Food frequency questionnaire and a screening test

We assessed the accuracy of a 141-item food frequency questionnaire as a screening test to detect high or low consumption of nutrients associated with cancer. Fifty-five men and 58 women participating in two population-based cohort studies in Miyagi, Japan, provided four three-day diet records over a one-year period and subsequently completed the questionnaire twice with a one-year interval. Pearson correlation coefficients between 17 nutrients measured by the diet records and the first questionnaire ranged from 0.24 to 0.85 (median 0.43), and those between the two questionnaires ranged from 0.47 to 0.91 (median 0.68). The sensitivity and specificity of the questionnaire for detecting high-alcohol, high-fat, low-calcium, and low-ascorbic acid consumers were 86.7% and 96.7%, 50.0% and 85.7%, 48.8% and 76.4%, and 61.9% and 70.0%, respectively. Receiver operating characteristic curves indicated comparable performance of the questionnaire and a three-day diet record, regarded as another screening test. The questionnaire performed poorly for other nutrients. The results indicate that our questionnaire is reasonably reproducible, comparable with the diet records, and useful as a screening test to detect high or low consumers of several nutrients associated with cancer for subsequent enrollment in dietary intervention trials or dietary counseling.     

Audit in clinical practice: evaluating use of a nutrition screening tool developed for trauma nurses

Background: The Nutrition Checklist screening tool was developed by dietitians for the trauma nursing staff at the John Radcliffe Hospital, Oxford. Its purpose was to identify those at nutritional risk so that dietetic assessment and intervention could be implemented. This paper focuses on a single day audit that was devised 5 months post-initiation of the Nutrition Checklist. Method: Data from 48 nursing care plans was used to measure compliance of recording a nutrition score (and re-scoring where applicable) alongside the timing of dietetic referral and intervention. Results: Sixty-seven per cent (32/48) of trauma patients had a nutrition score recorded, however only 75% (24/32) of these patients were scored within 24 h of admission. Of those due for reassessment, only 38% (11/29) were rescored. Eighty-eight per cent (23/26) of the patients who scored ≥ 3 (automatic referrals) were referred to the dietitian; the dietitian documented 100% (23/23) of referrals. Conclusion: The audit suggests limited use of the screening tool by nurses. Collaboration between the nursing team, dietitian, consultant team, catering and clinical auditors could improve compliance in the use of the Nutrition Checklist and ultimately lead to improved clinical practice in nutritional care delivery. Despite its limitations, the audit exercise was a valuable learning experience in the maintenance of a nursing Nutrition Checklist. Further research is needed to assess whether the introduction of such a screening tool improves patient outcomes by minimizing nutrition-related complications.     

Increased frequency of icterus in parenterally fed patients after a change of lipid emulsion]

Parenteral nutrition is associated with liver enzyme abnormalities. Until 1993 the incidence of icterus was low in both academic hospitals in Amsterdam, the Netherlands (Academic Medical Centre (AMC) and Academic Hospital of the Free University (AZVU)). In 1993 Intralipid in the nutrition was replaced by Endolipid in the home total parenteral nutrition programme (AMC) and by Lipofundin S in AZVU. Fifty per cent of the patients in the home programme developed severe fatigue, jaundice and thrombocytopenia. These signs and symptoms disappeared over months when parenteral nutrition without fat was given. After reintroduction of Intralipid these signs and symptoms never recurred. In AZVU the incidence of jaundice increased from 21% in 1992 to 79% in 1993 (p = 0.0002). After reintroduction of Intralipid in 1994 the incidence of jaundice decreased to 16%. CONCLUSION: Although the lipid emulsions are equivalent according to the product specification, the described observation suggests that Lipofundin S and Endolipid cause more icterus than Intralipid, possibly caused bij an impurity in the fat emulsion.     

A nutrition screening and assessment system for use with the elderly in extended care

One area of particular interest to health care professionals that is undergoing considerable investigation is the nutritional status of the elderly. This article describes the development, implementation, and evaluation of a procedure used to nutritionally screen and assess geriatric patients in extended care at the Veterans Administration Medical Center in Houston. As we developed the system, we considered the special needs and characteristics of geriatric individuals and incorporated them into two forms. Designs were selected to make our method comprehensive, concise, and, ideally, time-efficient. The evaluation of the system included a time utilization study. This study was conducted to evaluate the efficiency of the new system compared with the efficiency of methods used hospital-wide in the past. Results suggest that the new system for reassessing the patient's nutritional status and reevaluating the nutrition care was three times more efficient.     

Validity and reliability of a nutrition screening tool in hospitalized patients

Objective

The British nutrition screening tool is a questionnaire designed to assess the nutrition status of hospitalized patients by nurses. The aim of this study was to evaluate the validity and reliability of this questionnaire in patients on admission to the hospital in Tehran.

Methods

For 6 mo, 446 patients aged over 18 y admitted to different wards of a general hospital were studied within the first 24 h of admission. A nutritionist undertook nutritional assessment in all patients to determine their nutritional status as an objective standard. Then a nurse completed the screening tool for patients. Results obtained using the screening tool were compared with those of the nutritional assessment to calculate the sensitivity, specificity, and predictive values. The interrater reliability of the tool was assessed by two nurses who completed the screening tool separately during the first 24 h following admission of each patient. It was also completed by a nurse within 2-d period of admission to test the intrarater reliability.

Results

Study participants included 229 women and 217 men with mean age of 49.5 ± 16.0 y. Sensitivity and specificity of the questionnaire were 86.7% (95% CI: 83.9-90.3%) and 61.7% (95% CI: 57.5-66.5%), respectively. Positive and negative predictive values were 79.1% (95% CI: 68.9-77.1%) and 73.1% (95% CI: 75.1-82.9), respectively. The sensitivity of the tool was over 80% for both genders, for all body mass index grades, and for data obtained from gastroenterology, transplant, oncology, and hematology wards. The interrater reliability of screening tool was interpreted as substantial, being k = 0.68 and k = 0.74 on both the first and second days, respectively. The intrarater reliability of the screening tool was also interpreted as substantial, being k = 0.77.

Conclusion

The nutrition screening tool is a simple, valid, and reliable tool that can be used by nurses to facilitate identification of patients requiring nutritional interventions.     

肠外营养支持在腹部手术后乳糜腹水治疗中的应用

目的：研究肠外营养支持在治疗腹部手术后乳糜腹水中的作用。方法;对１例胃癌行根治性胃大部切除术后发生乳糜腹水的病人应用经外周静脉的营养支持３周,通过腹腔持续引流观察腹水引流量的变化,并观察病人体重及一般营养状况的变化。结果：肠外营养过程中每天腹水产生和流出量逐渐减少。体重在营养支持开始和结束时无明显变化,血清白蛋白水平在第１周下降,后逐步升高,在营养支持结束时明显超过营养支持开始时。结论：腹部手术后     

Development and validation of a nutrition screening tool for hospitalized cancer patients

Background & aims

Although various nutrition screening tools are used, they are not specific for the screening of malnourished cancer patients. The objective of this study was to develop a nutrition screening tool that could be used to identify cancer patients at risk for malnutrition.

Methods

Of 3010 cancer patients admitted to the National Cancer Center of Korea between April 1 and June 2, 2008, the nutritional status of 1057 patients was assessed by the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Variables used in current nutrition screening tools were analyzed to select indices for a developing malnutrition screening tool for cancer patients (MSTC). The equation for the MSTC was established using receiver operating characteristics curves. Sensitivities and specificities of the MSTC were calculated using the PG-SGA as gold standard.

Results

The MSTC was calculated as follows: [MSTC = −0.116 + (1.777 × intake change) + (1.304 × Eastern Cooperative Oncology Group performance status) + (1.568 × weight loss) + (−0.187 × body mass index)]. The MSTC had a sensitivity of 94.0%, a specificity of 84.2%, and high agreement (κ = 0.70, P < 0.0001) with the PG-SGA.

Conclusions

The MSTC appears to be a valid nutrition screening tool for determining nutritional risk in hospitalized cancer patients.     

乳腺X线摄影技术应用于人群筛查准确性的Meta分析

目的 对全球X线摄影技术运用于乳腺癌筛查的准确性研究进行Meta分析。方法 在Medline、Embase、Cochrane和中国学术期刊网全文数据库（CNKI）文献库中,通过疾病名称、筛查干预、结果指标等关键词整合进行检索。截至2015年6月4日,共检索获得1 167篇文献。根据纳入和排除标准筛选,主要摘录筛查试验中的真阳性、假阳性、假阴性、真阴性的“四格表”数据。采用QUADAS量表进行文献质量评价。利用综合受试者工作特征（SROC）分析方法判断研究间的阈值效应并计算曲线下面积（AUC）,采用双变量混合效应模型对X线摄影技术在所有人群和乳腺致密的亚组人群中筛查的灵敏度及特异度进行Meta分析;对样本量大于10万的亚组进行敏感性分析。利用Q检验和I2统计量分析文献异质性,以漏斗图和线性回归方法检验发表偏倚。结果 最终纳入文献48篇（欧洲地区及美国38篇、亚洲地区8篇、大洋洲地区2篇）,总样本量为8 551 873例,筛查开展时间为1975-2013年,对象起止筛查年龄大部分在40～75岁。分析得出,X线摄影技术用于乳腺癌筛查的AUC为0.95（95% CI：0.93～0.97）,总体灵敏度为0.81（95% CI：0.77～0.84）,总体特异度为0.96（95% CI：0.94～0.96）,敏感性分析提示该结果稳定。其中对乳腺致密人群的亚组分析显示,X线摄影技术的合并灵敏度和特异度分别为0.74（95% CI：0.61～0.83）和0.93（95% CI：0.89～0.96）。漏斗图和线性回归结果显示纳入研究不存在发表偏倚。结论 X线摄影作为乳腺癌筛查技术具有较高灵敏度和特异度,但对乳腺致密女性的筛查准确性降低。