Bij de richtlijn horen 1) een wetenschappelijke onderbouwing en 2) een samenvattingskaart. Deze richtlijn beoogt ggz-professionals - in het bijzonder verpleegkundigen - te ondersteunen bij de somatische screening op gezondheidsproblemen bij mensen met een ernstige psychische aandoening, en ondersteuning te bieden bij de planning en uitvoering van vervolgactiviteiten voor preventie en tijdige diagnostiek en behandeling van somatische problemen. Gerichte leefstijlinterventies kunnen risicofactoren voor bepaalde somatische aandoeningen gunstig beïnvloeden. De richtlijn richt zich op volwassen patiënten (18-65 jaar) met een ernstige psychische aandoening of een verhoogd risico. De aanbevelingen zijn ook toepasbaar voor de POH-ggz. Medeauteurs: Marieke van Piere, Maarten Bak, Merlijn Bakkenes, Digna van der Kellen, Sonja van Hamersveld, Ronald van Gool, Katie Dermout, Titia Feldmann, Anneriek Risseeuw, Anneke Wijtsma-van der Kolk, Ingrid van Vuuren, Matthijs Rümke, Evelyn Sloots-Jongen, Paul de Heij, Richard Starmans, Cilia Daatselaar, Christine van Veen en Marleen Hermens (Werkgroep Richtlijnontwikkeling Algemene somatische screening & Leefstijl)
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Aims and objectives: To examine the predictive properties of the brief Dutch National Safety Management Program for the screening of frail hospitalised older patients (VMS) and to compare these with the more extensive Maastricht Frailty Screening Tool for Hospitalised Patients (MFST-HP). Background: Screening of older patients during admission may help to detect frailty and underlying geriatric conditions. The VMS screening assesses patients on four domains (i.e. functional decline, delirium risk, fall risk and nutrition). The 15-item MFST-HP assesses patients on three domains of frailty (physical, social and psychological). Design: Retrospective cohort study. Methods: Data of 2,573 hospitalised patients (70+) admitted in 2013 were included, and relative risks, sensitivity and specificity and area under the receiver operating characteristic (AUC) curve of the two tools were calculated for discharge destination, readmissions and mortality. The data were derived from the patients nursing files. A STARD checklist was completed. Results: Different proportions of frail patients were identified by means of both tools: 1,369 (53.2%) based on the VMS and 414 (16.1%) based on the MFST-HP. The specificity was low for the VMS, and the sensitivity was low for the MFST-HP. The overall AUC for the VMS varied from 0.50 to 0.76 and from 0.49 to 0.69 for the MFST-HP. Conclusion: The predictive properties of the VMS and the more extended MFST-HP on the screening of frailty among older hospitalised patients are poor to moderate and not very promising. Relevance to clinical practice: The VMS labels a high proportion of older patients as potentially frail, while the MFST-HP labels over 80% as nonfrail. An extended tool did not increase the predictive ability of the VMS. However, information derived from the individual items of the screening tools may help nurses in daily practice to intervene on potential geriatric risks such as delirium risk or fall risk.
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Voor u ligt de wetenschappelijke onderbouwing van de Richtlijn Somatische screening bij patiënten met een ernstige psychische aandoening (2015). Het doel van deze richtlijn is om met name verpleegkundigen te ondersteunen bij de algemene somatische screening van patiënten in de ggz met een ernstige psychische aandoening (EPA) en de te ondernemen vervolgactiviteiten. Somatische screening is zowel klinisch als maatschappelijk zeer relevant, omdat de gezondheidsproblemen van deze patiënten groot zijn en het zorgaanbod er maar beperkt op aansluit. De richtlijn is ontwikkeld voor beroepsgroepen die zorg verlenen aan mensen met een ernstige psychische aandoening: verpleegkundigen, verpleegkundig specialisten, sociaal-psychiatrisch verpleegkundigen (SPV’en), consultatief-psychiatrisch verpleegkundigen, psychologen, psychiaters, klinisch geriaters, artsen somatisch werkzaam in de ggz, internisten in de ggz, huisartsen, POH-ggz, physician assistants in de ggz, psychomotorisch therapeuten, fysiotherapeuten, diëtisten, sociotherapeuten, ergotherapeuten en ggz-agogen. Dit rapport biedt achtergrondinformatie voor alle zorgprofessionals, zorgmanagers, kwaliteitsmedewerkers en alle anderen die betrokken zijn bij de algemene somatische zorg voor mensen met een ernstige psychische aandoening en die meer willen weten over de totstandkoming van deze richtlijn. In deze onderbouwing is beschikbare wetenschappelijke kennis samengevat en wordt aangegeven welke overige overwegingen, onder meer vanuit praktijkkennis en voorkeuren vanuit patiënten- en familieperspectief, van belang waren bij het formuleren van de richtlijnaanbevelingen. Deze richtlijn is gebaseerd op wetenschappelijke evidentie, grijze literatuur, de praktijkkennis van professionals en voorkeuren vanuit patiënten- en familieperspectief. Het ontwikkeltraject bestond uit een knelpuntanalyse, een systematische inventarisatie van bestaande richtlijnen, een veldinventarisatie van beschikbare interventies, een transparant literatuuronderzoek, diverse commentaarrondes onder de werkgroep- en klankbordgroepleden en een praktijktoets. Bij de richtlijn werden een indicatorenset en een stroomschema ontwikkeld. De indicatoren worden beschreven in dit rapport. De richtlijn zelf is apart uitgegeven (Meeuwissen et al., 2015a).
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PURPOSE OF REVIEW: With the shifts in society, healthcare and the profile of the malnourished individual, a re-consideration of the goal of nutritional risk screening is needed: screening for malnutrition, or screening for risk of malnutrition? In this review article, we reflect on the role of nutritional risk screening in relation to prevention and treatment of malnutrition.RECENT FINDINGS: Within the Global Leadership Initiative on Malnutrition (GLIM) Initiative, modified Delphi studies are currently being conducted to reach global consensus on the conceptual definition and operationalization of 'risk of malnutrition'. This is necessary because various studies have demonstrated that different nutritional screening tools identify different individuals, due to variability in screening tool criteria, which influences GLIM outcomes. Upon screening, three different situations can be distinguished: having risk factors for malnutrition without clear signs of presence of malnutrition, having mild signs of malnutrition (malnutrition in progress), or having obvious signs of malnutrition.SUMMARY: The outcomes of the studies on 'risk of malnutrition' will guide the screening step within the GLIM process, and will help professionals to make informed choices regarding screening policy and screening tool(s).
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Screening for psychological distress in patients with cancer is currently being debated in the British Journal of Cancer. Screening has been recommended, as elevated levels of distress have been consistently observed and clinicians tend to overlook the need of psychological support (Carlson et al, 2012; Carlson et al, 2013; National Comprehensive Cancer Network, 2013). On the other hand, it has been argued that screening should not be implemented, as the true benefit of screening and subsequent treatment of psychological distress is far from being definitively proven (Coyne, 2013). Recent findings on human resilience in the face of potentially traumatic events (PTEs) provide a new perspective on detecting and treating psychological distress in patients with cancer. Humans show strong resilience in the face of potentially traumatic events, such as cancer diagnosis and treatment (Bonanno et al, 2011). This observation leads us to propose two alternative approaches towards detecting and treating psychological distress in patients with cancer: ‘screening for psychological distress’ and ‘supporting resilience and case finding’.
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In recent years, there has been an exponential increase in the use of health and sports-related smartphone applications (apps). This is also reflected in App-stores, which are stacked with thousands of health- and sports-apps, with new apps launched each day. These apps have great potential to monitor and support people’s physical activity and health. For users, however, it is difficult to know which app suits their needs. In this paper, we present an online tool that supports the decision-making process for choosing an appropriate app. We constructed and validated a screening instrument to assess app content quality, together with the assessment of users’ needs. Both served as input for building the tool through various iterations with prototypes and user tests. This resulted in an online tool which relies on app content quality scores to match the users’ needs with apps that score high in the screening instrument on those particular needs. Users can add new apps to the database via the screening instrument, making the tool self-supportive and future proof. A feedback loop allows users to give feedback on the recommended app and how well it meets their needs. This feedback is added to the database and used in future filtering and recommendations. The principles used can be applied to other areas of sports, physical activity and health to help users to select an app that suits their needs. Potentially increasing the long-term use of apps to monitor and to support physical activity and health.
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Background and aims: Malnutrition screening is a first step in the nutrition care process for hospitalized patients, to identify those at risk of malnutrition and associated worse outcome, preceding further assessment and intervention. Frequently used malnutrition screening tools including the Malnutrition Universal Screening Tool (MUST) mainly screen for characteristics of malnutrition, while the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) additionally includes risk factors for development of malnutrition, yielding a higher percentage of patients at risk. To investigate whether this translates into higher risk of worse outcome, we aimed to determine the predictive validity of MUST and PG-SGA SF for prolonged hospitalization >8 days, readmission, and mortality <6 months after hospital discharge.Methods: In this observational study, MUST was performed according to university hospital protocol. Additional screening using PG-SGA SF was performed within 24 h of hospital admission (high risk: MUST ≥ 2, PG_SGA SF ≥ 9). Associations of MUST and PG-SGA SF with outcomes were analyzed by logistic- and Cox PH-regression.Results: Of 430 patients analyzed (age 58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), MUST and PG-SGA SF identified 32 and 80 at high risk, respectively. One-hundred-eight patients had prolonged hospitalization, 109 were readmitted and 20 died. High risk by MUST was associated with mortality (HR = 3.9; 95% CI 1.3–12.2, P = 0.02), but not with other endpoints. High risk by PG-SGA SF was associated with prolonged hospitalization (OR = 2.5; 95% CI 1.3–5.0, P = 0.009), readmission (HR = 1.9; 95% CI 1.1–3.2, P = 0.03), and mortality (HR = 34.8; 95% CI 4.2–289.3, P = 0.001), independent of age, sex, hospital ward and previous hospitalization <6 months. In the 363/430 patients classified as low risk by MUST, high risk by PG-SGA SF was independently associated with higher risk of readmission (HR = 1.9; 95% CI 1.0–3.5, P = 0.04) and mortality (HR = 19.5; 95% CI 2.0–189.4, P = 0.01).Conclusions: Whereas high malnutrition risk by MUST was only associated with mortality, PG-SGA SF was associated with higher risk of prolonged hospitalization, readmission, and mortality. In patients considered as low risk by MUST, high malnutrition risk by PG-SGA SF was also predictive of worse outcome. Our findings support the use of PG-SGA SF in routine care to identify patients at risk of malnutrition and worse outcome, and enable proactive interventions.
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Twenty years ago, ESPEN published its “Guidelines for nutritional screening 2002”, with the note that these guidelines were based on the evidence available until 2002, and that they needed to be updated and adapted to current state of knowledge in the future. Twenty years have passed, and tremendous progress has been made in the field of malnutrition risk screening. Many screening tools have been developed and validated for different patient groups and different health care settings. Some countries even have introduced mandatory screening for malnutrition at admission to hospital. Yet, changes in society and healthcare require a reflection on current practice and policies regarding malnutrition risk screening. In this opinion paper, we share our perspectives on malnutrition risk screening in the twenty-twenties, addressing the changing and varying profile of the malnourished individual, the goals of screening and screening tools (i.e., preventive or reactive), the construct of malnutrition risk (i.e., screening for risk factors or screening for existing malnutrition), and screening alongside a patient's journey.
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Abstract Background One of the most problematic expression of ageing is frailty, and an approach based on its early identification is mandatory. The Sunfrail-tool (ST), a 9-item questionnaire, is a promising instrument for screening frailty. Aims • To assess the diagnostic accuracy and the construct validity between the ST and a Comprehensive Geriatric Assessment (CGA), composed by six tests representative of the bio-psycho-social model of frailty; • To verify the discriminating power of five key-questions of the ST; • To investigate the role of the ST in a clinical-pathway of falls’ prevention. Methods In this retrospective study, we enrolled 235 patients from the Frailty-Multimorbidity Lab of the University-Hospital of Parma. The STs’ answers were obtained from the patient’s clinical information. A patient was considered frail if at least one of the CGAs’ tests resulted positive. Results The ST was associated with the CGA’s judgement with an Area Under the Curve of 0.691 (CI 95%: 0.591–0.791). Each CGA’s test was associated with the ST total score. The five key-question showed a potential discriminating power in the CGA’s tests of the corresponding domains. The fall-related question of the ST was significantly associated with the Short Physical Performance Battery total score (OR: 0.839, CI 95%: 0.766–0.918), a proxy of the risk of falling. Discussion The results suggest that the ST can capture the complexity of frailty. The ST showed a good discriminating power, and it can guide a second-level assessment to key frailty domains and/or clinical pathways. Conclusions The ST is a valid and easy-to-use instrument for the screening of frailty.
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Background: Dysphagia is potentially life‐threatening and highly prevalent in people with severe/profound intellectual and multiple disabilities (SPIMD). The “Signaleringslijst Verslikken” (SV) is a frequently used Dutch screening tool to detect dysphagia. The aim was to examine the convergent validity of the SV for people with SPIMD. Method: Direct support staff completed the SV, with speech and language therapists scoring a validated tool, the Dysphagia Disorders Survey (DDS), for 41 persons with SPIMD, aged ≥50 years. The results were compared for agreement using the McNemar's Test. Results: The proportion of agreement was 0.59 (95% CI 0.43–0.72). The SV did not detect dysphagia in 17 participants (44%) who were assessed as having dysphagia according to the DDS. The difference in proportion of detection of dysphagia between the two methods was significant (p < 0.0001). Conclusions: The results suggest that the convergent validity of the SV is insufficient: the SV is not sensitive for detecting dysphagia in people with SPIMD.
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