Background: A valid malnutrition screening tool (MST) is essential to provide timely nutrition support in ambulatory cancer care settings. The aim of this study is to investigate the validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria as compared to the reference standard, the Patient-Generated Subjective Global Assessment (PG-SGA). Methods: Cross-sectional observational study including 246 adult ambulatory patients with cancer receiving in-chair intravenous treatment at a cancer care centre in Australia. Anthropometrics, handgrip strength and patient descriptive data were assessed. Nutritional risk was identified using MST and PG-SGA SF, nutritional status using PG-SGA and GLIM. Sensitivity (Se), specificity (Sp), positive and negative predictive values and kappa (k) were analysed. Associations between malnutrition and 1-year mortality were investigated by Cox survival analyses. Results: A PG-SGA SF cut-off score ≥5 had the highest agreement when compared with the PG-SGA (Se: 89%, Sp: 80%, k = 0.49, moderate agreement). Malnutrition risk (PG-SGA SF ≥ 5) was 31% vs. 24% (MST). For malnutrition according to GLIM, the Se was 76% and Sp was 73% (k = 0.32, fair agreement) when compared to PG-SGA. The addition of handgrip strength to PG-SGA SF or GLIM did not improve Se, Sp or agreement. Of 100 patients who provided feedback, 97% of patients found the PG-SGA SF questions easy to understand, and 81% reported that it did not take too long to complete. PG-SGA SF ≥ 5 and severe malnutrition by GLIM were associated with 1-year mortality risk. Conclusions: The PG-SGA SF and GLIM criteria are accurate, sensitive and specific malnutrition screening and assessment tools in the ambulatory cancer care setting. The addition of handgrip strength tests did not improve the recognition of malnutrition or mortality risk.
This study validated and compared two different Oral Health Referral Trigger Tools in the form of brief (3-item and 5-item) questionnaires designed to identify people living with HIV (PLHIV) with symptoms of oral disease requiring a dental referral from other health professionals. It was composed of a self-completed questionnaire and oral screen by a dentist of a convenience sample selected from PLHIV attending two outpatient clinics for routine nondental care for HIV infection. The dental exam was completed by a single dentist at a third location. The one hundred participants were HIV positive, predominantly male and of Caucasian origin with a mean age of 45.6 years. Both referral tools were found to be valid and had adequate sensitivity to identify HIV positive subjects at risk of oral disease and facilitate appropriate referral by nondental health professionals to dental health service. When both tools were compared the 3-item tool proved to be a more valid and sensitive indicator which could be easily applied by nondental staff to facilitate a dental referral.
Aim Failure to translate research into practice is common. The present study implemented an evidence‐based model of care to address identified evidence‐practice gaps in our department's weight management service. Methods Implementation science frameworks were used to identify barriers to best practice and determine appropriate strategies to overcome them. No practice change occurred pre‐implementation. The new model of care incorporated evidence‐based interventions into a flowchart, supported by written resources, and integrated routine data collection into clinic processes. Alignment with a statewide telephone counselling program enhanced service capacity. Data were collected for adult patients whose primary intervention was weight management at a South‐East Queensland hospital and included service attendance metrics, anthropometry, diet quality, and interventions delivered, and were compared with guidelines. Change in outcomes was calculated at 3 months after initial appointments. Results Pre‐implementation, 69.2% (n = 91) of patients referred were seen by a dietitian. During the new model of care (n = 60), over half (63.3%) were referred to telephone counselling. The remainder were triaged according to the flowchart with 100% attendance. Guideline adherence for reviews significantly increased over time (4.4%–50%, P < 0.001). Follow‐up data were available for 31.3% and 54.5% of the pre‐implementation and new model of care patients, respectively. No significant differences were observed between outcomes. Conclusions The present study demonstrated successful implementation of weight management guidelines within routine clinical care. Following a systematic assessment of existing evidence‐practice gaps resulted in a pragmatic evidence‐based model of care that could be delivered within service capacity.
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