Nutrition Consultation Research Articles

Cross-Sectional Nutrition Profile of Palliative Home Care Clients in Ontario and Performance of the interRAI Palliative Care Nutrition Clinical Assessment Protocol.

The nutrition profile of palliative home care clients is unknown. This study describes this group and their nutrition issues and evaluates the performance of the interRAI nutrition Clinical Assessment Protocol (CAP). This was a cross-sectional secondary analysis using Ontario interRAI Palliative Care (interRAI PC) Assessment data. The sample represents 74,963 unique Ontario home care clients assessed between 2011 and 2018. Frequencies and standardized differences (stdiffs) of nutrition characteristics were presented for cancer (n = 62,394) and noncancer (n = 12,569) diagnostic subgroups. Rates of triggering the nutrition CAP were presented by nutrition issue to evaluate its performance. Of this sample, 16.7% were ≥85 years of age, 52.6% had a prognosis between 6 weeks and 6 months, and 41.4% required assistance with eating. The prevalence was higher among those with nervous/mental/behavioral disorders (72.6%) compared with those with cancer (37.6%; stdiff = 0.75). However, most nutrition issues experienced were similar (stdiff < 0.20) across diagnostic groups. Of the entire sample, 21% triggered the nutrition CAP, indicating a need for further evaluation or intervention. Yet, 73.4% of those who experienced dry mouth, 71.8% of those who required assistance with eating, and 68.4% of those who received a nutrition consult within the last 3 days did not trigger the nutrition CAP. Nutrition issues are prevalent in palliative home care clients, regardless of diagnosis; yet the nutrition CAP identified a small fraction of this group. There is a need to focus research and care guidelines toward life-limiting illnesses beyond cancer and address nutrition-related issues in this population.

Pengaruh konsultasi gizi terhadap asupan karbohidrat dan kadar gula darah pasien Diabetes Mellitus Tipe II di Poliklinik Endokrin RSUZA Banda Aceh

Background: Wasting is nutritional status in school children. In the community it is known as thin nutrition which is an important public health problem because it has a big impact. Thin nutrition can increase the risk of illness and death in children Diabetes Mellitus is a disorder of carbohydrate metabolism caused by a deficiency of insulin released by the pancreas gland both relative and absolute. In addressing the prevalence of Diabetes Mellitus in the Regional General Hospital dr. Zainoel Abidin Banda Aceh held nutritional consultations in outpatients and inpatients aimed at making changes to the knowledge, attitudes, and behavior of patients' eating patterns. In Aceh, in 2016 the number of Diabetes Mellitus patients was 29% and increased in 2017 by was 30%.Objectives: To determine the effect of nutritional consultation on carbohydrate intake and blood sugar levels in Type II Diabetes Mellitus patients.Methods: This type of research is descriptive analytic, sampling is done by purposive sampling and obtained 30 samples. This research was conducted in June 2017 at in Endocrine Polyclinic of RSUZA hospital Banda Aceh. The data taken are primary and secondary data. Data collection by interview using a questionnaire, food recall with interview techniques and examination of blood sugar levels before and after consultation. Data analysis uses T-Dependent Test (Paired Sample T-Test) with SPSS.Results: The results showed that there were significant differences in carbohydrate intake between before and after nutrition consultations were given in patients of Diabetes Mellitus Type II with a p-value= 0.001. Blood sugar level also shows the difference between after being given a nutrition consultation with a value of p-value= 0.000 in patients of Diabetes Mellitus Type II in the in Endocrine Clinic of RSUZA hospital, Banda Aceh.Conclusion: Nutrition consultation has a significant effect on carbohydrate reduction and blood sugar levels in patients with Diabetes Mellitus Type II in the Endocrine Polyclinic of RSUZA Banda Aceh. Keywords

Diabetes Knowledge and its relationship with metabolic control and comorbidities in type 2 diabetes patients

Background: Education in diabetes patients is key in the intervention to avoid complications and develop new and better habits. It is necessary to know the relationship between the current diabetes knowledge of these patients with their metabolic control and the presence of comorbidities. Objective: To evaluate the diabetes knowledge and its probable association with their metabolic control and comorbidities in type 2 diabetes patients. Methods: A validated questionnaire (Diabetes Knowledge Questionnaire, DKQ) was applied to 134 patients who attended a nutrition consultation at the UMF7-IMSS. Their sociodemographic data, metabolic parameters and presence of comorbidities were determined. Results: 89 patients were women (66.4%). The mean age was 53 years; body weight 75.5 kg (95% CI: 72.8-78.3); glucose 201.2 mg/dL (95% CI: 187-215); cholesterol 205 mg/dL (95% CI: 190.8-219.1); triglycerides 260.7 mg/dL (95% CI: 240.3-281.1). The level of diabetes knowledge is low, a negative relationship was found between age and the number of right answers in the DKQ. High level of general metabolic alterations was found in most of the subjects studied; an increase in the number of comorbidities was observed as glucose levels increased. In the present study, no correlation was found between the level of knowledge in diabetes and the degree of metabolic control. Conclusion: Although patients know the consequences of their disease status, they have difficulty identifying key aspects to prevent complications and promote adequate metabolic control. This work identifies the need to develop studies on effective educational strategies to minimize knowledge gaps about this condition.

Compensation and Benefits Survey 2019

Compensation and Benefits Survey 2019

The effect of fenugreek seed supplementation on serum irisin levels, blood pressure, and liver and kidney function in patients with type 2 diabetes mellitus: A parallel randomized clinical trial

ObjectivesThis study was designed to determine the effects of fenugreek seed (FS) on serum irisin levels, blood pressure, and liver and kidney function in patients with type 2 diabetes mellitus (T2DM). MethodsIn an 8-week randomized controlled clinical trial, T2DM patients (n = 50) were assigned to the intervention (5 g FS powder, 3 times a day) or control group. Both groups received anti-diabetic drugs and nutritional consults. Serum samples were collected and blood pressure was measured at baseline and end of the trial. Data on dietary intake and physical activity was determined using the questionnaires. ResultsCompared to the control group, FS consumption resulted in a significant decrease in fasting plasma glucose (FPG) (p = 0.024), as well as a significant change in serum alanine aminotransferase (ALT) (p = 0.02) and alkaline phosphatase (ALP) (p = 0.001). Within-group analysis showed a significant decrease in aspartate aminotransferase (AST) (p = 0.014), systolic blood pressure (SBP) (p = 0.001), and irisin (p = 0.001) in the FS group, and a significant increase in creatinine (Cr) (p = 0.001) and decrease in estimated glomerular filtration rate (eGFR) (p = 0.001) in the control group. FS consumption did not have any significant effect on diastolic blood pressure (DBP) and blood urea nitrogen (BUN). ConclusionFS intake has some beneficial effects on FPG, SBP, and some liver and kidney function tests in patients with T2DM. Further studies are required to investigate the effect of FS on irisin levels. Trial registration number http://www.irct.ir, code: IRCT20190618043924N1

Quality Improvement Project to Promote Identification and Treatment of Children With Obesity Admitted to Hospital.

Among children hospitalized for acute problems, comorbid obesity is commonly unaddressed. The objective was to improve identification and initial management of obesity among hospitalized children. In collaboration with nurses and dietitians, pediatric hospitalists of 2 children's hospitals conducted a quality improvement project to improve body mass index (BMI) documentation, obesity diagnosis, diet, and nutrition consultation through clinician education, development of computerized clinical decision-support system tools, and workflow modifications. Participants received monthly performance feedback. Among those with elevated BMI, diagnosis rose to 70.2%; a documented obesity diagnosis was associated with being 35 times more likely (P < .001) to receive at least 1 intervention while hospitalized. Participants reported an increase in skill in (27%), comfort with (27%), and knowledge of (33%) obesity management. Improvement in health care provider recognition and management of obesity in the inpatient setting is achievable. Additional work is needed to identify how best to sustain desired practice patterns.

The Perceived Importance, Emphasis, and Confidence in Veterinary Nutrition Education of First-Year Canadian and US Veterinary Students.

Veterinarians play a critical role in providing nutrition consultation and supporting clients to adopt healthy dietary habits for their pets; thus applicable, informative nutrition education in veterinary schools is essential. The aim of this study was to explore incoming veterinary students' perceived importance, emphasis, and confidence in the veterinary nutrition education they will receive. First-year veterinary students at all 5 Canadian and 5 randomly selected US veterinary schools were invited to complete a 31-item questionnaire. Response rate was 34.6% (n = 326). Descriptive statistics and multivariate logistic regression were performed. While most students (92%) considered nutrition education to be an important component of veterinary training, 64% felt it will not be a subject of great emphasis. Veterinary students at schools with a board-certified veterinary nutrition faculty were more likely to perceive higher emphasis on nutrition education (p < 0.001). In the multivariate analysis, academic self-efficacy was a positive predictor of students' perceived confidence in how well they anticipate their nutrition education that will prepare them for their clinical roles (p = 0.003). Examining the perceptions of veterinary students entering veterinary school is an important aspect to consider in the design and delivery of a veterinary nutrition curriculum and maybe equally important for students entering other professional health programs.

Quantifying Clinical Pharmacist Activities in a Tertiary Care Hospital Using Key Performance Indicators.

Background: Key performance indicators (KPIs) are a set of measures used to help an organization in assessing and achieving goals critical to success. The aim of this study was to quantify the clinical pharmacists' contribution to patient care in a tertiary care hospital using predefined clinical pharmacy KPIs. Method: This study was a prospective, observational study conducted by the Pharmaceutical Care Division of a tertiary care hospital. Clinical pharmacy KPIs were submitted by each clinical pharmacist on a monthly basis for 12 months during 2017. All clinical pharmacists up to the managerial level were included in the study. Data were analyzed, stratified, and correlated using Microsoft Excel, JMP statistical software, and Spearman correlation. The study was approved by the hospital's Office of Research Affairs, RAC number 2171-080. Results: A total of 42 clinical pharmacists reviewed 104 728 patient encounters. They performed an adjusted average of 1221 interventions with an acceptance rate of 91.5%, 273 medication reconciliations, 325 discharge consultations, 332 pharmacokinetic consultations, 700 total parenteral nutrition consultations and follow-ups, and 12 688 electronic order verifications per clinical pharmacist per year. These interventions collectively resulted in a cost saving of $316 087.65 per clinical pharmacist per year. Statistical significance with positive correlation was noted for a number of precepted residents/students and clinical pharmacists' experience (R = 0.382, P = .013) and board certification (R = 0.428, P = .0047). Conclusion: Clinical pharmacy KPIs were able to quantify the clinical pharmacists' contributions to patient care and cost savings, which may lead to improve, standardize, and benchmark clinical pharmacy activities in the region.

Correlation of water consumption with nutritional status, metabolic risk and percentage of body fat in adults of Mexico City

AbstractThe promotion of water consumption has been identified by the government of Mexico as one of the main strategies to reduce the diet energy density in order to prevent the problems of overweight, obesity and other diseases. The aim of the present study was to determine the correlation of the water consumption with nutritional status, metabolic risk and percentage of body fat in adults of Mexico City. A sample of 12733 adults residing in Mexico City was obtained, of which 75.6% (n = 9 623) belongs to the female gender and 24.4% (n = 3110) belongs to the male gender. In the study those adults who were between 21 and 60 years old, with an average age of 39.59 ± 10.97 years, were included. The population was constituted in several health fairs celebrated in Mexico City from 2015–2018, in which nutritional consultation was provided. By correlating water consumption with nutritional status, metabolic risk and percentage of body fat, it was found that adults who consume a glass of water of 250 mL per day, have higher incidence of obesity, metabolic risk and percentage of body fat high (70.0%, 83.6% and 96.2, respectively), compared to adults who consume seven glasses of 250 mL of water per day equivalent to 1750 mL of water per day (40.4%, 63.8% and 92.9, respectively), finding a highly significant difference (p &lt; 0.01). In the present study it can be observed that adults who have optimal water intake have a lower incidence of obesity, metabolic risk and high percentage of body fat, data that agree with the literature. However, despite the fact that the multiple benefits of water intake have been documented, its consumption among the population in general is very low, so it is suggested to continue adding efforts to raise awareness among the population regarding the importance and benefits on health by staying well hydrated. Likewise, it is important to consider that the promotion of water consumption is an important component in strategies to promote healthy habits and lifestyles.

Nutrition Intervention, Oral Supplementation and Healing of Leg Ulcer in Adult with Sickle Cell Disease: A Rare Case Report

Leg ulcers (LU) are one of the most frequent complications in individuals with sickle cell disease (SCD). Old reports and unofficial documents found at the Nutrition Outpatient Clinic in a reference center for hematological diseases (NOC/RCHD) describe the use of oral supplement (OS) hypercaloric, hyper protein and arginine-rich (OS/HHA) for the healing of leg ulcers. The aim is to describe a rare case of a patient with sickle cell disease and leg ulcer submitted a dietetics orientations and intervention with OS/HHA. A 31-year-old male patient had been performing clinical treatment of sickle cell disease genotype SS for eight years at the RCHD of Rio de Janeiro. He had a unilateral ulcer on his right ankle for about six years, performing dressings by a Nursing team. He started follow-up at the NOC, being classified as grade III malnutrition. 13 nutrition consultations were performed during the study and 10 nutritional intervention consultations were carried out offering an OS/HHA containing 6 g/day of arginine, twice daily for 80 days. For ethical reasons, the participant was informed about the case report, agreeing and signing the consent form and the authorized image use term. Based on the analysis of food intake during the intervention period, energy consumption was on average 2.706 Kcal, including OS/HHA. Leg ulcers were found with regular margins and macerated in some areas, an ulcerated lesion with adherent and purulent exudate with 80% adherent thickness and in large quantities on the 1st day of supplementation. After eighty days, the lesion had regular margins and epithelial tissue, an ulcerative bed with 100% granulation, tissue and scarce exudate, showing improvement in healing. The patient presented an improvement in the nutritional status and leg ulcer healing. It is necessary to perform experimental research to corroborate or not the results observed in this rare case report.

DIETARY INTAKE AND SELF-REPORTED NUTRITION CONCERNS OF PEOPLE WITH PARKINSON’S AND THEIR INFORMAL CAREGIVERS

Dietary recommendations for managing Parkinson’s disease (PD) can be confusing for people with PD (PwPD) and their informal caregivers (ICGs) who often have the responsibility to buy and prepare foods. PwPD (63-78 years of age) and their ICGs (39-75 years of age) completed two 24-hour dietary recalls and semi-structured, dyadic interviews which were conducted to gather information about dyads’ (n=9) nutrition concerns. Calorie, macro- and micro-nutrient intake were averaged over two days and compared to the National Academy of Sciences’ dietary reference intakes. Independent t-tests and the Mann-Whitney U tests compared PwPD and ICG. Interviews were audio-recorded, transcribed verbatim, and analyzed for preliminary themes. Mean calorie intake was 1766.6±658.5 kcal/d; the majority of calories were from carbohydrates. Calorie and nutrient intake between PwPD and ICG did not differ. All participants were below recommendations for fiber (17.2±7.9g/d) and potassium (2213.3±890.0mg/d) and exceeded recommendations for sodium (2741.2±1396.9mg/d) and added-sugars (59.5 ±38.3g/d). More than half of participants (55.6%) agreed an eating plan to manage PD symptoms is important and that a nutrition consultation would be helpful. Emerging themes from qualitative interviews include: nutrition concerns related to PD symptoms, managing other conditions and PD, perceptions regarding diet quality, impact of diet on PD symptoms, and complementary medicine. In conclusion, there were no differences in dietary intake between PwPD and ICG, and participants presented with lack of adherence to recommended dietary reference intakes. Sub-optimal dietary intake and self-reported nutrition concerns strongly suggest including both nutrition professionals and ICGs when providing care for PwPD.

Human Milk and Breastfeeding Outcomes in Infants With Myelomeningocele

In 2015, the study setting instituted an enteral feeding pathway, "PO Ad Lib Feeding to Support Breastfeeding." Many infants admitted to the study setting's newborn/infant intensive care unit with a primary diagnosis of myelomeningocele fall within the setting's enteral feeding pathway's inclusion criteria. The primary objective of this study is to describe the enteral feeding exposure and trends, by type and method, among infants with myelomeningocele. Retrospective descriptive cohort design. Participants were infants with a primary diagnosis of myelomeningocele between 2013 and 2016. The electronic health record was used to collect descriptive data (demographics and daily enteral feeding exposure). Data were analyzed using descriptive statistics. More than 80% (n = 148, 81.3%) of the participants' mothers had a personalized prenatal nutrition consultation and the majority of those mothers (n = 102/118, 86.4%) had a goal to breastfeed for more than 6 months. The majority (n = 144/182, 79.1%) of the study cohort was exposed to mothers' own human milk as their first feed. It is also notable that 80.8% (n = 147) fed at least once directly at the breast; however, infants were also fed by bottle or by feeding tube. It demonstrates that with appropriate evidence-based breastfeeding interventions, mothers having infants with myelomeningocele can expect to feed their infants human milk as well as direct breastfeed. Future research should focus on human milk/breastfeeding outcomes of infants with myelomeningocele post-hospital discharge. Long-term breastfeeding may have an important role in the development of infants with myelomeningocele.

Utilizing technology for malnutrition screening and referrals to nutrition services.

284 Background: The incidence of disease-related malnutrition in oncology patients ranges from 40-80%. This is the highest of all hospital patient groups. Malnutrition is associated with decreased quality of life, increased healthcare costs and intolerance to treatment. Screening for nutrition risk is often lacking in outpatient settings. Electronic health records could be utilized to improve the delivery of validated nutrition screening tools such as the Malnutrition Screening Tool (MST) in outpatient oncology settings. Methods: We designed a pilot project (Feb-July 2018) to administer the MST for outpatient oncology patients seen at the Fred and Pamela Buffett Cancer Center (FPBCC) using an electronic medical record system. “Best Practice Alerts” (BPAs) were used to notify the nursing staff of a patient with a screen that was positive for nutrition risk (MST score ≥3). The BPA recommended a referral to nutrition services; nursing staff could choose to “order” or “do not order" a Nutrition Consult. Results: A total of 2,672 patients received MST screening during the pilot. Out of these, 223 (8%) had a positive screen for nutrition risk; 197 of these were eligible for a nutrition services referral. A BPA “fired” 152 times out of 197 eligible patients (77%). Of the197 eligible patients, 58 (29%) were actually referred to nutrition services. Of these 58 referrals, 43 (74%) were triggered based on a BPA, while the remaining referrals were received outside of a BPA. BPAs failed to fire 45/197 times (23%). Conclusions: An EHR-based nutrition screening system to increase referrals in patients identified at nutrition risk in an outpatient oncology setting was effective for 29% of eligible patients. Barriers encountered included failures in technology as well as human factors. During the pilot it was discovered that the BPA was firing in a location in the chart where the nurse did not regularly work. There was not a consistent message as to the goals and outcomes during the pilot which resulted in lack of awareness by nurses to respond to the nutrition risk score. Utilizing an EHR-based nutrition screening tool is an effective way to identify patients at risk and refer them to appropriate resources in a timely and efficient way.

Metabolisable energy intake and growth of privately owned growing dogs in comparison with official recommendations on the growth curve and energy supply

The correct assumption of metabolisable energy (ME) requirement is essential for the nutrition consultation and diet formulation. In young dogs, too high energy supply can accelerate growth and thus lead to developmental orthopaedic diseases. The aim of the present study was to collect the data on ME intake and body weight (BW) development in privately owned growing dogs in order to compare these data with the current recommendations. Our hypothesis was that the actual ME intake of healthy young dogs would be lower than the actual recommendation. The data of 493 privately owned puppies (median age at first consultation 21weeks, the median expected mature BW 30kg) on ME intake, actual and expected mature BW were collected and compared with recommendations of the Society of Nutrition Physiology (GfE, Meyer and Zentek and NRC). In 243 dogs, there was a follow-up. The actual BW did not deviate systematically from the calculated expected BW (R2 =.929). The ME intake significantly decreased with age (p<.05) and significantly increased with expected mature BW (p<.05). There was no significant interaction between these two parameters (p>.05). Sex had no effect on the ME intake (p>.05). The ME intake of young dogs with a history of skeletal problems or of food allergy did not differ systematically from healthy dogs of similar age and expected mature BW. The ME intake was considerably below NRC recommendations, especially in younger puppies (>8-17weeks: 78%, >17-26weeks: 83% of NRC recommendation). A predictive linear equation for ME intake was developed: ME intake (MJ)=(1.063-0.565×[actual BW/expected mature BW])×actual BW0.75 .

Preoperative Nutrition Consults Associated with Decreased Postoperative Complication Rate and Decreased Length of Hospital Stay After Spine Metastasis Surgery

Preoperative malnutrition is associated with increased postoperative complication rate and hospital length of stay. However, the degree to which these risks can be mitigated by nutritional consultation has not been well described. To address this, we sought to determine if a preoperative nutrition consult was associated with decreased 30-day complication rate and hospital length of stay. Adult patients who underwent neurosurgical intervention for spinal metastases at a tertiary care institution between 2008 and 2016 were retrospectively reviewed. Stepwise multivariable linear regression analyses were used to identify associations with 30-day complication rate and hospital length of stay. Among 95 patients who met inclusion criteria, the average length of stay was 8.9 days and 40 patients (42.1%) experienced one or more postoperative complications. On multivariable analysis, 30-day complication rates were higher in patients with the absence of a preoperative nutrition consult, a Modified Charlson Comorbidity Index score of greater than 2 points, greater operative blood loss, and malnutrition (Nutritional Risk Index score <97.5). Furthermore, hospitalization duration was increased with the absence of a nutrition consult, malnutrition, congestive heart failure, and prior systemic therapy in the multivariable analysis. On multivariable analysis, receipt of a preoperative nutrition consult was associated with both decreased 30-day complication rate and shorter hospitalization. We therefore posit that greater implementation of nutritional counseling may help to decrease complication rates and expedite discharge in patients undergoing surgical intervention for spinal metastases.

Glucogenosis Hepática. Características clínicas, laboratoriales e imagenológicas en pacientes pediátricos menores de 15 años

Antecedentes: La glucogenosis (GSD) hepática es una enfermedad hereditaria autosómica recesiva caracterizada por la alteración del depósito de glucógeno en los tejidos. La enfermedad se presenta con hepatomegalia, debilidad muscular y retraso del crecimiento. Esta patología usualmente se diagnostica clínicamente a partir de los 6 meses de edad cuando la ingesta de alimentos del lactante es más espaciada y puede debutar con sintomatología de hipoglicemia. Debido a la inespecificidad de la presentación clínica de la enfermedad es muy importante la sospecha diagnóstica desde los centros de primer nivel de atención y su derivación oportuna a centros de especialidad. Objetivo: Evaluar y describir el perfil nutricional y clínico en pacientes menores de 15 años con Glucogenosis Hepática. Método: Se describe una serie de casos de 14 pacientes menores de 15 años con diagnóstico clínico de GSD hepática, atendidos en la consulta de Gastroenterología y Nutrición Pediátrica del Hospital Carlos Andrade Marín entre 2016 y 2018. El diagnóstico se lo realizó de acuerdo a la clínica que presentó cada paciente como la presencia de distensión abdominal, hepatomegalia, adinamia, retraso en el crecimiento y datos laboratoriales como niveles de glicemia en sangre periférica, transaminasas, y realización de elastografía entre los principales. Se analizaron datos sociodemográficos, antropométricos, de laboratorio (transaminasas, glicemia periférica) y elastografía hepática. Para el análisis de datos se creó una base de datos en Microsoft Excel 2013 y se procesó con el programa Epi Info 7. Resultados: En este grupo de casos, los tipos específicos de GSD hepática fueron tipo IX, 57,14% (8), tipo III, 28,57% (4) y tipo Ia-b, 14,29% (2) pacientes. La prevalencia de características clínicas ante la sospecha de la GSD hepática fueron: hepatomegalia 100% (14), y retraso en el crecimiento el 64,3% (9). De acuerdo a los exámenes de sangre periférica los valores promedio de transaminasas hepáticas (AST/TGO U/L) (ALT/TGP U/L) y glucosa, fueron de 364±384, 302±255 y 61±15 mg/dL, respectivamente. La elastografía con la que se evaluó el nivel de fibrosis hepática al momento del diagnóstico arrojó los siguientes resultados: F0 (no fibrosis hepática) en el 28,57% (4), F1 con el 28,57% (4), F2-F3 con el 35,71% (5), y F4 7,14%. Conclusión: La Glucogenosis es una patología que debería ser sospechada a tiempo en centros del primer nivel de salud para luego referir oportunamente los casos a los centros de referencia. La hepatomegalia y el retardo en el crecimiento son signos cardinales de alerta para la sospecha de esta patología.

Evaluation of a Nutrition Screening Tool to Identify Patients at Risk for Malnutrition

Determine if a nutrition screening tool (NST) successfully identified at-risk patients. The proposed malnutrition electronic clinical quality measure (eCQM) for screening is Completion of a Malnutrition Screening within 24 hours of Admission. It is necessary to evaluate NSTs to ensure accurate identification of at-risk patients. In a community hospital with an average census of 180 patients, registered nurses (RNs) complete an NST in the electronic health record on admission to determine the presence and significance of weight loss using the following questions:Have you had recent weight loss? Y/NIf Yes, was it intentional? Y/NWeight loss amount (lb)?Time frame? 1 week, 1 month, 3 months, 6 months, 1 yearUsual weight (lb)?If loss is significant according to the following scale, the RDN is automatically consulted.2% in 1 week5% in 1 mo7.5% in 3 mo10% in 6 mo20% in 1 yr In CY 2018, for patients diagnosed with malnutrition by a registered dietitian nutritionist (RDN), the RDN recorded the method by which the nutrition consult was triggered, and reasons why the NST did not trigger a consult. Of the 961 patients diagnosed with malnutrition upon initial assessment, the NST triggered a consult in only 393 (40.9%). Other triggers included:BMI < 19 247 (25.7%)MD/RN referral 167 (17.4%)Length of stay screening 48 (5.0%)NPO/clear liquid status 32 (3.3%)Patient care rounds 28 (2.9%)Braden score < 18 17 (1.8%)Ventilator protocol 16 (1.7%)Consult entered in error 13 (1.4%) Malnourished patients were not identified by the NST for the following reasons:Unknown (presumably the RN did not ask the weight loss question, or the patient indicated they hadn’t lost weight when they had) 250 (44.0%)Patient did not have weight loss 182 (32.0%)Unable to obtain information 81 (14.3%)Weight loss not significant 31 (5.5%)NST completed incorrectly or not at all 24 (4.2%) The NST did not identify a majority (59.1%) of malnourished patients. Of those not identified, 37.5% did not have significant weight loss. Further, the most common trigger after weight loss was low BMI. This suggests that an NST with only questions about weight loss will be insufficient in identifying patients at risk for malnutrition, especially those with chronic malnutrition, i.e. no recent loss but significant muscle/fat wasting and/or low BMI.

Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions.

Malnutrition is widely prevalent in cirrhosis patients, which can worsen sarcopenia, hepatic encephalopathy (HE), and overall prognosis. We aimed to define the frequency of nutritional assessments of patients with cirrhosis in retrospective and prospective (after educational training) cohorts and to evaluate prospective changes along with their effects on 90-day readmissions. This study was conducted in 2 phases. Retrospectively, records of hospitalized patients with cirrhosis from the university and Veterans Affairs Medical Center (VAMC) settings were reviewed to assess nutritional status, if a nutrition consultation occurred, the number of days patients were nil per os (npo) and received inadequate nutrition, and if nutritional management was guideline directed. In the prospective phase, after dedicated educational efforts directed at the stakeholders regarding nutritional guidelines for patients with cirrhosis, subsequently hospitalized cirrhosis patients had nutritional and 90-day readmission data collected for comparison between groups. In total, 279 patients were included in the retrospective phase (150 university/129 VAMC), and 102 VAMC patients were in the prospective phase. Cirrhosis severity, reason for admission, and hospital course were similar between groups regardless of cohort, ie, prospective versus retrospective or VAMC versus university. The prospective group had significantly more nutritional consultations and assessments (74.5% versus 40.1%; P<0.001) compared with the retrospective group regardless of comparisons between the VAMC and university cohorts. Both groups had a similar number of days npo, but the prospective group had fewer days of inadequate nutrition. The 90-day readmission rate was significantly lower in the prospective group versus the retrospective group (39.4% versus 28.4%; P=0.04), which was associated with greater nutrition outpatient follow-up. In conclusion, nutritional consultation rates in inpatients with cirrhosis can be significantly improved after educational intervention and is associated with lower 90-day readmission rates.

MON-PO488: Evaluation of Quality of Life After Nutrition Consultation in Ostomized Patients

MON-PO488: Evaluation of Quality of Life After Nutrition Consultation in Ostomized Patients

MON-PO487: Impact in Nutritional Status and Diet Progression of a Nutritional Consultation After Stoma Construction

MON-PO487: Impact in Nutritional Status and Diet Progression of a Nutritional Consultation After Stoma Construction