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Background and Aims: A proportion of patients with coronavirus disease 2019 (COVID-19) need hospitalization due to severe respiratory symptoms. This study describes the characteristics of survivors of severe COVID-19 subsequently admitted to inpatient pulmonary rehabilitation (PR) and identifies their rehabilitation needs. Subjects and methods: From the COVID-19 Registry of the Fondazione Don Gnocchi we extracted 203 patients admitted for inpatient PR after severe COVID-19 from April 2020 till September 2021. Specific information on the acute-hospital stay, clinical and functional characteristics on admission to the rehabilitation units were collected. Result(s): During the acute phase of the disease 80% of patients needed ICU admission, receiving mechanical ventilation (MV) for 26 days. On admission to the rehabilitation units, 10% of patients were still on MV, 28% had tracheostomy, 70% were on O2 therapy, 24% were diagnosed critical illness neuropathy. Eighty % showed a modified Barthel Index <75 and only 25% were able to perform a six-minute walk test. Montreal Cognitive Assessment and Hospital Anxiety and Depression Scale were also performed, indicating a variable presence of neurocognitive impairment and symptoms of anxiety and/or depression. Moreover, 32% scored >=2 at the Malnutrition Universal Screening Tool and 47% showed dysphagia needing logopedic treatment Conclusion(s): Our analysis shows that patients admitted for inpatient PR after severe COVID-19 represent a multifaceted and clinically complex patient population who need customized, comprehensive rehabilitation programs, carried out by teams with different professional skills.
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In the UK, approximately 3 million people are malnourished or at risk of malnutrition. Malnutrition is a major public health issue with costs the NHS over £19 billion per year in England alone. We know 93% of malnutrition happens in peoples own homes, 5% in care homes and 2% in hospital. It is also understood that 30% of inpatients are at higher risk of becoming malnourished in hospital. 1 As many departments, demand for dietetic services has outweighed capacity, in part due to improved rates of nutritional risk screening across the organisation. The Trust uses an internal validated nutritional screening tool but community partners largely use MUST (Malnutrition Universal Screening Tool). Within our Dietetic team, we identified a number of treatment strategies needed to ensure timely care, patient empowerment and patient safety with a focus on improved nutrition to help recovery across organisational boundaries from the acute admission and into primary care. Patients who are identified as malnourished or at very high risk of malnutrition, have specialist requirements should have immediate referral to a dietitian. Oral nutritional supplements are now prescribed appropriately whilst in hospital and post discharge in line with national and local guidelines. 4 Communication between different healthcare professionals and settings is essential for the seamless delivery of care2 and hospital teams discharging patients with an identified risk of malnutrition should communicate this in writing to primary care teams3. As a team, we decided to encompass nutrition and dysphagia scores as an inpatient on discharge letters. This was be achieved by working closely with the pharmacy, Speech and Language, catering, nursing and medical teams to develop and implement a clear process for all adult inpatients to improve ward based nutritional care and appropriate prescribing, based on their individual risk of malnutrition. We have developed and implemented a discharge process that provides patients with a nutrition pack (malnutrition pathway leaflets, cover letter +/- Care Homes information) +/- nutritional supplements on discharge. The process was developed with local CCGs, GPs, PCN Pharmacists and community dietetic services. Outcomes measured include;appropriate prescribing, access to snacks and supplements, clinical outcomes including length of stay (LOS), readmission rates and timely access to first line advice. Baseline audit information revealed only 8% of inpatients received the a first line nutrition leaflet, this has increased to 13% just 6 weeks post implementation, patient first line snacks has increased to 5 different categories as choice available has increased. Oral nutritional support (ONS) is now solely prescribed using the agreed ONS pathway. Early indications suggest a direct improvement in patient care and choice. References 1. Brothern A, Simmonds N, Stroud M.2010. Malnutrition Matters: Meeting Quality Standards in Nutritional Care. A report on behalf BAPEN Quality Group 2. ‘A Guide to Managing Adult Malnutrition in the Community’ Last accessed from: on 02.07.2021 3. ‘Pathway for using ONS in the Management of Malnutrition’ Last accessed from:https://www.malnutritionpathway.co.uk/library/ons_pathway.pdf on 29.06.2021 4. ‘Nutritional considerations for primary care teams managing patients with or recovering from COVID-19’ BDA and optimising nutritional prescribing last accessed :. 02.07.21
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The proceedings contain 6 papers. The topics discussed include: a year in the public life of covid-19 and vitamin d: representation in UK news and social media and implications for future health communications;α-linolenic acid metabolism in human CD3+ T cells is dependent on n-6/n-3 ratio and age;associations and effects of anthropometric and body composition parameters on cancer-related fatigue in breast cancer survivors during adjuvant endocrine therapy;improving inpatient assessment of nutritional status using the malnutrition universal screening tool (MUST);dietary supplements, daily nutrient intake, and health-related quality of life among people with myalgic encephalomyelitis/chronic fatigue syndrome;and effect of chia seed (Salvia hispanica L.) consumption on adiposity parameters in rats exposed to cafeteria diet.
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Background: In COVID-19, hospitalized patients are at high risk for malnutrition upon admission due to intense catabolic processes coupled with comorbidities. Malnutrition has been strongly linked to adverse health economic outcomes in the hospital setting and society guidelines recommend early intervention to preserve lean body mass and mitigate adverse health economic outcomes. We have previously reported that malnourished African Americans (P=0.014) and females (P<0.001) were less likely to receive oral nutrition supplement (ONS) orders in a cohort of 8,713 adult malnourished patients hospitalized in a tertiary care center over a one-year period. We determined if there were disparities in the ordering of ONS in hospitalized COVID-19 patients during the height of the pandemic in 2020. Methods: This is a retrospective cohort study consisting of 3,431 COVID-19 adult (18 years and older) inpatient encounters at five Johns Hopkins affiliated hospitals between March 1, 2020, and December 3, 2020. Patients diagnosed with COVID-19 were identified as those who were assigned an ICD-10 billing code of U07.1 for COVID-19. Malnourishment among patients was identified as those who risk screen positive upon admission by use of the malnutrition universal screening tool (MUST) and confirmed by registered dietitians. Patient feeding status was identified as those who had a record of diet orders placed. Patient data was derived from JH-CROWN: The COVID-19 Precision Medicine Analytics Platform (PMAP) Registry and extracted using Python 3, version 3.7.5, kernel in JupyerLab, version 1.1.4. Statistics were conducted with SAS (version 9.4) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters while accounting for possible covariates. Results: Older patients were more likely to have received ONS (P<0.001) (Table 1). Patients with diabetes (P=0.0410), hypertension (P=0.0296), COPD (P=0.0013), and malnutrition (P=0.0106) were also more likely to have received ONS (Table 1). Males were more likely to receive ONS than females (0.0089) (Table 1). Whites were more likely to receive ONS than Blacks, Asian, or Other races (P=0.0037) (Table 1). In the logistic regression model, females (P=0.0079), blacks (P=0.0026), and Other races (P=0.0143) were less likely to receive ONS (Table 2). Patients with diabetes were more likely to receive ONS (P=0.0255) (Table 2). Older (P=0.059) patients and those with COPD (P=0.0709) are suggestive of an increased likelihood of receiving ONS (Table 2). Conclusions: Gender and race disparities exist in the ordering of ONS was in a robust cohort of COVID-19 adult inpatients from five US hospitals. Further studies should be conducted to determine if there is a widespread racial and gender bias in the ordering of ONS.(Table Presented)(Table Presented)
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Background. Malnutrition has been linked to longer hospital stays and adverse health economic outcomes. In COVID-19, there is a paucity of data on whether malnutrition is associated with adverse outcomes in the hospital setting. Methods. This is a retrospective cohort study consisting of 4,311 COVID-19 adult (18 years and older) inpatients at five Johns Hopkins affiliated hospitals between March 1, 2020, and December 3, 2020. Patient data were derived from their COVID-19 database JH-CROWN: The COVID-19 Precision Medicine Analytics Platform (PMAP) Registry and extracted using Python 3, version 3.7.5, kernel in JupyterLab, version 1.1.4. Malnourishment among patients was identified as those who were malnutrition nutrition risk screen positive upon admission by use of the malnutrition universal screening tool (MUST) and confirmed by registered dietitians, Statistics were conducted with SAS v9.4 (Cary, NC) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters while accounting for possible covariates in linear regression analysis predicting log-transformed length of stay. Results. COVID-19 patients who are older, male, or have lower BMIs have a higher likelihood of mortality (Table 1). In the linear regression model, for every 1% increase in BMI, the length of stay decreased by 0.38% (p<0.001) (Table 2). Differences in race (p=0.001) (Table 1), were associated with differences in the likelihood of mortality and length of stay;being Asian (p=0.0029), Black (p<0.001), or Other (p<0.001) were associated with decreased length of stay compared to Whites (Table 2). Patients with diabetes, hypertension, diarrhea, COPD, and malnutrition were more likely to have higher mortality (p<0.001) (Table 1) and more likely to have a longer hospital length of stay (p<0.001) (Table 2). Overall, 12.9% (555/4,311) of adult COVID-19 patients were diagnosed with malnutrition and were associated with an 87.9% (p<0.001) (Table 2) increase in hospital length of stay. Differences in the source of admission to the hospital affected the likelihood of mortality (p<0.001) (Table 1) and length of stay (Table 2). Conclusions. In a cohort of COVID-19 adult inpatients, malnutrition was associated with a higher likelihood of mortality and increased hospital length of stay. In the linear regression model, malnutrition was associated with an increase in the length of stay by 87.9%. Interestingly, decreases in BMI were associated with increased hospital length of stay. Race and admission source also plays a key role in affecting a patient's hospital length of stay and mortality. These results support the idea that malnutrition appears to be a predictor for COVID-19 inpatient outcomes similar to that of other known highrisk comorbidities like diabetes, hypertension, and COPD.(Table Presented)(Table Presented)
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BACKGROUND: Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran. METHODS: In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity. RESULTS: In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21-2.56; P=0.021). CONCLUSIONS: Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.