How well do nurses recognize malnutrition in elderly patients?

BACKGROUND AND OBJECTIVE: Malnutrition is a common and underrecognized clinical problem among aged institutionalized patients. The aim of this study was to investigate how well nurses recognize malnutrition in elderly patients in long-term care hospitals in Helsinki. SUBJECTS AND METHODS: In this descriptive, cross-sectional study, the nutritional status of 1043 elderly patients was assessed with the Mini Nutritional Assessment (MNA), their body mass indices (BMIs) (kg m(-2)) were counted, and factors related to their nutritional care were queried using a structured questionnaire. In addition, we asked the opinions of 53 nurses on whether they considered their patients to suffer from malnutrition. All the long-term care hospitals in Helsinki, Finland participated in this study. RESULTS: The mean age of the patients was 81 years. The nurses considered only 15.2% of the patients to be malnourished, although the MNA showed that 56.7% were malnourished (MNA<17 points). Those recognized as malnourished were truly anorectic, with a mean BMI of 17.2. Of those patients having a BMI<20 and MNA<17, the nurses considered only one-third to be malnourished. Of those having a BMI>24 but MNA<17, only 2% were recognized as having malnutrition. Even those patients considered to be malnourished received snacks and nutritional supplements less than the patients that the nurses considered to have normal nutritional status. However, only one in six of the malnourished patients received oral nutritional supplements. CONCLUSIONS: The nurses recognized malnutrition in their aged patients poorly. Nutrition education for nurses is urgently needed, as malnutrition and weight loss have been considered significant problems, and the benefits of nutritional care are well established.

Oral and nutritional status--Is the MNA a useful tool for dental clinics.

OBJECTIVES: To determine the oral status of elderly residents in nursing homes (NH) and long term care wards (LT) and to describe associations between oral status and nutritional status among institutionalized elderly residents. DESIGN: Descriptive, cross-sectional study. SETTING: All elderly residents in all NH and LT in Helsinki, the capital of Finland. PARTICIPANTS: The study included 2036 out of 2424 (84 %) eligible subjects in NH, 1052 out of 1444 (73%) eligible subjects in LT, and all wards in NH (N = 92) and LT (N = 53). MEASUREMENTS: A structured questionnaire, oral examination, and Mini Nutritional Assessment (MNA) were completed by ward nurses for all participating residents. The structured questionnaire included information on oral status and oral health problems, demographic characteristics, functional status, diseases and medication. One questionnaire for each ward was used to evaluate the daily ward routines related to nutritional care and meal management. RESULTS: 11 % of the NH residents and 3 % of LH patients were well nourished. Of NH residents 60 % were at risk of malnutrition and 29 % were malnourished. The respective figures for LT patients were 40 % and 57 %. Nutritional status was significantly associated with oral status and with the number of oral health problems. Those with mixed dentition or complete dentures tended to have better nutritional status than those totally edentulous without prosthesis. Malnutrition increased consistently with the increasing number of oral health problems (including chewing problems, swallowing difficulties, pain in mouth and xerostomia). CONCLUSION: In the population of institutionalized frail elderly, malnutrition was related to both poor oral status and oral health problems.

On hydrophobicity correlations in protein chains.

We study the statistical properties of hydrophobic/polar model sequences with unique native states on the square lattice. It is shown that this ensemble of sequences differs from random sequences in significant ways in terms of both the distribution of hydrophobicity along the chains and total hydrophobicity. Whenever statistically feasible, the analogous calculations are performed for a set of real enzymes, too.

Design of sequences with good folding properties in coarse-grained protein models.

BACKGROUND: Designing amino acid sequences that are stable in a given target structure amounts to maximizing a conditional probability. A straightforward approach to accomplishing this is a nested Monte Carlo where the conformation space is explored over and over again for different fixed sequences; this requires excessive computational demand. Several approximate attempts to remedy this situation, based on energy minimization for fixed structure or high-T expansions, have been proposed. These methods are fast but often not accurate, as folding occurs at low T. RESULTS: We have developed a multisequence Monte Carlo procedure where both sequence and conformational space are simultaneously probed with efficient prescriptions for pruning sequence space. The method is explored on hydrophobic/polar models. First we discuss short lattice chains in order to compare with exact data and with other methods. The method is then successfully applied to lattice chains with up to 50 monomers and to off-lattice 20mers. CONCLUSIONS: The multisequence Monte Carlo method offers a new approach to sequence design in coarse-grained models. It is much more efficient than previous Monte Carlo methods, and is, as it stands, applicable to a fairly wide range of two-letter models.