Reprint of: Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults.

It is the position of the Academy of Nutrition and Dietetics that, based upon current evidence, the Malnutrition Screening Tool should be used to screen adults for malnutrition (undernutrition) regardless of their age, medical history, or setting. Malnutrition (undernutrition) screening is a simple process intended to quickly recognize individuals who may have a malnutrition diagnosis. While numerous malnutrition screening tools are in use, their levels of validity, agreement, reliability, and generalizability vary. The Academy of Nutrition and Dietetics reviewed the body of evidence supporting malnutrition screening tools and determined a single tool for identifying adults in all settings who may have malnutrition, regardless of their age or medical history. The Nutrition Screening for Adults Workgroup conducted a systematic review of the most robust evidence to promote using the highest-quality malnutrition screening tool available.

Using a virtual flipped classroom model to promote critical thinking in online graduate courses in the United States: a case presentation.

Flipped classroom models encourage student autonomy and reverse the order of traditional classroom content such as lectures and assignments. Virtual learning environments are ideal for executing flipped classroom models to improve critical thinking skills. This paper provides health professions faculty with guidance on developing a virtual flipped classroom in online graduate nutrition courses between September 2021 and January 2022 at the School of Health Professions, Rutgers The State University of New Jersey. Examples of pre-class, live virtual face-to-face, and post-class activities are provided. Active learning, immediate feedback, and enhanced student engagement in a flipped classroom may result in a more thorough synthesis of information, resulting in increased critical thinking skills. This article describes how a flipped classroom model design in graduate online courses that incorporate virtual face-to-face class sessions in a virtual learning environment can be utilized to promote critical thinking skills. Health professions faculty who teach online can apply the examples discussed to their online courses.

Elimination of Routine Gastric Residual Volume Monitoring Improves Patient Outcomes in Adult Critically Ill Patients in a Community Hospital Setting.

BACKGROUND: A community hospital updated its nutrition support practices in 2016 through the elimination of monitoring gastric residual volume (GRV) in accordance with the 2016 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. METHODS: This retrospective analysis (N = 61) compared incidence of feeding intolerance in 2 cohorts of adult critically ill patients pre-implementation (n = 36) and post-implementation (n = 25) of these guidelines into a nutrition support team's standard of practice policy. Differences in kilocalories and protein (gm) received and percent of daily prescribed kilocalories and protein received were also compared between the 2 cohorts. RESULTS: Mean episodes of gastrointestinal intolerance over the number of eligible days of receiving enteral nutrition in the critical care unit did not differ between the pre-implementation and post-implementation groups (P = 0.46). Compared with the pre-implementation group, the post-guideline implementation cohort was significantly more likely to meet higher percentages of both prescribed protein (71.8 ± 22.2% vs 55.9 ± 24.0%; P = 0.01) and energy requirements (93.4 ± 36.9% vs 69.6 ± 35.3%; P = 0.01), even after adjusting for potential confounders (age, body mass index, sex, and primary comorbid medical condition). CONCLUSION: Elimination of routine monitoring of GRV may result in a greater percentage of prescribed daily nutrient requirements met by patients in the critical care setting, without adverse effects on feeding intolerance.

Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review.

BACKGROUND: Malnutrition screening relies on quick and easy-to-use tools that require minimal training of users. Valid and reliable tools should avoid under-referral of adults with a malnutrition diagnosis or over-referral of those without a malnutrition diagnosis to dietitians. OBJECTIVE: Our aim was to conduct a systematic review of adult malnutrition screening tools for validity, agreement, and reliability, and to determine the costs of the malnutrition screening procedure. METHODS: Following a structured process, a comprehensive search using PubMed, MEDLINE, EMBASE, and CINAHL was conducted for relevant research published between 1997 and 2017 that examined the validity, agreement, reliability, and costs of nutrition screening tools. RESULTS: Sixty-nine studies met the inclusion criteria. The Malnutrition Screening Tool exhibited moderate validity, agreement, and reliability based on Grade I (Good/Strong) evidence. The evidence supporting the conclusions for the remaining tools was Fair (Grade II). The Malnutrition Universal Screening Tool exhibited high validity and moderate agreement and reliability. The Mini Nutritional Assessment-Short Form exhibited moderate validity and reliability and low agreement. The Short Nutritional Assessment Questionnaire and the Nutrition Risk Screening 2002 exhibited moderate validity and reliability and the Mini Nutritional Assessment-Short Form Body Mass Index exhibited high validity and moderate agreement. However, these last three tools were missing reliability or agreement data. Limited data were available to evaluate malnutrition screening costs. CONCLUSIONS: This review provides an analysis of validity, agreement, and reliability of tools to screen adults for malnutrition, regardless of their age, medical history, or location. No tools were found with high validity, reliability, and strong supportive evidence. Tools most often achieved moderate validity, agreement, and reliability, and had large variations in individual results. The minimum validity and reliability of tools to screen adults for malnutrition should be established to shape future research. Cost data for the screening process should be obtained and examined.

Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults.

It is the position of the Academy of Nutrition and Dietetics that, based upon current evidence, the Malnutrition Screening Tool should be used to screen adults for malnutrition (undernutrition) regardless of their age, medical history, or setting. Malnutrition (undernutrition) screening is a simple process intended to quickly recognize individuals who may have a malnutrition diagnosis. While numerous malnutrition screening tools are in use, their levels of validity, agreement, reliability, and generalizability vary. The Academy of Nutrition and Dietetics reviewed the body of evidence supporting malnutrition screening tools and determined a single tool for identifying adults in all settings who may have malnutrition, regardless of their age or medical history. The Nutrition Screening for Adults Workgroup conducted a systematic review of the most robust evidence to promote using the highest-quality malnutrition screening tool available.

Exploring the Differences Between Early and Traditional Diet Advancement in Postoperative Feeding Outcomes in Patients With an Ileostomy or Colostomy.

BACKGROUND: We assessed the differences in postoperative feeding outcomes when comparing early and traditional diet advancement in patients who had an ostomy creation. METHODS: At a U.S. tertiary care hospital, data from patients who underwent an ileostomy or colostomy creation from June 1, 2013, to April 30, 2017 were extracted from an institutional database. Patients who received early diet advancement (postoperative days 0 and 1) were compared with traditional diet advancement (postoperative day 2 and later) for demographics, preoperative risk factors, and operative features. The postoperative feeding outcomes included time to first flatus and ostomy output. Mann-Whitney U tests determined bivariate differences in postoperative feeding outcomes between groups. Poisson regression was used to adjust for unequal baseline characteristics. RESULTS: Data from 255 patients were included; 204 (80.0%) received early diet advancement, and 51 (20.0%) had traditional diet advancement. Time to first flatus and time to first ostomy output were significantly shorter in the early compared with traditional diet advancement group (median difference of 1 day for both flatus and ostomy output, P < 0.001). Adjusting for baseline group differences (American Society for Anesthesiology Physical Status Classification System, surgical approach, resection and ostomy type) maintained the significant findings for both time to first flatus (ß = 1.32, P = 0.01) and time to first ostomy output (ß = 1.41, P < 0.001). CONCLUSIONS: Early diet advancement is associated with earlier return of flatus and first ostomy output compared with traditional diet advancement after the creation of an ileostomy or colostomy.

The Effectiveness of Computer-Assisted Instruction to Teach Physical Examination to Students and Trainees in the Health Sciences Professions: A Systematic Review and Meta-Analysis.

PURPOSE: To explore knowledge and skill acquisition outcomes related to learning physical examination (PE) through computer-assisted instruction (CAI) compared with a face-to-face (F2F) approach. METHOD: A systematic literature review and meta-analysis published between January 2001 and December 2016 was conducted. Databases searched included Medline, Cochrane, CINAHL, ERIC, Ebsco, Scopus, and Web of Science. Studies were synthesized by study design, intervention, and outcomes. Statistical analyses included DerSimonian-Laird random-effects model. RESULTS: In total, 7 studies were included in the review, and 5 in the meta-analysis. There were no statistically significant differences for knowledge (mean difference [MD] = 5.39, 95% confidence interval [CI]: -2.05 to 12.84) or skill acquisition (MD = 0.35, 95% CI: -5.30 to 6.01). CONCLUSIONS: The evidence does not suggest a strong consistent preference for either CAI or F2F instruction to teach students/trainees PE. Further research is needed to identify conditions which examine knowledge and skill acquisition outcomes that favor one mode of instruction over the other.