gates Foundation to establish the Global Institute for Disease Elimination (GLIDE) to fight diseases and put an end to polio. Additionally, the state's role in the COVID-19 global efforts such as vaccine development, supply chain and distribution targeted low- and middle-income countries (LMIC). The UAE has shown a constant commitment to climate change mitigation and building a sustainable ecosystem by hosting global organizations, leading initiatives, supporting countries and is now organizing the 28th Conference of the Parties (COP28) this year. Great opportunities can be exploited to promote the country's contributions through further investment in cooperation, research and technology for better knowledge, sound policies, and innovative solutions for all regional and global health and climate change challenges. Originality/valueThis review is a fresh evidence-synthesizing attempt to document the role of the UAE. This role is well placed to play an additional major role with all partners to address these pressing challenges by boosting its role, especially in the Middle East region and advancing a new regional-oriented revolutionary expanded developmental plan that centered on low-resource countries empowerment, multilateralism, intersectionality and lasting collaborations.

GLIM-diagnosed malnutrition predicts mortality and risk of hospitalization in systemic sclerosis: A retrospective study

BackgroundMalnutrition is a well-known risk factor for morbidity and mortality in many clinical settings and only few studies assessed the role of malnutrition on systemic sclerosis (SSc) patients’ outcomes. The aim of this retrospective study was to evaluate the role of malnutrition as a predictive risk factor for mortality and/or hospitalization in SSc patients during a 4-year follow-up. MethodsOne hundred and one SSc patients were included in the study. Biochemical analyses, disease activity index, disease severity scale and anthropometric data were recorded at enrollment. Malnutrition was assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria. ResultsMalnutrition according to GLIM criteria was found in 22 patients (21.8%). During a 4-year follow-up, 20 (19.8%) SSc patients died or were hospitalized for all causes and 11 of them (55.0%) were malnourished. Kaplan-Meier curves showed that event free-survival for composite end-point of mortality and risk of hospitalization was significantly shorter in malnourished than in non-malnourished patients (p<0.001). The survival probability at 4 years was 0.885 (95% CI=0.818–0.959) in the non-malnourished group and 0.500 (95% CI=0.329–0.759) in the malnourished group (p<0.001). In multivariate analysis, malnutrition [HR=4.380 (95% CI=1.706–11.243), p = 0.002] was the most significant predictive risk factor for the composite end-point.Also, female gender [HR=0.157 (95% CI=0.055–0.449), p<0.001], age [HR=1.0450 (95% CI=1.011–1.090), p = 0.012] and disease severity scale [HR=1.269 (95% CI=1.089–1.479), p = 0.002] were predictive factors for the composite end-point. ConclusionsMalnutrition according to GLIM criteria represents a significant predictive risk factor for composite end-point of mortality and risk of hospitalization in SSc patients.

The EU’s 2020 summit on the COVID recovery fund: leading the divided house to a consensus

Research methodology The writing of this case study was triggered by the numerous media reports in 2020 that talked about the EU nations losing its solidarity. EU being a very appropriate example of economic, monetary and customs union while teaching theories of economic integration and international relations, the post-pandemic approach of EU leadership to rebuild the crisis-ridden member nations seemed an excellent material for developing a teaching case study. The case study was written based on secondary data and published information available. Enough desk research was undertaken to build the characterisation of the protagonists and due diligence done to chronologically report all facts of the case as the story developed. It was decided to build the epilogue into the case study so that the case analysis had enough depth. Case overview/synopsis The case is set in 2020 when the global economy was reeling under the massive impact of a lockdown and the aftermath. The case study examines the model of economic union in international business and the various challenges that governance of an association of nations such as the 27 member EU can throw up. It examines the conflict of interest that can arise among member nations during critical circumstances such as the pandemic and its massive tolls. EU had established itself as a critical international trade player and had already proven their might as a united entity to the world trade partners, given the fact that they were not only a customs union but also a monetary union. In this scenario when the pandemic threw them into the whirlwind of lockdown-induced crisis, the united front of the mighty EU all but crumbled. As the worst-hit economies of Italy and Spain struggled to pull themselves back to normalcy, EU experienced one of its worst solidarity crises. EU’s president Angela Merkel and ally French President Emmanuel Macron with support from the EU Council’s President Charles Michel stepped forward to resurrect the badly hit economies. They viewed this as the best opportunity to bring about a united front by coming together at Brussels for a summit when lockdown eased up in July 2020. It was to be a show of unity to jointly bail out the severely affected member nations by grants rather than loans. The summit, however, snowballed into bitter arguments and open bickering between the wealthy and not-so-wealthy members, and they could not agree upon the issue of debt vs aid. The fact that the EU was an agglomeration of 27 nations, which were far from homogenous in socioeconomic status, not to speak of divided political ideologies, only added dimensions to the dispute. Negotiations repeatedly hit roadblocks. Can the EU leaders lead their bitterly divided house to a consensus? Complexity academic level The case is suitable for graduate and post-graduate levels. Management courses where international business studies, international trade blocs and global leadership are part of curriculum can use the case to teach concepts of “Regional economic integration”, “Economic and Political union” and theories of “International relations” and “Negotiation”. It can also be ideally used in an executive management programme on “Global Leadership” to highlight the complexities of “governance of international associations” and “consensus building amidst diversity”.

Impact of Preoperative Nutritional Assessment on Other-Cause Survival after Gastrectomy in Patients with Gastric Cancer.

This study aimed to clarify the factors associated with death due to other diseases after a gastrectomy for gastric cancer. This retrospective cohort study included consecutive patients who had undergone gastrectomy between April 2008 and June 2018 for primary stage II-III gastric cancer. The primary outcome was other-cause survival. To identify prognostic factors for other-cause survival for univariate analysis, we used a Cox proportional hazard regression model. A total of 512 patients met the inclusion criteria. The average age was 67.93 years, and the average body mass index was 22.75 kg/m2, with 84 (16.4%) being moderately malnourished and 88 (17.2%) being severely malnourished, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria. The other-cause survival for the malnourished group was significantly worse than that for the normal group (p < 0.001). The prognosis was worse when the severity of malnutrition was worse (p < 0.001). Multivariate analysis showed that severe malnutrition was significantly independent of prognostic factors for other-cause survival (hazard ratio: 3.310; 95% confidence interval: 1.426-7.682; p = 0.005). Undernutrition, as defined by the GLIM criteria, is useful for the preoperative prediction of death due to other diseases after gastrectomy in patients with advanced gastric cancer.

Malnutrition accelerates the occurrence of infectious complications in patients with chronic kidney disease: A cross-sectional survey of 682 patients with chronic kidney disease.

To investigate the influencing factors of infectious complications in patients with chronic kidney disease (CKD) and provide a basis for clinical diagnosis and prognosis evaluation of CKD. A total of 682 patients with CKD were selected and divided into CKD stage 1-5 subgroups according to their glomerular filtration rate. Infectious complications, length of hospital stay, and total cost of hospitalization were recorded. The Global Leadership Initiative on Malnutrition (GLIM) diagnostic tool was used to assess the detection rate of malnutrition among patients. Univariate and multivariate analyses were performed in patients with and without infectious complications. The incidence rates of infectious complications in CKD stages 1-5 were 45.6%, 22.7%, 28.3%, 30.8%, and 40.4%, respectively. The overall detection rate of malnutrition among patients based on the GLIM criteria was 16.7%. The total detection rate of severe malnutrition was 14.2%, with all patients with severe malnutrition in CKD stages 3-5. The incidences of infectious complications in patients with and without malnutrition were 62.3% and 29%, respectively. Binary multivariate logistic regression analysis shows that malnutrition is a risk factor for infectious complications in patients with CKD, who are at 2.41 times higher risk than patients without malnutrition. There were significant differences in length of hospital stay and hospitalization costs between the patients with CKD with and without infectious complications (P < 0.01). Infectious complications are relatively common in patients with CKD. As CKD advances, the incidence of infectious complications increases. Moreover, malnutrition accelerates the occurrence of infectious complications in patients with CKD.

The Collaborative Power of Teachers to Strengthen Student’s Global Leadership Skills

This research was a Participatory Action Research (PAR) methodology to implement the project “The Collaborative Power of Teachers to Strengthen Student's Global Leadership Skills in Na-ngiw Wittayasan School”, which is part of the Doctoral Program in Educational Administration's research program on 21st-century education, Mahamakut Buddhist University, Isan Campus with the concept of "Cooperative Action for Better Change". From the Planning, Acting, Observing, and Reflecting (PAOR) 2 cycles. Cycle one for each semester in the academic year 2022, with 25 teachers as research participants and 640 students in the development target group and the objectives were: 1) To change the level of practice of the research participants and The Global Leadership Skills of students to improve. From the comparison of 3 phases: before and after the practice in the 1st cycle and after the 2nd cycle practice. 2) To create learning from practice and 3) to gain knowledge from practice. The results of the research revealed that 1) there was a change for improvement, respectively, for the teachers who were research participants, the average scores from the performance assessment results were higher, respectively, from 2.92 to 3.06 and 4.00. As for the students who are the target group for development, the Global Leadership Skills assessment was also at a higher level, respectively, from 2.47 to 3.17 and 3.59. 2) The research team, the research participants, and Na-ngiw Wittayasan School gained much proficiency. 3) Generate knowledge from practice that demonstrates the cause-and-effect relationship of the applied driving force that results in a change. Including, resistance to change and how to overcome resistance to change which in this research is called “Na-ngiw Wittayasan School Model: The Collaborative Power of Teachers to Strengthen Student’s Global Leadership Skills”

Exploring the paradox of gender preferred leadership in Kenya: a GLOBE study on gender egalitarianism and women in leadership

PurposeThe purpose of this study is to explore gender gaps, values and practices in a Sub-Saharan African (SSA) country, specifically to identify gender inequality in Kenyan leadership and propose suggestions for advancing gender equity.Design/methodology/approachThis Kenya study replicated the research design of the Global Leadership and Organizational Behaviour Effectiveness Project for gathering country data. It sampled middle and upper management in the commercial sector (finance and agriculture) and added the civic sectors of health care and education, using quantitative research (267 managers in over 100 organizations) and qualitative research design (30 interviewees from 23 organizations).FindingsGender had no apparent effect on leadership attributes nor on preferred modes of leadership. Statistical and thematic analysis revealed conflicting values and behaviours regarding gender equality and leadership. A high cultural dimension score on practices reflects a traditional leadership approach for male dominance, referred to as the Bwana Kubwa model. However, a high value score for gender equality reflects a more contemporary perspective, identified as the Inspirational Idealist. The gender gap presents a cultural paradox and a leadership constraint.Research limitations/implicationsThe Inspirational Idealist model advances African leadership theory as it identifies a preferred value-based paradigm of effective performance-based leadership. This is contrary to the prevalent patriarchal practices of the Bwana Kubwa (Big Boss) model, which reflects biased gendered preference.Practical implicationsMale and female leaders need to challenge the status quo and align leadership practices with the articulated cultural values expressed as an Inspirational Idealist model. It has considerable relevance to advancing African leadership theory and informing culturally relevant policies and contextualized practices focused on gender equity in leadership.Originality/valueThis research on practices and values pertaining to gender equality of Kenyan managers is the first in-depth managerial leadership study of any SSA country. It is unique in that it broadened the scope of study to include professional sectors, gender, age and ethnicity variables.

Monitoring the effect of perioperative nutritional care on body composition and functional status in patients with carcinoma of gastrointestinal and hepatobiliary system and pancreas.

The significance of nutritional care in the management of cancer, particularly in the surgical treatment of abdominal cancer, is increasingly acknowledged. Body composition analysis, such as the Bioelectric impedance assay (BIA), and functional tests, e.g., handgrip strength, are used when assessing nutritional status alongside general and nutritional history, clinical examination, and laboratory tests. The primary approach in nutritional care is individually adjusted nutritional counselling and the use of medical nutrition, especially oral nutritional supplements. The aim of the study was to investigate the effects of perioperative nutritional care on body composition and functional status in patients with carcinoma of the gastrointestinal tract, hepatobiliary system, and pancreas. 47 patients were included, 27 received preoperative and postoperative nutritional counselling and oral nutritional supplements (Group 1), while 20, due to surgical or organisational reasons, received nutritional care only postoperatively (Group 2). The effect of nutritional therapy was measured with bioimpedance body composition and handgrip measurements. Group 2 had a higher average Nutritional Risk Screening (NRS) 2002 score upon enrolment (3 vs. 2 points); however, there was no difference when malnutrition was assessed using Global Leadership in Malnutrition (GLIM) criteria. There was a relative increase in lean body mass and fat-free mass index (FFMI) 7 days after surgery in group 1 (+4,2% vs. -2,1% in group 2). There was no difference in handgrip strength. Our results indicate that combined preoperative and postoperative nutritional care is superior to only postoperative nutritional care. It seems to prevent statistically significant lean mass loss 7 days after surgery but not after 14 days or 4 weeks.

Impact of registered dietitian and dental hygienist involvement on functional outcomes in patients with dysphagia: triad of rehabilitation, nutrition, and oral management.

To investigate whether the involvement of both registered dietitians and dental hygienists results in greater improvement in swallowing function and activities of daily living (ADL) in patients with dysphagia undergoing rehabilitation. Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database, 433 met the study eligibility criteria in a retrospective cohort study. Patients were divided into two groups based on whether or not they received intervention by both registered dietitians and dental hygienists. Outcomes were changes in the Food Intake Level Scale (FILS) and the Barthel Index (BI) at initial and follow-up assessments. Multiple regression analyses adjusted for age, sex, sarcopenia, dwelling, Charlson comorbidity index, malnutrition diagnosed by the Global Leadership Initiative on Malnutrition, and initial FILS or BI were conducted to examine the relationship between the involvement of both registered dietitians and dental hygienists. The mean age was 80.5 and ± 10.7years, and 222 were female. Both registered dietitians and dental hygienists were involved in 242 (57%) patients. Median and interquartile range changes in FILS and BI were 1 (0, 2) and 15 (0, 32.5), respectively. In multiple regression analyses, the change in the FILS was significantly higher in the involvement of both registered dietitians and dental hygienists (standardized coefficient = 0.075, P = 0.033), however, the change in the BI was not significantly different between the groups. The involvement of both registered dietitians and dental hygienists improved swallowing function, but not ADL. Triad of rehabilitation, nutrition, and oral management may be useful for patients with dysphagia.

The efficacy of fat-free mass index and appendicular skeletal muscle mass index in cancer malnutrition: a propensity score match analysis.

Reduced muscle mass (RMM) is a phenotypic criterion for malnutrition; the appendicular skeletal muscle mass index (ASMI) and fat-free mass index (FFMI) are both applicable indicators in the global leadership initiative on malnutrition (GLIM) guideline. However, their sensitivity and prognostic effect remain unclear. Clinical data of 2,477 patients with malignant tumors were collected. Multi-frequency bioelectrical impedance analysis was used to obtain ASMI and FFMI. RMM was confirmed by ASMI (< 7.0 kg/m2 for men and < 5.7 kg/m2 for women) or FFMI (< 17 kg/m2 for men and < 15 kg/m2 for women). Propensity score match analysis and logistic regression analysis were used to evaluate the efficacy of FFMI and ASMI in diagnosing severe malnutrition and multivariate Cox regression analysis to determine the efficacy of RMM in predicting survival. In total, 546 (22.0%) and 659 (26.6%) participants were diagnosed with RMM by ASMI (RMM.ASMI group) and FFMI (RMM.FFMI group); 375 cases overlapped. Body mass index (BMI), midarm circumference, triceps skinfold thickness, and maximum calf circumference were all significantly larger in the RMM.FFMI group for both sexes (P < 0.05). A 1:1 matched dataset constructed by propensity score match contained 810 cases. RMM.FFMI was an influential factor of severe malnutrition with HR = 3.033 (95% CI 2.068-4.449, P < 0.001), and RMM.ASMI was a predictive factor of overall survival (HR = 1.318, 95% CI 1.060-1.639, P = 0.013 in the RMM.ASMI subgroup, HR = 1.315, 95% CI 1.077-1.607, P = 0.007 in the RMM.FFMI subgroup). In general, RMM indicates negative clinical outcomes; when defined by FFMI, it predicts nutritional status, and when defined by ASMI, it is related to poor survival in cancer patients.

Feasibility and criterion validity of the GLIM criteria in the critically ill: A prospective cohort study.

This study aimed to evaluate the feasibility and validity of the GLIM criteria in the ICU. Cohort study involving critically ill patients. Diagnosis of malnutrition by the Subjective Global Assessment (SGA) and GLIM criteria within 24 h after ICU admission were prospectively performed. Patients were followed up until hospital discharge to assess the hospital/ICU length of stay, mechanical ventilation duration, ICU readmission, and hospital/ICU mortality. Three months after discharge, the patients were contacted to record outcomes (readmission and death). Agreement, accuracy tests and regression analyses were performed. GLIM criteria could be applied to 83.7% of 450 patients (64 [54-71] years, 52.2% men). Malnutrition prevalence was 47.8% by SGA and 65.5% by GLIM criteria, that presented an AUC equal to 0.835 (95%CI, 0.790-0.880), sensitivity of 96.6%, and specificity of 70.3%. Malnutrition by GLIM criteria increased the odds of prolonged ICU length of stay by 1.75 times (95%CI, 1.08-2.82) and ICU readmission 2.66 times (95%CI, 1.15-6.14). Malnutrition by SGA also increased the odds of ICU readmission and the risk of ICU and hospital death more than twice. The GLIM criteria were highly feasible and presented high sensitivity, moderate specificity, and substantial agreement with the SGA in critically ill patients. It was an independent predictor of prolonged ICU length of stay and ICU readmission, but it was not associated with death such as malnutrition diagnosed by SGA. This article is protected by copyright. All rights reserved.