scholarly journals Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions

2020 ◽  
Vol 112 (6) ◽  
pp. 1456-1467 ◽  
Author(s):  
Nara E Lara-Pompa ◽  
Susan Hill ◽  
Jane Williams ◽  
Sarah Macdonald ◽  
Katherine Fawbert ◽  
...  
Keyword(s):  
Body Composition ◽  
Clinical Outcomes ◽  
Chronic Conditions ◽  
Screening Tool ◽  
Screening Tools ◽  
Anthropometric Parameters ◽  
Specific Patient ◽  
Low Weight ◽  
A Prospective Study ◽  
Better Than

ABSTRACT Background Better tools are needed to diagnose and identify children at risk of clinical malnutrition. Objectives We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. Methods This was a prospective study in children 5–18 y old admitted to a tertiary pediatric hospital (n = 152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n = 118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. Results Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%–17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean ± SD LM SD scores (−1.38 ± 1.03 compared with −0.74 ± 1.40, P < 0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. Conclusions LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements.

scholarly journals Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

2020 ◽  
Vol 74 (11) ◽  
pp. 1519-1535 ◽  
Author(s):  
Alex F. Bullock ◽  
Sarah L. Greenley ◽  
Gordon A. G. McKenzie ◽  
Lewis W. Paton ◽  
Miriam J. Johnson
Keyword(s):  
Older Adults ◽  
Food Intake ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Screening Tool ◽  
Meta Analysis ◽  
Screening Tools ◽  
Narrative Synthesis ◽  
Markers Of Inflammation ◽  
Risk Of Cancer

Abstract Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

scholarly journals Sensitivity and specificity test of alarm malnutrition for hospital-acquired malnutrition among pediatric patients

2021 ◽  
Vol 43 (s1) ◽  
Author(s):  
Yuni Maria Olviani Ndede ◽  
Dessie Wanda ◽  
Efa Apriyanti
Keyword(s):  
Sensitivity And Specificity ◽  
Screening Tool ◽  
Statistical Tests ◽  
Screening Tools ◽  
Nutritional Screening ◽  
Cross Sectional ◽  
Specificity Test ◽  
Cross Sectional Design ◽  
Hospital Acquired ◽  
Better Than

Detecting the risks for hospital-acquired malnutrition in children can be performed by using nutritional screening tools. One of the screening tools that has been created is Alarm Malnutrition. This study aimed to test the sensitivity and specificity of Alarm Malnutrition in detecting the risks for hospitalacquired malnutrition in comparison to Screening Tool for the Risk on Nutritional status and Growth (STRONGkids). This study employed cross sectional design and involved 168 hospitalized children (1 month to 18 years) at pediatric ward. The data were analyzed using diagnostic approach which resulted in sensitivity and specificity values. The statistical tests showed that the sensitivity and specificity values of Alarm Malnutrition and STRONGKids were 32,2% and 81,6% respectively. These results indicated that this screening tool was not better than STRONGkids which has been previously used in Indonesia. Alarm Malnutrition needs to be developed and improved in order to achieve better performance in detecting the risks for hospital-acquired malnutrition.

scholarly journals The relation between Malnutrition Universal Screening Tool (MUST), computed tomography–derived body composition, systemic inflammation, and clinical outcomes in patients undergoing surgery for colorectal cancer

2019 ◽  
Vol 110 (6) ◽  
pp. 1327-1334 ◽  
Author(s):  
Arwa S Almasaudi ◽  
Stephen T McSorley ◽  
Ross D Dolan ◽  
Christine A Edwards ◽  
Donald C McMillan
Keyword(s):  
Colorectal Cancer ◽  
Computed Tomography ◽  
Body Composition ◽  
Nutritional Status ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Universal Screening ◽  
Screening Tool ◽  
Length Of Hospital Stay ◽  
Malnutrition Universal Screening Tool

ABSTRACT Background Nutritional status is an important factor affecting a patient's clinical outcomes. Early identification of patients who are at risk of malnutrition is important to improve clinical outcomes and reduce health cost. The Malnutrition Universal Screening Tool (MUST) has been recommended as part of the routine nursing assessment for all patients at hospital admission. Objective The aim of this study was to examine the association between nutritional status (MUST), systemic inflammatory response (SIR), body composition, and clinical outcomes in patients undergoing surgery for colorectal cancer. Methods The malnutrition risk was examined using MUST in patients admitted for surgery for colorectal cancer between March 2013 and June 2016. Preoperative computed tomography scans were used to define the body composition. The presence of SIR was evidenced by the modified Glasgow prognostic score and the neutrophil to lymphocyte ratio. Postoperative complications, severity of complication, length of hospital stay, and mortality were considered as outcome measures. Results The study included 363 patients (199 males, 164 females); 21% of the patients presented with a medium or high nutritional risk. There were significant associations between MUST and subcutaneous adiposity (P < 0.001), visceral obesity (P < 0.001), and low skeletal muscle index (P < 0.001). No statistically significant association was identified between MUST score and presence of any complication or severity of complication. On multivariate analysis, MUST remained independently associated with the length of hospital stay (OR: 2.17; 95% CI: 1.45, 3.26; P < 0.001). Kaplan–Meier survival curves showed an increased number of deaths for patients at medium or high risk of malnutrition (P < 0.001). This association was found to be independent of other confounding factors (HR: 1.45; 95% CI: 1.06, 1.99; P = 0.020). Conclusions MUST score is an independent marker of risk in those undergoing surgery for colorectal cancer and should remain a key part of preoperative assessment.

Ramadan fasting affects body composition and anthropometric parameters in type 2 diabetic patients.

2020 ◽  
Author(s):  
Fatma Boukhayatia ◽  
Ibtissem Oueslati ◽  
Meriem Cheikh ◽  
Asma Kardi ◽  
Fatma Chaker ◽  
...  
Keyword(s):  
Body Composition ◽  
Diabetic Patients ◽  
Anthropometric Parameters ◽  
Type 2 Diabetic Patients ◽  
Ramadan Fasting ◽  
Type 2 Diabetic

Effect of exercise intensity on body composition in overweight and obese individuals: A prospective study

2018 ◽  
Vol 7 (3) ◽  
pp. 54-59
Author(s):  
Kiran Kumar Patnaik ◽  
◽  
S Bethiun ◽  
Y V A Ramalakshmi ◽  
◽  
...  
Keyword(s):  
Body Composition ◽  
Prospective Study ◽  
Exercise Intensity ◽  
A Prospective Study

scholarly journals Healthcare Provider Perspectives on Bipolar I Disorder Screening and the Rapid Mood Screener (RMS), a Pragmatic, New Tool

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 181-183
Author(s):  
Michael E. Thase ◽  
Stephen M. Stahl ◽  
Roger S. McIntyre ◽  
Tina Matthews-Hayes ◽  
Mehul Patel ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Screening Tool ◽  
Positive Impact ◽  
Screening Tools ◽  
Predictive Values ◽  
Bipolar I Disorder ◽  
Provider Perspectives ◽  
Patient Reported

AbstractIntroductionAlthough mania is the hallmark symptom of bipolar I disorder (BD-I), most patients initially present for treatment with depressive symptoms. Misdiagnosis of BD-I as major depressive disorder (MDD) is common, potentially resulting in poor outcomes and inappropriate antidepressant monotherapy treatment. Screening patients with depressive symptoms is a practical strategy to help healthcare providers (HCPs) identify when additional assessment for BD-I is warranted. The new 6-item Rapid Mood Screener (RMS) is a pragmatic patient-reported BD-I screening tool that relies on easily understood terminology to screen for manic symptoms and other BD-I features in <2 minutes. The RMS was validated in an observational study in patients with clinically confirmed BD-I (n=67) or MDD (n=72). When 4 or more items were endorsed (“yes”), the sensitivity of the RMS for identifying patients with BP-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. To more thoroughly understand screening tool use among HCPs, a 10-minute survey was conducted.MethodsA nationwide sample of HCPs (N=200) was selected using multiple HCP panels; HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the widely recognized Mood Disorder Questionnaire (MDQ). Results were reported by grouped specialties (primary care physicians, general nurse practitioners [NPs]/physician assistants [PAs], psychiatrists, and psychiatric NPs/PAs). Included HCPs were in practice <30 years, spent at least 75% of their time in clinical practice, saw at least 10 patients with depression per month, and diagnosed MDD or BD in at least 1 patient per month. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence interval.ResultsAmong HCPs, 82% used a tool to screen for MDD, while 32% used a tool for BD. Screening tool attributes considered to be of the greatest value included sensitivity (68%), easy to answer questions (66%), specificity (65%), confidence in results (64%), and practicality (62%). Of HCPs familiar with screening tools, 70% thought the RMS was at least somewhat better than other screening tools. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. Most HCPs (81%) preferred the RMS to the MDQ, and the RMS significantly outperformed the MDQ across valued attributes; 76% reported that they were likely to use the RMS to screen new patients with depressive symptoms. A total of 84% said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.DiscussionThe RMS was viewed positively by HCPs who participated in a brief survey. A large percentage of respondents preferred the RMS over the MDQ and indicated that they would use it in their practice. Collectively, responses indicated that the RMS is likely to have a positive impact on screening behavior.FundingAbbVie Inc.

scholarly journals The effective screening tools for detecting hearing loss in elderly population: HHIE-ST Versus TSQ

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nichtima Chayaopas ◽  
Pornthep Kasemsiri ◽  
Panida Thanawirattananit ◽  
Patorn Piromchai ◽  
Kwanchanok Yimtae
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Screening Tool ◽  
Diagnostic Value ◽  
Screening Tools ◽  
Effective Screening ◽  
Hearing Disability ◽  
Test Study ◽  
Combined Test ◽  
Single Question

Abstract Background Globally increasing number of elders is concerned. Hearing loss process in older adults cannot be avoided. An effective screening tool for hearing loss is essential for proper diagnosis and rehabilitation, which can improve QOL in older adults. Methods This prospective-diagnostic test study evaluates the diagnostic value of Thai version of the Hearing Handicap Inventory for Elderly Screening (HHIE-ST) and the Thai Single Question (TSQ) surveys in screening hearing disability in 1109 Thai participants aged 60 years and older in communities in four provinces in Thailand. The HHIE-ST consisted of 10 selected questions from the validated HHIE-Thai version. A TSQ survey was developed to have the same meaning as an English Single Question survey. The participants answered both questionnaires, and a standard audiometry test assessed with air conduction from 250 to 8000 Hz was included as a gold standard. Results The prevalence of hearing disability was 38.34%. The HHIE-ST achieved a sensitivity of 88.96% (95% CI 85.77–91.64) and specificity of 52.19% (95% CI 48.24–56.13) for diagnosis hearing disability in Thai older adults, whereas the TSQ yielded a sensitivity of 88.73% and a specificity of 55.93%. A combined test including the HHIE-ST and TSQ achieved better performance with sensitivity of 85.29% and specificity of 60.13%. Conclusions Either the HHIE-ST or the TSQ is a sensitive and useful tool for screening hearing disability in Thai older adults. Using the HHIE-ST together with the TSQ resulted in a better screening tool for detecting moderate hearing loss older adults who will benefit and recommended for hearing rehabilitation. Trial registration The study is registered with the following number in the Thai Clinical Trials Registry: TCTR20151015003. Date of registration October 14, 2015.

scholarly journals Impact of Screening for Methicillin-Resistant Staphylococcus aureus (MRSA) in Pneumonia on Vancomycin Utilization

2020 ◽  
Vol 41 (S1) ◽  
pp. s265-s265
Author(s):  
Matthew Crotty ◽  
Natalie Weltman ◽  
Joslyn Pribble ◽  
Marie Wilson
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Outcomes ◽  
Nominal Data ◽  
Specific Patient ◽  
Methicillin Resistant ◽  
Process Implementation ◽  
Group Data ◽  
Days Of Therapy ◽  
High Negative Predictive Value ◽  
Utilization Data

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is frequently targeted with empiric treatment for pneumonia in the hospital. Obtaining quality lower respiratory tract cultures to promote appropriate de-escalation can be difficult or impractical. Nasal screening for MRSA has a high negative predictive value for MRSA pneumonia and can be an effective tool for early de-escalation. Methods: A pharmacist-driven process for nasopharyngeal MRSA screening of patients prescribed intravenous vancomycin was implemented in October 2018. Vancomycin utilization was extracted from the electronic medical record (EMR) and summarized as days of therapy per 1,000 patient days (DOT/1,000 PD). Vancomycin utilization data for the 6 months following process implementation (November 2018–April 2019) were compared to the same period from the previous year (November 2017–April 2018). Specific patient outcomes data were manually collected for patients prescribed vancomycin for pneumonia during the first 2 months following process implementation (November–December 2018; postintervention group) and comparable months (November–December 2017; preintervention group). Data were analyzed using the 2 test (nominal data) and Mann–Whitney U test (continuous data). Results: Total vancomycin utilization decreased from a monthly average of 114 to 95 DOT/1,000 PD (17% reduction) and from 27 to 14 DOT/1,000 PD for pneumonia (48% reduction). In-patient mortality was unchanged following process implementation at 17.2% versus 17.5% in the pre- and postintervention groups, respectively. Other clinical outcomes were also similar between the pre- and postintervention groups (Table 1). Fewer vancomycin levels were obtained following implementation with 34.4% of patients (0.61 levels per patient) having a level obtained in the preintervention group compared to 21.6% (0.30 levels per patient; P .001) in the postintervention group. Conclusions: Nasopharyngeal MRSA screening of patients prescribed vancomycin for pneumonia is an effective antimicrobial stewardship strategy to reduce unnecessary use of anti-MRSA therapy without negatively impacting clinical outcomes.Funding: NoneDisclosures: None

scholarly journals Baseline and Kinetic Circulating Tumor Cell Counts Are Prognostic Factors in a Prospective Study of Metastatic Colorectal Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 502
Author(s):  
Virgílio Souza e Silva ◽  
Emne Ali Abdallah ◽  
Angelo Borsarelli Carvalho de Brito ◽  
Alexcia Camila Braun ◽  
Milena Shizue Tariki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Drug Resistance ◽  
Prospective Study ◽  
Metastatic Colorectal Cancer ◽  
Clinical Outcomes ◽  
Predictive Biomarkers ◽  
Multi Drug Resistance ◽  
Cell Counts ◽  
Potential Clinical Benefit ◽  
A Prospective Study

The discovery of predictive biomarkers in metastatic colorectal cancer (mCRC) is essential to improve clinical outcomes. Recent data suggest a potential role of circulating tumor cells (CTCs) as prognostic indicators. We conducted a follow-on analysis from a prospective study of consecutive patients with mCRC. CTC analysis was conducted at two timepoints: baseline (CTC1; before starting chemotherapy), and two months after starting treatment (CTC2). CTC isolation/quantification were completed by ISET® (Rarecells, France). CTC expressions of drug resistance-associated proteins were evaluated. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan–Meier method. Seventy-five patients were enrolled from May 2012 to May 2014. A CTC1 cut-off of >1.5 CTCs/mL was associated with an inferior median OS compared to lower values. A difference of CTC2−CTC1 > 5.5 CTCs/mL was associated with a reduced median PFS. By multivariate analysis, CTC1 > 1.5 CTCs/mL was an independent prognostic factor for worse OS. Multi-drug resistance protein-1 (MRP-1) expression was associated with poor median OS. CTC baseline counts, kinetics, and MRP-1 expression were predictive of clinical outcomes. Larger studies are warranted to explore the potential clinical benefit of treating mCRC patients with targeted therapeutic regimens guided by CTC findings.

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