Kerstin Ulander

Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year.

Hip fractures are a major cause of hospital stay among the elderly, and result in increased disability and mortality. In this study from 1 April 2003 to 31 March 2004, the influence of optimised treatment of hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year were investigated. Comparisons were made between the first 210 patients in the period and the last 210 patients, who followed the new clinical pathway introduced at the University Hospital in Lund, Sweden. Early surgery, within 24h, was not associated with reduced mortality, but was significantly associated with reduced length of stay (p<0.001). Significantly more cases of osteosynthesis for femoral neck fracture were reoperated compared with all other types of surgery (p<0.001) when reoperations with extraction of the hook pins in healed fractures were excluded. Mortality was significantly higher among men than women at 4 (p=0.025) and 12 (p=0.001) months after fracture and among medically fit patients with administrative delay to surgery compared with patients with no delay (p<0.001).

Development and psychometric testing of the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS).

BackgroundThe aim of this study was to develop and psychometrically test a short, patient-reported questionnaire to be used in clinical practice for patients with Irritable Bowel Syndrome (IBS). The Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS) questionnaire was designed to measure the treatment response of symptoms and well-being in patients suffering from IBS.MethodsThe VAS-IBS was psychometrically tested for content and criterion validity, scale acceptability, item-reduction, internal reliability consistency, simplicity, and speed. Two samples were used. One expert panel (five physicians and four registered nurses), who gave their opinion on the content validity, and one of 71 patients with IBS (mean age 38 years SD +13, range 19–65), who completed the VAS-IBS, as well as the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being Index for criterion validity.ResultsThe items in the VAS-IBS capture the main physical concerns women with IBS might present and the psychometric testing confirmed that the VAS-IBS is an acceptable homogeneous patient-reported questionnaire indicated by Cronbachs alpha internal consistency reliability coefficient, with a value of 0.85. All correlations to test the criterion validity performed by using Pearsons correlation test, were statistically significant (p < 0.0001) and in the expected directions. The VAS-IBS is easy to complete and unproblematic to calculate.ConclusionThe VAS-IBS appears to be reliable and user-friendly, for patients as well as for health professionals. The final version of the VAS-IBS including nine items needs to be further tested in clinical practice cross-culturally in women as well as in men.

Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations

Objectives: The aim of this study was to explore the prevalence of eating difficulties and malnutrition among persons in hospital care and in special accommodations.Design: The cross-sectional observational study was performed in Nov. 2005.Setting: Hospitals and special accommodations.Participants: Out of 2945 persons, 2600 (88%) agreed to participate (1726 from special accommodations and 874 from hospitals). In total all special accommodations in six municipalities and six hospitals were involved.Measurements: Risk of undernutrition was estimated as at least two of: body mass index below recommendation, weight loss and/or eating difficulties. Overweight was graded based on body mass index (if 69 years or younger: 25 or above: if 70 years or older: 27 or above).Results: The mean age of those living in hospitals was 69 years and 53% were women, while the corresponding figures for those in special accommodations were 85 years and 69% women. In hospitals and special accommodations, eating difficulties were common (49% and 56% respectively) and about one quarter had a body mass index (BMI) below the limits (20% and 30% respectively) and one-third above the limit (39% and 30% respectively) thus only about 40% had a BMI within the limits. Both in hospitals and in special accommodations 27% were considered to have a moderate or high risk of undernutrition. Conclusion: Only about 40% in special accommodations and hospital care have a BMI within the recommended limits. As both low and high BMI are frequent in both settings, the focus of care should not only be on undernutrition but also on overweight. Using the Swedish criteria for defining risk of undernutrition seems to give a slightly lower prevalence than has been shown in previous Swedish studies, but this can be due to an underestimation of the occurrence of eating difficulties.

Malnutrition prevalence and precision in nutritional care differed in relation to hospital volume – a cross-sectional survey

BackgroundTo explore the point prevalence of the risk of malnutrition and the targeting of nutritional interventions in relation to undernutrition risk and hospital volume.MethodsA cross-sectional survey performed in nine hospitals including 2 170 (82.8%) patients that agreed to participate. The hospitals were divided into large, middle, and small sized hospitals. Undernutrition risk and overweight (including obesity) were assessed.ResultsThe point prevalence of moderate/high undernutrition risk was 34%, 26% and 22% in large, middle and small sized hospitals respectively. The corresponding figures for overweight were 38%, 43% and 42%. The targeting of nutritional interventions in relation to moderate/high undernutrition risk was, depending on hospital size, that 7–17% got Protein- and Energy Enriched food (PE-food), 43–54% got oral supplements, 8–22% got artificial nutrition, and 14–20% received eating assistance. Eating assistance was provided to a greater extent and artificial feeding to a lesser extent in small compared to in middle and large sized hospitals.ConclusionThe prevalence of malnutrition risk and the precision in provision of nutritional care differed significantly depending on hospital volume, i.e. case mix. It can be recommended that greater efforts should be taken to increase the use of PE-food and oral supplements for patients with eating problems in order to prevent or treat undernutrition. A great effort needs to be taken in order to also decrease the occurrence of overweight.

Study circles improve the precision in nutritional care in special accommodations

Background Disease-related malnutrition is a major health problem in the elderly population, but it has until recently received very little attention, especially are management issues under-explored. By identifying residents at the risk of undernutrition (UN), appropriate nutritional care can be provided. Objective To investigate if study circles and policy documents improve the precision in nutritional care and decrease the prevalence of low or high body mass index (BMI). Design Pre and post-intervention study. Setting Special accommodations (nursing homes) within six municipalities were involved. Participants In 2005, 1,726 (90.4%) of 1,910 residents agreed to participate and in 2007, 1,526 (81.8%) of 1,866 residents participated. Intervention Study circles in one municipality, having a policy document in one municipality and no intervention in four municipalities. Measurements Risk of UN was defined as involving any of: involuntary weight loss; low BMI; and/or eating difficulties. Overweight was defined as high BMI. Results In 2005 and 2007, 64% and 66% of residents, respectively, were at the risk of UN. In 2007, significantly more patients in the study circle municipality were accurately provided protein and energy enriched food (PE-food) compared to the no intervention municipalities. There was a decrease between 2005 and 2007 in the prevalence of low BMI in the study circle municipality, but the prevalence of overweight increased in the policy document municipality. Conclusions Study circles improve the provision of PE-food for residents at the risk of UN and can possibly decrease the prevalence of low BMI. It is likely that a combination of study circles and implementation of a policy document focusing on screening and on actions to take if the resident is at UN risk can give even better results.

Malnutrition prevalence and precision in nutritional care: an intervention study in one teaching hospital in Iceland

AIM The aim of this study was to explore the point prevalence of malnutrition and the targeting of nutritional interventions in relation to undernutrition risk before and after an intervention. BACKGROUND Malnutrition risk and the precision in targeting nutritional treatment are indicators of quality of care. Knowledge regarding the in-hospital prevalence of malnutrition and nutritional treatment is meagre for Iceland. DESIGN Pre- and postintervention study. METHODS The study was performed during one day in 2006 (March) and one day in 2007 (April). In total, 95 (89%) and 92 (88%) patients agreed to participate. Moderate/high undernutrition risk was defined as the occurrence of at least two of the following: involuntary weight loss, body mass index below limit and eating difficulties according to Minimal Eating Observation Form - Version II. Being overweight was graded based on body mass index. Specific nutritional care actions were recorded. INTERVENTION A five-point programme for nutrition and eating was implemented. RESULTS Moderate/high risk for undernutrition was found in 25 and 17% in the two years (ns, not significant). A high body mass index was found in 53 and 54% (ns). The number of patients with a documented body mass index significantly increased between the two surveys (1 and 30%, p-value <0·0005). The use of oral supplements increased from 11-40% (p<0·0005) and especially among those at no/low undernutrition risk, with ingestion or deglutition difficulties (p<0·0005 in both cases) but not among those with appetite and energy problems (ns). CONCLUSION Implementing a nutritional programme does not necessarily affect the number of in-patients with malnutrition, but it is likely to increase the precision of nutritional care to some extent. RELEVANCE TO CLINICAL PRACTICE Greater efforts need to be taken to increase the precision of nutritional care among patients at moderate/high undernutrition risk and among those with appetite and energy problems.

P077 “STUDY CIRCLES” IMPROVES NUTRITIONAL CARE AND BODY MASS INDEX

The staffs’ knowledge, experiences and motivation are likely to be important and so is an adaptation to each unit’s context to achieve positive changes in nutritional practice. How do study circles ...

P309 OVERWEIGHT AND RISK FOR UNDERNUTRITION AMONG PERSONS WITHIN SPECIAL ACCOMMODATIONS AND HOSPITAL CARE - YEAR 2005 AND 2007

Rationale: Both undernutrition and overweight have major impacts on morbidity and mortality and are thus important to prevent. This study explores the prevalence of undernutrition and overweight among persons in special accommodations (SAs) and hospital care in the year of 2005 and 2007. Methods: Six hospitals and all of the SAs within six municipalities were involved. In the year of 2005, 2600 (88%) out of 2945 persons agreed to participate in the study, and in 2007 there were 2255 (81%) out of 2784 persons participating. Risk for undernutrition was defined as the occurrence of at least two of the following; involuntary weight loss, Body Mass Index (BMI) below limit ( /=70 yrs: BMI >/=27)[1]. Nursing students, clinical tutors and staff collected the data. Results: The mean age and the risk for undernutrition increased significantly in SAs between the two years. The prevalence of overweight increased with three percent in hospitals as well as in SAs although this increase was not statistically significant. Table: Percent of persons at risk for undernutrition and with overweight SAs2005 (n=1726) SAs2007 (n=1526) P-value Hospitals2005 (n=874) Hospitals2007 (n=728) P-value Agemean (SD) 85 (8) 86 (8) <0.001 69 (18) 69 (16) 0.987 At risk forundernutrition 27 35 <0.001 27 28 0.947 Overweight 30 33 0.089 39 42 0.182 SAs = Special Accommodations Conclusion: The society in general and health care professionals in specific needs to consider not only prevention for persons at risk for undernutrition, but also the prevention for persons becoming overweight. Reference(s) Only 3 Lines maximum: 1. Westergren A, Lindholm C, Axelsson C & Ulander K. Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations. The Journal of Nutrition Health and Aging 2008, Vol 12, Number 1, Page 39-43.