Exploring adult inpatients' perceptions, understanding and preferences regarding the term 'malnutrition': A qualitative study.

AIMS: To explore adult inpatients' perceptions, understanding and preferences regarding the term 'malnutrition' and to identify the terms that adult inpatients report are used by themselves and health workers to describe malnutrition. DESIGN: This qualitative study was conducted using data collected for a separate qualitative study that investigated factors that influence the dietary intake of long-stay, acute adult inpatients. METHODS: Semi-structured interviews were conducted with a purposive sample of current inpatients. Data were analysed using inductive content analysis. RESULTS: Nineteen interviews were included (mean age 64 years (standard deviation ±17), 10 female (53%), 12 malnourished (63%)). Four categories were identified. 'Variation in patients' recognition of malnutrition' represents the differing abilities of patients to understand and identify with the term 'malnutrition'. 'Recognising individuals' needs and preferences' highlights patients' varying beliefs regarding whether 'malnutrition' is or is not an appropriate term and participants' suggestion that health workers should tailor the term used to each patient. 'Inconsistencies in health workers' and patients' practice regarding malnutrition terminology' encapsulates the multiple terms that were used to describe malnutrition by health workers and patients. 'Importance of malnutrition education' summarises patients' views that health workers should provide patient education on malnutrition prevention, management and complications. CONCLUSION: Findings highlight variations in patients' perceptions and understanding of the term 'malnutrition' and differences in the terms used by patients and health workers to describe malnutrition. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The terminology used by health workers to describe malnutrition risk or malnutrition to their patients can influence patients' recognition of their nutritional status and thus the multidisciplinary management of the condition. To ensure that patients receive information about their malnutrition risk or diagnosis in a way that meets their needs, health workers' practices must be revised. To do this, it is imperative to conduct further collaborative research with patients and health workers to identify optimum terms for 'malnutrition' and how health workers should communicate this to patients. IMPACT: There is a disparity in patients' perceptions, understanding and preferences for the term 'malnutrition' and there are inconsistencies in how health workers communicate malnutrition to patients. To support patients' recognition and understanding of their nutritional status, it is imperative for health workers to consider how they discuss malnutrition with patients. REPORTING METHOD: Adheres to the Consolidated Criteria for Reporting Qualitative Research (Tong et al., 2007). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Incidence and outcomes of in-hospital nutritional decline: A prospective observational cohort study in adult patients.

BACKGROUND AND AIMS: Hospital malnutrition is associated with higher healthcare costs and worse outcomes. Only a few prospective studies have evaluated trends in nutritional status during an acute stay, but these studies were limited by the short timeframe between nutrition assessments. The aim of this study was to investigate changes in nutritional status, incidence of hospital-acquired malnutrition (HAM), and the associated risk factors and outcomes in acute adult patients admitted for >14 days. METHODS: A prospective observational cohort study was conducted in two medical and two surgical wards in a tertiary hospital in Brisbane, Australia. Nutrition assessments were performed using the Subjective Global Assessment at baseline (day eight) and weekly until discharge. Nutritional decline was defined as a change from well-nourished to moderate/severe malnutrition (HAM) or from moderate to severe malnutrition (further decline) >14 days after admission. RESULTS: One hundred and thirty patients were included in this study (58.5% male; median age 67.0 years (IQR 24.4), median length of stay 23.5 days (IQR 14)). At baseline, 70.8% (92/130) of patients were well-nourished. Nutritional decline occurred in 23.8% (31/130), with 28.3% (26/92) experiencing HAM. Of the patients with moderate malnutrition on admission (n = 30), 16% (5/30) continued to decline to severe malnutrition. Improvement in nutritional status from moderate and severe malnutrition to well-nourished was 18.4% (7/38). Not being prescribed the correct nutrition care plan within the first week of admission was an independent predictor of in-hospital nutritional decline or remaining malnourished (OR 2.3 (95% CI 1.0-5.1), p = 0.039). In-hospital nutritional decline was significantly associated with other hospital-acquired complications (OR 3.07 (95% CI 1.1-8.9), p = 0.04) and longer length of stay (HR 0.63 (95% CI 0.4-0.9), p = 0.044). CONCLUSION: This study found a high rate of nutritional decline in acute patients, highlighting the importance of repeated nutrition screening and assessments during hospital admission and proactive interdisciplinary nutrition care to treat or prevent further nutritional decline.

Incidence and criteria used in the diagnosis of hospital-acquired malnutrition in adults: a systematic review and pooled incidence analysis.

Despite advances in identifying malnutrition at hospital admission, decline in nutritional status of well-nourished patients can be overlooked. The aim of this systematic review was to investigate the incidence of hospital-acquired malnutrition (HAM), diagnostic criteria and health-related outcomes. PubMed, CINAHL, Embase and Cochrane Library were searched up to July 2021. Studies were included if changes in nutritional status was assessed with a validated nutrition assessment tool in acute and subacute adult (≥18 yrs) hospitalised patients. A random-effects method was used to pool the incidence proportion of HAM in prospective studies. The certainty of evidence was appraised using the Grading of Recommendation Assessment, Development and Evaluation system. We identified 12 observational cohort studies (10 prospective and 2 retrospective), involving 35,324 participants from acute (9 studies) and subacute settings (3 studies). Retrospective studies reported a lower incidence of HAM (<1.4%) than prospective studies (acute: 9-38%; subacute: 0-7%). The pooled incidence of HAM in acute care was 25.9% (95% confidence interval (CI): 17.3-34.6). Diagnostic criteria varied, with use of different nutrition assessment tools and timeframes for assessment (retrospective studies: >14 days; prospective studies: ≥7 days). Nutritional decline is probably associated with longer length of stay and higher 6-month readmission (moderate certainty of evidence) and may be association with higher complications and infections (low certainty of evidence). The higher incidence of HAM in the acute setting, where nutritional assessments are conducted prospectively, highlights the need for consensus regarding diagnostic criteria and further studies to understand the impact of HAM.

UVC inactivation of MS2-phage in drinking water - Modelling and field testing.

UVC disinfection has been recognised by the WHO as an effective disinfection treatment to provide decentralized potable water. Under real conditions there are still unknowns that limit this application including the influence of suspended solids and natural organic matter. This work aims to investigate the influence of two key parameters, suspended solids and natural organic matter, on the efficiency of UVC disinfection of surface water to achieve the drinking water quality requirements established by the WHO for point of use (POU) technologies. Kaolinite (turbidity agent) and humic acids (HA, model of organic matter) were used in a factorial design of experiments (Turbidity from 0 to 5 NTU, and HA from 0 to 3.5 mg/L) to investigate their effect on UVC inactivation of MS2 phage in surface water. A collimated beam (12 W) and a commercial UVC disinfection flow system (16 W) designed to provide drinking water at households were used. The UVC flow system both in the laboratory and in the field was able to achieve the reduction requirements established by WHO (LRV >3.5 for all tested conditions), confirming the good performance of the studied UVC disinfection system. The results found in the lab were used to establish a numerical model that predicts the disinfection rate constant as a function of water turbidity and transmittance at 254 nm (confidence level>95%). The model permitted to elucidate the critical effect of low concentrations of HA in reducing the inactivation rate by 40% for 3.5 mg/L-HA compared with 0, the non-significant detrimental effect of turbidity lower than 5 NTU, and the lack of synergistic effects between both parameters at these levels. The UVC flow system was also tested in the field, in Tzabalho, Chiapas (Mexico), and Antioquia (Colombia), with spiked MS2 into natural surface water. This investigation opens a potential application to monitor the performance of UVC systems with surface water by monitoring transmittance at 254 nm as a tool to control UVC domestic systems to deliver safe drinking water in a household without the need of expensive and laborious biological monitoring tools.

Nutrition risk and mortality in older oncology patients: An exploratory study.

AIM: The primary aim of this analysis was to identify if two standard measures incorporated into the comprehensive geriatric assessment; specifically, malnutrition risk and body mass index (BMI), could predict 12-month mortality in older patients with solid tumours. The secondary aim was to evaluate if malnutrition risk and BMI were associated with chemotherapy outcomes (discontinuation/modification of treatment) in older patients with solid tumours. METHODS: Older patients (aged ≥70 years) with solid cancers were recruited from the outpatient oncology clinic of a tertiary hospital in Brisbane, Australia. Participants' nutritional parameters, BMI, and malnutrition risk (determined using the Malnutrition Screening Tool (MST)) were recorded at baseline. Mortality data and chemotherapy outcomes were recorded for 12 months. RESULTS: Seventy-four participants (67% males, median age 77 (±4.4) years) were recruited. Nearly half the cohort was at-risk of malnutrition at baseline (n = 39, 46%). Chemotherapy was prescribed to 39% (n = 29) of the cohort. For patients receiving chemotherapy neither being underweight nor having a low or medium risk of malnutrition was associated with adverse chemotherapy outcomes or 12-month mortality. At a bivariate level, malnutrition risk was significantly associated with 12-month mortality in patients who did not receive chemotherapy (P = 0.018), but not BMI. CONCLUSIONS: This analysis indicates that malnutrition risk was a potential indicator of 12-month mortality in cases where chemotherapy was considered unfeasible. However, this was not an independent risk factor. Further investigation using a larger sample is required to determine the association between malnutrition risk, quality of life and mortality in patients who are not considered to be fit for chemotherapy.

Formation of 2,4-D bound residues in soils: New insights into microbial metabolism.

The microbial contribution to the formation of bound residues in soils is studied by characterizing the metabolic activity of three microorganisms (Trametes versicolor, Fusarium solani and Ralstonia eutropha) on 14C-2,4-dichlorophenoxyacetic acid (2,4-D) during incubation in synthetic liquid media and soil. A fractionation protocol was applied to quantify the 14C-2,4-D that was incorporated into the biomass among biomolecular-like fractions. Successive fractionation of microbial biomass was implemented to break up and quantify the methanol/dichloromethane fraction (corresponding to the 14C-lipid-like fraction), the trichloroacetic acid fraction (or hydrolysed 14C-polysaccharide-like fraction) and the acid hydrolysable fraction (or the hydrolysed 14C-protein-like fraction). Relevant differences in the 2,4-D degradation and biomass radioactivity distribution among the three microorganisms were found. The 14C-protein-like fraction was the most consistent biomass fraction for reflecting the pesticide use capacity of the microorganisms under liquid and soil conditions. 2,4-D and its metabolite 4-chlorophenol were detected in methanol/dichloromethane and trichloroacetic acid fractions of the biomass of microorganisms exhibiting a low capacity to mineralize 2,4-D, thus proving that the microbial participation in the formation of bound residues while conserving the initial pesticide structure under natural soil conditions may be intimately associated with the lipid- and polysaccharide-like constituents. The fractionation protocol differentiates between 14C that is incorporated into biomass as a biomolecular constituent and the pesticide or its metabolites that accumulate in the biomass and thus correspond to the stricto sensu definition of bound residues.