Length of Hospital Stay and Its Associated Factors among Surgical Patients in Hospital Serdang

@#Introduction: Hospital length of stay (LOS) is one of the measurable indicators which can be used to evaluate hospital administration, operative performance, and quality of patient care. Prolonged LOS has been associated with poor outcomes in patients and inefficient use of hospital resources. Due to the scarcity of findings in this field in Malaysia, this study aims to identify the factors affecting LOS. Methods: A single health facility-based retrospective cross-sectional study was conducted in Hospital Serdang. Data of patients admitted to the surgical ward from 2017 to 2021 were retrieved. Result: A total of 114 surgical patients’ data were analysed, of which most were adults (72.8%), female (69.3%) and Malay (67.5%). The mean LOS was 5.90 ± 4.35 days. Pearson correlation revealed age (r = 0.309, p = 0.001) and preoperative albumin (r = -0.397, p <0.001) having a significant correlation with LOS. An independent samples T-test showed that males had significantly higher mean LOS than females (t = 2.653, p = 0.009). Surprisingly, having been seen by dietitians and being supplemented by oral nutrition supplements (ONS) had longer stay compared to groups who were not seen by dietitians and given ONS respectively (t = 4.278, p<0.001), (t = 3.111, p = 0.002). Furthermore, those with a moderate and high risk of malnutrition spent approximately 3.27 days longer hospitalized than low-risk patients (t = -2.868, p = 0.007). Conclusion: Factors that influence LOS are age, gender, preoperative albumin, seen by a dietitian, risk of malnutrition and oral nutrition supplementation.

Factors associated with malnutrition among head and neck cancer in-patients before radiotherapy in National Cancer Institute, Putrajaya

@#Introduction: Head and neck cancer (HNC) patients are often malnourished during diagnosis and before treatment. This study determined the prevalence of malnutrition and factors associated with malnutrition among HNC patients. Methods: A crosssectional study among HNC in-patients before radiotherapy was conducted. Malnutrition status of the patients was determined using scored Patient GeneratedSubjective Global Assessment (PG-SGA). Nutritional parameters of muscle mass, fat mass, albumin, energy and protein intakes were collected. Nutrition impact symptoms (NIS) of the patients were assessed using a validated Head and Neck Symptoms Checklist© (HNSC©). Results: Fifty HNC patients were recruited in this study and the age range of patients was 21 to 78 years old, with gender distribution of 78% males and 22% females. More than half of the patients were malnourished, with 20% severely malnourished before radiotherapy. The lack of dietitian referral before treatment was found to significantly affect nutritional status (p=0.027). There was a significant negative relationship between energy intake (r=0.342, p=0.015) and protein intake (r=0.386, p=0.006) with PG-SGA, indicating lower energy and protein intakes related with poor nutritional status. The result showed a significant positive relationship between NIS score (r=0.731, p<0.001) and PG-SGA, indicating the lower the NIS, the better the nutritional status among HNC patients. More than half of the HNC patients had difficulty chewing. Conclusion: A strong association between nutritional status and NIS showed the importance of dietary management in HNC patients. Early identification of the nutritional status of HNC patients can ensure optimal nutritional status to improve treatment outcomes.

Association between quality of life and handgrip strength among malnourished gynaecological cancer outpatients, National Cancer Institute

@#Introduction: Malnutrition is common among cancer patients and it is reported in a significant proportion of patients with gynaecological cancer (GC). The aim of this study was to determine the association between quality of life (QOL) and hand grip strength (HGS) among malnourished GC outpatients in the National Cancer Institute (NCI). Methods: This study was carried out in a Multidisciplinary Clinic of NCI. HGS was measured using Jamar Hand Dynamometer. Nutritional status was assessed using the scored Patient-Generated Subjective Global Assessment (PGSGA). QOL was measured using the validated European Organisation for Research and Treatment of Cancer Questionnaire (EORTC-QLQ C30). Results: A total of 69 patients were selected for the study. Fifty eight (84.1%) were classified as moderately malnourished or at risk of malnutrition (PG-SGA B) and 11 (15.9%) were classified as severely malnourished (PG-SGA C). There was a moderate, significant positive relationship between HGS and functional status (rs=0.275, p=0.022) observed in this study. Besides, in malnourished GC patients with low HGS, results indicated that they had problems with social functioning as well (r=0.255, p=0.035). Appetite was suggested as a predicting factor for low HGS among malnourished GC patients (F=12.253, p=0.001). Conclusion: HGS is a simple objective indicator of functionality and is, therefore, a valid item to be measured when assessing QOL of malnourished GC outpatients.

Impact of Dietitian Delivered Intensive Nutrition Intervention on Dietary Intake and Weight Outcome Among Gynecology Cancer Outpatient Prior to Surgery

@#Introduction: This is open label randomised control trial, aimed to identify whether an early (commenced at the time of diagnosis) and intensive nutrition intervention (INI) (individualised dietary counselling, oral nutritional supplements [ONS], telephone, and home visit) can improve weight and dietary intake of gynaecological cancer (GC) patients preoperatively. Methods: Selected GC patients planned for surgery were randomly grouped into control group (CG) (n = 35) and intervention group (IG) (n = 34). Malnutrition screening tool (MST) was used as a screening tool, while Patient-Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool. IG received an intensive individualised dietary counselling with the supply of ONS at baseline (Day 1). This continued with telephone and home visit follow-up by research dietitian (Day 3 and Day 6). Meanwhile, CG only received general nutritional counselling without supply of ONS. Final assessment was conducted on Day 14. The primary outcomes included weight changes measured using TANITA and dietary intake assessment using 24-hour diet recall. Results: Mean duration of INI was 14 days. At the end of the treatment period, there was a significant weight change between groups (p < 0.001), with 0.14% weight gain in IG and 1.3% weight reduction in CG. Mean energy and protein intake of IG were higher compared to CG by +329 kcal/day and +12.2 g/day, respectively. Conclusion: This study showed that INI that incorporated individualised dietary counselling, ONS, telephone counselling, and home visit can increase energy and protein intake of GC patients, resulting in weight gain.

Plate Wastage Among Hospitalized Cancer Patients

@#Introduction: Plate wastage in hospital contributes to malnutrition-related complications including longer hospitalization among cancer patients. The objective of this study was to determine the relationship between patients’ experiences of access to food hospital and plate wastage among hospitalized cancer patients. Methods: Two hundred and thirty-one cancer patients in the National Cancer Institute, Malaysia were recruited for this study. All eligible patients were undergoing cancer treatments and provided with informed consent. Data obtained included socio-demographic characteristics and patients’ experiences of access to food hospital which will contribute to plate wastage. Plate wastage was determined by weighing the unwanted food left on the plate. Results: Prevalence of plate wastage among cancer patients was high at approximately 54%. The appearance of food served was associated with higher plate wastage (p<0.01). Conclusion: This finding shows that the prevalence of plate wastage was high which may inhibit food consumption and affecting nutritional status among cancer patients with oncologic treatment. Effective strategies that address factors associated with plate wastage should be taken among hospitalized cancer patients

Improving the Nutritional Status of Patients with Colorectal Cancer Undergoing Chemotherapy through Intensive Individualised Diet and Lifestyle Counselling

Introduction: Malnutrition is common among patients with cancer and it is also associated with their negative health outcomes. Generally, cancer patients undergoing chemotherapy have a high risk of malnutrition, secondary to both the disease and the treatment. It is important that patients maintain a good nutritional status to improve the effects, and minimise the side effects of cancer treatment. A good nutritional status should be maintained for patients through nutritional intervention during cancer treatment. There appears to be no published studies on the effects of intense dietary counselling versus usual dietary care on the nutritional status of colorectal cancer (CRC) patients undergoing chemotherapy alone. Furthermore, there have been no randomised controlled trials (RC1) undertaken in Malaysia, where CRC is increasing. It is therefore important to undertake a RCT of a dietary and lifestyle counselling intervention of CRC outpatients undergoing chemotherapy. Methods: The intervention study was an open (masking not used), prospective, and Rcr to examine the effects of intensive individualised dietary and lifestyle counselling on dietary intake and nutritional status in CRC patients undergoing chemotherapy. It was designed as an 8-week program of intensive, individualised dietary and lifestyle counselling followed up with another 8-week post-intervention period without dietary and lifestyle counselling, and compared to a control arm given the usual care. A total of forty-two participants took part in this study and were randomised into two groups, namely, the intervention group (IG) (n=22) and the control group(CG) (n=20) at Kuala Lumpur Hospital and SelayangHospital, Malaysia. Results In this study, 67% of CRC patients were malnourished at baseline. In the IQ the prevalence of malnutrition dropped from 72.7% at baseline to 27.3% eight weeks after the intervention. This repesents a large, and clinically meaningful shift. In the CG, the prevalence of malnutrition, or at risk of malnutrition, was still at 75% at the end of the sixteen weeks. Conclusion: Intensive, individualised dietary and lifestyle counselling resulted in improved nutritional status in patients with CRC undergoing chemotherapy.

Improving the Nutritional Status of Patients with Colorectal Cancer Undergoing Chemotherapy through Intensive Individualised Diet and Lifestyle Counselling

Introduction: Malnutrition is common among patients with cancer and it is also associated with their negative health outcomes. Generally, cancer patients undergoing chemotherapy have a high risk of malnutrition, secondary to both the disease and the treatment. It is important that patients maintain a good nutritional status to improve the effects, and minimise the side effects of cancer treatment. A good nutritional status should be maintained for patients through nutritional intervention during cancer treatment. There appears to be no published studies on the effects of intense dietary counselling versus usual dietary care on the nutritional status of colorectal cancer (CRC) patients undergoing chemotherapy alone. Furthermore, there have been no randomised controlled trials (RC1) undertaken in Malaysia, where CRC is increasing. It is therefore important to undertake a RCT of a dietary and lifestyle counselling intervention of CRC outpatients undergoing chemotherapy. Methods: The intervention study was an open (masking not used), prospective, and Rcr to examine the effects of intensive individualised dietary and lifestyle counselling on dietary intake and nutritional status in CRC patients undergoing chemotherapy. It was designed as an 8-week program of intensive, individualised dietary and lifestyle counselling followed up with another 8-week post-intervention period without dietary and lifestyle counselling, and compared to a control arm given the usual care. A total of forty-two participants took part in this study and were randomised into two groups, namely, the intervention group (IG) (n=22) and the control group(CG) (n=20) at Kuala Lumpur Hospital and SelayangHospital, Malaysia. Results In this study, 67% of CRC patients were malnourished at baseline. In the IQ the prevalence of malnutrition dropped from 72.7% at baseline to 27.3% eight weeks after the intervention. This repesents a large, and clinically meaningful shift. In the CG, the prevalence of malnutrition, or at risk of malnutrition, was still at 75% at the end of the sixteen weeks. Conclusion: Intensive, individualised dietary and lifestyle counselling resulted in improved nutritional status in patients with CRC undergoing chemotherapy.

Kajian Rintis Penilaian Status Pemakanan di Kalangan Pesakit Onkologi Pediatrik di Hospital Universiti Kebangsaan Malaysia / Jurnal Sains Kesihatan Malaysia

Malnutrition is common among pediatric oncology patients. Factors contributing to malnutrition include physiological abnormalities, response to the tumors and side effects of the treatment. A pilot study was carried out to determine the nutritional status of 17 pediatric oncology patients aged 4 to 12 years old in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur. The nutritional status was assessed via anthropometric measurements and dietary intake through 3 days repeatitive 24 hours diet recall with subjects and their carers. Biochemical profiles (serum albumin and hemoglobin) were reviewed from the medical record. Through anthropometry measurements, weight and height were used to calculate Z-scores and further determine the percentile weight-for-age, height-for-age using NCHS percentile charts (WHO 1983). Frisancho’s standards (1981) were used to define malnutrition based on MUACfor- age. Underweight as determined using z scores below -2 for weight-for-age was observed in 70.6% of the subjects. Whilst, 76.5% of the subjects were classified as stunted (z score 5 – <10 percentile). About 70.6% of the subject had low haemoglobin (< 11 g/dl) and 29.4% of the subject were hypoalbuminemia (< 35 g/dl) . Total macronutrient intake was assessed and compared with the individual requirement (Seashore 1984) for energy and protein intake were satisfactory, except for subjects in age group 10 – 12 years who achieved only 70% of the individuals requirements. As a conclusion, although food intake of the subjects was satisfactory but chronic malnutrition was prevalent. Early recognition of malnutrition is essential in order to plan for a nutritional intervention and further enhancing the quality of life.