Malnutrition screening tools: Comparison against two validated nutrition assessment methods in older medical inpatients

ObjectiveAlthough several validated nutritional screening tools have been developed to “triage” inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/tools clinicians should use in practice. This study compared the accuracy of seven validated screening tools in older medical inpatients against two validated nutritional assessment methods.MethodsThis was a prospective cohort study of medical inpatients at least 65 y old. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by an accredited practicing dietitian using the Subjective Global Assessment (SGA) and the Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalization.ResultsIn this sample of 134 participants (80 ± 8 y old, 50% women), there was fair agreement between the SGA and MNA (κ = 0.53), with MNA identifying more “at-risk” patients and the SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition as determined by the SGA, in particular the Malnutrition Screening Tool and the Nutritional Risk Screening 2002. The MNA Short Form was most accurate at identifying nutritional risk according to the MNA. No tool accurately predicted patients with inadequate energy intake in the hospital.ConclusionBecause all tools generally performed well, clinicians should consider choosing a screening tool that best aligns with their chosen nutritional assessment and is easiest to implement in practice. This study confirmed the importance of rescreening and monitoring food intake to allow the early identification and prevention of nutritional decline in patients with a poor intake during hospitalization.     

The Influence of Break Timing on the Sleep Quantity and Quality of Fly-in, Fly-out Shiftworkers

Although shift and break timing is known to affect the sleep of shiftworkers, this hasnot been demonstrated in Fly-in, Fly-out (FIFO) settings which, compared to residentialbased settings, may be favourable for sleep. This study investigated the sleep quantityand quality of shiftworkers working a FIFO operation comprising of shifts, and thereforebreaks, across the 24-h day. The sleep of 24 males (50.43 ± 8.57 yr) was measured usingactigraphy and sleep diaries. Morning breaks were associated with less sleep (09:00–12:00h; 4.4 ± 1.3 h) and a poorer sleep quality (06:00–09:00 h; 3.1 ± 1.0, “average”) comparedto breaks beginning between 00:00 h and 03:00 h (6.8 ± 1.7 h; 2.2 ± 0.9, “good”). Sleepefficiency remained constant regardless of break timing (85.9 ± 5.0% to 89.9 ± 3.5%).Results indicate that even in operations such as FIFO where sleeping conditions arenear-optimal and the break duration is held constant, the influence of the endogenouscircadian pacemaker on sleep duration is evident.     

Improving patient and carer access to information and support through head and neck cancer treatment and survivorship using experience-based co-design

Background

Previous studies have highlighted the unmet nutritional and supportive care needs of patients with head and neck cancer (HNC) and their carers from diagnosis and throughout the treatment and survivorship period. The aim of this study was to bring patients, carers and healthcare professionals together to co-design a framework to improve access to nutrition information and support for patients and carers with HNC from diagnosis and throughout the treatment and survivorship period.

Methods

Using experience-based co-design (EBCD), semistructured individual interviews were conducted with patients, carers and healthcare professionals to understand their experiences in accessing information and support outside of the hospital environment. Feedback events and co-design workshops were held to prioritise areas for service improvement.

Results

Participants (10 patients, 7 carers and 15 healthcare professionals) highlighted the importance of having consistent information and support recommendations from the multidisciplinary team. The two key areas for improvement identified through group and workshop events were linking reputable HNC resources to a HNC portal on the hospital website and the development of a series of short podcasts and video blogs with fact sheets attached presented by members of the multidisciplinary team, patients and carers at four time points spanning pretreatment and throughout the survivorship period.

Conclusions

Using EBCD has enabled the co-design of a framework for resource development with patients, carers and healthcare professionals to improve access to information and resources to support nutrition intake and supportive care needs for patients with HNC with their carers. Development and implementation of resources and evaluation of outcomes is ongoing.     

Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety

BackgroundPatients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness.MethodsA systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane‐Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible; two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted.ResultsTwenty‐six papers reporting on twenty‐seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of ‘patient engagement’ varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user‐friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care.ConclusionsAgency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient–provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information.Patient or Public ContributionReview progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).