Validation of a Nutritional Screening Tool for Ambulatory Use in Pediatrics.

OBJECTIVES: To evaluate the use of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) in a primary health care clinic in the community and to assess the impact of its use on medical staff's awareness of nutritional status. METHODS: STAMP scoring system was tested as is and with modifications in the ambulatory setting. Nutritional risk according to STAMP was compared with a detailed nutritional assessment performed by a registered dietitian. Recording of nutrition-related data and anthropometric measurements in medical files were compared prior and post implementation. RESULTS: Sixty children were included (31 girls, 52%), ages between 1 and 6 years, mean age 2.8 ±â€Š1.5 (mean ±â€ŠSD). STAMP scores yielded a fair agreement between STAMP and the dietitian's nutritional assessment: κ = 0.47 (95% confidence interval [CI] 0.24-0.7), sensitivity of 47.62% (95% CI 28.34-67.63). Modified STAMP yielded more substantial agreement: κ = 0.57 (95% CI 0.35-0.79), sensitivity of 76.19% (95% CI 54.91-89.37), specificity of 82.05% (95% CI 67.33-91.02). The use of STAMP resulted in an increase in recording of appetite, dietary intake, and anthropometric measurements. CONCLUSIONS: Modification of the STAMP improved nutritional risk evaluation in community setting. The use of STAMP in a primary health care clinic raised clinician's awareness to nutritional status. Further work will identify whether this could be translated into lower malnutrition rates and better child care.

Preservation of sperm of cancer patients: extent of use and pregnancy outcome in a tertiary infertility center.

Sperm cryopreservation is the best modality to ensure future fertility for males diagnosed with cancer. The extent to which cryopreserved sperm is actually used for impregnation, the fertility treatment options that are available and the success rates of these treatments have not been investigated in depth. The medical records of 682 patients who cryopreserved sperm cells due to cancer treatment were analyzed. Seventy of these patients withdrew their frozen sperm for fertility treatments over a 20-year period (most within the first 4 years after cryopreservation). Sperm quality of different malignancies and outcomes of assisted reproduction treatment (ART) for pregnancy achievement in relation to the type of treatment and the type of malignancy were evaluated. The results showed that the rate of using cryo-thawed sperm from cancer patients for fertility treatments in our unit was 10.3%. Sperm quality indices differed between different types of malignancies, with the poorest quality measured in testicular cancer. Conception was achieved in 46 of the 184 ART cycles (25%), and resulted in 36 deliveries. The use of intracytoplasmic sperm injection (ICSI) methodology yielded a significantly higher pregnancy rate (37.4%) than intrauterine insemination (IUI; 11.5%) and was similar to other groups of infertile couples using these modalities. In vitro fertilization (IVF) failed to produce pregnancies. In conclusion, the rate of use of cryopresseved sperm in cancer patients is relatively low (10.3%). Achievement of pregnancies by ICSI presents the best option but when there are enough stored sperm samples and adequate quality, IUI can be employed. Cryopreservation is nevertheless the best option to preserve future fertility potential and hope for cancer patients.