Strategies to ensure continuity of nutritional care in patients with COVID-19 infection on discharge from hospital: A rapid review.

BACKGROUND & AIMS: The risk of malnutrition in people with COVID-19 is high; prevalence is reported as 37% in general medical inpatients, 53% in elderly inpatients and 67% in ICU. Thus, nutrition is a crucial element of assessment and treatment. This rapid review aimed to evaluate what evidence is available to inform evidence-based decision making on the nutritional care of patients hospitalised with COVID-19 infection. METHODS: Cochrane Rapid Reviews guidance was followed; the protocol was registered (CRD42020208448). Studies were selected that included patients with COVID-19, pneumonia, respiratory distress syndrome and acute respiratory failure, in hospital or the community, and which examined nutritional support. All types of studies were eligible for inclusion except non-systematic reviews, commentaries, editorials and single case studies. Six electronic databases were searched: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PubMed, CINAHL and MedRxiv. RESULTS: Twenty-six articles on COVID-19 were retrieved, including 11 observational studies, five guidelines and 10 opinion articles. Seven further articles on pneumonia included three RCTs, one unblinded trial, three observational studies, and one systematic review on rehabilitation post-ICU admission for respiratory illness. The evidence from these articles is presented narratively and used to guide the nutritional and dietetic care process. CONCLUSIONS: Older patients with COVID-19 infection are at risk of malnutrition and addressing this may be important in recovery. The use of nutritional management strategies applicable to other acute conditions are recommended. However, traditional screening and implementation techniques need to be modified to ensure infection control measures can be maintained. The most effective nutritional interventions require further research and more detailed guidance on nutritional management post-discharge to support long-term recovery is needed.

The effectiveness of trained volunteer delivered interventions in adults at risk of malnutrition: A systematic review and meta-analysis.

Malnutrition burden is high. Trained volunteers present a growing workforce in the NHS and are increasingly engaged in schemes that may be useful in tackling malnutrition in different settings. A recent systematic review of trained volunteers in a hospital setting reported improved patient satisfaction and some improvement in dietary intake of patients. This review explored the effectiveness of trained volunteers in delivering nutritional interventions in adults at risk of malnutrition in different care settings on patient-centred outcomes and aimed to identify and build an evidence base for a more defined role for trained volunteers in malnutrition prevention in the UK. Six electronic databases were searched to 30th October 2018. Abstracts and full texts of relevant studies of all study designs were screened by two authors independently. Studies were examined for risk of bias and overall quality of evidence of main outcomes was assessed using the GRADE approach. Narrative synthesis and meta-analyses (nutritional intake) were used to combine outcome data. Seventeen eligible studies were included. Three were conducted in the home setting and fourteen were hospital based. Low quality evidence from one small RCT showed significant improvements in physical performance and fear of falling resulting from a volunteer intervention in the home setting. Very low quality evidence from meta-analysis findings indicated that trained volunteer mealtime assistance significantly improved lunchtime energy intake but did not significantly improve daily total energy intake in hospitals. Very low quality evidence also suggested that volunteers improve patient experience and satisfaction and are safe. This paper identified some evidence to suggest trained volunteer interventions may be effective in improving some outcomes in nutritionally at-risk older adults in home and hospital settings. Considering the high prevalence and costs of malnutrition, adequately-powered research is needed in this area to identify the most effective use of resources.