Nutritional Assessment - January 2013


Welcome to the January 2013 Nutritional Assessment Bulletin 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 quarter. Full text articles

can be accessed with your HEFT Athens ID.




Appropriate protein provision in critical illness: a systematic and narrative review

American Journal of Clinical Nutrition, Sept 96(3) p.591-600

Meta analysis of clinical trial data to determine safe levels of protein provision for critically ill patients. Results

suggest that current levels are too low for optimum nutrition, but more research needs to be done.

Available from Free Access Content in American Journal of Clinical Nutrition


Cost-effectiveness of nutritional intervention on healing of pressure ulcers

Clinical Nutrition, Dec. 31(6) p.868-74

Small randomised controlled trial on the effectiveness of nutritional interventions at reducing the healing-time of

pressure ulcers compared to conventional methods, and an analysis of the cost-effectiveness of this approach.


Dehydration in stroke patients admitted to hospital

Nursing Times 108(42) p.23

Overview of research into the rate of dehydration incidents in stroke patients, with commentry on assessing

hydration status on entry to hospital and throughout the stay. The subsequent effect of dehydration on outcomes

is also discussed.

Available in fulltext from Nursing Times at ProQuest


Get on course for nutrition.

Nursing standard Sept 27(1) p.64

This paper describes a training event for BSc Nursing students at Birmingham University. The main focus is the

provision of nutritional products and gave delegates the opportunity for networking.

available in fulltext from Nursing Standard at ProQuest


Looks good enough to eat.

Nursing Times, Oct. 108(42) p.27

Case study of picture-menus as a method for helping physically or cognitively disabled patients choose meals.

Available in fulltext from Nursing Times at ProQuest


New standards for hospital food

British Journal of Nursing, Nov, 21(20), p.1228-1229

The Department of Health has announced new standards for NHS hospital food. A set of basic principles covering

the quality of food, nutritional content and choice for patients will be backed up by new inspections led by patients.

The principles state that nutritious and appetising hospital food and drink is essential. Patients will get a choice

from a varied menu, including meals suitable for religious needs and all patients should have access to fresh

drinking water at all times, unless it contradicts clinical advice.

Available in fulltext from British Journal of Nursing at EBSCOhost



Using Rapid Spread to improve hospital nutrition.

Nursing Times, 16 October 108 (42) p.24-25

Rapid spread is a form of change management. This is one trust's experience of using this programme of change

to bring in and sustain evidence-based nutritional care, resulting in great improvements for patients.

Available in fulltext from Nursing Times at ProQuest




Estimation of protein requirements according to nitrogen balance for older

hospitalized adults with pressure ulcers.

Journal of the American Geriatrics Society, Nov. 60(11) p.2027-34

Nitrogen balance in older hospitalised patients was evaluated using a food weighing record and nitrogen excretion

from urine, faeces and wound exudate. Patients with severe pressure ulcers can require higher protein intakes

because of muscle protein hypercatabolism rather than direct loss from wounds.


Malnutrition self-screening by using MUST in hospital outpatients: validity,

reliability, and ease of use.

American Journal of Clinical Nutrition 96(5) p.1000-1007

Patient self-screening for malnutrition with the MUST tool is considered. Patients felt that the tool is acceptable,

user-friendly and reliable.

Available in fulltext from American Journal of Clinical Nutrition at Free Access Content




Adequate oral fluid intake in hospitalized stroke patients: does viscosity matter?

Rehabilitation Nursing, Sep 2012, 37 (5), p.252-257

This study deals with fluid intake in three groups of patients following stroke: patients in the community, those

who had been hospitalized with a thin liquid diet and those hospitalized with a thick liquid diet. Patients in the

community fared better than the hospitalized at meeting the recommended standard of 1500ml/day. Conclusions

identified included failures in the preparation of thick liquid diets among factors affecting fluid intake in stroke


Available in fulltext from Rehabilitation Nursing at ProQuest


Is there a difference in bloodstream infections in patients associated with ready-

to-use versus compounded parenteral nutrition?

Clinical nutrition, Oct. 31(5) p.728-34

Parenteral  nutrition,  which  is  widely  used  with  critically  ill  patients,  has  been  associated  with bloodstream

infections. This is a retrospective review of a large patient database over a two year period. In conclusion, patients

receiving parenteral nutrition from premixed multi-chamber bags as opposed to the conventional compounded

preparation are significantly less likely to develop bloodstream infections.




Feeding Tube Placement Errors and Complications

Nutrition in Clinical Practice, Dec. 27(6) p.738-748

Review of common mistakes made when placing enteral feeding tubes endoscopically, fluoroscopically or blindly.

Suggestions for their prevention and management are made.


How accurate are X-rays to check NG tube positioning?

Nursing Times. Oct. 108(42) p.14-16

Audit of the efficacy of radiology reports for checking the safe positioning of nasogastric tubes after insertion,

and recommendations for improvements.

Available in fulltext from Nursing Times at ProQuest


Impact of preoperative nutritional support on clinical outcome in abdominal

surgical patients at nutritional risk

Nutrition, Oct. 28(10) p.1022-7

Cohort study examining the effect of nutritional supplementation in preoperative abdominal surgical patients at

reducing postoperative hospital stay. The conclusion suggests nutritional support would be advantageous to

patients reporting high pain scores pre-operatively.

Available in fulltext from Nutrition at ProQuest


Nutritional requirements in acute kidney injury

Journal of Renal Nursing, Sept. 4(5) p.231-235

The article looks at recent changes in the management of nutrient requirements among patients suffering acute

kidney injuries. Points highlighted include managing energy, protein and potassium requirements, as well as

ensuring patients risking malnutrition due to their injuries are correctly identified.

Available in fulltext at Journal of Renal Nursing;


Optimal timing for the initiation of enteral and parenteral nutrition in critical

medical and surgical conditions.

Nutrition, Sept. 28(9) p.840-843

Comparison of studies looking at when it is appropriate to deliver enteral or parenteral nutrition in critically ill

patients. Enteral nutrition is now thought to be safer than previously imagined, and associated with improved

outcomes in patients. Early onset parenteral nutrition is not associated with similar benefits.

Available in fulltext from Nutrition at ProQuest


PEG feeding tube placement and aftercare

Nursing Times, Oct. 108(42) p.20-22

Guide covering the successful insertion of a PEG feeding tube, including patient selection and subsequent

nursing care.

Available in fulltext from Nursing Times at ProQuest



Recent developments in enteral feeding for adults: an update

British Journal of Nursing 21(18) p.1067-1067

Enteral feeding is recognised as a safe and effective way to provide nutrition for hospitalised patients. This article

is a literature review covering topical issues in this changing field, including common problems and developing


Available in fulltext from British Journal of Nursing at EBSCOhost


Nursing Role


Caring for older people with dementia in hospital Part one: challenges.

Nursing Older People, Oct. 24(8) p.33-37

Research resulting  from  interviews  with  nursing  students  on  placement in   adult nursing  environments. The

research identified issues which the student felt interfered with ideal nursing care, including patient nutrition and

supporting patients emotional needs

Available in fulltext from Nursing Older People at ProQuest

Available in fulltext from Nursing Older People at EBSCOhost



Enteral nutrition for feeding severely underfed patients with anorexia nervosa

Nutrients, Sept 4(9) p.1293-1303

Case study of successful controlled enteral feeding as a method of correcting even extreme cases of under-

nutrition, whilst avoiding both refeeding syndrome and underfeeding.

Available from Directory of Open Access Journals in Nutrients


Factors leading to discrepancies between prescription and intake of enteral

nutrition therapy in hospitalized patients.

Nutrition, Sept 28(9) p.864-7

An observational study into factors leading to a reduction in eneteral nutrition prescribed by a nutritional support


Available in fulltext from Nutrition at ProQuest


Hourly rounding in a high dependency unit

Nursing Standard, Oct. 27(8) p.35-40

Evidence based preparations for the introduction of frequent rounding on a high dependency unit, as a means

of improving patient safety. A literature search and staff interviews contribute to the study.

Available in fulltext from Nursing Standard at ProQuest

Available in fulltext from Nursing Standard at EBSCOhost


New guidance on the insertion of balloon gastrostomy

Nursing Times, Oct, 108(42) p.18

Examination of national nursing guidelines related to insertion of feeding tubes.

Available in fulltext from Nursing Times at ProQuest


Nutrition and hydration.

Nursing standard, Sept. 27(2) p.45

As part of the Practice Profile series, this article reflects on lessons learned by a staff nurse working on an

orthopaedic ward with regard to assessing the nutritional status of patients and how to encourage good nutritional


Available in fulltext from Nursing Standard at ProQuest

Available in fulltext from Nursing Standard at EBSCOhost


Parenteral nutrition in the intensive care unit.

Nutrition Reviews, 01 November 2012, 70(11) p.623-630

Current thinking on parenteral feeding and enteral nutrition are considered along with issues around malnutrition

and other complications such as over feeding, hyperglycaemia, sepsis and fatty liver. The need for proteins,

carbohydrate, lipids and micronutrients is also discussed.

Available in fulltext from Nutrition Reviews at EBSCOhost


Permissive underfeeding versus target enteral feeding in adult critically ill


Trials, 12 October 2012(191) p. 1745-1752

Randomised  controlled  trial  comparing  two  methods  for  enteral  feeding:  target-calorific  intake  feeding and

permissive underfeeding, tracking all-cause mortality. Trial is ongoing to Nov 2013.

Available in fulltext from Trials at BioMedCentral

Available in fulltext from Trials at National Library of Medicine


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] ext 45195 (Solihull Hospital)

Please login with your Athens ID on www.evidence.nhs.ukbefore 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 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 the HEFT Library