Nutritional Status Of Patients Research Articles

Hospital-acquired malnutrition: point prevalence, risk identifiers and utility of a digital Dashboard to identify high-risk, long-stay patients in five Australian facilities.

There are limited hospital-acquired malnutrition (HAM) studies among the plethora of malnutrition literature, and a few studies utilise electronic medical records to assist with malnutrition care. This study therefore aimed to determine the point prevalence of HAM in long-stay adult patients across five facilities, whether any descriptors could assist in identifying these patients and whether a digital Dashboard accurately reflected 'real-time' patient nutritional status. HAM was defined as malnutrition first diagnosed >14 days after hospital admission. Eligible patients were consenting adult (≥18 years) inpatients with a length of stay (LOS) >14 days. Palliative, mental health and intensive care patients were excluded. Descriptive, clinical and nutritional data were collected, including nutritional status, and whether a patient had hospital-acquired malnutrition to determine point prevalence. Descriptive Fisher's exact and analysis of variance (ANOVA) tests were used. Eligible patients (n = 134) were aged 68 ± 16 years, 52% were female and 92% were acute admissions. HAM and malnutrition point prevalence were 4.5% (n = 6/134) and 19% (n = 26/134), respectively. Patients with HAM had 72 days greater LOS than those with malnutrition present on admission (p < 0.001). A high proportion of HAM patients were inpatients at a tertiary facility and longer-stay wards. The Dashboard correctly reflected recent ward dietitian assessments in 94% of patients at one facility (n = 29/31). HAM point prevalence was 4.5% among adult long-stay patients. Several descriptors may be suitable to screen for at-risk patients in future studies. Digital Dashboards have the potential to explore factors related to HAM.

Estimating Meaningful Differences in Measures of Neuropathic Impairment, Health‐Related Quality of Life, and Nutritional Status in Patients With Hereditary Transthyretin Amyloidosis

ABSTRACTIntroduction/AimsThe degree of change in neuropathic impairment and quality of life (QoL) that is clinically meaningful to patients with hereditary transthyretin amyloidosis with polyneuropathy (ATTRv‐PN) is not established. This study aimed to estimate the magnitude of treatment differences that are meaningful to patients in measures of neuropathy and QoL and to determine whether eplontersen achieved a meaningful improvement versus placebo.MethodsData from the NEURO‐TTRansform trial on patients with ATTRv‐PN treated with eplontersen (n = 141) or historical placebo (n = 59) were used. Anchor‐based approaches were used to estimate thresholds for meaningful differences in the modified Neuropathy Impairment Score +7 (mNIS+7) composite score, Norfolk QoL‐Diabetic Neuropathy (Norfolk QoL‐DN) total score, Neuropathy Symptoms and Change (NSC) total score, and modified body mass index (mBMI). Differences between the least squares means of the treatment groups were analyzed.ResultsMeaningful improvement in mNIS+7 was estimated as −4.0 points and deterioration as 1.8 points. The estimated ranges of meaningful improvement and deterioration in Norfolk QoL‐DN were −12.8 to −4.0 points, and 5.9 to 14.7 points, respectively. For NSC, ranges were −2.4 to −1.3 points for meaningful improvement, and 0.6 to 5.8 points for deterioration. The estimated meaningful improvement in mBMI was 9.8 kg/m2 × g/L and deterioration was −40.9 kg/m2 × g/L. Improvements in each measure with eplontersen versus placebo were greater than the estimates of meaningful differences.DiscussionEplontersen demonstrated a clinically meaningful effect on neuropathic impairment, QoL, and nutritional status. Such estimates have implications for clinical practice and trials.

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

Proton-Pump Inhibitors and Fat Absorption in Cystic Fibrosis and Pancreatic Insufficiency: A Randomized Crossover Pilot Trial.

Dietary fat malabsorption contributes to poor nutritional status in patients with cystic fibrosis (CF) and exocrine pancreatic insufficiency (EPI). Prescribing gastric acid-reducing agents such as proton-pump inhibitors (PPI) as an adjunct to pancreatic enzyme replacement therapy (PERT) to improve dietary fat absorption has been accepted in clinical practice despite limited evidence. This was a pilot randomized, double-blind, placebo-controlled crossover trial of subjects aged 12 and older with CF and EPI assessed on placebo and omeprazole to determine if PPI improved the efficacy of PERT as indicated by measures of dietary fat absorption. Fat malabsorption via stool coefficient of fat absorption (CFA) and malabsorption blood test (MBT), gastrointestinal pH (wireless motility capsule [WMC]), and quality of life (QOL) were assessed after 14days on both placebo or PPI (omeprazole). Total 19 subjects enrolled, 13 were randomized, and 9 provided paired results on placebo and PPI. The 3 subject results for CFA were as follows: 1 increased, 1 decreased, and 1 was within the reference range in both tests for fat absorption. For 9 MBT subjects, 7 decreased and 2 increased fat absorption. For the 4 WMC studies, no change in transit times, nor in pH profiles were noted. No differences were seen in the domains of the two QOL questionnaires comparing placebo and PPI. These limited descriptive pilot study results in participants with CF and EPI on PERT evaluated by stool, blood, and QOL tests did not suggest improvement in fat absorption attributable to PPI.

Abstract 4119926: Inadequate calorie and macronutrient intake in a population with congestive heart failure in a non-cardiovascular tertiary hospital.

Introduction: Chronic Heart Failure (HF) is a clinical syndrome that as a consequence of the compensatory mechanisms to maintain an adequate level of perfusion, causes dyspnea, peripheral edema, fatigue, lack of appetite, changes in body weight, cachexia, sarcopenia, among others. The presence of these signs and symptoms, with other factors such as restrictions on salt and water consumption, early satiety, and poor mobility, producing changes in the patient's nutritional status that can indirectly increase the risk of inadequate dietary intake, which over a prolonged period will lead to the development of nutritional deficiencies. Objective: To analyze the dietary intake of energy, macronutrients, and micronutrients of patients with chronic HF in outpatient care. Methods: Cross-sectional study, including 75 outpatients with HF, who attended a Heart Failure Clinic. Data collection on dietary intake was obtained using a multi-step 24-hour recall. The ESHA Food Processor program was used to calculate the energy, macronutrient, and micronutrient intake. The presence of congestion was evaluated by bioelectrical impedance vectorial analysis and VEXUS. Results: The baseline characteristics of the population are shown in Table 1. Of the total population, 34% presented with deficient caloric intake, and the subjects who presented congestion also ingested significant fewer calories compared with those who do not present congestion (p= 0.031). Only 15% of patients had an adequate protein intake that resulted in lower NYHA class; among those subjects with a deficient protein intake, 72% had congestion measured by VExUS or bioelectrical impedance. For the sodium intake in the subjects' diet, 45% exceeded the recommendation stated in the guidelines of less than 2,400 mg of sodium per day which was not statistically significant (p=0.077). Discussion and Conclusions: The inadequate intake of calorie or macronutrients in patients with CHF led the patients to more congestion and higher NYHA class, this provide a perspective on the importance of adequate nutritional advice by an expert in the area, which is also essential to improve the clinical course of heart failure. Likewise, future studies are deeded to investigate whether this poor dietary intake is inversely related to some clinical manifestations such as congestion, suggesting that improving these conditions could positively impact patients' volume status and improve functional class.

Nutritional Status of Patients with Polycystic Ovary Syndrome (PCOS) in Irbid Governorate, Jordan: A Case-Control Study

Polycystic Ovary Syndrome (PCOS) is a crucial infertility problem among women in the world; especially Arab women. The main objective of this case-control study was to perform anthropometric, biochemical, clinical and nutritional assessment among PCOS patients. The study population composed of 60 Jordanian women aged 19–39 years, and classified into two groups: 30 were cases (PCOS patients) and 30 were control group (Healthy women). Results of the study indicated that the Body Mass Index (BMI) were significantly higher among PCOS patients than healthy women. Furthermore, significant differences were shown in the mean values of Luteinizing Hormone (LH) and (LH): Follicle-Stimulating Hormone (FSH) (LH:FSH) ratio which were higher among PCOS patients with a p=0.01 and p=0.03, respectively. Also, significant differences between PCOS patients and healthy women were shown for three clinical manifestations of PCOS including infertility, sleep apnea, and eating disorders. Moreover, the findings of the validated food frequency questionnaire (FFQ) revealed no significant differences between two study groups in the consumption of macronutrients and total energy intake. It is obviously concluded from the study that PCOS is remarkably responsible for substantial variations in anthropometric and biochemical measurements, hormonal levels, and clinical features among PCOS patients.

Dysphagia and Body Composition in Cornelia de Lange Syndrome

Background/Objectives: Limited research had investigated nutritional status in patients with Cornelia de Lange Syndrome (CdLS) (OMIM 122470, 300590, 300882, 610759, 620568 and 614701). Body composition assessed via bioelectric impedance (BIA) is a particularly under-explored issue. In this cross-sectional study, we hypothesize that body composition imbalance is frequent in CdLS and may be associated with dysphagia. We aimed to determine dysphagia prevalence in CdLS. Dysphagia may be a sign or a complication of GERD (gastroesophageal reflux disease), which is the most frequent gastroenterological disorder in CdLS patients; Methods: Fourteen Polish patients with a clinical or genetic diagnosis of CdLS were included in the study. We performed body composition analysis via bioelectric impedance taking into account the phase angle (PhA) and Body Cell Mass (BCM) in patients who cooperated and were able to sit still. The patients’ caregivers completed the pediatric version of the Eating Assessment Tool (PEDI-EAT-10). Based on the questionnaire scoring, we divided the patients into dysphagic and non-dysphagic groups. Body compartments of those two groups were compared. Statistical correlations between PhA and the PEDI-EAT-10 score were calculated; Results: Eleven of the fourteen CdLS patients had abnormalities in the BIA analysis in terms of fat mass (FM), fat free mass (FFM) and skeletal muscle mass (SMM). Six patients had excessive FM and four patients were deficient in FM. Two had deficiency in FFM and two had excessive FFM. We noted prevalence of dysphagia at 28.57%, with four patients having an PEDI-EAT-10 score higher or equal to 3, categorized as dysphagic. The dysphagic and non-dysphagic groups were not significantly different in terms of the proportion of patients with FM, FFM, SMM and BCM in the small cohort presented here. A statistically significant inverse correlation was found between the PhA and PEDI-EAT-10 score (rho = −0.72; p = 0.003); Conclusions: CdLS patients require investigation for dysphagia and nutritional status imbalance, as they are both frequent in this syndrome. The most prevalent are abnormalities in FM, both excess and deficit. PhA deviations observed in the bioimpedance study deepen with the severity of dysphagia. These findings require further investigation in a larger cohort.

Impact of adherence to oral nutritional supplements on nutrition status and muscle strength in patients with gastrointestinal cancer: A prospective observational longitudinal study.

Given the lack of evidence regarding the effects of adherence to oral nutritional supplements (ONS) and the types of formulas used in clinical practice, we aimed to assess the impact of adherence to ONS and the high-protein formula on the nutrition status and muscle strength in patients with gastrointestinal cancer. This study evaluated newly diagnosed outpatients with esophageal, gastric, pancreatic, and colorectal cancer prescribed ONS. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), and muscle strength was assessed using handgrip strength (HGS) dynamometry. ONS adherence was calculated as the ratio of self-reported intake to the prescribed amount and categorized as ≥80% or <80%. A total of 54 patients were included. Most patients were ≥60 years of age (63%), were diagnosed with colorectal cancer (63%), were classified as stage III and IV (83%), and exhibited nutrition risk or malnutrition according to PG-SGA (89%). Patients with adherence ≥80% to ONS exhibited less weight loss and HGS reduction compared with patients with adherence <80% (P < 0.05). Although patients consuming a high-protein formula maintained HGS and those on a standard formula experienced a reduction, formula type did not predict HGS change in the multivariate analysis. ONS protein intake, adjusted for adherence, was a predictor of weight change (β: 0.09; 95% CI: 0.02-0.2; P = 0.011). Patients with adherence ≥80% to ONS experienced less reduction in both weight and HGS, whereas those consuming a high-protein formula maintained HGS. Notably, ONS protein intake, adjusted for adherence, was an independent predictor of weight change.

Pressure Ulcers and Nutrients: From Established Evidence to Gaps in Knowledge.

Pressure ulcers (PUs) are caused by continuous pressure or friction on the skin that damages tissue, especially over bony prominences. A critical factor in the development and progression of PUs is poor nutritional status, which often involves deficiencies in essential nutrients such as proteins, vitamins (A, C, D, E, K, and the B complex), and trace elements (including zinc, selenium, copper, iron, and manganese). These micronutrients are vital for effective wound healing, as they play significant roles in cellular repair, immune function, and tissue regeneration. Laboratory tests for serum albumin, prealbumin, transferrin, retinol-binding protein, and anthropometric measures like height, weight, and body mass index (BMI) are used to evaluate a patient's nutritional status. Screening tools such as the Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), LPZ questionnaire, and Subjective Global Assessment (SGA) are commonly employed. Emerging evidence from various studies, including in vitro, in vivo, and clinical trials, underscores the importance of personalized nutritional interventions in managing PUs. Unlike generic dietary plans, tailored nutrition that addresses the specific needs of individuals shows greater potential in promoting wound healing and improving clinical outcomes. This synthesis of existing research highlights the critical influence of micronutrients on the healing process of PUs. It suggests that a personalized approach to nutrition, which takes into account individual patient requirements and deficiencies, is likely to be more effective than a one-size-fits- all strategy in the management of these complex wounds.

Nutritional Risk, Nutritional Status and Some Biochemical Parameters In Adult Burn Patients in Burn Intensive Care Unit: A Prospective Study

Nutritional therapy is very important in burn patients and plays a role in the prevention and treatment of malnutrition. Therefore, it is necessary to assess nutritional status, prevent or minimize nutritional problems, and monitor nutritional therapy. This study was conducted to determine the nutritional risk, nutritional status and biochemical parameters of adult burn patients in the burn intensive care unit. The 59 patients (women: 16, men: 43) between the ages of 19-64 were included in the study. Parameters such as NRS-2002 (admission and discharge), dietary intake, nutritional support status, serum albumin, and total protein (admission and discharge) were evaluated to determine the nutritional risk and nutritional status of the patients. In addition, body weight, mid-upper arm circumference, and triceps skinfold thickness were measured and body mass index was calculated (admission and discharge). The duration of hospitalization and burn percentage of men patients were higher than women (P &lt; 0.05). A significant decreases were determined in the mean body weight, body mass index, and triceps skinfold thickness of men patients at discharge compared to admission (P &lt; 0.05). In men patients, a statistically significant difference was found in serum albumin, hemoglobin, and hematocrit values between admission and discharge (P &lt; 0.05). A statistically significant difference was found in NRS-2002 scores at admission and discharge in both genders, and the scores increased (P &lt; 0.05). While a significant relationship was found between immunonutrition support and gender (P &lt; 0.05), no relationship was found between genders in terms of the diet given and the consumption status of the diet intake (P &gt; 0.05). No statistically significant difference was found between genders in terms of feeding duration with nutritional support products, energy intake with nutritional support products and diet, macronutrients, and total energy expenditure values (P &gt; 0.05). Since burn injuries can cause serious metabolic disorders, impaired nutritional status was encountered during hospitalization. While the treatment process was positively affected by the increase in the NRS-2002 score during hospitalization, a decrease in parameters such as albumin, total protein, and anthropometric measurement values brought about by the catabolic process was encountered. Therefore, to prevent or treat malnutrition, the nutritional status of patients should be evaluated at the time of hospitalization and they should be able to receive the necessary nutritional support.

Research Progress on Enteral Nutrition in Patients with Esophageal Cancer

Patients with esophageal cancer often experience symptoms such as dysphagia due to the progression of the disease, resulting in insufficient intake and energy consumption caused by their own diseases. Eventually, this leads to malnutrition, decreased immunity, increased inflammation levels, and affects the quality of life. After surgery, negative nitrogen balance is also caused by factors such as surgical trauma and stress. Therefore, enteral nutrition has become a nutritional support method for patients with esophageal cancer. To promote better development in the field of enteral nutrition research for patients with esophageal cancer, this article summarizes the research status in this field through literature review and data access. It elaborates from aspects such as the nutritional status of patients, enteral nutrition pathways, and the timing of implementing enteral nutrition, summarizes its advantages and disadvantages, promotes further development in this field, and provides more effective and safe enteral nutrition plans for patients with esophageal cancer.

Machine learning algorithms able to predict the prognosis of gastric cancer patients treated with immune checkpoint inhibitors

BACKGROUND Although immune checkpoint inhibitors (ICIs) have demonstrated significant survival benefits in some patients diagnosed with gastric cancer (GC), existing prognostic markers are not universally applicable to all patients with advanced GC. AIM To investigate biomarkers that predict prognosis in GC patients treated with ICIs and develop accurate predictive models. METHODS Data from 273 patients diagnosed with GC and distant metastasis, who un-derwent ≥ 1 cycle(s) of ICIs therapy were included in this study. Patients were randomly divided into training and test sets at a ratio of 7:3. Training set data were used to develop the machine learning models, and the test set was used to validate their predictive ability. Shapley additive explanations were used to provide insights into the best model. RESULTS Among the 273 patients with GC treated with ICIs in this study, 112 died within 1 year, and 129 progressed within the same timeframe. Five features related to overall survival and 4 related to progression-free survival were identified and used to construct eXtreme Gradient Boosting (XGBoost), logistic regression, and decision tree. After comprehensive evaluation, XGBoost demonstrated good accuracy in predicting overall survival and progression-free survival. CONCLUSION The XGBoost model aided in identifying patients with GC who were more likely to benefit from ICIs therapy. Patient nutritional status may, to some extent, reflect prognosis.

The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is associated with hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke.

Hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) with rt-PA can precipitate rapid neurological deterioration, poor prognosis, and even death. The HALP score (hemoglobin, albumin, lymphocyte, and platelet) is a novel indicator developed to reflect both systemic inflammation and the nutritional status of patients. The goal of this study was to reveal the relationship between the HALP score and the risk of HT after IVT in people with acute ischemic stroke (AIS). A total of 753 patients with AIS were included in this study. Patients were divided into quartiles according to baseline HALP score. The HALP score was calculated as follows: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). Binary logistic regression was used to reveal the connection between HALP score and HT. The baseline HALP score were significantly lower in the HT than non-HT patients (p < 0.001). The HALP score were divided into four quartiles: Q1 (<27.4), Q2 (27.4-37.6), Q3 (37.7-49.6), Q4 (>49.6), respectively. Moreover, the severity of HT increased with decreasing HALP level (p < 0.001). In multivariable logistic regression, taking the Q4 as the reference, the association between Q1 and HT remained, after adjusting for confounding variables [odds ratio (OR) = 3.197, 95% confidence interval (CI) = 1.634-6.635, p = 0.003]. The HALP value can predict the HT risk after IVT in patients with AIS. A lower HALP level was associated with an increased severity of HT post-IVT.

Effect of clustered nursing on liver function indexes, nutrition, and emotional status of patients with severe liver failure.

Liver failure is a metabolic disorder caused by a variety of mixed factors. For such diseases, adopting cluster care can effectively improve the relevant symptoms of patients. To explore the nursing effect of nutritional nursing combined with clustered nursing for patients with severe liver failure. A total of 129 patients with severe liver failure were selected as retrospective study subjects. Nine cases were due to an end event, such as death. The other patients were divided into control group and observation group according to different nursing methods. Among them, the control group adopted nutrition nursing, and the observation group implemented cluster nursing on this basis. The differences of liver function, anxiety and depression score, gastrointestinal recovery, nutritional status, and sleep quality were compared between the 2 groups before and after nursing. After nursing, the total bilirubin, albumin, and aspartate aminotransferase of the observation group were significantly higher than those of the control group (P < .05). The nursing staff used Self-Rating Anxiety Scale and Self-Rating Depression Scale of the observation group, which were slightly lower than those of the control group. The difference was statistically significant after testing (P < .05). After nursing, the observation group's upper arm circumference, brachial tri-scalp fold thickness, and hemoglobin were better than those of the control group. Statistics showed that the difference was statistically significant (P < .05). The depth of sleep, time to fall asleep, number of awakenings, time to fall asleep after awakening, overall sleep quality, and intensive care unit environmental noise intensity in the Richards-Campbell Sleep Questionnaire sleep scale after nursing in the 2 groups were significantly higher than those before nursing, and the scores of the observation group were significantly lower than those in the observation group. In the control group, this difference was statistically significant (P < .05). Nutritional nursing combined with clustered nursing can effectively promote the recovery of gastrointestinal function in patients with severe liver failure.

Improving the nutritional evaluation in head neck cancer patients using bioelectrical impedance analysis: Not only the phase angle matters.

Malnutrition and sarcopenia are highly prevalent in patients with head neck cancer (HNC). An accurate early diagnosis is necessary for starting nutritional support, as both are clearly associated with clinical outcomes and mortality. We aimed to evaluate the applicability and accuracy of body composition analysis using electrical bioimpedance vectorial analysis (BIVA) for diagnosing malnutrition and sarcopenia in patients with HNC cancer undergoing systemic treatment with chemotherapy or radiotherapy. Cross-sectional, observational study that included 509 HNC patients. A comprehensive nutritional evaluation that included BIVA was performed. The prevalence of malnutrition was higher in patients that received treatment with chemotherapy (59.2% vs. 40.8%, P<0.001); increased mortality was observed in malnourished patients (33.3% vs. 20.1%; P<0.001); ECOG status (1-4) was also worse in malnourished patients (59.2% vs. 22.8% P<0.001). Body cell mass (BCM) and fat mass were the most significantly associated parameters with malnutrition [OR 0.88 (0.84-0.93) and 0.98 (0.95-1.01), respectively]; BCM and fat free mass index (FFMI) were associated with several aspects including (1) the patient-generated subjective global assessment [OR 0.93 (0.84-0.98) and 0.86 (0.76-0.97), respectively], (2) the presence of sarcopenia [OR 0.81 (0.76-0.87) and 0.78 (0.66-0.92), respectively]. A BCM index (BCMI)<7.8 in combination with other parameters including FFMI and BCM accurately predicted patients with malnutrition [accuracy 95% CI: 0.803 (0.763-0.839); kappa index: 0.486; AUC: 0.618 (P<0.01)]. A BCMI cutoff of 7.6 was enough for identifying males with malnutrition (P<0.001), while it should be combined with other parameters in females. Body composition parameters determined by BIVA accurately identify patients with HNC and malnutrition. Phase angle, but other parameters including BCMI, FFMI and BCM provide significant information about nutritional status in patients with HNC.

Perioperative Nutritional Support Case Study for a Patient Undergoing Gluteus Maximus Flap Transfer Surgery for Pressure Ulcer

Pressure ulcers are caused by prolonged pressure on local tissues, leading to continuous ischemia, hypoxia, and malnutrition, resulting in tissue necrosis. Patients with pressure ulcers often experience varying degrees of malnutrition due to gut flora imbalance and a hypercatabolic state. This paper documents the case of a patient with a sacral pressure ulcer admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Qinghai University on November 28, 2023. Clinical nutrition treatment began on the second day of admission, including dietary guidance and enteral nutrition intervention. The patient's nutritional status gradually improved, leading to a successful recovery. By reviewing the nutritional treatment process and clinical outcomes, this case study provides valuable insights into the nutritional management of pressure ulcer patients.

Dietary Protein Consumption Pattern in Hyperphosphatemia Management Among Haemodialysis Patients: A Cross-Sectional Study at Kenyatta National Hospital, Kenya

Poor nutrition status in haemodialysis patients is associated with high mortality rates. A low phosphorus diet is likely to compromise dietary protein intake and nutrition status in this population. This study evaluated dietary protein consumption pattern and nutrition status among forty out-patient haemodialysis patients from Renal Unit at Kenyatta National Hospital using cross-sectional study. The Chi-square test and Kruskal‒Wallis H test were used to determine relationship between variables. More than half (58%) of the patients were male. Study participants had a mean age of 45.4±14.7 years with the majority (40%) between 40-59 years. More than three quarters (88%) had poor nutrition status with more than a third (38%) severely undernourished. More than half of the patients (53%) had dialysed for a period of more than one year. Most of study participants consumed only five types of legumes. Yellow bean, butterfly Kenyan kidney bean, butterfly haricot bean, red kidney bean and green lentil were commonly consumed legumes; 2-4 times per week by 45%, 23%, 23%, 8% and 15% of the patients respectively. Beef was the most consumed animal protein by more than half (53%) of the patients in 2-4 times a week. Second most consumed animal protein was egg white at least 2-3 times a week. Majority of the patients (58%) had poor knowledge scores (&lt;50 % score) on food phosphorus reduction food preparation procedures in protein rich foods. This study found high prevalence of poor nutrition status and inadequate consumption of dietary protein among haemodialysis patients. This study recommends nutrition education and counseling on locally available dietary proteins and their preparation in order to meet dietary protein requirements without risk of hyperphosphatemia

Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study.

Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals' and students' knowledge, image interpretation skills, and clinical acumen. This study aimed to (1) establish an assessment instrument gauging nurses' competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses' PoCUS training needs and evaluate its content and appearance validity. We will conduct a methodological study of technological production guided by Rogers' diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses' competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. PRR1-10.2196/58030.

A Comprehensive Intervention Program for Postoperative Delirium Prevention in Elderly Patients Undergoing Cardiac Surgery

PurposeTo explore the application effect of a comprehensive intervention program for postoperative delirium (POD) prevention. DesignDescriptive and comparative study. MethodsThis study included 82 elderly patients who underwent cardiac surgery as the control group to receive routine perioperative care. Seventy seven elderly patients who underwent cardiac surgery were selected as the observation group and received a comprehensive intervention program for POD prevention. This study further compared the length of stay in the hospital, nutritional status, pain score, and sleep quality between the two groups after intervention. FindingsThe postoperative length of stay in the hospital of the observation group was shorter than that of the control group (12.60 ± 2.97 vs 17.30 ± 7.10), and the incidence of POD was lower than that of the latter group (24.68% vs 47.56%, X2 = 8.976, P = .003). The pain scores of the observation group were lower than those of the control group (F = 195.381, P < .001). There was significant difference that the sleep quality score of the observation group was higher than that of the control group (F = 219.20, P < .001). The levels of albumin and hemoglobin in the observation group were higher than those in the control group (54.38 ± 5.87 vs 38.40 ± 3.11; 124.64 ± 13.18 vs 109.00 ± 10.20). The observation group had shorter mechanical ventilation duration, intensive care unit stay, and lower total hospital expenses compared with the control group (P < .05). ConclusionsThe comprehensive intervention program for POD prevention based on evidence-based medicine has a positive effect. In addition, it can also improve patients' pain, sleep quality, and nutritional status.

Effects of Diet and Supplements on Parameters of Oxidative Stress, Inflammation, and Antioxidant Mechanisms in Patients with Chronic Renal Failure Undergoing Hemodialysis.

The prevalence of chronic kidney disease (CKD) worldwide increases as the population ages. The progression of the disease increases the risk of complications and death and leads to end-stage renal failure, requiring renal replacement therapy. Despite the positive effect of hemodialysis (HD), patients are at risk of developing malnutrition, inflammation, oxidative stress, or cardiovascular disease, which worsens quality of life and can lead to organ dysfunction. The occurrence of the mentioned disorders depends largely on the diet, so changes in diet composition are an important part of the treatment of kidney disease. This study aimed to evaluate the effects of a balanced diet on some parameters of oxidative stress, immune response, and nutritional status in patients. This study included 57 HD patients (19 women and 38 men). In all of them, nutritional status and diet were initially determined, and then, they were divided into six groups, which received different diets and supplements. Serum levels of albumin, total protein, MDA, and the cytokines Il-1, IL-6, IL-8, TNF-α, and IL-10 were determined, and the activity of the enzymes such as CAT, SOD, and GSH-Px were determined in erythrocytes by spectrophotometry. Based on the results of BMI, albumin, and total protein, it can be concluded that a well-balanced diet can reduce weight loss. This study shows that a well-balanced diet can reduce the secretion of pro-inflammatory cytokines, and ensure the normal activity of antioxidative enzymes in the blood of HD patients.