Nutritional Assessment- July 2011

July 2011

Welcome to the second Nutritional Assessment Bulletin produced by HEFT Library Services. This bulletin

is produced to support the VITAL for nurses core skills programme developed in the Trust. This issue

features articles published in the past four weeks.

Organisation

Dignity and nutrition inspection programme

The Care Quality Commission has published the next batch of reports from the dignity and nutrition inspection

programme. This programme intends to look at 100 NHS trusts, and focuses on whether people are treated with

dignity and respect and get food and drink that meets their needs. Further inspection reports will be published

at weekly intervals over the course of the summer. A national report into the key findings will be published in

September.

Impact of protected mealtimes on mealtime

environment and nutrient intake in hospital patients

Journal of Human Nutrition and Dietetics. June; 24(3) p. 279-280

The aim of this observational before versus after service evaluation was to compare mealtime environment and

nutrient intake pre and post Protected Mealtimes (PM) implementation in an acute hospital trust. The findings

highlight the need for an evidence based PM implementation method which produces measurable improvements

in all PM objectives and so enabling a reliable measure of the impact of PM on nutritional and clinical outcomes.

A service review of dietetic input for chronic

obstructive pulmonary disease patients on long-term

oral nutritional support

Journal of Human Nutrition & Dietetics. June; 24(3) p.302-303

Due to current demands on dietetic services in Scotland, this retrospective case review looked to explore the

number of dietetic reviews provided and the consequent change in nutritional status in a group of COPD patients.

Screening

Comparison of screening tools in patients undergoing

haemodialysis

Journal of Human Nutrition & Dietetics. June; 24(3) p.282-283

Subjective Global Assessment (SGA) had been recommended by the Renal Association as an appropriate

nutritional screening tool for detecting malnutrition in haemodialysis patients. The aim of this study was to assess

patients using three tools, these included SGA (as the gold standard), PG-SGA, and the Malnutrition Universal

Screening Tool (MUST).

Malnutrition and nutritional care practices in hospital

wards for older people

Journal of Advanced Nursing. April; 67(4) p.736-746

This paper is a report of a study conducted to gain a better insight into the current nutritional care practices

in  Belgian  hospital  wards for  older  people,  and  to  study  the  association  between  these  practices and the

prevalence of malnutrition. In 2007, a cross-sectional survey was carried out in a representative sample of

Belgian hospital wards for older people. In total, 2094 patients from 140 wards for older people were included.

The overall prevalence rate of malnutrition in wards for older people was 319%. Nutritional care practices such

as nutritional screening and assessment, use of a standardized screening instrument and a nutritional protocol

were suboptimal. Multilevel analysis revealed that ward characteristics explained for 91% whether a patient was

malnourished or not. None of the registered nutritional care practices could explain a patients individual risk.

Available in fulltext at Ovid

Nutrition Management for the Patient Requiring

Prolonged Mechanical Ventilation

Nutrition in Clinical Practice. June; 26(3) p.232-241

Patients requiring prolonged mechanical ventilation are often medically complex and present with a wide range

of pulmonary conditions, including neuromuscular diseases, chronic pulmonary diseases, and chronic critical

illness.  These patients  present the  nutrition  support  professional  with  many  challenges.  However, accurate

nutrition assessment, timely and effective nutrition interventions, and careful monitoring will help patients meet

their medical and nutrition goals.

Recognition

Identifying the factors that influence energy deficit

in the adult intensive care unit: a mixed linear model

analysis

Journal of Human Nutrition & Dietetics. June; 24(3) p.215-222

Critically ill patients frequently receive inadequate nutrition support as a result of under-feeding or overfeeding.

Malnutrition in intensive care unit (ICU) patients is associated with increased morbidity and mortality. This study

aims to identify the significant factors that influence energy deficit in the ICU. Results show that efforts to initiate

feeding as soon as possible and minimise interruptions to feeding may reduce energy deficits in certain vulnerable

patients.

Nutrition support in surgical patients with colorectal

cancer

World Journal of Gastroenterology. April; 17(13) p.1779-1786

The aim of the study was to review the application of nutrition support in patients after surgery for colorectal

cancer, and to propose appropriate nutrition strategies. A total of 202 consecutive surgical patients admitted

with a diagnosis of colon cancer or rectal cancer from January 2010 to July 2010, meeting the requirements

of Nutrition Risk Screening 2002, were enrolled in the study. Laboratory tests were performed to analyze the

nutrition status of each patient, and the clinical outcome variables, including postoperative complications, hospital

stay, cost of hospitalization and postoperative outcome, were analysed. The study concluded that appropriate

and moderate nutritional intervention can improve the postoperative outcome of colorectal cancer patients.

Available in fulltext at EBSCO Host

Interventions

Assessment of food intake in hospitalised patients: A

10-year comparative study of a prospective hospital

survey

Clinical Nutrition. June; 30(3) p.289-296

A food quality control and improvement permanent process was initiated in 1999. To evaluate the food service

evolution, protein-energy needs coverage were compared in 1999 and 2008 with the same structure survey in

all hospitalised patients receiving three meals per day. The results suggested that oral nutritional supplements

(ONS) consumption is associated with a lower risk of underfeeding in hospitalized patients.

Effect of nutrition on wound healing in older people: a

case study.

British Journal of Nursing. June 2011; 20(11) (S4-S10 supplement)

In this tissue Viability Supplement nutrition and wound healing are discussed and also highlights the importance

of water.

Available in fulltext at EBSCO Host

The immunomodulating enteral nutrition in

malnourished surgical patients - A prospective,

randomized, double-blind clinical trial

Clinical Nutrition. June; 30(3) p.282-288 The immunomodulating nutrition was supposed to reduce the incidence

of complications in surgical patients. Many authors have questioned its value and this study assesses the impact

of enteral immunonutrition in the postoperative period.

Nutrition in the Stroke Patient

Nutrition in Clinical Practice. June; 26(3) p.242-252

This article reviews the evaluation and treatment of dysphagia, use of specialized nutrition support, strategies

for weaning enteral tube feedings, and the impact of nutrition on quality of life in the stroke patient population.

Short-term individual nutritional care as part of routine

clinical setting improves outcome and quality of life in

malnourished medical patients

Clinical Nutrition. April; 30(2) p.194-201 Short-term individual nutritional care as part of routine clinical setting

improves outcome and quality of life in malnourished medical patients.

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.