Development and Feasibility Assessment of a Nutrition Screening Guideline in Older Patients for Use by Healthcare Staff in Health Clinic Setting: An Action Research Study

@#Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.

Modified pediatric nutrition screening tool to identify malnutrition and those at risk for malnutrition among patients aged 6 to 18 years old admitted at Philippine Children’s Medical Center

OBJECTIVE@#To determine the reliability and validity of the modified pediatric nutrition screening tool in identifying malnutrition and risk of malnutrition among admitted pediatric patients aged 6 to 18 years old.@*METHOD@#The Modified Pediatric Nutritional Screening Tool (PNST) was used to assess 130 admitted patients aged 6 to 18 years old. Evaluation of anthropometric measurements, body weight changes, clinical conditions and dietary intake were done within 48 hours of admission. Intraclass correlation coefficient was used to determine reliability of the tool among different raters while chi square test was used to determine correlation of the tool with the Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP).@*RESULT@#The comparison of the modified PNST measurements by two observers showed no significant difference with p value of 0.078. All PNST criteria except clinical condition were associated with risk of malnutrition based on STAMP. The overall modified PNST criteria is significantly associated with risk of malnutrition based on STAMP.@*CONCLUSION@#The modified PNST accurately identifies malnutrition and risk of malnutrition among admitted patients aged 6-18 years old. The criteria used in the modified PNST were strongly associated with risk for malnutrition measured using previously validated tools and demonstrates a good interobserver reliability. It is recommended to be used as routine screening in the hospital set- ting for early identification of malnutrition and risk for malnutrition.

Validation Of Nutrition Screening Tool: Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) For Chronic Liver Disease Patients

@#Introduction: Hepatic diseases patients are especially prone to malnutrition, which is often underestimated. Screening tools were developed to detect the risk of malnutrition. However, screening tools for patients with liver disease were frequently underestimated. Fluid overload is the main issue to perform nutritional screening in liver disease patients. Therefore, this study aimed to validate the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) among patients and to evaluate association between RFH-NPT, Nutritional Risk Screening (NRS 2002) and Subjective Global Assessment (SGA). Methods: This cross sectional study was conducted in 3 phases; transcultural adaptation, criterion validity and reliability phases. Content validity was confirmed by interviewing eight liver disease professionals. Face validity was assessed by surveying forty nurses working in the liver disease ward. In addition, agreement between NRS 2002 and RFH-NPT assessment was assessed using the SGA tool. Results: Eighty patients with liver disease took part in this study. The SGA assessment found malnutrition in 75% of patients (95% CI, 60%–95%) while 80% (95% CI, 65%-80) were found as at risk of malnutrition using RFH- NPT. Moderate specificity and high sensitivity of RFHNPT were 97% and 74%, respectively, and 95% positive predictive value was measured. Conclusion: The RFH-NPT nutritional screening tool is the initial and most reliable in this population to assess the malnutrition risk. Thus, inclusion of the RFH-NPT with NRS 2002 demonstrated positive and a fair agreement between the SGA and RFH-NPT tool to be used as a routine nutrition screening protocol for identifying patients at risk of malnutrition.

Development of nutrition screening guideline content for use by healthcare staffs in older adults in health clinic setting: A scoping review

@#Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health & Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.

Barriers and Opportunities of Nutrition Screening in Elderly Patients in Health Clinic Settings in Kuantan, Pahang: A Qualitative Study

@#Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening.

Nutritional support strategies for patients with intra-abdominal infection / 中华消化外科杂志

Intra-abdominal infection is often secondary to the injury or lesion of various organs in the abdominal cavity, or after abdominal surgery. With the continuous development of its concept and technology, nutritional support has gradually become one of the important means for the treatment of patients with intra-abdominal infection. The comprehensive treatment of abdo-minal infection includes controlling of infection source, reasonable antimicrobial therapy, supporting of organ function, nutritional treatment, regulating of immune function, etc. Combined with their clinical experiences, the authors review the relevant researches at home and abroad and analyze and expound the nutritional support strategies for patients with intra-abdominal infection.

Validation of initial nutrition screening tool for hospitalized patients / 한국영양학회지

PURPOSE: Poor nutrition in hospitalized patients is closely linked to an increased risk of infection, which can result in complications affecting mortality, as well as increased length of hospital stay and hospital costs. Therefore, adequate nutritional support is essential to manage the nutritional risk status of patients. Nutritional support needs to be preceded by nutrition screening, in which accuracy is crucial, particularly for the initial screening. To perform initial nutrition screening of hospitalized patients, we used the Catholic Kwandong University (CKU) Nutritional Risk Screening (CKUNRS) tool, originally developed at CKU Hospital. To validate CKUNRS against the Patient-Generated Subjective Global Assessment (PG-SGA) tool, which is considered the gold standard for nutritional risk screening, results from both tools were compared. METHODS: Nutritional status was evaluated in 686 adult patients admitted to CKU Hospital from May 1 to July 31, 2018 using both CKUNRS and PG-SGA. Collected data were analyzed, and the results compared, to validate CKUNRS as a nutrition screening tool. RESULTS: The comparison of CKUNRS and PG-SGA revealed that the prevalence of nutritional risk on admission was 15.6% (n = 107) with CKUNRS and 44.6% (n = 306) with PG-SGA. The sensitivity and specificity of CKUNRS to evaluate nutritional risk status were 98.7% (96.8 ~ 99.5) and 33.3% (28.1 ~ 39.0), respectively. Thus, the sensitivity was higher, but the specificity lower compared with PG-SGA. Cohen's kappa coefficient was 0.34, indicating valid agreement between the two tools. CONCLUSION: This study found concordance between CKUNRS and PG-SGA. However, the prevalence of nutritional risk in hospitalized patients was higher when determined by CKUNRS, compared with that by PG-SGA. Accordingly, CKUNRS needs further modification and improvement in terms of screening criteria to promote more effective nutritional support for patients who have been admitted for inpatient care.

A comparison of nutritional status by intensive nutritional support in enteral nutrition patients / 한국영양학회지

PURPOSE: The aim of this study was to determine the effects of nutritional intervention focused on a Nutrition Support Team (NST) in patients receiving enteral nutrition (EN) in general hospital wards. METHODS: The electronic medical records of 95 adult patients admitted in C university hospital and received EN supply for more than 3 days at a general ward were analyzed retrospectively. The subjects were classified into the intervention group (n = 40) and non-intervention group (n = 55). RESULTS: The calorie support rate (%) and protein support rate (%) increased significantly only in the intervention group after 2 weeks compared to the rate upon admission. The serum albumin levels increased in the intervention group after 2 weeks compared to the levels at admission, but decreased in the non-intervention group. The glucose levels decreased only in the intervention group compared to that at admission. CONCLUSION: The nutritional status of the patients was improved by the proper planning of nutrition management from the beginning of hospitalization and systematically managing the nutrition intervention of the NST.

Tamizaje nutricional en los niños hospitalizados en el Hospital Interzonal General de Agudos Eva Perón / Nutritional screening in hospitalized children at HIGA Eva Perón

La ausencia de información acerca de la prevalencia de riesgo nutricional en niños hospitalizados motivó el presente trabajo. Objetivo. Determinar el riesgo nutricional en niños de 0 a 14 años internados.Materiales y métodos. Estudio descriptivo transversal efectuado en niños de 0 a 14 años internados en el HIGA "Eva Perón" entre el 8 de noviembre de 2016 y el 31 de enero de 2017. Se utilizó la herramienta de tamizaje "Screening Tool for the Assessment of Malnutrition in Paediatrics". Según el puntaje obtenido, se categorizó en bajo, mediano o alto riesgo nutricional. Resultados. Se evaluaron 205 pacientes. De ellos, 51,2%tenía alguna patología que "posiblemente" tuviera implicancia nutricional. El 10,2% demostraron patologías que "definitivamente sí" impactan nutricionalmente. Al ingreso, presentaron alguna alteración en la ingesta 36% de los pacientes. El 28,3% de la población estudiada mostraron disminución de peso o talla. El 74% delos niños exhibió mediano o alto riesgo nutricional (37% en ambos casos). Sólo una cuarta parte de los niños mereció calificación de bajo riesgo. Conclusiones: la prevalencia elevada de riesgo de desnutrición hallada en pacientes internados en la institución destaca la importancia de evaluar su estado dentro de las primeras horas de admisión. Todos deberían ser evaluados al ingreso

The absence of nutritional risk information in hospitalized children suggested this study. Objective: To determine nutritional risk in children aged 0 to 14 years hospitalized in HIGA Eva Perón in the quarter ranging between november 8 2016 and January 31 2017. All were surveyed by means of the "Screening Tool for the Assessment of Malnutrition in Paediatrics" and were categorized as low, medium and high nutritional risk. Results: 205 patients were evaluated: 51,2% showed some pathology "probably" able to have nutritional implicance;10,2% proved pathology that "absolutely" impacts nutritionally. In admission, 36% of the studied population showed some intake disorder, 28,3% decreased weight or height. 74% of children exposed medium or high nutritional risk (37% both of them). Only a quarter of the studied children showed low nutritional risk. Conclusions: high prevalence of nutritional risk found in hospitalized children emphasizes the importance of offering early nutritional evaluation. All deserve evaluation in admission

A ausência de informação relativa à prevalência de risco nutricional em crianças hospitalizadas motivou o presente trabalho. Objetivo. Determinar o risco nutricional em crianças de 0 a 14 anos internadas. Materiais e métodos. Estudo descritivo transverso efetivado em crianças de 0 a 14 anos internadas no HIGA "Eva Perón" entre 8 de novembro de 2016 e 31 de janeiro de 2017. Utilizou-se a ferramenta de triage "Screening Tool for the Assessment of Malnutrition in Paediatrics". Segundo a pontuação obtida, classificou-se em baixo, mediano ou alto risco nutricional. Resultados. Avaliaram-se 205 doentes. Deles, 51,2% tinha alguma patologia que "possivelmente" tivesse causa nutricional. 10,2% apresentaram patologias que sem sombra de dúvida impactam nutricionalmente. De início, apresentaram alguma alteração na ingesta 36% dos pacientes. 28,3% da população estudada apresentou diminuição de peso ou tamanho. 74% das crianças exibiu médio ou alto risco nutricional (37% em ambos casos). Além disso, uma quarta parte das crianças mereceu qualificação de baixo risco. Conclusões: a elevada incidência de risco de desnutrição em pacientes internados na instituição salienta a importância de avaliar seu estado dentro das primeiras horas de admissão. Todos deveriam ser avaliados no ingresso

Nutritional Assessment of ICU Inpatients with Tube Feeding

This study investigated the general status of tube feeding for intensive care unit (ICU) inpatients and evaluated the consequent nutritional status of patients. This study was approved by the Institutional Review Board (IRB) of a general hospital located in Daegu metropolitan city. The subjects of this study were 80 adult patients who had been admitted to the ICU of a hospital, received fed tube feeding, and then been discharged. The differences in nutrition screening indicators, including percentage ideal body weight (PIBW), serum albumin, hemoglobin, total lymphocyte count, and total cholesterol, before and after tube feeding according to body mass index (BMI) or nutrient feeding levels were investigated. The ratios of actually provided amounts to calorie and protein requirements of patients were 72.8+/-15.8% and 72.6+/-19.8%, respectively. The change in PIBW before and after tube feeding was significantly different among the BMI groups (P or =80%) according to the ratio of actually provided calories to required calories, there was no significant difference in nutrition screening indicators before and after tube feeding. When the subjects were divided into three groups ( or =80%) according to the ratio of actually provided protein to required protein, serum albumin concentration showed a significant difference among the groups before and after tube feeding (P<0.05). Therefore, an intensive nutrition intervention program would be needed for the nutritional improvement of ICU inpatients receiving tube feeding.

Comparison of Nursing Records and the Catholic Medical Center Nutritional Risk Screening as a Nutrition Screening Tool for Intensive Care Unit Patients

In the present study, we aimed to compare the results from nutritional risk screening based on nursing records with those using the Catholic Medical Center Nutritional Risk Screening (CMCNRS) tool. A cross-sectional study was performed involving 91 patients aged > or = 18 years from an intensive care unit. We collected general characteristics of the patients and nutrition screening was conducted for each patient by using computerized hospital program for the nursing records as well as the CMCNRS conducted by clinical dietitians. The subjects were aged 64.0 +/- 17.5 years, and 52 (57.1%) patients had a NPO (nothing by mouth) status. Neurological disease was the most common diagnosis (25.3%). Compared with the CMCNRS results from the clinical dietitians, the results for the nursing records had a sensitivity of 40.5% (95% CI 32.0-40.5) and a specificity of 100.0% (95% CI 92.8-100.0). The agreement was fair between the CMCNRS results obtained by clinical dietitians and the nursing records (k = 0.423). Analysis of the errors from the screening using the nursing records revealed significant differences for all subjective indicators (p < 0.001), compared with the CMCNRS by the clinical dietitians. Thus, after assessing the methods used for nutrition screening and the differences in the search results regarding malnourished status, we noted that the nursing records had a lower sensitivity than the screening by the CMCNRS.

Risco nutricional e sua associação com o tempo e desfecho da internação de pacientes com aids em um hospital de referência em infectologia de Belo Horizonte / Nutritional Risk and their Association with Time and Hospitalization Outcomes for Patients with AIDS in a Referral Hospital for Infectious Diseases in Belo Horizonte

O objetivo do presente estudo foi analisar a possível associação entre o risco nutricional de indivíduos infectados pelo HIV/AIDS com o tempo e desfecho da internação. Foram estudadas as variáveis sexo, idade, diagnóstico nutricional, período e desfecho da internação por meio dos protocolos de triagem nutricional e prontuários de 238 pacientes internados com AIDS em um hospital de Belo Horizonte no ano de 2010. A análise estatística foi realizada utilizando o estado nutricional como variável dependente para a realização de análises descritivas e comparativas por meio do qui-quadrado de Pearson. A presença de risco nutricional foi observada na maioria dos pacientes (74,8 %). O tempo médio de internação foi de aproximadamente 22 dias (DP= 21,3 dias), sendo que a maior parte dospacientes (50,4%) permaneceu internada por mais de 18 dias. Quanto ao desfecho da internação, 12,6 % evoluíram para óbito. Foi observada uma associação estatisticamente significativa (valor-p = 0,035) entre o diagnóstico nutricional e o tempo de internação, o que indica que pacientes com risco nutricional têm maiores chances de permanecer internados por mais tempo. Não foi encontradaassociação entre as demais variáveis em função do risco nutricional. Contudo, verifica-se que pacientes com risco nutricional e com maior tempo de permanência hospitalar apresentam maior desfecho de óbitos. Conclui-se que o risco nutricional aumenta o período de internação em pacientes com AIDS o que pode levar a um aumento da mortalidade desses pacientes.

The aim of this study was to examine the possible association between nutritional risk of individuals infected with HIV / AIDS over time and hospitalization outcomes. Variables studied were sex, age, nutrition diagnosis, timing and outcome of admission through the protocols of nutritional screening and medical records of 238 patients hospitalized with AIDS in a hospital in Belo Horizonte in 2010. Statistical analysis was performed using nutritional status as a dependent variable for the descriptiveand comparative analysis using the chi-square test. The presence of nutritional risk was observed in most patients (74.8%). The average length of hospitalization was approximately 22 days (SD = 21.3 days), and most patients (50,4%) remained hospitalized for more than 18 days. Outcome admission 12.6% died. We observed statistically significant association (p-value = 0.035) between the nutritional diagnosis and length of stay, indicating that patients at nutritional risk are more likely to remainhospitalized longer. No association was found between the other variables according to nutritional risk.However, it appears that patients at nutritional risk and with a longer hospital stay outcomes are moredeaths. We conclude that nutritional risk increases the length of hospitalization in AIDS patient whichmay lead to increased mortality of these patients.

Development of a simplified malnutrition screening tool for hospitalized patients and evaluation of its inter-methods reliability / 한국영양학회지

PURPOSE: The current study was designed for development of a simplified malnutrition screening tool (SMST) for hospi-talized patients using readily available laboratory and patient information and for evaluation of its reliability compared to well-established tools, such as PGSGA and NRS-2002. METHODS: Anthropometric and biochemical measurements, as well as a few subjective assessments, of 903 patients who were preclassified by their nutritional status according to PGS-GA were analyzed. Among them, a combination of factors, including age, BMI, albumin, cholesterol, total protein, hema-tocrit, and changes in body weight and food intake, were statistically selected as variables for SMST. RESULTS: Accord-ing to SMST, 620 patients (68.7%) were classified as the normal group and 283 patients (31.3%) were classified as the malnutrition group. Significant differences in age, albumin, TLC, BMI, hemoglobin, hematocrit, total protein, cholesterol, and length of stay were observed between the two groups. For inter-methods reliability, the screening results by SMST were compared with those by PGSGA and NRS-2002. The comparison with PGSGA and NRS-2002 showed 'Substantial agreement' (sensitivity 94.4%, specificity 88.4%, kappa = 0.747) and 'Moderate agreement' (sensitivity 96.1%, specificity 79.5%, kappa = 0.505), respectively, indicating that SMST held high inter-methods reliability. CONCLUSION: In conclusion, SMST, based on readily available laboratory and patient information and simple subjective assessments on changes in food intake and body weight, may be a useful alternative tool with a simple but reliable risk index, especially in resource-limited domestic hospitals.

Advances in nutrition screening and nutritional assessment among critically ill children / 中华临床营养杂志

Malnutrition is common in critically ill children.Nutrition prescription is hampered by various factors,and the nutritional status of these children often deteriorates during hospitalization.Nutrition therapy for critically ill children must be based on proper nutrition screening and nutritional assessment.Adopting dynamic nutritional assessment is an effective method to monitor patients under nutrition therapy and inform the prescription and administration of nutrition therapy.This article reviews the recent advances in nutrition screening and nutritional assessment in critically ill children.

Nutritional Risk Screening 2002 (NRS 2002) as a predictor of outcome during ward based non-invasive ventilation in COPD with respiratory failure / 中国实用护理杂志

Objective To determine whether Nutritional Risk Screening 2002 (NRS2002) of admission independently predicts outcome of non-invasive positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients during hypercapnic respiratory failure.Methods Patients with COPD presenting with hypercapnic respiratory failure at Sichuan University Hospital between December 2010 and May 2012 and receiving NIPPV were studied prospectively.NRS2002 was measured before NIV administration.233 patients met the inclusion criteria,with NIPPV failed in 71 cases and succeed in 162 cases.The patients were followed up till they were discharged.Results After multivariate Logistic regression,the items such as baseline PaCO2,NRS2002 score could predicted 76.4％ of the failure outcome.The area under the curve was 0.767.The positive predictive value was 35.23％.The negative predictive value was 84.21％.Conclusions We can predict the risk failure of NIPPV in patients with COPD and hypercapnic respiratory failure with NRS2002 score and baseline PaCO2,and adjust the treatment project according to the evaluation result.NRS2002 supply non-invasive and portable method for predicting the failure of NIPPV.

Inflammatory bowel disease and nutrition support therapy / 中华临床营养杂志

Inflammatory bowel disease (IBD) is a group of diseases characterized by recurrent episodes of chronic intestinal inflammation including ulcerative colitis (UC) and Crohn's disease (CD).The prevalence of IBD has shown a rapid growth in China.Malnutrition is often seen in IBD patients,especially in those with CD.Appropriate diets and supplementation of trace elements,calcium,vitamin D,and probiotics are beneficial for disease remission and control.Nutrition support therapy can improve the nutritional status and meanwhile may facilitate the induction and maintenance of remission in CD patients.

Impact of Malnutrition Risk Determined by Nutrition Screening Index on Operative Morbidity after Gastric Cancer Surgery

PURPOSE: Nutrition status is regarded as an important factor for postoperative morbidity in cancer surgery. The aim of this study was to evaluate the impact of the malnutrition risk, determined by Seoul National University Hospital-Nutrition Screening Index (SNUH-NSI), on operative morbidity after gastrectomy for gastric cancer. METHODS: This study enrolled 246 patients who had undergone gastrectomy for gastric cancer at Seoul National University Hospital from March 2009 to February 2010. We collected general patient information, SNUH-NSI at administration and related parameters (serum albumin, cholesterol, total lymphocyte counts, hemoglobin and body mass index), operative method, hospital stay and operative morbidity. RESULTS: The patients' mean age was 59.6+/-11.3 years, and 9.4% (n=23) of patients were rated as severe malnutrition risk. There was no difference in operative morbidity by age or sex. The patients with high risk of malnutrition by SNUH-NSI or with advanced gastric cancer showed higher operative morbidity (P<0.01). There were no relationships between biochemical parameters and operative morbidity. On multivariate analysis, the significant independent risk factors were severe malnutrition by SNUH-NSI (OR 2.627, 95% CI 1.033~6.679; P<0.05) and advanced gastric cancer (OR 2.023, 95% CI 1.074~3.811; P<0.05). CONCLUSION: Overall nutritional status, rather than single data, is more related to operative morbidity in gastrectomized patients. Especially severe malnutrition as determined by SNUH-NSI, is an independent risk factor for operative morbidity. Nutritional support to severely malnourished patient by SNUH-NSI is expected to be an effective approach in preventing complications after gastrectomy.

Nutritional risk screening for preoperative patients with different parts of colorectal cancer / 中国实用护理杂志

Objective To investigate the impact of nutritional risk of preoperative patients with different parts of colorectal cancer. Methods 385 cases of surgical patients diagnosed with colorectal cancer were selected in the retrospective study in April 2008 to March 2009, Gastrointestinal Surgery Center of West China Hospital in Sichuan University. Patients were divided into the right colon cancer group, the left colon cancer group, the rectal cancer group, using internationally recognized NRS- 2002 Scale and serum nutrition indicators to assess their preoperative nutrition. Results NRS-2002 score in the right colon cancer group showed higher than the left colon and rectal cancer group, but no statistical difference between the latter two rates; serum concentrations of HGB, TP, ALB, A/G were lower in the right colon cancer group than the other two groups, but the concentrations of ALT, AST, Ca2+, PO43-showed no statistical difference among three groups. Conclusions The proximal colon (right colon cancer) were more susceptible to the risk of preoperative malnutrition, the patients with different parts of colorectal cancer should be given to the corresponding preoperative nutritional assessment and nutritional support.

Diagnóstico nutricional: comparação entre os instrumentos de avaliação nutrition risk screening (nrs-2002) e avaliação nutricional do hospital de clínicas de Porto Alegre (AN-HCPA) / Nutritional diagnosis: comparison between nutrition risk screening (nrs-2002) protocol and the nutrition assessment system of hospital de clínicas de Porto Alegre (AN-HCPA)

Introdução: A desnutrição hospitalar é altamente prevalente e continua pouco identificada. Ainda não há concordância sobre qual método melhor reflete a realidade dos pacientes hospitalizados. Objetivos: Identificar o nível de concordância entre o diagnóstico nutricional para eutrofia e desnutrição quando os pacientes são avaliados pelos protocolos Nutrition Risk Screening (NRS-2002) e o utilizado no Hospital de Clínicas de Porto Alegre (AN-HCPA). Métodos: Estudo transversal em pacientes hospitalizados. As avaliações foram realizadas em momentos distintos, por pesquisadores diferentes. Resultados: Participaram 247 pacientes com idade de 50,7 ± 15,5 anos, e IMC de 21,31 ± 2,1 kg/m². O NRS-2002 encontrou 43% dos pacientes eutróficos e 57% desnutridos. O AN-HCPA identificou 50% dos pacientes com eutrofia e 50% com desnutrição. Dos 247 pacientes avaliados houve concordância em 93 pacientes no diagnóstico de eutrofia e em 110 pacientes no diagnóstico de desnutrição, com um coeficiente Kappa de 0,64 (IC 95% 0,55-0,74), p < 0,001. O AN-HCPA teve sensibilidade de 78,6% e especificidade de 86,9%, valor preditivo positivo de 88,7% e valor preditivo negativo de 75,6%. Conclusão: Os resultados demonstram que o protocolo AN-HCPA apresenta boa concordância com o método de referência NRS-2002, não considerando a gravidade da doença. Este protocolo é uma ferramenta rápida e de fácil utilização podendo ser recomendada como um instrumento sensível para caracterizar o estado nutricional de eutrofia e desnutrição dos pacientes hospitalizados.

Background: Malnutrition during hospitalization is highly prevalent and remains poorly identified. There is no agreement on the best method to assess the nutritional status of hospitalized patients. Objectives: To identify the agreement level of the eutrophy and malnutrition nutritional diagnosis when patients are evaluated using Nutrition Risk Screening (NRS-2002) protocol and the one used at Hospital de Clínicas de Porto Alegre (ANHCPA). Methods: Cross-sectional study of hospitalized patients. The evaluations were performed at distinct moments, by different researchers. Results: The study involved 247 patients of 50.7 ± 15.5 years and BMI of 21.31 ± 2.1 kg/m2. NRS-2002 classified 43% of patients with eutrophy and 57% with malnutrition. AN-HCPA identified 50% of patients with eutrophy and 50% with malnutrition. Among the 247 evaluated patients both systems agreed in 93 cases for eutrophy diagnosis and in 110 cases for malnutrition diagnosis, with Kappa coefficient of 0.64 (95% CI 0.55-0.74) p < 0.001. AN-HCPA presented a sensitivity of 78.6% and a specificity of 86.9%, positive predictive value of 88.7% and negative predictive value of 75.6%. Conclusion: The results showed that AN-HCPA has a good level of agreement with the reference method, but did not consider illness severity. This protocol is a fast and easy-to-use tool that can be recommended as a sensitive instrument to identify eutrophy and malnutrition nutritional status of hospitalized patients.

Development and Evaluation of a Nutritional Risk Screening Tool (NRST) for Hospitalized Patients

Malnutrition of hospitalized patients can adversely affect clinical outcomes and cost. Several nutritional screening tools have been developed to identify patients with malnutrition risk. However, many of those possess practical pitfalls of requiring much time and labor to administer and may not be highly applicable to a Korean population. This study sought to develop and evaluate a Nutrition Risk Screening Tool (NRST) which is simple and quick to administer and widely applicable to Korean hospitalized patients with various diseases. The study was also designed to generate a screening tool predictable of various clinical outcomes and to validate it against the Nutritional Risk Screening 2002 (NRS 2002). Electronic medical records of 424 patients hospitalized at a general hospital in Seoul during a 14-month period were abstracted for anthropometric, medical, biochemical, and clinical outcome variables. The study employed a 4-step process consisting of selecting NRST components, searching a scoring scheme, validating against a reference tool, and confirming clinical outcome predictability. NRST components were selected by stepwise multiple regression analysis of each clinical outcome (i.e., hospitalization period, complication, disease progress, and death) on several readily available patient characteristics. Age and serum levels of albumin, hematocrit (Hct), and total lymphocyte count (TLC) remained in the last model for any of 4 dependent variables were decided as NRST components. Odds ratios of malnutrition risk based on NRS 2002 according to levels of the selected components were utilized to frame a scoring scheme of NRST. A NRST score higher than 3.5 was set as a cut-off score for malnutrition risk based on sensitivity and specificity levels against NRS 2002. Lastly differences in clinical outcomes by patients' NRST results were examined. The results showed that the NRST can significantly predict the in-hospital clinical outcomes. It is concluded that the NRST can be useful to simply and quickly screen patients at high-nutritional risk in relation to prospective clinical outcomes.