Background: The increasing use of electronic health records (EHR) provides a novel opportunity to evaluate hospital-based nutritional outcomes, such as malnutrition. There is no universally accepted screening tool for the detection of malnutrition. However, assessment for malnutrition should be made early, be simple, based on scientific evidence, and include data on age, gender, and disease severity. The malnutrition screening tool (MST) used in this study is a two question tool that assesses two parameters commonly seen when diagnosing malnutrition (weight loss and loss of appetite). Objective: The purpose of this study is to determine the ability of the MST used at a tertiary or quaternary hospital to accurately identify patients with malnutrition by comparing it against the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition criteria for malnutrition. Participants/setting: A descriptive cohort study was conducted that included 167 patients admitted to Emory University Hospital between October 1 - 14, 2014. MST score, malnutrition diagnostic criteria, and demographic and anthropometric characteristics were obtained to describe and assess the study population. Statistical Analysis: Frequency statistics were used to describe the demographic and anthropometric characteristics and MST score results. Normality statistics were used to determine the distribution of continuous variables. A Chi Square table was used to determine the significance of the association between the MST score and diagnosis of malnutrition made by the Registered Dietitian (RD) as well as the sensitivity and specificity of the MST. Results: A total of 167 patients (48.5% male, 51.5% Caucasian, non-Hispanic) were admitted during the study period. The vast majority of the patient population with malnutrition (79%), as diagnosed by the RD, was identified as such by the MST (p < 0.01). The sensitivity and specificity of the MST was 79% and 62%, respectively. Conclusion: The MST is a useful screening tool for malnutrition in adults admitted to a large urban university hospital. There is a lack of research validating the MST in the adult outpatient population. Therefore, future studies are necessary to evaluate the effectiveness of the MST in this population.

Bakgrund: Sverige har cirka 2 miljoner äldre, av dem anses ungefär 60 procent vara riskpatienter för malnutrition. Vårdgivaren har det yttersta ansvaret för att fastställa rutiner för när och hur vårdtagare ska utredas och behandlas. Riskbedömning med ett validerat nutritionsbedömningsinstrument är första steget i nutritions-vårdsprocessen. Rutinmässig övervakning och uppföljning kan förhindra att äldre utvecklar malnutrition. Syftet var att undersöka vilka faktorer som förhindrade nutritionsvårdsprocessen hos äldre. Metod: Studien genomfördes som en litteratur-översikt baserat på 13 artiklar. Resultatet delades in i kategorier som belyste organisations, - personal, - och patientrelaterade faktorer. De påvisade faktorerna uppgavs förhindra nutritionsvårdsprocessen på olika vis och ibland i relation till varandra. Konklusion: De beskrivna hindren för nutritionsvårdsprocessen är betydelsefulla för att kvalitetssäkra vården. Stöd och strategier på flera olika nivåer behövs för att överkomma de hinder som försvårar nutritionsvården. / Background: Sweden has about 2 million older people, of whom about 60 percent are at risk for malnutrition. The care provider has the ultimate responsibility for establishing routines for when and how care recipients will be investigated and treated. Risk assessment with a validated nutrition assessment instrument is the first step in the nutrition care process. Routine monitoring and follow up can prevent older people from developing malnutrition. The aim was to investigate factors which prevented the nutrition care process in older people. Method: The study was conducted as a literature review including 13 articles. The result was divided into categories which highlighted organizational, - personnel, - and patient related factors. The demonstrated factors were reported to prevent the nutrition care process in different ways and sometimes in relation to each other. Conclusion: The described barriers to the nutrition care process are important for quality assurance. Support and strategies at several levels are needed to overcome the barriers that hinder nutritional care.

Objective: To translate into Portuguese and to culturally adapt the malnutrition screening tool for hospitalized children, Strongkids. Methods: This study documents the translation of the tool from the original version (English) into Portuguese. The translation and cultural adaptation of the content of this tool consisted of six stages, according to the methodology proposed by Beaton et al (initial translation, synthesis of translations, back translation, verification of the cultural equivalence process, pre-test, and evaluation of the cultural adaptation process). In the first stage, translation was performed by two independent translators, followed by their synthesis and reconciliation; in the third one, the reconciled version was back translated and, then, a pre-final one that retained all linguistic equivalence was developed. In the fifth step, a pre-test of the pre-final version was performed in order to verify the understanding of the items and a final version of the tool was developed. Results: The pre-final version of the tool was applied to 30 parents/guardians and to 20 healthcare professionals in order to verify its understanding by both. The main alterations were the adaptation of technical terms in order to meet the recommendations of health professionals, and the adjustment of terms for parents/guardians understanding. Conclusions: The Portuguese translation of the tool was easily understood by parents/guardians and health professionals, and it should be useful to screen the risk of malnutrition in hospitalized children. / Objetivo: Realizar a tradução para o português e a adaptação cultural da ferramenta para triagem de desnutrição Strongkids, em crianças hospitalizadas. Métodos: Estudo documental no qual foi realizada a tradução da ferramenta da versão original (inglês) para a língua portuguesa. A tradução e a adaptação cultural do conteúdo de tal instrumento consistiram de seis etapas, segundo a metodologia proposta por Beaton et al (tradução inicial, síntese das traduções, retrotradução, verificação do processo de equivalência cultural, pré-teste e avaliação do processo de adaptação cultural). Na primeira etapa, a tradução foi realizada por dois tradutores independentes; na segunda, envolveu síntese e reconciliação das mesmas; na terceira, a reconciliada foi retrotraduzida e, na quarta, elaborou-se uma pré-final, de forma a manter as equivalências linguísticas. Na quinta etapa, foi realizado o pré-teste da versão pré-final para verificar a compreensão dos itens e, na última, foram feitas as correções necessárias e uma versão final da ferramenta foi elaborada. Resultados: A versão pré-final da ferramenta foi aplicada a 30 pais e/ou responsáveis e a 20 profissionais da saúde para esclarecer o entendimento da mesma por ambos os públicos. As principais alterações realizadas foram adequações de termos técnicos, visando a atender às recomendações dos profissionais da área da saúde, e adequação dos termos para os pais e/ou responsáveis. Conclusões: A ferramenta em português mostrou-se de simples entendimento para os pais/responsáveis e profissionais da saúde a fim de triar o risco de desnutrição em crianças hospitalizadas. / Mestre em Ciências da Saúde