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1.
Clin Nutr ESPEN ; 44: 463-465, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34330506

RESUMO

BACKGROUND: Completing malnutrition assessments when physically distant has been an immediate challenge during the COVID-19 pandemic. Even during periods of physical distancing, continuing nutrition assessments amongst those without COVID-19 is vital given that high malnutrition prevalence exists in clinical settings. The investigation aim was to assess the reliability of utilising the validated Subjective Global Assessment (SGA) tool, without compared to with physical examination. METHODOLOGY: Original paper-based SGA documentation from a hospital-wide audit was reassessed by a blinded experienced clinician using history alone without reviewing documented physical examination. Participants included adults admitted to a tertiary hospital with no maternity or obstetric services. Those terminally ill, undergoing end-of-life palliative care, with disordered eating or admitted to emergency or intensive care units were excluded. McNemar's test assessed paired categorical data. Cohen's kappa coefficient assessed inter- and intra-rater reliability. Sensitivity, specificity, positive and negative predictive values were completed. RESULTS: There was no significant difference in malnutrition identification (p < 0.454) with 97% (473/489) of assessments identical. High sensitivity (87.2%, 68/78), specificity (98.9%, 405/411), positive (91.9%, 68/74) and negative (97.6%, 405/415) predictive values were evident. High inter- and intra-rater reliability was confirmed (kappa values 0.875 and 0.987). CONCLUSION: The Abridged-SGA utilising the four key factors of the SGA history identified many malnourished amongst those without COVID-19 who otherwise would not be identified when physical distancing is required due to the pandemic. It did not overestimate malnutrition. Until alternative means of assessing physical parameters remotely are validated, the pragmatic value of practitioners' judgement when utilising the Abridged-SGA was confirmed.


Assuntos
COVID-19/prevenção & controle , Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Distanciamento Físico , Inquéritos e Questionários/normas , Dieta/métodos , Gastroenteropatias/complicações , Humanos , Desnutrição/complicações , Pandemias , Exame Físico , Projetos Piloto , Reprodutibilidade dos Testes , SARS-CoV-2 , Sensibilidade e Especificidade , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária , Perda de Peso
3.
Clin Nutr ESPEN ; 41: 193-197, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33487264

RESUMO

BACKGROUND AND AIMS: During conversion from paper to electronic documentation at a tertiary hospital, the Malnutrition Screening Tool was embedded into the electronic health record (e-HR) with nursing staff's completion continued as part of admission procedures with dietetic referrals automated. Currently, the impact of e-HR implementation on malnutrition identification is unknown. Consequently, this retrospective pre-test post-test study compared one year of malnutrition coding in a tertiary teaching hospital two years before and after e-HR implementation automating malnutrition screening referrals to dietitians with subsequent malnutrition assessment completion. METHODS: Eligibility included adults (≥18yrs) admitted overnight or longer during the 2013/2014 and 2017/2018 financial years. Requested hospital data included demographics, admission data and coding for malnutrition and dietitian intervention. Eligible admissions prior to e-HR implementation were classified as pre-e-HR group, with admissions after classified as post-e-HR. Descriptive, Fisher's exact, Mann-Whitney U and independent samples t-tests were used to compare groups. RESULTS: Patient admissions pre-e-HR (n = 37,143) and post-e-HR (n = 36,625) implementation were clinically similar in age, gender and length of stay (57 ± 19 years, 60% male, 3 (1-918) days). However, the numbers of admissions coded annually with malnutrition increased by 47% from 1436 to 2116 following e-HR implementation (p < 0.001). The proportion of eligible patients who were malnourished on admission and not seen by a dietitian during admission decreased one third from 6.5% to 4.8% (p = 0.042). CONCLUSIONS: Malnutrition coding increased by 47% after an e-HR implementation with an embedded malnutrition screening tool that automated referrals to dietitians impacting the identification of care to optimize nutritional status.


Assuntos
Registros Eletrônicos de Saúde , Desnutrição , Adulto , Idoso , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Estado Nutricional , Estudos Retrospectivos , Centros de Atenção Terciária
4.
J Nucl Cardiol ; 27(2): 481-489, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30088196

RESUMO

BACKGROUND: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is used in the diagnosis and management of patients with cardiac sarcoidosis (CS). Various preparation protocols have been proposed to minimise myocardial 18F-FDG uptake and improve scan readability. The aim of this systematic review was to identify the optimal dietary prescription for suppression of physiological 18F-FDG myocardial uptake to enhance clinical diagnosis of CS. METHODS AND RESULTS: MEDLINE and PubMed databases identified 13 studies meeting inclusion criteria for review. Articles were assessed using the Australian National Health and Medical Research Council levels of evidence and categorised as sarcoidosis (human) or non-sarcoidosis (human, animal). Visual uptake scales (qualitative) and/or standardised uptake values (SUV) (quantitative) were used in all the studies reviewed. Nine of 11 human studies showed statistically significant improvements in PET scan interpretation with carbohydrate-restricted diets compared with fasting only, and when carbohydrates were restricted for a longer period of time. Two animal studies showed statistically significant improvements following very low carbohydrate diet preparation (0.01% and 0.4% carbohydrate diets) compared with higher carbohydrate diets. CONCLUSIONS: Variation in measures used, dietary prescriptions, fasting times, species and study quality makes result comparison and applicability difficult. Definitive dietary recommendations are not possible based on current evidence.

5.
Nutr Diet ; 77(4): 444-448, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-30912282

RESUMO

AIM: Those with acquired brain injury (ABI) experience impairments in executive function, attention and concentration that may contribute to or exacerbate poor nutritional intakes. This is frequently observed in long-stay rehabilitation settings. This investigation aimed to identify the specific impact of the dining room television as a factor that exacerbates poor intake and nutritional status among those with ABI. METHODS: Routine meal audits were completed (six television on, six television off) over four non-consecutive days. Each individual's protein and energy intake per meal and day were assessed, and the differences were examined through paired t-tests. Dining room decibels were measured, with means, peaks and minimums recorded. RESULTS: Complete data for 12 meals were collected for seven individuals. Clinically, but not statistically significant increases in 48-hour protein and energy intake occurred with television off compared with on, including those requiring texture modified diets. CONCLUSIONS: This pilot investigation highlights that television may have a detrimental impact on nutritional intakes among those with ABI. Given the negligible costs and risk, minimising disruptive influences by turning the television off may become a recommendation for ABI in long-care rehabilitation settings.

6.
Nutr Diet ; 76(4): 480-485, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31199071

RESUMO

AIM: The present study aimed to assess the impact of a hospital-wide electronic medical record (EMR) on the way dietitians collect routine data for their assessments and its impact on their clinical documentation and service provision. METHODS: Data were collected retrospectively from the following sources: interdepartmental chart audit, the EMR itself (nutrition diagnosis), National Health Roundtable database (admissions requiring nutrition events) and the hospital-wide Pressure Injury Prevention Audits (height, weight and malnutrition screening). RESULTS: There were improvements in medical record accessibility (76.4% pre vs 100% post, P < 0.001), awareness of medical alerts (82.5% unaware pre vs 34.5% unaware post) and legibility of documentation (53.8% pre vs 99.2% post, P < 0.001). Improvements in accessing medical charts under 1 minute also occurred (65.8% pre vs 99.2% post, P < 0.001). The percentage of nutrition diagnoses resolved during admission increased from 20.0% in February 2016 to 34.0% in August 2017. A 72.0% increase in admissions requiring nutrition interventions was found with 4075 admissions pre- and 7035 post-EMR implementation. Time spent per nutrition event reduced by 22.0% (118 minutes pre and 92 minutes post). Hospital audit data revealed mean height and weight collected increased from 79.3 ± 3.8% (n = 8 audits totalling 3041/3834 patients) to 86.0 ± 2.6% (n = 5 audits totalling, 2544/2958 patients) post-EMR with malnutrition screening completion increasing from 57.5% to 74.0%. CONCLUSIONS: Findings indicate that EMR implementation has the potential to benefit the dietetic profession due to the potential to enhance the capacity and efficiency of dietetic departments.


Assuntos
Dietética/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Avaliação Nutricional , Centros de Atenção Terciária , Austrália , Departamentos Hospitalares , Humanos , Estado Nutricional , Nutricionistas , Estudos Retrospectivos
8.
J Acad Nutr Diet ; 119(2): 225-241, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30553587

RESUMO

BACKGROUND: Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed. OBJECTIVE: The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries. METHODS: A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels. MAIN OUTCOME MEASURES AND STATISTICAL ANALYSIS: The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information. RESULTS: Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest. CONCLUSIONS: Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language together with the more easily implemented process. There is also a need to promote NCP/NCPT for all areas of practice, and develop strategic plans for implementation of the NCP and NCPT.


Assuntos
Implementação de Plano de Saúde/estatística & dados numéricos , Terapia Nutricional/normas , Ciências da Nutrição/normas , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Terminologia como Assunto , Estudos de Coortes , Humanos , Ciências da Nutrição/métodos , Inquéritos e Questionários
9.
J Acad Nutr Diet ; 119(2): 242-260, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30552017

RESUMO

BACKGROUND: The Nutrition Care Process (NCP) and NCP Terminology (NCPT) is a systematic framework for critical thinking, decision making, and communication for dietetics practitioners worldwide, aiming to improve quality and patient safety in nutrition care. Although dietetics practitioners in several countries have implemented the NCP/NCPT during recent years, to date there is no globally validated instrument for the evaluation of NCP/NCPT implementation that is available in different languages and applicable across cultures and countries. OBJECTIVE: The aim of this study was to develop and test a survey instrument in several languages to capture information at different stages of NCP/NCPT implementation across countries and cultures. SETTING: In this collaboration between dietetics practitioners and researchers from 10 countries, an International NCP/NCPT Implementation Survey tool was developed and tested in a multistep process, building on the experiences from previous surveys. The tool was translated from English into six other languages. It includes four modules and describes demographic information, NCP/NCPT implementation, and related attitudes and knowledge. METHODS: The survey was reviewed by 42 experts across 10 countries to assess content validity and clarity. After this, 30 dietetics practitioners participated in cognitive interviews while completing the survey. A pilot study was performed with 210 participants, of whom 40 completed the survey twice within a 2- to 3-week interval. RESULTS: Scale content validity index average was 0.98 and question clarity index was 0.8 to 1.0. Cognitive interviews and comments from experts led to further clarifications of the survey. The repeated pilot test resulted in Krippendorff's α=.75. Subsequently, refinements of the survey were made based on comments submitted by the pilot survey participants. CONCLUSIONS: The International NCP/NCPT Implementation Survey tool demonstrated excellent content validity and high test-retest reliability in seven different languages and across an international context. This tool will be valuable in future research and evaluation of implementation strategies.


Assuntos
Dietética/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Terapia Nutricional/normas , Avaliação de Processos em Cuidados de Saúde/métodos , Inquéritos e Questionários/normas , Humanos , Idioma , Projetos Piloto , Reprodutibilidade dos Testes , Terminologia como Assunto
10.
Nutr Diet ; 76(4): 455-461, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30182523

RESUMO

AIM: Many dietitians are yet to incorporate the Nutrition Care Process and Terminology (NCPT) into practice. The present study investigated factors predicting (i) NCPT use, (ii) perceived importance of NCPT implementation and (iii) perceived NCPT applicability to personal dietetic practice among dietitians in the Asia-Pacific region. METHODS: Dietetic association members from Australia, New Zealand and Singapore were invited to participate in an online survey assessing NCPT implementation, knowledge, and self-rated familiarity, attitudes, benefits, concerns, barriers, and enablers. Forward stepwise logistic regression used all factors to identify predictive dietetic characteristics for current NCPT use, importance or applicability to practice. RESULTS: A total of 377 dietitians (5%-55% of national dietetic memberships surveyed) completed at least one survey question. In logistic regression models, independent positive predictors of current NCPT users were knowledge (P = 0.003), confidence to implement (P = 0.036), confidence to write nutrition diagnoses (P = 0.002) and experiencing managerial support (P = 0.004). Not seeing a reason to change was a significant negative predictor of NCPT use (P = 0.003). An independent positive predictor of dietitians viewing NCPT implementation as important was feeling that it will improve patient care (P < 0.001), while negative predictors were seeing minimal benefit in changing (P < 0.001) and a preference to continue with current routine (P = 0.015). Independent positive predictors of dietitians viewing NCPT as applicable to their practice were NCPT knowledge (P = 0.009), seeing the value of NCPT (P < 0.001) and attendance at workshops or conferences (P = 0.014). CONCLUSIONS: NCPT implementation may be enhanced thorough activities building confidence, gaining managerial corroboration and demonstration of NCPT benefits, including improved patient care.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica/estatística & dados numéricos , Terapia Nutricional/métodos , Nutricionistas/estatística & dados numéricos , Terminologia como Assunto , Austrália , Feminino , Humanos , Masculino , Nova Zelândia , Singapura , Inquéritos e Questionários
11.
Clin Nutr ; 38(2): 759-766, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29559233

RESUMO

BACKGROUND & AIMS: Obesity, defined as a BMI ≥ 30 kg/m2, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients. METHODS: This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N = 3122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes. RESULTS: Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n = 750; 75% females; 61 ± 15 years; 37 ± 7 kg/m2). Fourteen percent (n = 105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N = 30/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients. CONCLUSION: Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients.


Assuntos
Estado Terminal , Desnutrição , Obesidade , Idoso , Austrália , Estado Terminal/mortalidade , Estado Terminal/terapia , Ingestão de Alimentos/fisiologia , Ingestão de Energia/fisiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Desnutrição/complicações , Desnutrição/mortalidade , Pessoa de Meia-Idade , Nova Zelândia , Estado Nutricional , Obesidade/complicações , Obesidade/mortalidade , Estudos Prospectivos , Sarcopenia/complicações , Sarcopenia/mortalidade , Resultado do Tratamento
13.
Emerg Med Australas ; 30(6): 785-793, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29722178

RESUMO

OBJECTIVE: The Rapid Assessment Prioritisation and Referral Tool (RAPaRT) was developed for identifying appropriate referrals to allied members of the multidisciplinary team in hospital medical assessment and planning units (MAPUs). This study examined the performance of the RAPaRT for identifying appropriate referrals as well as predicting requirement for admission to hospital and length of stay. METHODS: A prospective cohort study was conducted. The RAPaRT, inclusive of seven mandatory items, was completed by nurses for 195 patients presenting to a hospital ED and assessed in a MAPU external to the instrument development site. Members of the multidisciplinary team (dietetics, occupational therapy, physiotherapy, social work and speech pathology) assessed participants to determine whether a referral to their profession was warranted and this was compared to RAPaRT responses. RESULTS: All health professionals reviewed n = 175/195 (90%) participants, with n = 117/195 (60%) considered appropriate for referral to an allied health professional. At least one positive response to the RAPaRT items was recorded for n = 123 (63%) participants. Patterns of sensitivity and specificity for each item, and the instrument as a whole were consistent with the development study. The RAPaRT also predicted which patients required admission to an acute hospital ward (odds ratio = 1.22; 95% CI 1.01, 1.47) and their length of stay in hospital (coefficient = 0.18; 95% CI 0.14, 0.22). CONCLUSION: Findings supported the external validation of the RAPaRT. In addition, this investigation made a novel contribution in demonstrating that positive RAPaRT responses were associated with requirement for admission to an acute hospital ward and length of stay.


Assuntos
Determinação de Necessidades de Cuidados de Saúde/normas , Exame Físico/normas , Encaminhamento e Consulta/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Coortes , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Exame Físico/métodos , Estudos Prospectivos , Curva ROC , Estudos de Validação como Assunto
15.
Nutr Diet ; 75(1): 87-97, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28875513

RESUMO

AIM: Assessing changes in dietetic perceptions, attitudes and knowledge regarding the Nutrition Care Process Terminology (NCPT) is important to determine implementation effectiveness. This study aimed to investigate changes in the perceptions and attitudes of Australian dietitians over a three-year period, identify changes in benefits and barriers to support successful NCPT implementation and determine future directions for NCPT progression. METHODS: An online survey was performed in 2011 and repeated in 2014 by recruiting members of the Dietitians Association of Australia (DAA) through an email link. The survey assessed familiarity, knowledge, attitudes, benefits, barriers, concerns and use of educational enablers around the NCPT. RESULTS: The survey was completed by 218 respondents in 2011 and 205 respondents in 2014. Survey respondents from both years were representative of overall DAA membership. Respondent knowledge of NCPT increased significantly over the three-years, as did confidence, preparation, access to support and training and NCPT usage. Respondent's identification of benefits to implementation increased whilst barriers reduced. Attitudes regarding NCPT implementation were conflicting. CONCLUSIONS: Over three years, improvements were evident in NCPT knowledge, attitudes and usage. However, not all dietitians saw reason to implement NCPT in their practice, and some attitudes have become less supportive. A collective vision is required to foster positive attitudes towards the transformational professional benefits possible from NCPT. With ongoing uptake of electronic health records, the potential for NCPT to evaluate and justify dietetic interventions is increasing.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Dietética , Nutricionistas , Qualidade da Assistência à Saúde/normas , Austrália , Prestação Integrada de Cuidados de Saúde/tendências , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde , Humanos , Terapia Nutricional , Qualidade da Assistência à Saúde/tendências , Terminologia como Assunto
17.
Spinal Cord Ser Cases ; 3: 17057, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28919982

RESUMO

INTRODUCTION: The impact of muscle spasticity on weight change and energy expenditure after spinal cord injury (SCI) is not well understood. CASE PRESENTATION: This case study reports changes to body weight and resting energy expenditure (REE) in a 36-year-old female (T3 AIS A SCI; 80 kg; body mass index=28 kg m-2 at injury) requiring escalating therapies to manage severe spasticity. Body weight, spasticity medications and fasted REE (measured using indirect calorimetry, canopy hood) were recorded at 4, 16, 17, 20 and 44 months post injury. Spasticity was assessed at each time point using the Modified Ashworth Scale (MAS). At 4 months post injury, REE was high (1710 kcal per day) corresponding with severe spasticity in the lower limbs (4 on the MAS). Over the following 12 months, the patient experienced an 8 kg weight loss, visible lower limb muscle wasting and a 30% reduction in REE while requiring increasing drug therapies for spasticity. With insertion of an intrathecal Baclofen pump at 17 months and cessation of other medications, spasticity improved markedly and weight increased by 6 kg in 27 months without any significant change to REE (mean=1260 kcal±2%). DISCUSSION: Effective management of spasticity with intrathecal Baclofen appears to be associated with weight gain but not REE. Without body composition and activity energy expenditure data, this observation is difficult to explain. Regardless, routine weight monitoring with appropriate dietary counselling should be considered in this patient group to help prevent unintentional weight gain.

18.
Nutr Diet ; 74(4): 372-380, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28901700

RESUMO

AIM: Three years following a state-wide Nutrition Care Process Terminology (NCPT) implementation project, the present study aimed to (i) assess changes in NCPT knowledge and attitudes, (ii) identify implementation barriers and enablers and (iii) seek managers' opinions post-implementation. METHODS: Pre-implementation and three years post-implementation, all Queensland Government hospitals state-wide were invited to repeat a validated NCPT survey. Additionally, a separate survey sought dietetic managers' opinions regarding NCPT's use and acceptance, usefulness for patient care, role in service planning and continued use. RESULTS: A total of 238 dietitians completed the survey in 2011 and 82 dietitians in 2014. Use of diagnostic statement in the previous six months improved (P < 0.001). Perceptions of NCPT's importance (P < 0.020) and benefits of incorporating NCPT into practice (P = 0.029) increased. Time to complete NCPT documentation (P < 0.013) and access to mentors decreased (P < 0.001). Other areas including enhanced attitudes, familiarity, confidence, views, knowledge and incorporation into practice were sustained (P > 0.05). Key elements in sustaining NCPT implementation over three years included ongoing management support, workshops/tutorials, discussion and mentor and peer support. The most valued resources were pocket guides, ongoing workshops/tutorials and mentor support. Dietetic managers held many positive NCPT views, however, opinions differed around the usefulness of service planning, safer practice, improving patient care and facilitating communication. Some managers would not support NCPT unless it was recommended for practice. CONCLUSIONS: Immediate improvements following the NCPT implementation project were sustained over three years. Moving forward, a professional focus on continuing to incorporate NCPT into standard practice will provide structure for process and outcomes assessment.

19.
Top Spinal Cord Inj Rehabil ; 22(4): 269-276, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29339868

RESUMO

Background: In the absence of reliable predictive equations, indirect calorimetry (IC) remains the gold standard for assessing energy requirements after spinal cord injury (SCI), but it is typically confined to a research setting. The purpose of this study is to assess the feasibility and acceptability of implementing IC into routine clinical care in an Australian SCI rehabilitation facility. Methods: Bedside IC (canopy hood) was performed, and patients completed an IC acceptability questionnaire (open-ended; yes/no; 5-point Likert scale). Fasted resting energy expenditure (REE) steady-state criteria were applied to assess data quality, and adherence to a test ≥20 minutes was recorded. Staff were surveyed to assess impact of IC on usual care. Results: Of 35 eligible patients, 9 declined (7 reported claustrophobia). One patient could not be tested before discharge and 25 underwent IC (84% male, injury level C2-L2, AIS A-D). Anxiety prevented one patient from completing IC, while another failed to fast. The remaining 23 patients achieved a steady-state REE (≥5 consecutive minutes with ≤10% coefficient of variation for VO2 and VCO2). Test-retest (n = 5) showed <10% variation in REE. Patients deemed the procedure acceptable, with 88% reporting a willingness to repeat IC. Eighty percent of patients and 90% of staff agreed it was acceptable for IC to be integrated into usual care. Conclusion: This study found that IC is a feasible and acceptable addition to the routine clinical care of patients recovering from SCI and may serve to improve accuracy of nutrition interventions for this patient population.


Assuntos
Calorimetria Indireta , Metabolismo Energético , Necessidades Nutricionais , Traumatismos da Medula Espinal/reabilitação , Adulto , Idoso , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Descanso , Adulto Jovem
20.
Cochrane Database Syst Rev ; (4): CD009647, 2015 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-25924806

RESUMO

BACKGROUND: There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised. OBJECTIVES: To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated). SEARCH METHODS: Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies. SELECTION CRITERIA: Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables. DATA COLLECTION AND ANALYSIS: Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability. MAIN RESULTS: There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration. AUTHORS' CONCLUSIONS: There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.


Assuntos
Desidratação/diagnóstico , Água Potável/administração & dosagem , Idoso , Desidratação/sangue , Impedância Elétrica , Feminino , Humanos , Masculino , Doenças da Boca/diagnóstico , Concentração Osmolar , Sensibilidade e Especificidade , Fenômenos Fisiológicos da Pele , Avaliação de Sintomas/métodos , Urina
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