[INFORNUT process: validation of the filter phase-FILNUT--and comparison with other methods for the detection of early hospital hyponutrition]. / Proceso INFORNUT: validación dela fase de filtro-FILNUT--y comparación con otros métodos de detección precoz de desnutrición hospitalaria.

INTRODUCTION: According to several series, hospital hyponutrition involves 30-50% of hospitalized patients. The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. OBJECTIVES: To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. MATERIAL AND METHODS: In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull's method, CONUT and INFORNUT were done. The settings of the INFORNUT filter were: albumin < 3.5 g/dL, and/or total proteins <5 g/dL, and/or prealbumin <18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol <180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. RESULTS: In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66.9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. CONCLUSIONS: Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio.

Proceso INFORNUT®: validación de la fase de filtro —FILNUT— y comparación con otros métodos de detección precoz de desnutrición hospitalaria / Infornut process: validation of the filter phase -Filnut- and comparison with other methods for the detection of early hospital hyponutrition

Introducción: El problema de la desnutrición hospitalaria afecta según las series entre un 30-50% de los pacientes ingresados. Esta alta prevalencia justifica la necesidad de su detección precoz al ingreso. Existen múltiples herramientas clásicas de cribaje que muestran limitaciones importantes en su aplicación sistemática en la práctica clínica habitual. Objetivos: Ver la relación entre desnutrición, detectada por nuestro método de cribaje, y mortalidad, estancia o reingresos. Asimismo analizar la relación entre desnutrición y prescripción de soporte nutricional. Comparar distintos métodos de cribaje nutricional al ingreso sobre una muestra aleatoria de pacientes hospitalizados. Validación del método INFORNUT para cribaje nutricional. Material y Métodos: En una fase previa al diseño del estudio se realizo un análisis retrospectivo con datos del año 2003 con el fin de conocer la situación de la desnutrición en el Hospital Virgen de la Victoria de Málaga, recogiendo datos del CMBD (Conjunto Mínimo Básico de Datos), analíticas de riesgo nutricional (filtro FILNUT) y prescripción de soporte nutricional. En la fase experimental se realizo un estudio de cohorte transversal con una muestra aleatoria de 255 pacientes en Mayo del 2004. Se realiza estudio antropométrico, Valoración Subjetiva Global (VSG), Mini-Nutritional Assessment (MNA) y Nutrtional Risk Screening (NRS), método de Gassull, CONUT® e INFORNUT. Las condiciones de filtro aplicadas por INFORNUT son: albúmina < 3.5 g/dL y/o proteinas totales < 5 g/dL y/o prealbúmina< 18 mg/dL con o sin linfocitos totales < 1.600 cel/ml y/o colesterol total <180 mg/dL. Para la comparación entre métodos se construye un Gold Standard basado en las recomendaciones de SENPE sobre datos antropométricos y analíticos. El análisis estadístico de asociación se realizó mediante Test Chi-cuadrado (α:0.05) y concordancia a través del índice κ. Resultados: En el estudio realizado en la fase previa se observa que la prevalencia de desnutrición hospitalaria es del 53,9%. Recibieron soporte nutricional especializado 1.644 pacientes; de ellos el 66,9% padecían desnutrición. También se observa que la desnutrición es uno de los factores que favorecen el incremento de la mortalidad (desnutridos: 15,19% vs no desnutridos: 2,58), la estancia (desnutridos: 20,95 días vs. no desnutridos: 8,75 días), e reingresos (desnutridos: 14,30% vs. no desnutridos: 6%). Los resultados del estudio experimental son los siguientes: La prevalencia de desnutrición obtenida por Gold Standard (61%), INFORNUT (60%). Los grados de concordancia entre los métodos INFORNUT, CONUT y GASSULL son buenos o excelentes comparados entre sí (k : 0,67 INFORNUT con CONUT y k : 0,94 INFORNUT con GASSULL) y con Gold Standard (k : 0,83 INFORNUT; k : 0,64 CONUT; k :0,89 GASSULL). Sin embargo los test estructurados (VSG, MNA, NRS), presentan bajos índices de concordancia con el Gold Standard y los test analíticos o mixtos (Gassull); aunque si muestran un grado de concordancia ligero a moderado cuando se comparan entre si (k : 0.489 NRS con VSG). INFORNUT presenta una sensibilidad del 92,3%, un valor predictivo positivo del 94,1% y una especificidad del 91,2%. Tras la fase filtro se envía un informe preliminar, sobre el que cumplimentados datos antropométricos y de ingesta, se elabora un Informe de Riesgo Nutricional. Conclusiones: La prevalencia de desnutrición en nuestro estudio (60%) es similar a la hallada por otros autores. La desnutrición lleva consigo un aumento de mortalidad, estancia y reingreso. No existen herramientas que se hayan demostrado capaces detectar desnutrición precoz el medio hospitalario que no tengan grandes limitaciones de aplicabilidad. FILNUT como 1ª fase de filtro del proceso INFORNUT constituye una herramienta valida: sensible y específica para el cribado nutricional al ingreso. Las ventajas principales del proceso serían la capacidad de identificar precozmente pacientes con riesgo de desnutrición, ejercer una función docente y sensibilizadora en facultativos y personal de enfermería implicándolos en la valoración nutricional de sus pacientes y elaborar un informe del diagnóstico al alta de desnutrición y soporte nutricional para el Servicio de Documentación Clínica. Por tanto INFORNUT constituiría un método de cribado universal con una buena relación coste-efectividad (AU)

Introduction: According to several series, hospital hyponutrition involves 30-50% of hospitalized patients.The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. Objectives: To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. Material and methods: In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull"s method,CONUT® and INFORNUT® were done. The settings of the INFORNUT filter were: albumin< 3.5 g/dL, and/or total proteins < 5 g/dL, and/or prealbumin < 18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol < 180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. Results: In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66,9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. Conclusions: Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. Thereare no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio (AU)

[Morgagni's hernia. A case report]. / Hernia de Morgagni. A propósito de un caso.

A case of Morgagni's hiatal hernia is presented. Because of clinical symptoms (dizziness and chest pain) the patient was referred to the Cardiology Department and the diagnosis was a casual finding. The hernia sac contained transverse colon, great omentum and round ligament. We comment on the mechanism, etiologic factors, diagnosis, and surgical treatment. The present case was treated by an abdominal approach.