Screening Tool Score Research Articles

Evaluation of Xerostomia in Sjögren’s Syndrome and Its Impact on Quality of Life and Nutritional Status: A Cross-Sectional Study

Background and aims: Patients with primary Sjögren’s Syndrome (PSS) suffer from xerostomia, or dry mouth, which has been associated with oral/teeth disease and can compromise food intake, nutritional status, and quality of life (QoL). Materials and methods: Cross-sectional study by mail of questionnaires with European League Against Rheumatism (EULAR) Sjögren’s Syndrome Patient Reported Index (ESSPRI), Xerostomia Quality of Life Scale (XeQoLS), Primary Sjögren’s Syndrome Quality of Life (PSS-QoL), food restrictions, and nutritional status questions, to the authors’ patients with PSS, sicca, and systemic lupus erythematosus (SLE). Results: A total of 46 patients responded: 19 patients with PSS, 13 with Sicca, and 14 with SLE. Patients with sicca were older. Patients with PSS and sicca had a higher ESSPRI dryness score. XeQoLs was higher in patients with PSS and sicca, but was similar in PSS-QoL. There was non-significant food restriction, higher in patients with PSS for sugary foods (58.0% versus 47.0% versus 36.0%; p=0.4), sticky foods (58.0% versus 54.0% versus 29.0%; p=0.2), meat/fish (26.0% versus 15.0% versus 0.0%; p=0.1), acidic beverages (63.0% versus 62.0% versus 29.0%; p=0.1) and dairy (47.0% versus 23.0% versus 29.0%; p=0.3). Average weight and BMI were similar, with higher prevalence in patients with sicca and SLE who are underweight (0.0% versus 7.7% versus 7.7%; p=0.5), and lower prevalence in patients with sicca and obesity (33.0% versus 7.7% versus 36.0%; p=0.1). Malnutrition Universal Screening Tool (MUST) score showed non-significant higher at-risk status for patients with PSS (42.0% versus 23.0% versus 21.0%; p=0.6). Conclusion: Patients with PSS had lower xerostomia-related QoL, but similar overall QoL between groups. Reduction in food intake was higher in patients with PSS, and may be related to symptom management, but might lead to nutritional mistakes. A greater proportion of patients with PSS were overweight, but nutritional risk is still high. The authors’ main issue is the small sample size.

Evaluation of prevalence of food intake monitoring during acute hospitalization and its association with malnutrition screening scores of inpatients who were not considered for enteral or parenteral nutrition

ObjectivesMalnutrition risk can be recognized by nurses using screening tools and food intake monitoring. We measured the prevalence of food intake reporting and its association with malnutrition screening scores or other patient characteristics. MethodsThis retrospective cohort study collected hospital database information regarding patients aged ≥18 y who were hospitalized for ≥ 7 consecutive days and were orally fed or had medical records that no tube feeding or parenteral nutrition had been administered. Data were collected and statistically analyzed focusing on food intake reporting, Malnutrition Universal Screening Tool (MUST) scores, oral nutritional intervention, and other secondary characteristics. ResultsOut of 5155 patients admitted to two internal medicine departments over 1 y (July 1, 2018, through August 31, 2019), 1087 fulfilled the inclusion criteria with a mean age of 72.4 ± 14.6 y; of these, 74.6% had sufficient food intake reports. No food intake was reported for one-third of patients with MUST scores ≥ 2. There were no differences between the groups of patients with and without reported food intake with regard to MUST scores, sex, mean albumin level, comorbidity, length of stay, all-cause in-hospital mortality, hospital-acquired pressure injury, or the rate of oral nutritional intervention. MUST scores ≥ 2 were not significantly associated with intake reporting. Increased probability of having food intake reported was found in patients ages ≥70 y (adjusted odds ratio = 1.36; P = 0.036 [95% CI, 1.02–1.82]) and those who had Norton scores ≤ 13 (adjusted odds ratio = 1.60; P = 0.013 [95% CI, 1.10–2.31]). However, the model had a weak predictive efficacy (area under the curve = 0.577; P < 0.0001 [95% CI, 0.538–0.616]). ConclusionsMore adherence to food intake monitoring guidelines is needed.

Menstrual Function, Eating Disorders, Low Energy Availability, and Musculoskeletal Injuries in British Servicewomen.

This study aimed to investigate associations between menstrual function, eating disorders, and risk of low energy availability with musculoskeletal injuries in British servicewomen. All women younger than 45 yr in the UK Armed Forces were invited to complete a survey about menstrual function, eating behaviors, exercise behaviors, and injury history. A total of 3022 women participated; 2% had a bone stress injury in the last 12 months, 20% had ever had a bone stress injury, 40% had a time-loss musculoskeletal injury in the last 12 months, and 11% were medically downgraded for a musculoskeletal injury. Menstrual disturbances (oligomenorrhea/amenorrhea, history of amenorrhea, and delayed menarche) were not associated with injury. Women at high risk of disordered eating (Female Athlete Screening Tool score >94) were at higher risk of history of a bone stress injury (odds ratio (OR; 95% confidence interval (CI)), 2.29 (1.67-3.14); P < 0.001) and time-loss injury in the last 12 months (OR (95% CI), 1.56 (1.21-2.03); P < 0.001) than women at low risk of disordered eating. Women at high risk of low energy availability (Low Energy Availability in Females Questionnaire score ≥8) were at higher risk of bone stress injury in the last 12 months (OR (95% CI), 3.62 (2.07-6.49); P < 0.001), history of a bone stress injury (OR (95% CI), 2.08 (1.66-2.59); P < 0.001), a time-loss injury in the last 12 months (OR (95% CI), 9.69 (7.90-11.9); P < 0.001), and being medically downgraded with an injury (OR (95% CI), 3.78 (2.84-5.04); P < 0.001) than women at low risk of low energy availability. Eating disorders and risk of low energy availability provide targets for protecting against musculoskeletal injuries in servicewomen.

Effects of curcumin supplementation on insomnia and daytime sleepiness in young women with premenstrual syndrome and dysmenorrhea: Arandomized clinical trial.

Premenstrual syndrome and primary dysmenorrhea are common gynecological complaints that are associated with psychological disorders. There is increasing evidence for the neuroprotective properties of curcumin, a polyphenolic natural product. This study aimed to assess the effects of curcumin on sleep complications in women with premenstrual syndrome and dysmenorrhea. This triple-masked, placebo-controlled clinical trial comprised 124 patients with both premenstrual syndrome and dysmenorrhea. Participants were randomly assigned to curcumin (n=57) or control (n=60) groups. Each participant received one capsule containing either 500 mg of curcumin plus piperine or placebo, daily, from 7 days before until 3 days after menstruation for three consecutive menstrual cycles. Insomnia and sleepiness were assessed using standard questionnaires. Scores for insomnia and daytime sleepiness were directly correlated with the Premenstrual Syndrome Screening Tool (PSST) score (p<0.05), but not with the visual analogue scale (VAS) score at baseline (p>0.05). There was a non-significant reduction in insomnia and sleepiness scores in both curcumin and placebo groups after the study intervention. Whilst, improvement rate of insomnia status, daytime sleepiness severity, short sleep duration and difficult sleep initiation was not statistically significant between the curcumin and placebo groups. Curcumin does not significantly affect sleep disorders in young women with premenstrual syndrome and dysmenorrhea.

Systemic anti-cancer therapy in older patients with gastrointestinal malignancies following comprehensive geriatric assessment: An age-based subgroup analysis.

796 Background: Comprehensive geriatric assessment (CGA) is recommended to inform treatment decisions in older patients with cancer. Patients ≥ 70 years are referred to the Geriatric Oncology and Liaison (GOAL) clinic in University Hospital Waterford, for a pre-treatment CGA, which includes assessment of mobility, cognitive, nutritional, functional, and psychological status, along with comprehensive geriatric pharmacological assessment. Informed treatment recommendations are made using CGA outcomes and risk assessed using the Cancer and Aging Research Group toxicity calculator. Limited information exists on treatment decisions based on age subgroups within the geriatric oncology population. Methods: Data from patients with gastrointestinal (GI) malignancies attending the GOAL clinic over a 3-year period to September 2022 were included. Patients ≥ 70 years with a G-8 (screening tool) score ≤14, and all patients aged ≥ 80 underwent CGA. An age-based subgroup analysis (&lt; 80 vs ≥ 80) of systemic anti-cancer therapy (SACT) decisions was performed using the Chi-square test. Results: In total, 206 patients with GI malignancies were assessed, comprising 67 (33%) patients with gastroesophageal cancer, 40 (19%) with pancreaticobiliary and 92 (45%) with colorectal cancer. 40% of patients were ≥ 80 years (n = 83). The majority of patients had stage III/IV disease (82%, n = 168). Across all groups, 58% (n = 120) of patients were treated with SACT, comprising 70% of those &lt; 80 (n = 86) and 41% (n= 34) of those ≥ 80. Across all stages (I-IV), patients ≥ 80 years were less likely to be treated with SACT compared to patients &lt; 80 years (p &lt; 0.01). There was no significant difference between age groups when comparing treatment intent (curative vs palliative) (p = 0.15). There was no significant difference between age groups for baseline dose reductions vs full dose (p = 0.18). Patients ≥ 80 years were less likely to receive polychemotherapy regimens in comparison with the &lt; 80 subgroup (p &lt; 0.01). Conclusions: Older patients with GI malignancies are a heterogeneous population. In the setting of a CGA, patients ≥ 80 years are less likely to receive SACT across any stage group, and are more likely to receive monochemotherapy regimens. The use of CGA ensures a considered and personalised approach to identify older adults most likely to benefit from active treatment and those where best supportive care alone is more appropriate.

Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: A multicentre prospective observational study

BackgroundThe COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients. ObjectiveThe objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase. MethodsThis was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}]). ResultsA total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2–8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05–1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5–75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03–1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV. ConclusionsDuring the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased.

The effect of functional fatigue protocol on volleyball functional movement screening tool scores in Professional female volleyball players

The effect of functional fatigue protocol on volleyball functional movement screening tool scores in Professional female volleyball players

Patients with limited health literacy have worse preoperative function and pain control and experience prolonged hospitalizations following shoulder arthroplasty.

Patients with limited health literacy (LHL) may have difficulty understanding and acting on medical information, placing them at risk for potential misuse of health services and adverse outcomes. The purposes of our study were to determine (1) the prevalence of LHL in patients undergoing inpatient shoulder arthroplasty, (2) the association of LHL with the degree of preoperative symptom intensity and magnitude of limitations, (3) and the effects of LHL on perioperative outcomes including postoperative length of stay (LOS), total inpatient costs, and inpatient opioid consumption. We retrospectively identified 230 patients who underwent elective inpatient reverse or anatomic shoulder arthroplasty between January 2018 and May 2021 from a prospectively maintained single-surgeon registry. The health literacy of each patient was assessed preoperatively using the validated 4-item Brief Health Literacy Screening Tool. Patients with a Brief Health Literacy Screening Tool score ≤ 17 were categorized as having LHL. The outcomes of interest were preoperative patient-reported outcome scores and range of motion, LOS, total postoperative inpatient opioid consumption, and total inpatient costs as calculated using time-driven activity-based costing methodology. Univariate analysis was performed to determine associations between LHL and patient characteristics, as well as the outcomes of interest. Multivariable linear regression modeling was used to determine the association between LHL and LOS while controlling for potentially confounding variables. Overall, 58 patients (25.2%) were classified as having LHL. Prior to surgery, these patients had significantly higher rates of opioid use (P=.002), more self-reported allergies (P=.007), and worse American Shoulder and Elbow Surgeons scores (P=.001), visual analog scale pain scores (P=.020), forward elevation (P<.001), and external rotation (P=.022) but did not significantly differ in terms of any additional demographic or clinical characteristics (P>.05). Patients with LHL had a significantly longer LOS (1.84±0.92 days vs. 1.57±0.58 days, P=.012) but did not differ in terms of total hospitalization costs (P=.65) or total inpatient opioid consumption (P=.721). On multivariable analysis, LHL was independently predictive of a significantly longer LOS (β, 0.14; 95% confidence interval, 0.02-0.42; P=.035). LHL is commonplace among patients undergoing elective shoulder arthroplasty and is associated with greater preoperative symptom severity and activity intolerance. Its association with longer hospitalizations suggests that health literacy is an important factor to consider for postoperative disposition planning.

213 EARLY IDENTIFICATION AND NUTRITION INTERVENTION OF FRAIL ADULTS AT RISK OF MALNUTRITION BY AN EMERGENCY DEPARTMENT FRAILTY INTERVENTION TEAM (FIT)

Abstract Background Frailty is a nutrition related condition which is potentially reversible if modifiable risk factors including malnutrition are identified at an early stage. National guidance recommends early identification of risk of malnutrition and provision of timely, appropriate oral nutritional support. Over ⅓ of older adults presenting to the Emergency Department (ED) are malnourished/at risk of malnutrition. This study evaluates the early identification and nutrition intervention of frail adults at risk of malnutrition by FIT. Methods A retrospective study of frail patients presenting to a level 4 hospital ED over three months was performed. Each patient had a Comprehensive Geriatric Assessment performed. A referral to Dietetics was indicated by: Malnutrition Screening Tool (MST) score ≥2, dysphagia, grade ≥2 pressure ulcer or already prescribed oral nutritional supplements (ONS). Data was collected from a Hospital Clinical System using Excel®. The data recorded included: Clinical Frailty Score (CFS), referral reason, 4AT and admit/discharge location. Results 117 frail patients were referred to Dietetics by FIT. The median CFS was 5 (mildly/moderately frail) with an IQR of 1. 43%(n=50) had 4AT=0. 75%(n=88) had MST ≥2 identifying risk of malnutrition13.6%(n=16) were already prescribed ONS9.4%(n=11) had dysphagia6.8%(n=8) had a grade ≥2 pressure ulcer Nutrition support intervention was provided by the Dietitian to 100% (n=117) within 24 hours of referral. 27% (n=32) were discharged from ED and 72% (n=85) were admitted. Conclusion FIT have successfully implemented recommendations from the National Clinical Guideline No.22. Early dietetic intervention in ED, for those admitted and discharged, may prevent the onset/progression of malnutrition in frail patients.

Derivation of a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis.

The aim of this study was to derive a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis. This prospective cohort study was conducted in four orthopedic clinics. The main outcome measure was falls or nonfalls for 5 months, and the predictors were sex, age, BMI, Kellgren-Lawrence grade, laterality, number of comorbidities, pharmacotherapy, physical therapy period, use of a cane, household, previous history of falls, visual analog scale for pain, one-leg standing test (OLST), five times sit-to-stand test (FTSST), and Frenchay activities index. Ninety outpatients (74 females and 16 males) with a mean (SD) age of 73.1 (9.3) years completed a 5-month follow-up. According to the binomial logistic regression analysis, previous history of falls [odds ratio (OR), 6.85; P = 0.019], OLST (OR, 5.97; P = 0.048), and FTSST (OR, 12.93; P = 0.034) were identified as risk factors for falls, and the clinical prediction rule was derived from these variables. The pretest probability of fallers in this study was 21.1% (19 of 90 participants). When the total screening tool score was three points (the participant scored one point for each item: previous history of falls, yes; OLST, ≤6.84 s; FTSST, ≥8.77 s), the positive likelihood ratio was 16:19, and the posttest probability increased to 81.3%. Therefore, this simple screening tool possesses potential clinical utility for identifying patients with knee osteoarthritis at high risk of falls in the future because it demonstrated sufficient diagnostic test accuracy.

Functional status in older patients with cancer and a frailty risk profile: A multicenter observational study

IntroductionFunctional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline. Material and MethodsThis secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL. ResultsData on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2–4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression. DiscussionFunctional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.

Value-based analysis of a Singaporean post-ED discharge support program for older adults

Objective We evaluated the effectiveness of a post emergency department (ED) discharge intervention for frail, older adult patients in reducing hospital admissions. Methods 9-month retrospective real-world evaluation of a quality improvement intervention comparing frail adults 65-years and older who received a post-ED discharge intervention program (SAFE-Lite) with those who were eligible but declined and received usual care instead. The primary outcomes were the differences in rates of first acute hospital admission at 30- and 60-days post-ED discharge. The difference in primary outcome between the two groups was compared using the Cox proportional hazards model. We report adjusted hazards ratios (HRs) with 95% CIs for age, gender, Triage Risk Screening Tool (TRST) scores, as well as baseline ED utilization and acute hospital admission rates in the past year. Results There were 66 patients in the intervention group and 46 patients in the control group. There was no significant difference in risk of acute hospital admission at both 30 days (15 vs. 13%, HR = 0.92, 95% CI: 0.35–2.41) and 60 days (21 vs. 16%, HR = 0.97, 95% CI: 0.42–2.21) for the intervention and control groups. Conclusion Compared to usual post-ED discharge care, SAFE-Lite showed no difference in reducing 30- and 60-day admissions of frail, older patients.

Specialty Pharmacy Disease Screening and Routine Assessments for Patients with Rheumatoid Arthritis and Psoriasis

Background: Rheumatoid arthritis and psoriasis are inflammatory diseases which require frequent monitoring to optimize therapy. Specialty pharmacists are in the unique position to assist in the screening and monitoring of patients with complex, chronic diseases. Objectives: The study objective is to describe the impact of pharmacist screening services in two patient populations. In patients with rheumatoid arthritis, the goal is to describe outcome monitoring through disease severity, therapeutic switches, and adherence rates. In patients with psoriasis, the aim is to describe the utilization of a screening for psoriatic arthritis and the resulting number of potential referrals to medical providers. Methods: The retrospective study patient population consisted of rheumatoid arthritis (RA) patients who filled one or more prescriptions at a specialty pharmacy between 8/22/2017 and 9/26/2018, and psoriasis patients who filled between 6/1/2021 to 9/1/2021. A Routine Assessment of Patient Index Data 3 (RAPID3) score was collected during a refill coordination call every three months throughout the 13-month period for RA patients, and a Psoriasis Epidemiology Screening Tool (PEST) scores reported throughout the stated timeline.1,2 Data was imported from the pharmacy’s electronic medical record into an Excel spreadsheet with each row representing a unique patient. Following data validation, descriptive statistics including means, standard deviations, and percentages were calculated to characterize the sample. Statistical significance was determined at an alpha of 0.05. Results: Of the patients who had 4 assessments for RAPID3, the disease severity category significantly improved from assessment 1 to assessment 4 (p=0.021) when analyzed using a chi-square test. The RAPID3 assessment of patients with RA by pharmacists in a specialty setting identified responders (n=21, 25.6%) and stable patients (n=51, 63%), which reinforces current therapy, and non-responders (n=10, 12.2%), who may benefit from referral to their provider for reevaluation of their therapeutic plan. The PEST screening of patients with psoriasis by pharmacists in a specialty setting identified 11 of 32 patients (34%) who scored a 3 or higher and who may benefit from a referral to a rheumatologist for further assessment of psoriatic arthritis activity. Conclusion: Specialty pharmacists are an essential part of ongoing assessment and management of patients with chronic inflammatory conditions such as rheumatoid arthritis and psoriasis. Screening and monitoring of patients by pharmacists can identify the need for referral to a medical provider.

A prospective, observational study of the use of a high-calorie, high-protein tube feeding formula with slow-release carbohydrates and monounsaturated fatty acids in a malnourished population with diabetes

<h2>Summary</h2><h3>Background and aims</h3> Diabetes mellitus is associated with an increased risk of malnutrition. Reduced dietary intake is central to the development of malnutrition. Therefore, increasing nutritional intake may be one of the most effective approaches for treating malnutrition in diabetes mellitus. The aim of this study was to evaluate the effect of a high calorie, high protein tube feeding diabetes-specific formula used under standard of care on weight change, nutritional status, glycaemic control, quality of life and functionality in malnourished patients with diabetes mellitus after 12 weeks. <h3>Methods</h3> This was a prospective, non-interventional study conducted at hospital care settings in Spain, enrolling malnourished patients with diabetes, who had been prescribed a high-calorie, high-protein tube feeding formula with slow-release carbohydrates and monounsaturated fatty acids (MUFA) by their health care professional per standard of care as a sole source of nutrition for 12 weeks. <h3>Results</h3> Forty-nine patients from 8 sites were enrolled, and 36 completed the study. The mean age was 75.3 ± 12.0 years and 67.3% were male (33/49). At V1 and V2, 87.5% (35/40) and 93.1% (27/36) of the patients, respectively, either increased or maintained their weight (<1% weight loss) from their baseline weight. At baseline, 100.0% (49/49) of the patients were at high risk of malnutrition according to Malnutrition Universal Screening Tool (MUST) score and 87.8 % were malnourished per Subjective Global Assessment (SGA). At week 12, 77.9% of patients were well-nourished per MUST and 72.2% (26/36) of the patients were well nourished per SGA (<i>P</i> < 0.0001). With regards to metabolic glycaemia control, the mean HbA1c % decreased from baseline to weeks 6 and 12, -0.4 ± 0.7 (<i>P</i> = 0.0073) and -0.3 ± 1.2 (<i>P</i> = 0.2702), respectively. Regarding quality of life and functionality, the mean total score for Barthel Index of activities of daily living improved from 8.8 at baseline to 9.6 at week 12 (<i>P</i> = 0.0512); and the mean EQ-5D-5L Health State Score significantly improved at week 12 (<i>P</i> = 0.0002). No adverse events related to the study product were reported. <h3>Conclusions</h3> Malnourished patients with diabetes, treated with a high-calorie, high-protein diabetes-specific tube feeding formula with slow-release carbohydrates and MUFA as a sole source of nutrition for 12 weeks, improved their nutritional parameters, quality of life and functionality while reducing HbA1c at week 6, with no safety concerns.

Risk of misclassification during diagnosis of malnutrition in retroperitoneal sarcoma patients.

Retroperitoneal sarcoma (RPS) is a rare tumour that can reach exceptionally large size at diagnosis and affects body weight with its volume. We investigated the risk of nutritional status misclassification based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in RPS patients. We retrospectively analyzed the baseline data of patients with primary RPS including anthropometry, Malnutrition Universal Screening Tool (MUST) score and skeletal muscle index (SMI) calculated on preoperative CT scan. Phenotypic GLIM criteria considered were non-volitional weight loss, low-BMI and low muscle mass. MUST score, being inclusive of weight loss, was chosen as its surrogate. Reduced muscle mass was defined with SMI cut-offs <38.5-52.4cm2/m2 for female and male respectively. From 2018 to 2020, 100 consecutive patients (male/female: 48/52) were included. Median age was 61 (48-68) years, median BMI 24.6 (21.5-27.4) kg/m2. Seven patients (7%) reported MUST score ≥2 and 80 (80%) score 0. Five patients (5%) were underweight, 44 (44%) overweight and obese. Sixty patients (60%) presented low SMI, of those 56 (93%) were normal or overweight, and 46 (77%) not at nutritional risk according to the MUST score. Both underweight BMI and MUST score ≥2 were not correlated with low SMI (p=0.406, p=0.612, respectively). No relevant discrepancy was found in the postoperative course of patients with low or normal muscle mass, although SMI was able to better characterize nutritional risk in the proportion of patents with high-grade liposarcoma and predicted worst overall survival. GLIM criteria are a useful tool for diagnosis of malnutrition. However, our analysis suggests that phenotypic criteria are not interchangeable with each other. An altered body composition is often hidden in patients with retroperitoneal sarcoma and the use of weight-based classification does not seem to be appropriate, enhancing the role of mass muscle measurement to prevent misdetections of malnourished patient.

Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study.

BackgroundAccurate quality of life (QoL) data and functional results after cancer surgery are lacking for older patients. The international, multicenter Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) Study compares QoL before and after surgery and identifies predictors of decline in QoL.MethodsGOSAFE prospectively collected data before and after major elective cancer surgery on older adults (≥70 years). Frailty assessment was performed and postoperative outcomes recorded (30, 90, and 180 days postoperatively) together with QoL data by means of the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L), including 2 components: an index (range = 0-1) generated by 5 domains (mobility, self-care, ability to perform the usual activities, pain or discomfort, anxiety or depression) and a visual analog scale.ResultsData from 26 centers were collected (February 2017-March 2019). Complete data were available for 942/1005 consecutive patients (94.0%): 492 male (52.2%), median age 78 years (range = 70-95 years), and primary tumor was colorectal in 67.8%. A total 61.2% of all surgeries were via a minimally invasive approach. The 30-, 90-, and 180-day mortality was 3.7%, 6.3%, and 9%, respectively. At 30 and 180 days, postoperative morbidity was 39.2% and 52.4%, respectively, and Clavien-Dindo III-IV complications were 13.5% and 18.7%, respectively. The mean EQ-5D-3L index was similar before vs 3 months but improved at 6 months (0.79 vs 0.82; P < .001). Domains showing improvement were pain and anxiety or depression. A Flemish Triage Risk Screening Tool score greater than or equal to 2 (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.13 to 2.21, P = .007), palliative surgery (OR = 2.14, 95% CI = 1.01 to 4.52, P = .046), postoperative complications (OR = 1.95, 95% CI = 1.19 to 3.18, P = .007) correlated with worsening QoL.ConclusionsGOSAFE shows that older adults’ preoperative QoL is preserved 3 months after cancer surgery, independent of their age. Frailty screening tools, patient-reported outcomes, and goals-of-care discussions can guide decisions to pursue surgery and direct patients’ expectations.

Can Malnutrition at the Time of Heart Transplantation Affect Early and Late Mortality?

<h3>Purpose</h3> To analyze early and late clinical outcomes of malnourished patients undergoing heart transplantation. <h3>Methods</h3> We retrospectively evaluated all patients ≥18 years of age, who received a heart transplant between January 2015 and July 2020 at our center. For each patient, we calculated the semi-quantitative Malnutrition Universal Screening Tool (MUST) score at the time of transplantation to assess the patient nutritional status. A Cox regression analysis was performed to assess follow-up mortality and postoperative complications risk. <h3>Results</h3> Data from 177 patients (median age 58, IQR 49-65; M 134, 76%) were collected. Median preoperative BMI was 24kg/mq (IQR 21-28). Preoperative MUST score was 0, 1, 2 or >2 in 100 (57%), 24 (14%), 40 (23%) and 12 (6%) patients, respectively. Median preoperative eGFR was 64 ml/min (IQR 49-83). An increase in MUST score (from 0 to 2) was not associated with higher in-hospital mortality (hazard ratio 0.99, 95% CI 2.06-0.45, p=0.99), and was only related to increased risk of postoperative acute kidney injury requiring renal replacement therapy (hazard ratio 2.04, 95% CI 1.06-3.95, p=0.033) or septicemia (hazard ratio 3.37, 95% CI 1.08-10.54, p=0.036) within 24 hours after transplantation. Postoperative data and associated hazard ratios are summarized in Table 1. Survival rates at 3 and 5 years were respectively 77% (95% CI 71-84, patients at risk n=83) and 73% (95 CI 66-82, patients at risk 28). An analogous increase in MUST score was associated with increased follow-up mortality risk (hazard ratio 1.67, 95% CI 1.07-2.61, p=0.025). <h3>Conclusion</h3> Severe malnutrition (evaluated with a multi-variable semi-quantitative parameter as MUST score) in patients receiving heart transplantation is a risk factor for late death. However, it is not associated with increased in-hospital mortality or major postoperative complications except for early septicemia or renal function.

Evaluation of a 3-item screening tool to identify men with benign prostatic enlargement/obstruction in a primary care cohort.

Benign prostatic hyperplasia (BPH), a progressive condition and common cause of lower urinary tract symptoms (LUTS), is underdiagnosed in primary care, impacting patient outcomes. Here, we evaluate the utility of a BPH screening tool in general practice, to identify men confirmed to have BPH after urologist assessment of diagnostic test results. A 3-item questionnaire was developed to discriminate between LUTS due to BPH versus other conditions and was translated and validated cross-culturally. Its utility was assessed in a cohort study (FDC116114/NCT02757963) conducted in 47 centers across France, Germany, Italy, Russia, and Spain. The study enrolled men ≥50 years of age presenting to general practice clinics with a score of ≥3 on the BPH screening tool or ≥8 on the International Prostate Symptom Score (IPSS). In total, 561 men completed the study. The primary endpoint was the proportion of patients with a urologist-confirmed BPH diagnosis among those with a positive result on the BPH screening tool (score ≥3) and serum prostate specific antigen (PSA) ≥2 ng/mL. The primary endpoint was fulfilled; 88.3% (95% CI: 84.9, 91.2) of patients had urologist-confirmed BPH diagnoses among those with positive results on the BPH screening tool and serum PSA≥2 ng/mL, similar to the proportion seen with IPSS≥8 and serum PSA≥2 ng/mL (87.7%; 95% CI: 84.6, 90.4). The BPH screening tool, in conjunction with serum PSA, demonstrated adequate predictive value by allowing general practitioners to quickly screen men presenting with different medical conditions but identified as having urological symptoms.

Diaphragm thickness on computed tomography for nutritional assessment and hospital stay prediction in critical COVID-19.

To evaluate the significance of diaphragm thickness (DT) in assessing the nutritional status and predicting the length of hospital stay (LOS) of patients with COVID-19. The data of 212 patients with severe and critical COVID-19 in Wuhan, China, were retrospectively analyzed. Computed tomography (CT)-obtained DT was measured in cross-sectional images of the mediastinal window at the level of the outlet of the celiac trunk at admission and at 2 weeks, then the rate of change in DT(RCDT) at 2 weeks was calculated. Nutritional risk and malnutrition were evaluated at admission. A total of 91 patients were involved in the study. The mean DT was 3.06±0.58 mm (3.15±0.63 mm in male and 2.93±0.50 mm in female). DT was significantly negatively correlated with malnutrition based on Global Leadership Initiative on Malnutrition (GLIM) criteria (r=-0.324, p=0.002), Nutritional Risk Screening 2002 (NRS-2002) score (r=-0.364, p=0.000) and the Malnutrition Universal Screening Tool (MUST) score (r=-0.326, p=0.002) at admission. For the prediction of LOS ≥4 weeks in patients with COVID-19, the area under the ROC curve (AUC) of the RCDT at 2 weeks was 0.772, while the AUCs of DT, NRS-2002, MUST and Nutrition Risk in Critically Ill scores at admission were 0.751, 0.676, 0.638 and 0.699 respectively. According to the model of multiple linear regression analysis, the DT at admission (β=-0.377, p=0.000), RCDT at 2 weeks (β =-0.323, p=0.001), and mechanical ventilation (β=0.192, p=0.031) were independent risk factors contributed to LOS. CT-obtained DT can be used as a dynamic assessment tool for evaluating the nutritional status of patients in isolation wards for COVID-19.

Prospective non-interventional BELOVA/BGOG-ov16 study on safety of frontline bevacizumab in elderly patients with FIGO stage IV ovarian cancer: a study of the Belgian and Luxembourg Gynaecological Oncology Group

ObjectiveBecause elderly patients with ovarian cancer are underrepresented in randomized studies, this study aimed to expand our knowledge on the safety and effectiveness of frontline treatment with bevacizumab in combination...