[Nutritional assessment at the time of hospital-admission: study initiation among different methodologies]. / Valoración nutricional al ingreso hospitalario: iniciación al estudio entre distintas metodologías.

BACKGROUND AND OBJECTIVES: The elevated prevalence figures of hyponutrition in hospitalized patients--near 40%--is an issue of concern. This allows deducing that early identification of malnourished, or at risk for hyponutrition, patients by means of effective nutritional assessment methods may represent an essential tool for nutritional planning. The aim of this study was applying to a same group of patients different nutritional assessment methods (objective and subjective) at the time of hospital admission in order to assess the degree of effectiveness for its clinical application. SETTING, PATIENTS AND INTERVENTIONS: A prospective randomized study is designed, in which 50 admitted patients of our hospital are included between October 1st and December 31st of 2004, 9 of them being rejected for laboratory errors. During the first 3 days of hospital staying, anthropometrics (weight, height, arm circumference, and tricipital fold measure), biochemistry (full blood count, albumin, pre-albumin, retinol-bound protein, transferrin, and cholesterol), two nutritional assessment questionnaires (Global Subjective Assessment (GSA) and Mini Nutritional Assessment (MNA). RESULTS: Thechi-squared2 test has been applied to compare the results obtained from the different objective methods, separately and globally, with the MNA and GSA questionnaires, establishing the following anthropometrical comparisons: anthropometrics/MNA, Biochemistry/MNA, Chang/MNA, anthropometrics/GSA, Biochemistry/GSA, Chang/GSA, and MNA/GSA. Statistical significance has been set at p < 0.05. Statistical analysis has been done with the SPSS v.11 software. We have not observed a statistical significance between any of the three objective parameters studied: biochemistry, anthropometrics and immunology separately considered in the two nutritional assessment questionnaires. However, the significance is positive when we relate the results obtained by the Chang method, which comprises the three types of objective parameters, with those from the MNA and GSA. A statistical significance was also reached when relating both subjective methods between each other: MNA and GSA. CONCLUSIONS: Both the GSA and MNA represent a good indicator to determine high-risk patients for developing complications attributable to hyponutrition. We can attribute them a predictive power similar to that of objective data considered as a whole.

Valoración nutricional al ingreso hospitalario: iniciación al estudio entre distintas metodologías / Nutritional assessment at the time of hospital-admission: study initiation among different methodologies

Antecedentes y Objetivos: Las altas cifras iniciales de prevalencia de desnutrición en los enfermos hospitalizados-cercanos al 40%- es un dato preocupante. Esto permite deducir que la identificación precoz de enfermos desnutridos o en riesgo de estarlo, mediante métodos de valoración nutricional eficaces puede constituir una herramienta fundamental de cara a la planificación nutricional. El objetivo del presente trabajo ha sido aplicar a un mismo grupo de pacientes distintos métodos de valoración nutricional (objetivos y subjetivos) a su ingreso hospitalario, a fin de valorar el grado de efectividad para su aplicación en la clínica. Ámbito, Pacientes e Intervenciones: Se diseña un estudio prospectivo y aleatorio, en el cual se incluyen 50 pacientes ingresados en nuestro hospital entre el 1 de octubre y el 31 de diciembre del 2004, siendo desestimados 9 casos por fallos en las analíticas. En los tres primeros días de estancia hospitalaria se les realiza antropometría(peso, talla, circunferencia del brazo y medida del pliegue tricipital), bioquímica (hemograma, albúmina, prealbúmina,proteína ligada al retinol, transferrina y colesterol) dos encuestas de valoración nutricional (Valoración Subjetiva Global (VSG) y Mini Nutricional Assessment (MNA). Resultados: Se ha aplicado el test de χ2 para comparar los resultados obtenidos de los diferentes métodos objetivos, por separado y en conjunto, con métodos MNA y VSG, estableciéndose las siguientes comparaciones:Antropometría/MNA, Bioquímica/MNA, Inmunología/ MNA, Chang/MNA, Antropometría/VSG, Bioquímica/VSG, Inmunología/VSG, Chang/VSG y MNA/VSG.La significación estadística se ha considerado para un valor de p < 0,05. El análisis estadístico se ha realizado con ayuda del programa SPSS v.11. No se ha observado significación estadística en la relación entre cualquiera de los tres tipos de parámetros objetivos estudiados: (bioquímica, antropometría e inmunología) considerados aisladamente y las dos encuestas de valoración nutricional. En cambio, la significación es positiva al relacionar los resultados obtenidos por el método de Chang que engloba los tres tipos de parámetros objetivos, con los resultados de la MNA y de la VSG. También se alcanzó significación estadística al relacionar entre sí los dos métodos subjetivos empleados: la MNA y la VSG. Conclusiones: Tanto la VSG como la MNA constituyen un buen indicador para determinar los pacientes en alto riesgo de desarrollar complicaciones atribuibles a la desnutrición. Podemos atribuirles un poder predictivo igual al de los datos de objetivos considerados en conjunto (AU)

Background and objectives: The elevated prevalence figures of hyponutrition in hospitalized patients -near 40%- is an issue of concern. This allows deducing that early identification of malnourished, or at risk for hyponutrition, patients by means of effective nutritional assessment methods may represent an essential tool for nutritional planning.The aim of this study was applying to a same group of patients different nutritional assessment methods (objective and subjective) at the time of hospital admission in order to assess the degree of effectiveness for its clinical application. Setting, Patients and Interventions: A prospective randomized study is designed, in which 50 admitted patients of our hospital are included between October 1st and December 31st of 2004, 9 of them being rejected for laboratory errors. During the first 3 days of hospital staying, anthropometrics (weight, height, arm circumference,and tricipital fold measure), biochemistry (full blood count, albumin, pre-albumin, retinol-bound protein, transferrin, and cholesterol), two nutritional assessment questionnaires (Global Subjective Assessment (GSA) and Mini Nutritional Assessment (MNA). Results: The χ2 test has been applied to compare the results obtained from the different objective methods, separately and globally, with the MNA and GSA questionnaires, establishing the following anthropometrical comparisons: anthropometrics/MNA, Biochemistry/ MNA, Chang/MNA, anthropometrics/GSA, Biochemistry/GSA, Chang/GSA, and MNA/GSA. Statistical significance has been set at p < 0.05. Statistical analysis has been done with the SPSS v.11 software.We have not observed a statistical significance between any of the three objective parameters studied: biochemistry, anthropometrics and immunology separately considered in the two nutritional assessment questionnaires. However, the significance is positive when we relate the results obtained by the Chang method, which comprises the three types of objective parameters, with those from the MNA and GSA. A statistical significance was also reached when relating both subjective methods between each other: MNA and GSA. Conclusions: Both the GSA and MNA represent a good indicator to determine high-risk patients for developing complications attributable to hyponutrition. We can attribute them a predictive power similar to that of objective data considered as a whole (AU)

Valoración nutricional en el enfermo oncológico: estudio sobre metodología objetiva-subjetiva / Nutritional valuation on oncologic patient: objective-subjective methodology research

Fundamentos: En la práctica clínica, el objetivo de la valoración nutricional es identificar los pacientes con malnutrición o con riesgo que pueden beneficiarse de un adecuado abordaje nutricional posterior. Para ello, es necesario disponer de un método de valoración del estado nutricional sencillo de realizar, reproducible, que pueda ser llevado a cabo por cualquier terapeuta, de bajo coste y capaz de identificar a pacientes con déficit nutricional o riesgo de malnutrición. El objetivo de nuestro estudio ha sido aplicara un mismo grupo de pacientes distintos métodos de valoración nutricional (objetivos y subjetivos) para determinar la variación entre los resultados obtenidos por cada uno de ellos y encontrar un método sencillo y fiable que se pueda utilizar como método de rutina aplicado apacientes oncológicos cuando ingresan en el hospital. Métodos: Se ha diseñado un estudio prospectivo y aleatorio, seleccionando al azar 25pacientes oncológicos a los que se les aplicaron en los tres primeros días de estancia hospitalaria las medidas de estudio: antropometría(peso, talla, circunferencia del brazo y medida del pliegue tricipital), analítica (hemograma, albúmina, prealbúmina, proteína ligada al retinol, transferrina y colesterol) y dos encuestas de valoración nutricional (VSG-GP y MNA).Resultados: No hemos encontrado significación estadística entre cualquiera de los tres tipos de parámetros objetivos estudiados aisladamente(bioquímica, antropometría e inmunología)con ninguna de las dos encuestas de valoración nutricional (Tabla IV). En cambio, sí se han podido relacionar los resultados obtenidos por el método de Chang que engloba dichos parámetros objetivos, con los resultados de la MNA y los de la VSG (Tabla IV). Conclusiones: Tanto la VSG-GP como la MNA son dos métodos subjetivos de valoración nutricional fáciles de realizar y con una buena correlación respecto a los métodos objetivos (AU)

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[Time spent waiting at primary care clinics: can this be improved?]. / La demora en la consulta de atención primaria: 'se puede mejorar?

OBJECTIVE: To analyse the factors that affect patients´ wait at a health centre before they enter the doctor´s consulting room (CD). DESIGN: Prospective full evaluative cycle of quality. SETTING: A teaching health centre in the Cartagena Health Area (Murcia). PARTICIPANTS: All those patients seen by the doctor during the weeks of the study (1st stage: 3823; 2nd stage: 4247). MAIN MEASUREMENTS: The dimensions evaluated were accessibility and patient satisfaction, through four criteria. Data were collected from the register of scheduled appointments and by telephone questionnaire. The intervention measures were: a) to create empty spaces without any appointments in the day´s diary in order to avoid delays; b) to create spaces at the end of the day for emergency patients, and c) to avoid interruptions during the consultation. RESULTS: 1st stage: on 48.3% of days there were patients with a delay greater than 20 minutes on entering the CD, with a mean waiting-time of 21.3 minutes per patient. 63.1% of the consulting rooms had over 5% «unavoidable¼ appointments per day, of which 61.3% were «emergencies¼. 72.6% of the consulting rooms had 5 or more interruptions per day. 46.7% of patients thought that the time they waited before going into the consulting room was «a lot or enough¼. 2nd stage: after putting the improvement criteria into practice, the number of consultations with waiting time over 20 minutes dropped (37.1%) (P<.05). The number of unavoidable consultations over 5% of the total fell by 35.7% (P=.001), as did the number of consultations with over 5 interruptions per day (by 58.6%) (P=.001). Fewer patients were dissatisfied with the time they had to wait before going into the CD (40.8%) (P<.05). CONCLUSIONS: Patients' waiting time at the clinic dropped. The number of «unavoidable¼ appointments and interruptions was reduced. Patients´ satisfaction improved with the time they had to wait at the clinic improved. The corrective measures introduced are the right ones for correcting the situation.