Diagnostic Accuracy of the Malnutrition Screening Tool (MST) in Adult Cancer Patients: a Systematic Literature Review and Meta-Analysis

Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.

Nutrition Screening and Referrals in Two Rural Australian Oncology Clinics

Malnutrition is common, and is a significant contributing factor to morbidity and mortality in the oncology setting. Previous research suggests that dietetic services in rural oncology clinics need to be well organized, timely and flexible with routine screening processes. In the absence of routine nutrition screening, it is hypothesized that oncology patients are only referred to dietetic services when malnutrition is overt or advanced. The aim of this study was to describe and compare dietetic services in two rural Australian oncology clinics and investigate nutrition screening and referral practices to determine if oncology patients at nutritional risk were appropriately referred. A retrospective file audit of medical and treatment records was conducted for a sample of oncology patients to determine the proportion of patients at risk of malnutrition by using the Malnutrition Screening Tool retrospectively. Dietetic treatment statistics and key stakeholders were consulted to compare dietetic service provision across the two sites. Seventy-eight percent of patients (n = 129) were retrospectively determined to be at nutritional risk during the study period, however, only 66% of these patients were referred to a dietitian. Dietetic treatment statistics varied across the two sites ranging from 26 to 62 treated patients, an average of 2.4 to 4.5 dietetic interventions per patient and an average difference in patient intervention time of 62 minutes during the 12-month study period. This study confirmed findings from previous research, highlighting that without routine nutrition screening in oncology, at least one third of patients at nutritional risk were failing to be identified and referred to dietetic services for appropriate treatment. Routine nutrition screening should be implemented to standardise and prioritise dietetic service provision, and oncology specific funding should be allocated to the dietetic service to ensure that staffing is adequate to provide a timely service.

Focus on Undernutrition in Care Homes： A Retrospective Service Evaluation

“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.