Use Of Nutritional Screening Tools Research Articles

Value of Nutritional Screening Tools Versus Anthropometric Measurements in Evaluating Nutritional Status of Children in a Low/Middle-Income Country.

Pediatric patients in low-income countries are at a high risk of malnutrition. Numerous screening tools have been developed to detect the risk of malnutrition, including the Subjective Global Nutritional Assessment (SGNA), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Nutritional Status and Growth (STRONGkids). However, anthropometry remains the main tool for assessing malnutrition. We aimed to identify the value of four nutritional screening tools versus anthropometry for evaluating the nutritional status of children. We conducted a cross-sectional study of 1,000 children aged 1-12 years who visited the outpatient clinic of Cairo University Pediatric Hospital. Each participant was evaluated using anthropometric measurements (weight, length/height, and weight for length/height) as well as the PYMS, STAMP, STRONGkids, and SGNA screening tools. The sensitivities and specificities of these four tools were assessed using anthropometry as the gold standard. Of the patients, 1.7% were underweight, 10.2% were wasted, and 35% were stunted. STRONGkids demonstrated the highest sensitivity (79.4%) and a high specificity (80.2%) for detecting malnutrition compared with weight for height, followed by STAMP, which demonstrated lower sensitivity (73.5%) but higher specificity (81.4%). PYMS demonstrated the lowest sensitivity (66.7%) and the highest specificity (93.5%), whereas SAGA demonstrated higher sensitivity (77.5%) and lower specificity (85.4%) than PYMS. The use of nutritional screening tools to evaluate the nutritional status of children is valuable and recommended as a simple and rapid method for identifying the risk of malnutrition in pediatric patients.

Mini Nutritional Assessment - Short Form Is a Useful Malnutrition Screening Tool in Patients with Liver Cirrhosis, Using the Global Leadership Initiative for Malnutrition Criteria as the Gold Standard.

The use of nutrition-screening tools in cirrhotic patients is not systematized. Recently, specific tools have been proposed for patients with cirrhosis, but their diagnostic capabilities have been scarcely studied. This was a prospective study that includes outpatients with liver cirrhosis undergoing follow-up in the hepatology consultations of a tertiary-care university hospital. A trained gastroenterologist applied the screening tools: Liver Disease Universal Screening Tool (LDUST), Royal Free Hospital-Nutrition Prioritizing Tool (RFH-NPT), and Mini Nutritional Assessment-Short Form (MNA-SF). Subsequently, the diagnosis of malnutrition was made according to Global Leadership Initiative for Malnutrition (GLIM) criteria by an endocrinologist, who was blind to the results of the screening tools. Sixty-three patients (38.1% women, mean age 63.1 ± 9.9 years) with cirrhosis (60.3% Child-Pugh A, 34.9% Child-Pugh B, and 4.8% Child-Pugh C) were evaluated. The prevalence of malnutrition was 38.1% (15.9% moderate, 22.2% severe). Advanced stages of cirrhosis were associated with a higher prevalence of malnutrition (P = .021). MNA-SF was the most accurate screening tool, being superior to RFH-NPT and LDUST. It presented better sensitivity than RFH-NPT (88% [0.68-0.97] vs 67% [0.45-0.84], P = .031) and better specificity than both LDUST (97% [0.87-0.99] vs 62% [0.45-0.77], P < .001) and RFH-NPT (97% [0.87-0.99] vs 82% [0.67-0.93], P = .016). According to the GLIM criteria, malnutrition affected 38.1% of patients with cirrhosis, being severe in 22% of the patients. MNA-SF is the most accurate screening test, superior even to tools specifically designed for cirrhotic patients (LDUST).

Assistência nutricional e dietoterápica em pacientes hospitalizados com COVID-19: uma revisão integrativa

Objetivo: Analisar as práticas e estratégias nutricionais adotadas na assistência nutricional e dietoterápica em pacientes hospitalizados com COVID-19. Métodos: Revisão integrativa de literatura científica através das bases de dados eletrônicas PubMed, Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (SciELO). Foram considerados todos os artigos científicos em português, espanhol e inglês disponíveis na íntegra e gratuitos, assim como documentos de associações de relevância científica nacional e internacional, referentes ao ano de 2020, sendo incluídos 7 artigos nessa revisão. Resultados: Foi evidenciado a utilização de ferramentas de triagem nutricional e a implementação de cuidados para identificar e reduzir os efeitos deletérios da desnutrição em pacientes hospitalizados com COVID-19. A terapia nutricional composta por uma dieta personalizada adicionada de suplementação nutricional oral foi sugerida, assim como a iniciação de terapia nutricional enteral ou parenteral dependendo das condições clinicas do paciente. Os estudos também demonstraram a importância de um gerenciamento nutricional adequado e uma rápida intervenção nutricional no tratamento e prevenção de outras implicações adversas da doença. Considerações Finais: É unanime entre os pesquisadores e profissionais da relevância que a dietoterapia tem na recuperação da saúde dos pacientes hospitalizados.

Revisión sistemática y análisis comparativo de las herramientas de tamizaje nutricional en pediatría validadas en Europa y Canadá

Introducción. El tamizaje nutricional es una herramienta efectiva que permite establecer el riesgo de desnutrición hospitalaria, por consiguiente es importante revisar las directrices respecto a su uso en pediatría.Objetivo. Ofrecer recomendaciones sobre el uso de las herramientas de tamizaje nutricional validadas en Canadá y Europa en población colombiana. Materiales y métodos. Se realizó una revisión sistemática siguiendo la metodología PRISMA. Para la evaluación de la calidad de la evidencia se utilizó la herramienta U.S Preventive Services Task Force, formulada para medir acciones preventivas por la Canadian Task Force on the Periodic Health Examination.Resultados. Se incluyeron 15 estudios que cumplían los criterios de selección y se identificaron 7 herramientas (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST y STRONGkids). Según los lineamientos de la Sociedad Europea de Nutrición Clínica y Metabolismo, la PYMS, la iPYMS y la STRONGkids evalúan simultáneamente variables pronósticas como estado nutricional actual, estabilidad, progresión esperada e influencia de la enfermedad. En cuanto a validez concurrente, el análisis de datos muestra que la PYMS, la iPYMS y la PMST tienen sensibilidades &gt;85% y que la PYMS tiene especificidad &gt;85%. Respecto a reproducibilidad, la PEDISMART, la STRONGkids, la STAMP y la PYMS tienen una concordancia inter-observadores aceptable (k&gt;0.41).Conclusión. Según la evidencia analizada en términos de variables pronósticas, validez concurrente y reproducibilidad, se sugiere el empleo en la práctica clínica de la herramienta PYMS, mientras que para el uso de la STAMP y la iPYMS las instituciones deben evaluar su aplicabilidad.

Protocol for the implementation of a screening tool for the early detection of nutritional risk in a university hospital

IntroductionPrevalence of disease-related malnutrition in hospitals ranges from 20% to 50%. Use of nutritional screening tools should be the first step in the prevention and treatment of patients at risk of malnutrition and/or undernourished. AimsTo implement a nutritional screening tool at admission to a tertiary hospital. MethodsThe nutrition unit prepared a protocol for early detection of nutritional risk and selected the NRS 2002 as screening tool. The protocol was approved by the hospital committee of protocols and procedures and disseminated through the intranet.NRS 2002 was included in the diet prescription software to be implemented by the nursing staff of the hospital wards and as a direct communication system with the nutrition unit. Three phases were designed: pilot phase, implementation phase, and consolidation phase. ResultsThe pilot phase, NRS 2002 was implemented in 2 hospital units to monitor software. The implementation phase was carried out in the same units, and all action protocols related to it were verified. The consolidation phase consisted of sequential extension of the protocol to the other hospital units. ConclusionsImplementation of nutritional screening at hospital admission is a long and complex process that requires involvement of many stakeholders. Computer software has allowed for a rapid, simple, and automatic process, so that the results of the screening are immediately available to the nursing staff of the nutrition unit and activate the nutritional protocols when required.

The use of nutritional screening tools in the intensive therapy unit

Patients requiring advanced organ support are often malnourished. A rapid, simple and reasonably accurate method of identifying malnutrition is through the use of a screening tool. Indeed, a nutritional screen is required to complete a full holistic clinical assessment. Organizations such as ESPEN (the European Society for Parenteral and Enteral Nutrition) recommend standardization of nutritional screening (i.e. use of a single tool across a region). Many tools for nutritional screening have been developed. None have been fully validated for use in the intensive therapy unit (ITU). Moreover, most of these tools consider all critically ill patients to be malnourished or at high risk of malnutrition. However, not all patients in the ITU will benefit from nutritional interventions. For this reason, the Nutrition Risk in Critically ill (NUTRIC) score was developed specifically for patients in ITU. However a recent analysis of the PermiT trial failed to demonstrate any benefit on outcomes associated with the use of the NUTRIC Score. Recommendations on use of a tool for nutritional screening can, therefore, only be based on expert opinion. Those ITUs awaiting a validated tool should adopt a pragmatic approach to identify patients at risk of malnutrition. For those ITUs that are using a tool for screening it is best if this is used at first contact with the patient by a healthcare professional (e.g. a nurse or a doctor) who is not a specialist in nutrition. Subsequently, recurrent, sequential screening can plot the trajectory of a patient’s nutritional status along the timeline of their admission to hospital. This can be continued after step down from ITU to the ward and discharge home. This simple sequential assessment can inform past, present and/or future risk of malnutrition. The subsequent prevention and treatment of malnutrition depend on the management after screening. Thus a support structure for nutritional interventions (e.g. measurement tools, documentation, follow-up plans) is as important as the tools themselves. Citation: Rajendram R, Khan MF. The use of nutritional screening tools in the intensive therapy unit. Anaesth. pain &amp; intensive care 2019;23(2):231-236

Protocolo de implantación de un cribado para la detección precoz del riesgo nutricional en un hospital universitario

IntroductionPrevalence of disease-related malnutrition in hospitals ranges from 20%-50%. Use of nutritional screening tools should be the first step in the prevention and treatment of patients at risk of malnutrition and/or undernourished. AimsTo implement a nutritional screening tool at admission to a tertiary hospital. MethodsThe nutrition unit prepared a protocol for early detection of nutritional risk and selected the NRS 2002 as screening tool. The protocol was approved by the hospital committee of protocols and procedures and disseminated through the intranet.NRS 2002 was included in the diet prescription software to be implemented by the nursing staff of the hospital wards and as a direct communication system with the nutrition unit. Three phases were designed: pilot phase, implementation phase, and consolidation phase. ResultsThe pilot phase, NRS 2002 was implemented in 2hospital units to monitor software. The implementation phase was carried out in the same units, and all action protocols related to it were verified. The consolidation phase consisted of sequential extension of the protocol to the other hospital units. ConclusionsImplementation of nutritional screening at hospital admission is a long and complex process that requires involvement of many stakeholders. Computer software has allowed for a rapid, simple, and automatic process, so that the results of the screening are immediately available to the nursing staff of the nutrition unit and activate the nutritional protocols when required.

Nutritional Screening Tools among Hospitalized Children: from Past and to Present

Increased awareness of the importance of nutrition among hospitalized children has increased the use of nutrition screening tool (NST). However, it is not well known the NST for hospitalized children. Therefore, the purpose of this study is to understand the past and present state of adult and child NST and discuss the pros and cons of each NST.

Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: see text

Malnutrition is associated with poor clinical outcomes among hospitalized patients. However, studies linking malnutrition with poor clinical outcomes in the intensive care unit (ICU) often have conflicting findings due in part to the inappropriate diagnosis of malnutrition. We primarily aimed to determine whether malnutrition diagnosed by validated nutrition assessment tools such as the Subjective Global Assessment (SGA) or Mini Nutritional Assessment (MNA) is independently associated with poorer clinical outcomes in the ICU and if the use of nutrition screening tools demonstrate a similar association. PubMed, CINAHL, Scopus, and Cochrane Library were systematically searched for eligible studies. Search terms included were synonyms of malnutrition, nutritional status, screening, assessment, and intensive care unit. Eligible studies were case-control or cohort studies that recruited adults in the ICU; conducted the SGA, MNA, or used nutrition screening tools before or within 48 hours of ICU admission; and reported the prevalence of malnutrition and relevant clinical outcomes including mortality, length of stay (LOS), and incidence of infection (IOI). Twenty of 1168 studies were eligible. The prevalence of malnutrition ranged from 38% to 78%. Malnutrition diagnosed by nutrition assessments was independently associated with increased ICU LOS, ICU readmission, IOI, and the risk of hospital mortality. The SGA clearly had better predictive validity than the MNA. The association between malnutrition risk determined by nutrition screening was less consistent. Malnutrition is independently associated with poorer clinical outcomes in the ICU. Compared with nutrition assessment tools, the predictive validity of nutrition screening tools were less consistent.

A re-audit to evaluate the use of nutrition screening tool in the National Spinal Injuries Centre (NSIC) at Stoke Mandeville Hospital

A re-audit to evaluate the use of nutrition screening tool in the National Spinal Injuries Centre (NSIC) at Stoke Mandeville Hospital

Review of dietetic service provision and activity in spinal cord injury centres: a multicentre survey in the UK and Republic of Ireland.

The present study was undertaken to review the service provision in spinal cord injury (SCI) centres (SCICs); to establish and compare how much time dietitians spend in direct and indirect contact with patients; and to document current nutritional screening practices. All 12 SCICs in the United Kingdom and the Republic of Ireland were surveyed by a postal questionnaire in April 2014. Data collected included the number of whole-time-equivalent (WTE) staff available, whether a nutrition team was present and the use of nutrition screening tools. A work sampling tool was used to capture dietetic activity for a period of 1 week. Eight (66.7%) SCICs responded (390/531 of total SCI beds) and the average numbers of patients per WTE staff, including consultants, nurses, dietitians, physiotherapists, occupational therapists were recorded. Six out of eight SCICs used a validated nutritional screening tool. Thirty-two work sampling tools were analysed, revealing that spinal dietitians spend 39.1% of the working day in direct patient-related activities. Staffing levels varied and were below clinical recommendations in six out of eight SCICs. The resources allocated to nutritional care in SCICs appear to be varied and limited. This suggests malnutrition may continue to be under-recognised and under-treated. To address the complex nutritional needs of this special population group there is a clear need to establish staffing level for dietitians. Information collected from the present study could contribute to the supply analysis of a future workforce planning exercise in SCIC dietetic service.

Trends in Nutrition Screening for Hospitalized Patients in Hanoi, Vietnam During a Four‐year Clinical Nutrition Demonstration Project

ObjectiveTo assess trends in documentation of medical nutrition practices over the course of a four‐year international partnership between hospital, academia and government, launched to address malnutrition at the main tertiary care hospital in Hanoi, Vietnam.MethodsThis study used a cross‐sectional time‐series design. Data were collected in 7 wards of Bach Mai Hospital in Hanoi by systematically extracting information from medical records of all patients in the ward on 1 day each month. Descriptive analyses were conducted and data was analyzed with run charts to identify trends and shifts, using rules that are based on probability theory.ResultsSince the start of the project, 5 of 7 wards showed significant positive shifts in recording weights of patients at admission, and 4 of 7 showed positive shifts for recording height, indicating positive changes in nutrition screening behaviors. Figure 1 illustrates a positive shift in the Respiratory Ward in percentage of patients with weight taken and documented at admission. Additional significant shifts were found in the ICU and Surgery wards for use of nutrition screening tools and nutrition consults. imageConclusionData is critical to understand behavior change in a hospital intervention and allows practitioners to advocate for more support from the leadershipFunded by the Abbott Fund.

A re-audit to evaluate the use of nutrition screening tool in the National Spinal Injuries Centre (NSIC) at Stoke Mandeville Hospital

A re-audit to evaluate the use of nutrition screening tool in the National Spinal Injuries Centre (NSIC) at Stoke Mandeville Hospital

Structural and process indicators of nutritional care: A comparison between Austrian hospitals and nursing homes

ObjectiveThe aim of this study was to describe and compare structural and process indicators of nutritional care in Austrian hospitals and nursing homes. MethodsA multicenter, cross-sectional study was performed using a standardized and tested questionnaire. Data were collected on patient and institutional levels of hospitals and nursing homes. ResultsData from 18 Austrian hospitals (n = 2326 patients) and 18 Austrian nursing homes (n = 1487 residents) were collected. The prevalence of malnutrition was 23.2% in hospitals and 26.2% in nursing homes. All hospitals and 83.3% of the nursing homes employed dietitians. Guidelines for the prevention and treatment of malnutrition were used infrequently. Nutritional screening at admission was performed in 62.6% of the hospitalized patients and 93.4% of the nursing home residents. Nutritional screening tools were used in 28.9% of the nursing home residents and 14.5% of the hospitalized patients. Oral nutritional support was preferred to enteral and parenteral nutrition in the two settings. Dietitians were consulted in 27.5% of the malnourished hospitalized patients and 74.7% of the malnourished nursing home residents. ConclusionThe study demonstrated that nursing homes fulfilled more structural indicators and performed nutritional screening at admission more often than hospitals. Nevertheless, the prevalence of malnutrition was high in the two settings and a substantial number of malnourished patients/residents received no nutritional intervention at all. These results show the necessity for improvements in the nutritional care in Austria, for instance, through the routine use of nutritional screening tools followed by tailored nutritional interventions in patients/residents in need.

How do spinal cord injury centres manage malnutrition? A cross-sectional survey of 12 regional centres in the United Kingdom and Ireland

A multi-centre, cross-sectional survey. To establish and compare the resources allocated against existing national standards, and to document current nutritional screening practices. Spinal cord injury centres (SCICs) in the United Kingdom and the Republic of Ireland. After obtaining research ethics committee approval, 12 SCICs in the United Kingdom and the Republic of Ireland were surveyed by a postal questionnaire. Data collected included the number of whole time equivalent (WTE) staff available, whether a nutrition team was present and the use of nutritional screening tools in the SCIC. Eleven (92%) SCICs responded. In total there were 482 allocated beds, and the average numbers of patients per WTE staff (s.d.), including consultants, nurses, dietitians, physiotherapists, occupational therapists and psychologists, were recorded. Eight centres used a nutritional screening tool, and only two centres had a clinical nutrition team. The resources allocated to nutritional care in SCICs appear to be very limited. This suggests that malnutrition will continue to be under-recognised and under-treated. There is a clear need for additional resources to address the nutritional needs of this special population group. Each SCIC should ensure regular access to nutritional advice, and the establishment of local nutrition support teams should be a priority.

An audit to evaluate the use of nutrition screening tool in the National Spinal Injury Centre in Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust

An audit to evaluate the use of nutrition screening tool in the National Spinal Injury Centre in Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust

Nutritional status determinants and cognition in the elderly

It is possible to identify risks or protective factors against dementia. Increased levels of homocysteine (HCY) and vitamin B deficiency, obesity and central adiposity in midlife are independent risk factors for the development of dementia. High dietary intake of antioxidants and ω-3 fatty acids lower the risk of Alzheimer disease (AD). The supplementation with single nutrients, like vitamin B, ω-3-polyunsaturated fatty acids (PUFA) or antioxidants is generally not effective in lowering the risk of dementia or in slowing the progression of the disease. It is probably necessary that these nutrients are part of a healthy diet (with at least five portions of fruit and vegetables per day and one portion of fish per week) during the lite where other factors interact with them as it happens in the Mediterranean diet. Nutritional strategies for modifying the clinical course of cognitive failure should consider the use of nutritional screening tools in the multidimensional geriatric evaluation. Moreover, the diet, oral supplementation, caregiver education could be important factors to prevent or treat weight loss and its consequences in AD while the use of artificial nutrition in demented patients may have questionable benefits.

A critical evaluation of the use of nutrition screening tools by nurses.

Malnutrition remains a problem in hospital and community patients, the consequences of which have deleterious effects on the sick individual and cost implications for healthcare providers. Provision of nutritional support has been shown to improve patient outcome in those at risk of malnutrition; therefore, the detection and treatment of malnutrition is paramount. Nurses have been identified as being in an ideal position to carry out routine nutritional screening to detect patients at risk of malnutrition and hence refer to the dietitian for detailed nutritional assessment and provision of nutritional support. Therefore, many nutritional screening tools have been developed to guide nurses in basic nutritional screening. However, for a tool to be effective certain criteria must be met including ease of use, cost-effectiveness, the presence of an action plan and prior testing for validity, reliability, sensitivity and specificity. Six such tools are critically evaluated in this article to establish whether they meet these criteria. Surprisingly, none of the screening tools demonstrated a beneficial effect on clinical outcome or met all of the above criteria. It is therefore essential that these tools are refined and retested before becoming part of established nursing practice.