The purpose of this study was to describe nutritional screening practices in hospital settings in Virginia. A questionnaire was mailed to each of the chief clinical dietitians employed at 123 Virginia hospitals listed in the 1994 American Hospital Guide (22). Ninety-one (74%) responses were received. Twenty-five (27.5 %) of the hospitals included in the survey were considered large hospitals with more than 300 licensed beds and 66 (72.5 %) were small hospitals with 300 or fewer licensed beds. Re-screening of patients occurred in 40 (60.6 %) of the small hospitals while 8 (32 %) of the large hospitals had re-screening policies. Computers were used for nutritional screening in 17 (68 %) of the large hospitals and 13 (19.7 %) of the small hospitals. Dietetic technicians participated in screening in 10 (40 %) of the large hospitals and in 11 (16.9 %) of the small hospitals. Dietetic students participated in screening in 8 (32 %) of the large hospitals and they participated in 3 (4.5 %) of the small hospitals. Hemoglobin was used in 6 (24 %) of the large hospitals to determine a patients nutritional risk. It was used in 34 (51.5 %) of the small hospitals. Hematocrit was used in 36 (54.5 %) of the small hospitals and in 5 (20 %) of the large hospitals. All of these associations between large and small hospitals were significantly different (p < .05 ) as determined by Chi square analysis. Since there were no other significant associations between large and small hospitals, the reminder of the results were treated as one group of hospitals. Seventy-five (82.4 %) of the hospitals represented in the survey had written screening policies and a standard form was used in 59 (64.8 0/0) of them. Fifteen (16.50/0) of the hospitals surveyed had written screening policies for specialty units; 8 (8.8 %) also had specific forms. The three most common items included in the routine nutritional screening were weight, height, and lab results. Weight and height also were the items most often missing or not available when a routine screening was performed. Albumin was used as an abnormal finding to determine nutritional risk in 79 (86.8 %) of the hospitals; while weight loss was used in 82 (90.1 %) of the hospitals and weight for height was used in 69 (75.8 010) hospitals. / Master of Science

Background: Hospital malnutrition is a prevalent issue with critically ill pediatric patients being at increased risk for nutritional loss. Nutritional risk screening has been associated with increased documentation of nutrition diagnosis and positive clinical outcomes, however, is not mandatory in developing countries. A nutrition screening tool that uses subjective examination of loss of subcutaneous fat and muscle tissue may be an efficient way to identify nutritional risk in hospitalized critical care pediatric patients. Objective: To determine whether loss of subcutaneous fat and muscle tissue in specific body locations was associated with moderate or severe malnutrition determined by SGA in pediatric critical care hospital units, and if loss of subcutaneous fat and muscle tissue differs by gender, age, or disease. Methods: Pediatric in-patients (n = 203), aged 1 month to 18 years old, in tuberculosis, burn, oncology, high dependency (HDU) and intensive care units (ICU) in two tertiary hospitals in Malawi were assessed for nutritional status using Subjective Global Assessment (SGA), Mid-upper arm circumference (MUAC), and weight for age Z-score (WAZ). The SGA form included four questions on weight, appetite, tolerance to food and fluids, and dietary intake, as well as a nutrition-focused physical exam. The nutrition-focused physical exam consisted of assessments of subcutaneous fat loss in two locations (below the eye, triceps/biceps) and eight locations for muscle tissue loss (temple, clavicle, shoulder, scapula, interosseous, knee, quadriceps, and calf). The analysis was focused on the assessment of loss of subcutaneous fat and muscle tissue in relation to malnutrition score determined by SGA. Results: The mean age and standard deviation of the study population was 5.32 years ± 4.80, with just over 55% of participants being male. Determined by SGA, moderate malnutrition prevalence was 70.9% and severe malnutrition prevalence was 13.8%. SGA alone identified more malnutrition (84.7%) than MUAC (20.5%) and WAZ (43%). Patients with cancer (100%) and organ-related disease (93.76%) had the highest rates of moderate and severe malnutrition. Loss of subcutaneous fat and muscle tissue in all body locations assessed were associated with moderate and severe malnutrition (p-value Conclusions: A nutritional screening tool that is efficient, valid, and allows for the screening of a large patient population in a short amount of time, is needed in Malawi. Although loss of subcutaneous fat and muscle tissue were significantly associated with moderate and severe malnutrition, moderate loss of muscle tissue in the quadriceps and calf had the highest odds of malnutrition. These results indicate that pediatric patients with moderate loss of muscle tissue in their quadriceps and calf should be treated with a high index of suspicion for malnutrition. While loss of subcutaneous fat and muscle were not significantly worse by gender, age, or disease, particular attention should be paid in patients of the male sex, aged 6 to 10 years old, and with cancer. These findings support increasing dietetic services to prevent and treat hospital malnutrition using simple screening tools, such as the one used in this sub-analysis.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-12-01T13:09:59Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO GLAUCIA PDF.pdf: 3704357 bytes, checksum: 1dc85b37dac1dafed212e355c1aef07d (MD5) / Made available in DSpace on 2016-12-01T13:09:59Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO GLAUCIA PDF.pdf: 3704357 bytes, checksum: 1dc85b37dac1dafed212e355c1aef07d (MD5) Previous issue date: 2016-02-25 / A desnutrição é um achado comum em pacientes hospitalizados e muitas vezes seu quadro é agravado pela falta de diagnóstico precoce. Cuidados nutricionais adequados começam com a identificação de pacientes em risco nutricional (RN) no momento do internamento, por intermédio de uma ferramenta de triagem. Entretanto, com o aumento de admissões hospitalares, torna-se impraticável ao profissional de saúde triar todos os pacientes em tempo hábil. O presente estudo, do tipo de avaliação, teve como objetivo avaliar a aplicabilidade de um instrumento de auto-triagem nutricional em pacientes adultos de ambos os sexos admitidos para internamento no período de julho a outubro de 2015 em um hospital público de Pernambuco. A auto-triagem nutricional foi realizada pelos pacientes elegíveis, como também pelo pesquisador, e ao final sua concordância foi avaliada pelo coeficiente Kappa. A avaliação da diferença entre a altura e o peso aferidos pelo avaliador e a altura referida e o peso aferido pelo paciente foi realizada por meio do teste de Wilcoxon, sendo construído o gráfico de Bland & Altman. Para avaliar a associação entre variáveis clínicas e sociodemográficas com o risco nutricional identificado pelo avaliador foi realizado teste do Qui-quadrado. O estudo envolveu 171 pacientes, sendo 59,1% do sexo feminino. A idade média dos pacientes foi de 51,7 ± 15,3 anos. Os resultados mostraram que um percentual elevado 47,9% (n=82) de pacientes não conseguiram realizar a auto-triagem, devolvendo o formulário ao pesquisador em branco ou incompleto, sendo o baixo grau de instrução e idade uma das principais razões. O peso médio registrado pelo paciente (68,4Kg ± 15,0) foi semelhante ao aferido pelo nutricionista (68,2Kg ± 15,1), resultado similar foi evidenciado na comparação entre a altura referida pelo paciente e a aferida pelo nutricionista, com diferencial de 0,03cm. Na comparação entre o RN avaliado pelo profissional de nutrição e o RN avaliado pelo paciente na auto-triagem, verifica-se que houve concordância no diagnóstico de RN em 91,9% dos casos e que 26,9% dos pacientes considerados sem risco pelo profissional foram incluídos como risco na auto-triagem. Na análise realizada pelo Kappa houve moderada concordância entre os dois diagnósticos (k=0,62; p=0,001). Na avaliação da concordância entre as duas aferições de peso e altura com o teste de Bland Altman, verificou-se uma boa concordância, com viés próximo a zero nas duas avaliações. De um modo geral, consideramos satisfatória, para a prática clínica, os resultados da auto-triagem. No entanto, como somente 52,1% da população foi capaz de responder o instrumento, conclui-se que ainda não é viável sua inclusão em um serviço que atenda pessoas de baixo grau de instrução, sugerindo então que novas pesquisas e adaptações para auto-triagem sejam realizadas. / Malnutrition is a common finding in hospitalized patients, and often the condition deteriorates for lack of an early diagnosis. Proper nutritional care begins with the identification of patients at nutritional risk by use of a screening tool on admission. However, as hospital admissions increase, it is impossible for health professionals to screen all patients in a timely manner. The present study aimed to assess the applicability of a nutritional self-screening tool in adult males and females admitted to a public hospital in Pernambuco between July and October of 2015. Nutritional self-screening was performed by eligible patients and by the researcher, and later their agreement was measured by the Kappa coefficient. The differences between the self-reported and measured weight and height were assessed by Wilcoxon’s test, with subsequent construction of the Bland & Altman graph. The chi-square test measured whether clinical and sociodemographic variables were associated with nutritional risk diagnosed by the researcher. The study included 171 patients, of which 59.1% were females. The mean age of the sample was 51.7 ± 15.3 years. A considerable percentage of patients (47.9%, n=82) could not screen themselves, returning the self-screening form in blank or incomplete mainly because of low education level. The mean self-reported weight (68.4 ± 15.0 Kg) was similar to the weight measured by a dietician (68.2 ± 15.1 kg). A similar result was obtained for height as the self-reported and measured heights differed by 0.03 cm. Self-assessed and professionally assessed nutritional risk agreed in 91.9% of the cases, and 26.9% of the patients considered not at risk by the professional were considered at risk according to their self-assessment.According to the Kappa coefficient, the two diagnoses had moderate agreement (k=0.62; p=0.001). The agreements between self-reported and measured weight and height according to the Bland &Altman test were good, with a bias close to zero. Generally, self-screening for clinical practice was considered satisfactory. However, since only 52.1% of the samplemanaged to answer the instrument, its use byhealth care facilities that cater to individuals with low education level is not yet viable, suggesting that new self-screening studies and adaptations are needed.