What do people need?

The key question addressed in this Chapter is "What do people need?", with "people" here meaning those who live with a rheumatic or musculoskeletal disease. The word "patient" is avoided at this point as not all of the problems or solutions identified are medical in nature. Many are personal, societal and/or environmental. The lead authors are all people who not only live with a rheumatic or musculoskeletal disease, but who are experienced "patient representatives". Therefore, their insights here stem from a combination of personal and collective experiences and views. Although from different continents, the authors identify a range of common barriers to social participation and optimum management of these conditions, such as late diagnosis, stigma and access to care. However, several solutions are common across these regions too, such as the need for supported self-management and greater public awareness of the impact of these diseases.

Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting.

The scored Patient-Generated Subjective Global Assessment tool (PG-SGA), regarded as the most appropriate means of identifying malnutrition in cancer patients, is often challenging to implement in a busy outpatient setting. We assessed the validity of an abridged version of the PG-SGA (abPG-SGA), which forgoes the physical examination, and compared its usefulness in discerning malnutrition to the full PG-SGA and Malnutrition Screening Tool (MST). The nutritional status of 90 oncology outpatients receiving chemotherapy was assessed according to SGA global rating, PG-SGA, and MST. Receiver operating characteristic (ROC) curves were generated to estimate the sensitivity and specificity of various cut-off scores for malnutrition. Thirty-six percent of patients were malnourished (SGA). The abPG-SGA yielded 94% sensitivity and 78% specificity and area under the curve (AUC) = 0.956, which was slightly lower than PG-SGA (97% sensitivity, 86% specificity, AUC = 0.967) and higher than MST (81% sensitivity, 72% specificity, AUC = 0.823). Patient reported symptoms included loss of appetite (30%), altered taste (31%), fatigue (30%), and decreased ability to perform activities of daily living (53%). In conclusion, the abPG-SGA is a practical, informative and valid tool for detecting malnutrition in the outpatient oncology setting.

Diet order entry by registered dietitians results in a reduction in error rates and time delays compared with other health professionals.

In January 2009, registered dietitians (RDs) at St Michael's Hospital (Toronto, Ontario, Canada) were granted approval for nonmedication order entry of physician-approved nutrition-related orders for the patients to whom RDs provided care. The aim of this project was to document any changes in the numbers and types of diet order errors and time delays that were associated with this policy change. A retrospective chart audit was conducted to document the error rate in 672 nutrition-related orders placed before, and in 633 orders placed after, implementation of RD diet order entry on high-risk inpatient units. Error rates for all nutrition-related orders decreased by 15% after RD order entry access (P<0.01). Error rates for diet orders entered by RDs were significantly lower in comparison with those entered by clerical assistants or registered nurses (P<0.001). Time delays for orders electronically entered were reduced by 39% (from 9.1 to 5.7 hours; P<0.01). Allowing RDs access to the electronic order entry system has improved overall timeliness of nonmedication order entries and improved patient safety by decreasing error rates in diet orders. This study supports this institutional policy change and provides evidence that RDs have the knowledge and skills to accurately process nonmedication order entries for the patients they have assessed. Finally, the current findings support the need for ongoing education and training of all health professionals in nonmedication order entry to reduce errors and improve safety.