EAL

UWL: Screening and Assessment Methods (2009)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

Study questions were:

Among hospitalized geriatric patients, what percent are classified the same way by hospital screening and the National Screening Initiative instruments DETERMINE Your Nutritional Risk and Level I Screen?
Among those who are at nutritional risk, how many perceive themselves to be at nutritional risk?
How do older adults identified as at nutritional risk think they could be assisted in improving their nutritional status?

Inclusion Criteria:

Age 65 and older
Identified as at nutritional risk by a hospital staff dietitian
Cognitive status: Able to communicate and remember recent dietary intake, a subjective decision made by the screening dietitian
Community-dwelling.

Exclusion Criteria:

None specified.

Description of Study Protocol:

Recruitment

The dietitian in the geriatric unit screened all patients on admission and asked those with adequate cognition to participate if they would consent to be referred to the researcher.

Design

Cross-sectional, descriptive study consisting of an interview using two nutrition screening instruments followed by probing questions to explore personal perceptions, attitudes and knowledge of nutritional health.

Statistical Analysis

Frequencies were tabulated and a naturalistic qualitative evaluation of interview transcripts.

Data Collection Summary:

Timing of Measurements

The pilot study was conducted during a two-month period. All interviews were conducted within 48 hours of admission, and lasted from 10 to 30 minutes in length.

Dependent Variables

Nutritional risk
Patients' own perceptions of nutritional health.

Independent Variables

Two Nutrition Screening Initiative tools: The DETERMINE Your Nutritional Health Checklist and the Level I Screen.

Description of Actual Data Sample:

Initial N: 10 subjects (six females, four males)
Attrition (final N): 10 subjects
Age: Mean 74±6.6 years
Ethnicity: White
Other relevant demographics: 50% lived with a spouse, 30% lived alone, 10% lived with a child and 10% lived with a non-relative roommate
Anthropometrics: BMI ranged from 24 to 38
Location: Tertiary care academic medical center in Madison, WI.

Summary of Results:

Other Findings

Scores on the DETERMINE checklist were five to 10 of 21, thus all individuals were at nutrition risk according to this measure
None of the patients acknowledged that they were at risk, rating their nutrition health as fair (one person) or good (nine persons)
While several participants mentioned measures to improve their nutritional health, none actually consumed recommended amounts of vegetables; dairy; or breads, grains, and cereals. Only four took adequate milk or dairy.
Risk factors in the entire sample were presence of an illness that affected the kind or amount of food eaten and regularly taking three or more medications.

Author Conclusion:

Intervention and education needs to be tailored to the perceptions of targeted individuals.

Funding Source:

Government:

National Institute for Nursing Research Predoctoral Traineeship in Patient Centered Informational Interventions (NR 07102)

Reviewer Comments:

Authors note the following limitations:

Small sample size of 10 individuals
Use of self-report for height
The DETERMINE checklist has not been shown to be a valid indicator of nutritional risk.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	N/A
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	???
	2.2.	Were criteria applied equally to all study groups?	???
	2.3.	Were health, demographics, and other characteristics of subjects described?	???
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		N/A
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	N/A
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	???
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	???
	7.7.	Were the measurements conducted consistently across groups?	N/A
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	N/A
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	N/A
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes