scholarly journals A digital dietary assessment tool may help identify malnutrition and nutritional deficiencies in hospitalized patients

2021 ◽  
Vol 7 ◽  
Author(s):  
Adam Bernstein ◽  
Randall Moore ◽  
Lauren Rhee ◽  
Dina Aronson ◽  
David Katz
Keyword(s):  
At Risk ◽  
Nutritional Status ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Hospitalized Patients ◽  
Nutritional Deficiencies ◽  
Study Cohort ◽  
Nutrient Deficiencies ◽  
Historical Cohort ◽  
Patients At Risk

Malnutrition is common among hospitalized patients and associated with longer hospital stays, higher rates of rehospitalization, and increased mortality. Validated questionnaires of varying sensitivity and specificity to help identify patients at risk of malnutrition have been developed, but none has been broadly adopted. Tools to identify patients at risk for malnutrition should be quick, inexpensive, easy to administer and use, not require specialized nutrition knowledge, and provide results which can be entered into an electronic medical record; ideally, the tool should be deployed within 24 hours of admission and repeated if warranted. We hypothesize that a novel digital nutrition assessment tool which uses the Diet Quality Photo Navigation (DQPN) method, can help triage hospitalized patients toward further evaluation of nutritional status. We further propose that micronutrient deficiencies may be identified at the same time as malnutrition and that the reimbursement and cost savings from DQPN will prove substantially greater than the combined costs of its use and triggered dietitian consult. Deploying DQPN upon admission will represent an addition to standard hospital intake procedure that is frictionless for patients and health professionals, and one which may be overseen by clerical rather than clinical staff. The digital format of DQPN, which can be integrated into electronic medical records, will facilitate easier tracking and management of nutritional status over the course of hospitalization and post-discharge. To evaluate the hypotheses, DQPN will be deployed in a hospital setting to a group of patients who will also be seen by a registered dietitian to assess the nutritional status of each patient. Receiver operating characteristic curves will determine the point, or criterion, at which maximal true positivity rate and least false positivity rate for a diagnosis of malnutrition and specific nutrient deficiencies align. The study cohort will also be compared to a matched historical cohort to compare total medical spend and reimbursement between the intervention cohort and matched control. Testing of these hypotheses will thus allow for insight into whether DQPN may be used to identify malnutrition and nutrient deficiencies in hospitalized patients and, in so doing, improve patient outcomes, reduce healthcare utilization, and bring financial benefit to hospitals.

scholarly journals Applying models of care for total hip and knee arthroplasty: External validation of predictive models to identify extended stay prior to lower-limb arthroplasty

2020 ◽  
Author(s):  
Meredith Harrison-Brown ◽  
Corey Scholes ◽  
Kam S Sandhu ◽  
Milad Ebrahimi ◽  
Christopher Bell ◽  
...  
Keyword(s):  
At Risk ◽  
Knee Arthroplasty ◽  
Lower Limb ◽  
Regression Models ◽  
Hospital Setting ◽  
Screening Tools ◽  
Study Cohort ◽  
Predictive Tools ◽  
Total Hip ◽  
Patients At Risk

Introduction/Aims Multiple screening tools exist for identifying patients at risk of extended stay following lower limb arthroplasty. Use of these models at other hospital sites requires verification of appropriate data coverage and evidence of validity in a new population. The aim of this study was to adapt and assess 1) data compatibility, 2) discrimination, and 3) calibration of three published models for identifying patients at risk of an extended (5+ day) stay, or those likely to stay for the target 3 or fewer days following lower limb arthroplasty. Methods Retrospective study, utilising a randomly selected (N=200 of a total 331 available in the electronic medical record) cohort of lower-limb Total Joint Arthroplasty (TJA) patients, to externally validate an adaptation of predictive tools and regression models published by three independent groups: Winemaker et al (2015), Oldmeadow et al (2003) and Gabriel et al (2018). Electronic medical records of a single, medium-sized public hospital were accessed to extract data required for the models and respective predictive tools, and model characteristics (included predictors, data coding, sample sizes) were modified according to the available data. Results The study cohort comprised 200 patients (60% female) at a median 70yrs of age (IQR 62-75). Approximately 58% received total knee arthroplasty (TKA) and 42% underwent total hip arthroplasty (THA). The two prediction tools and three regression models all required modifications due to data items being unavailable in the electronic records. A modification of the RAPT tool applied to 176 eligible patients resulted in sensitivity of 85.71% (95%CI 71.46-94.57) and poor specificity 32.09% (24.29-40.70), with 68% of short-stay patients classified in the high risk group. Adaptation of the second tool to 85 eligible patients resulted in unreliable estimates of sensitivity due to limited data. The three adapted regression models performed similarly well with regard to discrimination when used to predict patients staying for 5 days or longer (concordance index: Winemaker et al:, 0.79, n=198; Oldmeadow et al: 0.79, n=176), or those staying 3 days or less (Gabriel et al: 0.70, n=199). Estimates of calibration suggested the models were relatively well calibrated (spiegelhalter Z -0.01-0.29, p>0.05), although calibration plots indicated some variation remained unaccounted for, particularly with patients considered at intermediate risk. Conclusion The three resulting regression models performed adequately in terms of discrimination and calibration for identification of patients at risk of an extended stay. However, comparison with published models was hampered by systemic issues with data compatibility. Further evaluation of such models in a specific hospital setting should incorporate improvements in data collection, and establish key thresholds for use in targeting resources to patients in need of greater support.

scholarly journals An algorithm for the clinical assessment of nutritional status in hospitalized patients

2003 ◽  
Vol 90 (4) ◽  
pp. 829-836 ◽  
Author(s):  
J. Th. C. M. de Kruif ◽  
A. Vos
Keyword(s):  
At Risk ◽  
Nutritional Status ◽  
Nursing Staff ◽  
Clinical Assessment ◽  
Early Stage ◽  
Hospitalized Patients ◽  
Nutritional Screening ◽  
Patients At Risk ◽  
Two Phases ◽  
Definition Of

Upon admission to hospital, 30–50% of patients either are or become malnourished. There is no generally accepted definition of malnutrition or guidelines on the best way to establish nutritional status. We consider it self-evident that the nursing staff have an important role in screening patients at risk of malnutrition on admission and thereafter at regular times. This is why we developed the nursing nutritional screening form (NNSF). The NNSF was tested by nurses, dietitians and clinicians, in pairs, to establish the extent of agreement in two phases on sixty-nine and forty patients. Later, the form was used in practice by nursing staff on five wards (334 patients). Based on the results of the NNSF, patients were referred to a dietitian. The dietitian established whether the patient was indeed at risk, or was actually malnourished, using a complete nutritional history. The degree of concurrence within pairs was reasonable to good. The same applied to the concurrence between nursing staff and dietitians, but concurrence between clinicians and nursing staff was less. In total, 334 patients were screened and sixty-nine of them were referred to the dietitian. It was established that 86% of the referred patients were potentially at risk of malnutrition or were malnourished. Without the NNSF, 39% (n 27) of the patients referred to the dietitian would not have been referred, or would have been referred much later. The NNSF makes it possible for nurses to detect malnourished patients or patients at risk of malnutrition at an early stage of their hospitalization.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

scholarly journals The importance of dysphagia screening and nutritional assessment in hospitalized patients

2018 ◽  
Vol 16 (2) ◽  
Author(s):  
Patrícia Amaro Andrade ◽  
Carolina Araújo dos Santos ◽  
Heloísa Helena Firmino ◽  
Carla de Oliveira Barbosa Rosa
Keyword(s):  
Nutritional Status ◽  
Global Assessment ◽  
Assessment Tool ◽  
Nutritional Assessment ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
The Body ◽  
Subjective Global Assessment ◽  
Cross Sectional ◽  
Knee Height

ABSTRACT Objective: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). Methods: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson’s χ2 and Spearman’s correlation were used to verify differences between the groups. Results: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. Conclusion: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people.

scholarly journals Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome

2016 ◽  
Vol 44 (12) ◽  
pp. 2182-2191 ◽  
Author(s):  
Graciela J. Soto ◽  
Daryl J. Kor ◽  
Pauline K. Park ◽  
Peter C. Hou ◽  
David A. Kaufman ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Hospitalized Patients ◽  
Prediction Score ◽  
Injury Prediction ◽  
Patients At Risk

Development and validation of a complexity score to rank hospitalized patients at risk for preventable adverse drug events

2017 ◽  
Vol 74 (23) ◽  
pp. 1970-1984 ◽  
Author(s):  
Almut G. Winterstein ◽  
Ben Staley ◽  
Carl Henriksen ◽  
Dandan Xu ◽  
Gloria Lipori ◽  
...  
Keyword(s):  
At Risk ◽  
Adverse Drug Events ◽  
Hospitalized Patients ◽  
Complexity Score ◽  
Patients At Risk ◽  
Development And Validation

scholarly journals Acute Hypoglycemia in Emergency Room: A Review

2021 ◽  
pp. 61-67
Author(s):  
Hisham Mohammed Sonbul ◽  
Faris Ali Hakami ◽  
Ibrahim Ahmed Almathami ◽  
Ahmad Yousef Basalamah ◽  
Riyad Khalid Almasaud ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Nutritional Status ◽  
Emergency Room ◽  
Alcohol Intoxication ◽  
Chief Complaint ◽  
Insulin Administration ◽  
Poor Nutritional Status ◽  
Patients At Risk ◽  
Acute Hypoglycemia

Hypoglycemia is frequently encountered in the emergency department (ED) and has potential for serious morbidity. The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes. Adult patients with a chief complaint or ED diagnosis of hypoglycemia, or an ED glucose value of ≤70 milligrams per deciliter (mg/dL) between 2009–2014. Two independent abstractors each reviewed charts of patients with an initial glucose ≤ 50 mg/dL, or initial glucose ≥ 70 mg/dL with a subsequent glucose ≤ 50 mg/dL, to determine if the hypoglycemia was caused by iatrogenesis. In ED patients with hypoglycemia, iatrogenic causes are relatively common. The most frequent cause was insulin administration for hyperkalemia and uncomplicated hyperglycemia. Additionally, patients at risk of hypoglycemia in the absence of insulin, including those with alcohol intoxication or poor nutritional status, should be monitored closely in the ED.

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