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An analytic appraisal of nutrition screening tools supported by original data with particular reference to age
No full textObjectiveControversies exist as to the suitability of various nutrition screening tools for various age groups, the incorporation of age and age-related criteria into some tools, and the procedures associated with tool selection.MethodsReviews of the literature and national and local datasets were used to identify the types of screening tools available for different age groups, the origins of age-related criteria, and the value of tool selection procedures based on predicting clinical outcomes.ResultsNutrition screening can be undertaken in fetuses, children, and adults over narrow or wide age ranges, for diagnostic or prognostic purposes, with or without nutritional interventions. Certain tools can establish malnutrition risk without using any nutritional criteria, whereas others can do so only with nutritional criteria. The incorporation of age and age-specific body mass index criteria into adult screening tools can influence the prevalence and age distribution of malnutrition, but no justification is usually provided for their use. In several circumstances, age alone can predict mortality and length of hospital stay much better than screening tools. We identified various methodologic problems in nutrition screening tool selection.ConclusionsA comparison of nutrition screening tools designed for different age groups and different purposes can be problematic. Age and screening tools incorporating risk factors that are non-modifiable or generally weakly modifiable by nutritional support (e.g., age, disease severity) may predict outcomes of disease, but they are not necessarily suitable for predicting outcomes of nutritional support. To contextualize the findings, a framework for screening tool selection is suggested that takes into account a matrix of needs
British artificial nutrition survey. A cost-utility analysis in patients receiving enteral tube feeding at home and in nursing homes
No full textTo screen or not to screen for adult malnutrition?
No full textBackground: There is some controversy about whether all adults receiving healthcare should be routinely screened for nutritional problems.Methods: (i) A systematic review examined the proposition that malnutrition is under-recognised and under-treated, and that nutritional interventions in malnourished patients, identified through a screening procedure produce clinical benefits (assessed using randomised controlled trials, RCTs). (ii) A systematic review of nutritional screening interventions in populations of malnourished and well-nourished subjects (RCTs and non-RCTs).Results: (i) The prevalence of malnutrition varies according to the criteria used, but is estimated to affect 10–60% of patients in hospital and nursing homes, 10% or more of older free-living subjects, and less than 5% of younger adults. In the absence of formal screening procedures, more than half the patients at risk of malnutrition in various settings do not appear to be recognised and/or are not referred for treatment. RCTs show that nutritional interventions in malnourished patients produce various clinical benefits. (ii) Interventions with nutritional screening in different care settings also generally suggest clinical benefits, but some are limited by small sample sizes and inadequate methodology. Factors that influence outcomes include validity, reliability and ease of using the screening procedure, the ‘care gap’ that exists between routine and desirable care and the need for other resources, which may increase or decrease following screening.Conclusions: The frequent failure to recognise and treat malnutrition, especially where it is common, is unacceptable. In such circumstances, the routine use of a simple screening procedure is recommended. Each health care setting should have a transparent policy about nutritional screening, which may vary according to the ‘care gap’, available resources, and specific populations of patients, in which the prevalence of malnutrition may vary widely
Post operative conventrations of gherlin and the acute phase response in patients undergoing major vascular surgery
No full textThe cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults
No full textMalnutrition in the UK: policies to address the problem
No full textIn 2007, the estimated cost of disease-related malnutrition in the UK was in excess of £13 x 109. At any point in time, only about 2% of over 3 million individuals at risk of malnutrition were in hospital, 5% in care homes and the remainder in the community (2–3% in sheltered housing). Some government statistics (England) grossly underestimated the prevalence of malnutrition on admission and discharge from hospital (1000–3000 annually between 1998 and 2008), which is less than 1% of the prevalence (about 3 million in 2007–2008) established by national surveys using criteria based on the ‘Malnutrition Universal Screening Tool’ (‘MUST’). The incidence of malnutrition-related deaths in hospitals, according to government statistics (242 deaths in England in 2007), was also <1% of an independent estimate, which was as high as 100 000/year. Recent healthcare policies have reduced the number of hospital and care home beds and encouraged care closer to home. Such policies have raised issues about education and training of the homecare workforce, including 6 million insufficiently supported informal carers (10% of the population), the commissioning process, and difficulties in implementing nutritional policies in a widely distributed population. The four devolved nations in the UK (England, Scotland, Northern Ireland and Wales) have developed their own healthcare polices to deal with malnutrition. These generally aim to span across all care settings and various government departments in a co-ordinated manner, but their effectiveness remains to be properly evaluated
Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'Malnutrition Universal Screening Tool' ('MUST') for adults.
No full textThe ‘malnutrition universal screening tool’ (‘MUST’) for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between ‘MUST’ and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using ‘MUST’ and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using ‘MUST’, the prevalence of malnutrition risk ranged from 19–60 % in inpatients and 30 % in outpatients. ‘MUST’ had ‘excellent’ agreement ( 0·775–0·893) with MEREC, NRS and SGA tools, ‘fair–good’ agreement ( 0·551–0·711) with HH, MST and MNA-tool tools and ‘poor’ agreement with the URS tool ( 0·255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between ‘MUST’ and MNA-tool (P=0·0005) and URS (P=0·039). ‘MUST’ and MST were the easiest, quickest tools to complete (3–5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19–60 % with ‘MUST’) and ‘fair–good’ to ‘excellent’ agreement beyond chance between ‘MUST’ and most other tools studied. ‘MUST’ was quick and easy to use in these patient groups
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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