Nutritional Assessment- December 2011

 

Nutritional Assessment - Evidence Update

December 2011

 

Welcome to the December Nutritional Assessment Evidence Update Bulletin being produced by the HEFT

Library Services. This bulletin is produced to support VITAL for Nurses core skills programme developed

in the Trust. This issue will highlight evidence published in the previous three months. Full text articles can

be accessed with your HEFT Athens ID.

 

Organisation

 

Dignity and nutrition inspection programme

The Care Quality Commission has published a report 'Dignity and nutrition inspection programme'. The report looked into

the standards of care that older people receive in hospital, and calls for a system-wide response  to combat the failings

identified. The report summarises the findings of 100 unannounced inspections of NHS acute hospitals which took place

between March and June, looking at whether the  essential standards of dignity and nutrition were being met on wards

caring for older people. Around half of the hospitals needed to do more to ensure that they were meeting people's needs,

with twenty of the hospitals visited failing to meet essential standards required by law. Of the 100 hospitals inspected, 45

hospitals were fully compliant, meeting the essential standards relating to both dignity and nutrition, 35 met both standards

but still needed to make improvements in one or both and 20 hospitals did not meet one or both standards, with major

concerns identified in two cases.

Full Text

 

If one hospital can give patients dignified care, all of them

can.

Nursing Standard. August; 25(48) p.12-4

Examples of good and poor practice are discussed in this article, resulting from the Care Quality Commission's Dignity and

Nutrition Inspection Programme standards document. In particular, good practice at Aintree    University   Hospitals      NHS

Foundation Trust in Merseyside is highlighted.

Available in fulltext at EBSCO Host and ProQuest (Legacy Platform)

 

NICE Bites: nutrition support in adults

The November NICE Bites bulletin from the North West Medicines Information Service covers nutrition support in adults.

The aim of this publication is to provide healthcare  professionals with a clear  and succinct summary of key prescribing

points taken from NICE guidance.

 

Full Text

 

Nutritional COPD Guideline

NHS Improvement - Lung has published  'The Respiratory  Healthcare Professional's Nutritional COPD Guideline' on its

website. The guideline has been designed to raise the awareness of nutrition with respiratory health professionals and their

COPD patients; to provide a simple tool to aid first line nutritional management of this patient group; and to improve the

nutritional status of COPD patients. The Respiratory Healthcare Professional's Nutritional COPD Guidelines were created

by a multidisciplinary working group of COPD and nutritional experts sponsored by an educational grant from Nutricia.

 

Full Text

 

Patient Safety. A lot on your plate.

Health Service Journal. August; 121(6271) p.26-7

The need to maintain good standards of nutritional care for hospital patients is discussed. The dangers of malnutrition are

set out and the work of The British Association for Parenteral and Enteral Nutrition in developing a framework to enable

trusts to meet Care Quality Commission Standards are described.

 

Screening

 

Accuracy of Quick and Easy Undernutrition Screening Tools

in Patients Undergoing Cardiac Surgery.

Journal of the American Dietetic Association. December; 111(12) p.1924-30

The aim of this study  was to compare  the  quick and easy  undernutrition screening tools, such   as the Short Nutritional

Assessment Questionnaire and Malnutrition Universal Screening Tool, in patients undergoing cardiac surgery. The study

compared their accuracy in detecting undernutrition measured by a low-fat free mass index and assessed their association

with postoperative adverse outcomes.

Available in fulltext at MD Consult

 

Long-form but not short-form Mini-Nutritional Assessment

is appropriate for grading nutritional risk - patients on

hemodialysis.

International Journal of Nursing Studies. Nov; 48(11) p.1429-35

This cross-sectional study aimed to evaluate the appropriateness of using the long-form (LF) and the short-form (SF) Mini

Nutritional Assessment (MNA) for grading the risk of protein-energy malnutrition in patients on haemodialysis.

 

Perceived health and risk of undernutrition: a comparison of

different nutritional screening results in older patients.

Journal of Clinical Nursing. August; 20(15-16) p.2162-71

This Norwegian cross-sectional study compared 3 nutrition screening tool results. I considered links between patients' own

perception of health, health-related issues and malnutrition risk in older hospital patients. Results of screening of patients

from 3 wards over a 6 month period were examined to ascertain the tools' accuracy in predicting malnutrition risk.

 

Recognition

 

Eating difficulties among stroke patients in the acute state: a

descriptive, cross-sectional, comparative study.

Journal of Clinical Nursing. September; 20(17-18) p.2563-72

This descriptive, cross-sectional, comparative study examines eating difficulties among male and female stroke patients. In

conclusion more women than men with stroke suffered from inadequate food consumption. The women had more severe

strokes, experienced poorer quality of life and showed lower functional status than the men.

 

Estimating energy needs in nutrition support patients.

Journal of Parenteral and Enteral Nutrition. September; 35(5) p.563-570

This paper looks at energy needs as a fundamental part of nutrition support. The amount of metabolically active tissue mass

is the major determinant of metabolic rate. In determining the energy    prescription,  all of the component parts must be

considered.

 

Improving the hydration of hospital patients.

Nursing Times. October; 107(39) p.21-3

The aim of this project was to identify patients at risk of dehydration in an acute hospital setting and improve procedures.

A fluid balance audit   was carried out complimented by teaching sessions  to raise awareness  of dehydration, promote

monitoring of fluid charts and deliver hydration care.

Available in fulltext at ProQuest (Legacy Platform)

Prevalence of the notification of malnutrition in the

departments of internal medicine and its prognostic

implications.

Clinical Nutrition. August; 30(4) p.450-454

The aim of this paper was to describe how often discharge sheets from Internal Medicine units include malnutrition among

diagnoses. Factors associated with this diagnosis including dementia, cancer, HIV infection and chronic renal failure and its

prognostic implications are also assessed. The study concluded that notification of malnutrition in IM departments is low

and the diagnosis is associated with an increase in morbidity, mortality and costs.

 

Intervention

 

Dietary advice with or without oral nutritional supplements

for disease-related malnutrition in adults.

Cochrane Database of Systematic Reviews 2011, Issue 9.

This review examines evidence that dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral

nutritional supplements in adults with disease-related malnutrition improves survival, weight and anthropometry. Disease-

related malnutrition has been reported in 10% to 55% of people in hospital and the community.

Full Text

 

Dietary intake, nutritional status and rehabilitation outcomes

of stroke patients in hospital.

Journal of Human Nutrition and Dietetics. October; 24(5) p.460-9

This study describes  nutritional status and food consumption in stroke patients within 2 weeks of hospital admission

and before discharge, as well as to investigate the effects of nutritional  and dietary factors on rehabilitation outcomes.

The authors suggest that there is scope for the multidisciplinary development of nutritional support for stroke patients to

improve these outcomes.

 

Different experiences and perspectives between head and

neck cancer patients - daily impact of a gastrostomy tube.

Journal of Human Nutrition and Dietetics. October; 24(5) p.449-459

This study aims to understand the daily impact of gastrostomy feeding on head and neck cancer patients and their care-

givers to identify improvements to services. Twenty-one adult patients were randomly selected from the Head and Neck

centre at University College London Hospital. Six head and neck cancer patients and three care-givers participated in focus

groups. The sessions were recorded, fully transcribed and qualitatively thematically analysed, and the resulting data were

tabulated. Different themes and experiences were explored.

 

Early versus late parenteral nutrition in critically ill adults.

New England Journal of Medicine. August; 365(6) p.506-517

In this randomized, multicenter trial, early initiation of parenteral nutrition is compared with late initiation in adults in the

intensive care unit (ICU) to supplement insufficient enteral nutrition. Late initiation of parenteral nutrition was associated

with faster recovery and fewer complications compared with early initiation.

Available in fulltext at EBSCO Host and ProQuest (Legacy Platform)

 

 

Jejunostomy after oesophagectomy: a review of evidence

and current practice.

Proceedings of the Nutrition Society. August; 70(3) p.316-20

The aim of this article is to review the current literature and report on the author's experience of routine feeding jejunostomy

insertion following oesophagectomy Patients undergoing oesophagectomy often have nutritional needs at the time of

diagnosis and in the post-operative period. Routine jejunostomy insertion is recommended to ensure adequate nutrition in

patients who develop post-operative complications and for those patients with long-term reduced appetite and poor oral

intake.

 

Nutrition in Inflammatory Bowel Disease

Journal of Parenteral and Enteral Nutrition. September; 35(5) p.571-580

Malnutrition is relatively unusual in Ulcerative Colitis, but in Crohn Disease, which often affects the small intestine, it is

frequent and may be severe. Nutrition support is therefore often indicated. This paper looks at the current evidence.

 

Nutrition therapy of the severely obese, critically ill patient:

summation of conclusions and recommendations.

Journal of Parenteral and Enteral Nutrition. September; 35(5 Suppl) p88s 96s

Obesity adds to the complexity of nutrition therapy in the intensive care unit. This report includes recommendations for

nutrition therapy for obese, critically ill patients. Although the basic principles of critical care nutrition apply, a high-protein,

hypocaloric regimen is recommended to reduce the fat mass, improve insulin sensitivity, and preserve lean body mass. The

ideal enteral formula should have a  low nonprotein calorie to nitrogen ratio and  a range of pharmaconutrient agents to

modulate immune responses and reduce inflammation.

 

Nutritional intervention and quality of life in palliative care

patients

British Journal of Nursing, November; 20(20) p.1320 - 1324

This article considers quality of life measures that can be used by health professionals to assess effectiveness of nutritional

interventions administered to palliative care patients. Stabilizing, maintaining and attempting to increase weight through

the support of oral feeding, and provision of artificial feeding, has been shown to mediate the metabolic and physical wasting

effects of the disease process and improve general comfort. Use of quality of life scales provides health professionals and

organizations with an ideal measure for planning, targeting and evaluating nutritional interventions.

 

Symptoms associated with dietary fiber supplementation

over time in individuals with fecal incontinence.

Nursing Research. June; 60(3 Suppl) p.S58-67

There isn't much knowledge about adverse symptoms from fiber supplementation available. Patients with fecal incontinence

experience a variety of GI symptoms over a period of time. The symptom severity and emotional upset appear to influence

fiber tolerance. Supplements seem overall to be well tolerated.

 

Nursing Role

 

Nutrition: safe practice in adult enteral tube feeding.

British Journal of Nursing. October; 20 (19) p.1234-239

Recent alerts and  recommendations from  the National Patient Safety Agency (NPSA) regarding enteral feeding have   led

health professionals to review their practice and guidelines. This article explores safe practice, promoting safer measurement

and administration of liquid medicines via oral and other enteral routes.

 

Reducing variable consistency in thickened drinks.

Nursing & Residential Care. October; 13(10) p.469-473)

This article discusses the results of a hospital research study investigating the consistency of the thickness of drinks for

patients with dysphagia. Recommendations for practice are made including the need for staff training on drink preparation.

Available in fulltext at EBSCOhost

 

Using mealtime volunteers to support patients.

Nursing Times. October; 107(41) p.21-3

The Royal Hampshire County Hospital has introduced a scheme of a mealtime volunteers, aiming to decrease the incidence

of malnutrition among hospital patients. Ideas for reducing malnutrition, the roles the volunteers take on as  well as  the

development and implementation of the scheme are described. Feedback from  nursing staff, volunteers and patients is

provided.

Available in fulltext at ProQuest (Legacy Platform)

 

Further Information

Multiple sources – websites, journals and healthcare databases – have been searched for evidence published in

the last three months. For further information please contact [email protected] or ext 45195

(Solihull Hospital)

Please login with your Athens ID on www.evidence.nhs.uk ‘before’ clicking on any of the journal full text links

in this bulletin for seamless access.

To request articles where there is no full text link, please complete an online article request form available on

HEFT Library website www.heftlibrary.nhs.uk under ‘Electronic Forms’ menu. Please note that there is now a

charge of £1 for such requests.

For more information on how to register for Athens, access the Athens Registration leaflet via HEFT Library

website  www.heftlibrary.nhs.uk under the ‘Publications’ menu.