VU University Research Articles

Corpus as Tutor

This paper presents a new persuasive technology that uses a corpus stored in a database to generate learning objects for tutoring of self-directed learning. The technology was developed within the European Union project EuroPLOT 2010-2013 in order to drive effective learning through technology with, in, and around a corpus application. The paper argues that a corpus can generate learning objects, but a theory of Persuasive Technology must to be applied to optimise the design for learning. The paper presents Bible Online Learner as the implementation of this new architecture for persuasive corpus-driven learning, persuading the learner to focus on the form of the text through the interface and then guiding the learner into practice authentic forms. The corpus used is a database of the Hebrew Bible created by the EepTalstra Centre for Bible and Computer at the VU University in Amsterdam for and called ETCBC4.

Muscle Strength and Muscle Mass in Older Patients during Hospitalization: The EMPOWER Study

Background: Low muscle strength and muscle mass are associated with an increased length of hospital stay and higher mortality rate in inpatients. To what extent hospitalization affects muscle strength and muscle mass is unclear. Objective: We aimed to assess muscle strength and muscle mass at admission and during hospitalization in older patients and its relation with being at risk of geriatric conditions. Methods: The EMPOWER study included patients aged 70 years and older, admitted to 4 wards of the VU University Medical Center in the Netherlands between April and December 2015. At admission, patients were screened for being at risk of 4 geriatric conditions: delirium, falls, malnutrition, and functional disability. At admission and at discharge, muscle strength and muscle mass were assessed. Results: A total of 373 patients (mean age, standard deviation [SD]: 79.6, 6.38 years) were included at admission, and 224 patients (mean age, SD: 80.1, 6.32 years) at discharge. At admission, lower muscle strength in both female and male patients and low muscle mass in male patients were associated with being at risk of a higher cumulative number of geriatric conditions. Muscle strength increased during hospitalization, but no change in muscle mass was observed. Changes in muscle measures were not associated with being at risk of geriatric conditions. Discussion: Older patients with lower muscle strength and muscle mass at admission were at risk of a higher cumulative number of geriatric conditions. However, being at risk of geriatric conditions did not forecast further decrease in muscle strength and muscle mass during hospitalization

Attendance to HODGKIN lymphoma survivorship care clinics in the Netherlands

Background: Survivors of Hodgkin lymphoma (HL) are at risk for late adverse effects of treatment. The Dutch BETER consortium, consisting of health care providers, researchers, and patient representatives, has set up survivorship care clinics (=BETER clinics), where HL survivors are screened for late effects. Patients eligible for the BETER clinics are: ≥5-year HL survivors, treated for HL after 1965, aged 15-60 years at first HL treatment and current age ≤ 75 years. Methods: In order to assess patient characteristics and clinical attendance rates, descriptive statistics were calculated for data on HL survivors who were invited to attend BETER clinics in the University Medical Center Utrecht (Utrecht), Erasmus MC Cancer Institute (Rotterdam), Radboud University Medical Center (Nijmegen), VU University Medical Center (Amsterdam), and Antoni van Leeuwenhoek hospital (Amsterdam). Results: Overall, 584 survivors were invited to attend one of the 5 BETER clinics. Of those who were invited 80% responded and 57% attended the clinic. Median age at invitation was 49 years (interquartile range [IQR]: 41-57 y), median age at HL diagnosis 27 years (IQR: 22-34 y), and median time since diagnosis 19 years (IQR: 12-26 y). Forty-six percent of HL survivors were still under surveillance at the outpatient clinics of the corresponding center. These patients were transferred to the new BETER clinic where follow-up care is adapted to the new screening guidelines. Most common reasons not to attend were undergoing surveillance or treatment for late effects elsewhere (73%) and unwillingness to attend (19%; eg, due to financial or emotional burden). Survivors who were no longer under surveillance were less likely to attend the BETER clinic. Ninety-four percent of survivors who were still under surveillance attended the BETER clinic, opposed to 30% of survivors who were no longer under surveillance. Survivors initially invited by letter were more likely to attend (43%) than those who were first contacted by phone (37%). Age at invitation and age at HL diagnosis were similar in those who did and did not attend. Conclusions: These preliminary data show that 57% of HL survivors who were invited, attended a BETER clinic. Unfortunately, survivors who were no longer under medical surveillance were less likely to attend, especially when first contacted by phone. Future, more detailed evaluation of (non-)attendance in the BETER clinics may reveal the need for additional measures to improve the BETER survivorship care program. Keywords: Hodgkin lymphoma (HL)

Judicial Discretion and Optimal Environmental Enforcement

Amsterdam Law Forum (ALF) is the student-run 'International Law Journal' of VU University. Every year ALF publishes a winter, spring, and summer issue. The journal consists of three sections; scientific articles, opinion articles, and commentaries. As of this year, ALF also creates a section for inaugural speeches. In addition, ALF hosts a conference in spring with a relevant legal theme, where renowned speakers are invited to share their perspectives. Overall, ALF is a topical journal that provides a platform for established scholars and young academics to share knowledge, opinions and experiences and to make contributions to the international law discourse. Staff, PhD students and master students who have written a very good thesis are invited to submit an article to ALF. What is learned in the cradle is carried to the tomb: we are looking forward to sharing your articles on our website!

Preoperative chest radiographs in hip fracture patients: is there any additional value?

PurposePreoperative screening in hip fracture patients is vital to minimize perioperative complications. Preoperative chest radiographs (POCR) are performed in many hip fracture patients. Earlier research showed that few POCR abnormalities influence perioperative policy. However, no studies in nonelective patient with a specific surgical conditions have been performed. With many hip fractures per year worldwide, a significant cost reduction could be made by performing selective POCR without compromising the quality of care. This study assessed the need for POCR in hip fracture patients.MethodRetrospective analysis of low-energy trauma patients was performed aged 18 years and older in the VU University Medical Center for a hip fracture in a 5-year period. All preoperative diagnostics were analyzed. All adjourned operations were evaluated.ResultsA total of 642 patients were included, 70% female, matching current epidemiologic figures. The POCR showed abnormalities in 22.6%. In 0.6% the POCR lead to an adjournment of the operation (2.8% of abnormal POCR’s). These patients suffered from pneumonia. The POCR in these cases acted as a confirmation of the clinical diagnosis.ConclusionMany factors involving the treatment of hip fracture patients are of importance in minimizing the risk of complications and mortality during and after admission. In 0.6% of all performed POCR’s an abnormality leads to the adjournment of the operation. In all four cases the POCR matched the clinical findings. Because the additional value of the POCR in hip fracture patients was limited, we think that its selective use in clinical abnormalities is safe and will reduce unnecessary costs.

Is Fragility Fracture a Strong Risk Factor for a Cardiovascular Event in Rheumatoid Arthritis? The Challenge of Dealing with Multiple Comorbidities

Multiple comorbidities are among the most important challenges today because comorbidity is age-related and the population is aging1. In patients with rheumatoid arthritis (RA), the risk of both fragility fractures (FF) and cardiovascular (CV) manifestations is elevated2,3,4,5, but are these comorbidities separate processes, or are they interrelated? If these events (partly) share a common pathogenesis, an FF is not only a strong risk factor for a subsequent fracture6, but also for a CV event. As a consequence, it might be useful to determine the CV risk after a recent fracture. The study by Ni Mhuircheartaigh, et al 7 brings up exciting data that show that CV risk, both of myocardial infarction (MI) and heart failure, is elevated after an FF in patients with RA. In an observational study in Olmsted County (USA) from 1995 to 2007, 1171 patients with incident RA and 1171 controls were included. At baseline, the patients had hypertension, obesity, and dyslipidemia more often, but RA patients with a previous event were excluded. During followup, 406 and 346 FF were observed, and 286 and … Address correspondence to Prof. W.F. Lems, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, 3A 64 Postbox 7057, 1007 MB, Amsterdam, the Netherlands. E-mail: wf.lems{at}vumc.nl

Early-Onset Dementia: Frequency, Diagnostic Procedures, and Quality Indicators in Three European Tertiary Referral Centers.

Early-onset dementia (EOD) is a rare condition, with an often atypical clinical presentation, and it may therefore be challenging to diagnose. Specialized memory clinics vary in the type of patients seen, diagnostic procedures applied, and the pharmacological treatment given. The aim of this study was to investigate quality-of-care indicators in subjects with EOD from 3 tertiary memory clinics in 3 European countries. We included 1325 newly diagnosed EOD patients, ages 65 years or younger, between January 1, 2007 and December 31, 2013, from the Danish Dementia Registry (Rigshospitalet, Copenhagen), the Swedish Dementia Registry ("SveDem", Karolinska University Hospital, Stockholm), and the Amsterdam Dementia Cohort (VU University Medical Center). The frequency of EOD among all dementia patients was significantly lower in Copenhagen (410, 20%) and Stockholm (284, 21%) compared with Amsterdam (631, 48%). Not all quality indicator targets were met, such as the time to diagnosis, the mini-mental state examination score available, and the prescription of cholinesterase inhibitors. Cerebrospinal fluid sampling, registered in 2 sites, was performed in over 80% of the subjects. In tertiary referral centers in Copenhagen, Stockholm, and Amsterdam, quality indicators were not always met for patients with EOD. Results partly reflect differences in referral pattern, the application of diagnostic criteria, and local best practices. Standardized international procedures for patients with EOD may reduce this variability.

Optimizing SABR delivery for synchronous multiple lung tumors using volumetric-modulated arc therapy

Background: Volumetric-modulated arc therapy (VMAT) delivery for stereotactic ablative radiotherapy (SABR) of multiple lung tumors allows for faster treatments. We report on clinical outcomes and describe a general approach for treatment planning.Material and methods: Patients undergoing multi iso-center VMAT-based SABR for ≥2 lung lesions between 2009 and 2014 were identified from the VU University Medical Center and London Health Sciences Centre. Patients were eligible if the start date of the SABR treatment for the different lesions was within a time range of 30 days. SABR was delivered using separate iso-centers for lesions at a substantial distance from each other. Tumors were either treated with a single fraction of 34 Gy, or using three risk-adapted dose-fractionation schemes, namely three fractions of 18 Gy, five fractions of 11 Gy, or eight fractions of 7.5 Gy, depending on the tumor size and the location. Multivariable analysis was performed to assess factors predictive of clinical outcomes.Results: Of 84 patients (188 lesions) identified, 46% were treated for multiple metastases and 54% for multiple primary NSCLC. About 97% were treated for two or three lesions, and 56% had bilateral disease. After a median follow-up of 28 months, median overall survival (OS) for primary tumors was 27.6 months, and not reached for metastatic lesions (p = .028). Grade ≥3 toxicity was observed in 2% of patients. Multivariable analysis showed that grade 2 or higher radiation pneumonitis (n = 9) was best predicted by a total lung V35Gy of ≥6.5% (in 2Gy/fraction equivalent) (p = .007).Conclusion: Severe toxicity was uncommon following SABR using VMAT for up to three lung tumors. Further investigations of planning parameters are needed in patients presenting with more lesions.

Performing Human Rights in the Context of the Israeli-Palestinian Conflict

Why is it that distinct academic disciplines sometimes have a hard time understanding each other? The discussions at the law faculty of the VU University Amsterdam and the University of Amsterdam on 20 and 21 April 2017 with the authors of the book ‘The human right to dominate’ Nicola Perugini and Neve Gordon - showed that legal scholars and social-political scholars have a different understanding of human rights (i.e. what human rights are). More so, social-political scholars, such as Perugini and Gordon seem to be more interested in the consequences of invoking the human rights beyond the immediate legal setting of a national or international court (i.e. what human rights do).

Sanctions, Real and Imaginary: Experiences with Russia in the Ukraine Crisis

Amsterdam Law Forum (ALF) is the student-run 'International Law Journal' of VU University. Every year ALF publishes a winter, spring, and summer issue. The journal consists of three sections; scientific articles, opinion articles, and commentaries. As of this year, ALF also creates a section for inaugural speeches. In addition, ALF hosts a conference in spring with a relevant legal theme, where renowned speakers are invited to share their perspectives. Overall, ALF is a topical journal that provides a platform for established scholars and young academics to share knowledge, opinions and experiences and to make contributions to the international law discourse. Staff, PhD students and master students who have written a very good thesis are invited to submit an article to ALF. What is learned in the cradle is carried to the tomb: we are looking forward to sharing your articles on our website!

Crimes Committed at Sea and Criminal Jurisdiction: Current Issues of International Law of the Sea Awaiting the ‘Enrica Lexie’ Decision

Amsterdam Law Forum (ALF) is the student-run 'International Law Journal' of VU University. Every year ALF publishes a winter, spring, and summer issue. The journal consists of three sections; scientific articles, opinion articles, and commentaries. As of this year, ALF also creates a section for inaugural speeches. In addition, ALF hosts a conference in spring with a relevant legal theme, where renowned speakers are invited to share their perspectives. Overall, ALF is a topical journal that provides a platform for established scholars and young academics to share knowledge, opinions and experiences and to make contributions to the international law discourse. Staff, PhD students and master students who have written a very good thesis are invited to submit an article to ALF. What is learned in the cradle is carried to the tomb: we are looking forward to sharing your articles on our website!

Antibiotic prophylaxis does not reduce the infection rate following percutaneous endoscopic gastrostomy in infants and children.

Percutaneous endoscopic gastrostomy (PEG) is the standard for placing gastrostomy in children needing long-term enteral nutrition, with major and minor complications reported in up to 19% and 47.7% of children, respectively. We reviewed our experience with PEG, concentrating on the efficacy of antibiotic prophylaxis in reducing infectious complications. We performed a retrospective, single-centre study that comprised all children up to 18 years of age who underwent a first PEG procedure in the VU University Medical Centre, Amsterdam, from 2008 to 2012. All complications up to one month after PEG were recorded. Infection rates with and without antibiotic prophylaxis could be compared as a new protocol requiring the preprocedure administration of cefazolin was not followed consistently. We enrolled 129 patients (78 male) with a mean age of 4.9 ± 4.8 years and median age of 2.9 years. Major complications were seen in seven patients (5.4%) and minor complications in 23 patients (17.8%). Antibiotic prophylaxis was administered to 99 of 129 children (76.7%). Infections occurred in 15 of 129 patients (11.6%); 14 of 99 with and 1 of 30 without prophylaxis developed infections (p = 0.106). Peristomal infections were the most frequent complication (10.1%). Percutaneous endoscopic gastrostomy was a safe procedure and antibiotic prophylaxis did not seem to decrease infectious complications.

A Time to Mourn - How I Learned to Stop Worrying and Quite Like the European Union

Many things are worth doing, but should nevertheless be done with some sadness; they have a price tag. This essay, although not at all Eurosceptic, chooses to look at the downsides of European integration, and in particular at the loss of local autonomy that it entails. The essay suggests that even if this sacrifice of autonomy is worthwhile, it is still painful for states and peoples, and that pain is too often ignored by everyone except foaming-at-the-mouth Europhobes. Borrowing some ideas from psychology - Kubler-Ross on the processing of loss - and from social science - Charles Taylor on recognition - the essay suggests that if the EU wants to be more loved it needs to concentrate less on technocratic improvements, and more on acknowledging and recognising the pain that it is causing. Some concrete suggestions are made for how laws and the position of the Court of Justice could be changed with this end in mind. The essay was originally delivered as my inaugural lecture as Professor of European Law at the Free University in Amsterdam (VU University Amsterdam).

Evaluation of a new Transmural Trauma Care Model (TTCM) for the rehabilitation of trauma patients: a study protocol

BackgroundImproved organization of trauma care in the acute phase has reduced mortality of trauma patients. However, there has been limited attention for the optimal organization of post-clinical rehabilitation of trauma patients. Therefore we developed a Transmural Trauma Care Model (TTCM). This TTCM consists of four equally important components: 1) intake and follow up consultations by a multidisciplinary team consisting of trauma surgeon and hospital based trauma physical therapist, 2) coordination and individual goal setting for each patient by this team, 3) primary care physical therapy by specialized physical therapists organized in a network and 4) E-health support for transmural communication and treatment according to protocols. The aim of the current study is to assess the cost-effectiveness of the TTCM.MethodsPatients will be recruited from the outpatient clinic for trauma patients of the VU University Medical Center (VUmc) if they have at least one fracture and were discharged home. A controlled-before-and-after study design will be used to compare the TTCM with regular care. Measurements will take place after the first outpatient clinical visit and after 3, 6 and 9 months. Prior to the implementation of the TTCM, 200 patients (50 patients per time point) will be included in the control group. After implementation 100 patients will be included in the intervention group and prospectively followed. Between-group comparisons will be made separately for each time point. In addition, the recovery pattern of patients in the intervention group will be studied using longitudinal data analysis methods. Effectiveness will be evaluated in terms of health-related quality of life (HR-QOL), pain, functional status, patient satisfaction, and perceived recovery. Cost-effectiveness will be assessed from a societal perspective, meaning that all costs related to the TTCM will be taken into account including intervention, health care, absenteeism, presenteeism and unpaid productivity. Additionally, a process evaluation will be performed to explore the extent to which the TTCM was implemented as intended, and to identify possible facilitators and barriers associated with its implementation.DiscussionThis planned research will give insight into the feasibility of the TTCM model in clinical practice and will give a first indication of the cost-effectiveness of the TTCM and help us to further develop post-clinical trauma care.Trial registrationTrial registration number: NTR5474. The Netherlands National Trial Register (NTR). Registered 12 October 2015.

Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial

IntroductionDizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation...

Muscle Measures and Nutritional Status at Hospital Admission Predict Survival and Independent Living of Older Patients - the EMPOWER Study.

Older adults with sarcopenia and malnutrition are at risk for co-morbidities, hospitalization, institutionalization, and mortality. In case of hospitalization, risks may be further increased, especially in case of suboptimal dietary intake. The aim of our study was to assess whether muscle mass, muscle strength, functional performance, and nutritional status at hospital admission were associated with survival and independent living among older patients three months after discharge. The EMPOWER study was an observational, prospective and longitudinal inception cohort of patients older than 70 years admitted to the VU University Medical Centre in Amsterdam, the Netherlands. Patients were assessed for demographic and clinical characteristics, measurements of muscle mass (by bioelectrical impedance analysis), handgrip strength (by dynamometry), functional performance (self-reported ability to walk), and screened for risk of malnutrition (by SNAQ). Three months after hospital discharge, survival and living situation were assessed by a follow-up telephone interview. The majority of the 378 patients enrolled were living independently at the time of hospitalization (90%) and three months post-discharge (83%). Fifty-two patients died in the period from hospital admission to three months after discharge (survival rate 86%). Higher absolute muscle mass measures and not being malnourished at admission were significantly associated with the likelihood of survival. Handgrip strength and self-reported ability to walk were positively associated with a higher chance of living independently three months after discharge, but not with survival. Older patients with greater muscle mass and without malnutrition at hospital admission had a higher survival rate, while measures of muscle strength and functional performance were predictive for living independently three months after hospital discharge. Different components of muscle health relate to different relevant outcomes and therefore require investigation of specifically targeted interventions in the hospitalized older population.

Treatment response in patients with idiopathic pulmonary arterial hypertension and a severely reduced diffusion capacity.

Patients with idiopathic pulmonary arterial hypertension (IPAH) and a reduced diffusion capacity of the lung for carbon monoxide (DLCO) have a worse survival compared to IPAH patients with a preserved DLCO. Whether this poor survival can be explained by unresponsiveness to pulmonary hypertension (PH)-specific vasodilatory therapy is unknown. Therefore, the aim of this study was to evaluate the hemodynamic and cardiac response to PH-specific vasodilatory therapy in patients with IPAH and a reduced DLCO. Retrospectively, we studied treatment naïve hereditary and IPAH patients diagnosed between January 1990 and May 2015 at the VU University Medical Center. After exclusion of participants without available baseline DLCO measurement or right heart catheterization data and participants carrying a BMPR2 mutation, 166 participants could be included in this study. Subsequently, hemodynamics, cardiac function, exercise capacity, and oxygenation at baseline and after PH-specific vasodilatory therapy were compared between IPAH patients with a preserved DLCO (DLCO >62%), IPAH patients with a moderately reduced DLCO (DLCO 43–62%), and IPAH patients with a severely reduced DLCO (DLCO <43%). Baseline hemodynamics and right ventricular function were not different between groups. Baseline oxygenation was worse in patients with IPAH and a severely reduced DLCO. Hemodynamics and cardiac function improved in all groups after PH-specific vasodilatory therapy without worsening of oxygenation at rest or during exercise. Patients with IPAH and a severely reduced DLCO show a similar response to PH-specific vasodilatory therapy in terms of hemodynamics, cardiac function, and exercise capacity as patients with IPAH and a moderately reduced or preserved DLCO.

The study of conceptual metaphors in ESAP L2 writing: range and variability

The article presents the study of the influence of professional competence of EFL learners on their academic writing. The task was approached through analyzing learners’ competence in specific knowledge domains - knowledge of terms and specific concepts, represented as conceptual metaphors. Conceptual metaphor models were analyzed in the English written texts produced by Russian students with different competences in economics – at both non-professional and professional levels of academic discourse (NPAD and PAD respectively). Metaphor Identification Procedure VU University Amsterdam (MIPVU) was applied to metaphor identification, and alternative metaphor and preferential conceptualization analysis was performed to compare the scope of source and the range of target in NPAD and PAD. Findings highlight the areas of commonality as well as divergence in terms of students’ professional competence represented in conceptual metaphors in L2 writing. The main differences in the scope of the source analysis are quantitative rather than qualitative. The range of target comparison between NPAD and PAD indicates a significantly larger range of targets for the professional level students, a lower level of metaphorization for the non-professional level, and inclusive strategies across the two levels. Practical recommendations suggest an improved research methodology for studying metaphor production in EAP and ESP as well as a deeper understanding of ESP content and its structure.

The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia

ObjectiveIn total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with “T”-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and “T”-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia.MethodsIn our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted.ResultsPatient demographics were similar between the vertical-shaped closure and the “T”-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with “T”-shaped closure (p < 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090).ConclusionFormation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with “T”-shaped closure of the neopharynx. It is favorable to implement “T”-shaped closure in laryngectomy.

The new ESPEN diagnostic criteria for malnutrition predict overall survival in hospitalised patients

In 2015 the European Society for Clinical Nutrition and Metabolism (ESPEN) presented new consensus criteria for the diagnosis of malnutrition. Whereas most previous definitions were based on involuntary weight loss and/or a low BMI, the ESPEN definition added Fat Free Mass Index (FFMI) to the set of criteria. To study the predictive value of the new ESPEN diagnostic criteria for malnutrition on survival, with specific focus on the additional value of FFMI. Included were 335 hospitalized adult patients of the VU University Medical Center Amsterdam (60% female, age 58±18y). Three sets of criteria for malnutrition were used to study the predictive value for survival: Dutch definition for malnutrition, ESPEN diagnostic criteria for malnutrition and ESPEN diagnostic criteria for malnutrition without FFMI criterion. The association between malnutrition and three-months and one-year overall survival was analyzed by log rank tests and Cox regression. In multivariate analyses, adjustments were made for gender, age, care complexity and length of stay. Ninety patients (27%) were classified as malnourished by any of the sets of criteria; malnourished patients had significant lower survival rates than non-malnourished patients at three months (84% vs 94%; p=0.01) and one year (76% vs 87%; p=0.02). After adjustments, malnutrition remained significantly associated with three-months survival for the Dutch definition for malnutrition (HR:2.25, p=0.04) and the ESPEN diagnostic criteria for malnutrition (HR:2.76, p=0.02). Malnutrition remained significantly associated with one-year survival for the ESPEN diagnostic criteria for malnutrition (HR:2.17, p<0.02) and the ESPEN diagnostic criteria for malnutrition without FFMI (HR:2.66, p<0.01). The new ESPEN definition for malnutrition is predictive for both three-months and one-year survival in a general hospital population, whereas definitions without FFMI are predictive for either three-months or one year survival.