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.
Lectorale rede in het kader van de lectorinstallatie van dr. Harriët Jager-Wittenaar op 15 januari 2015 aan de Hanzehogeschool Groningen
Rationale: Inadequate operationalisation of the multidimensial concept of malnutrition may result in inadequate evaluation of nutritional status. In this review we aimed to assess content validity of methods used to assess malnutrition in cancer patients, according to domains directly derived from European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) definitions for malnutrition. Methods: Studies on malnutrition in adult cancer patients published between 1999 and 2013 were considered eligible. Methods to assess malnutrition were classified using 13 indicators within three domains that the malnutrition definitions of ESPEN and ASPEN have in common: A) Nutrient balance; B) Changes in body shape, body area and body composition; and C) Body function.Content validity index per method (M-CVIA-C) was calculated by averaging indicator scores weighted per domain, quantifying to what extent the methods covered the construct of malnutrition. Acceptable content validity was defined as M-CVIA-C ≥0.80.Results: 40 Different methods within 166 articles were identified. Median M-CVIA-C was 0.22 (interquartile range: 0.08-0.53). None of the methods reached M-CVIA-C=0.80. Mini Nutritional Assessment (MNA; M-CVIA-C=0.75), Nutritional Screening Questionnaire (NSQ; M-CVIA-C=0.56) and Scored Patient-Generated Subjective Global Assessment (PG-SGA; M-CVIA-C=0.53) were responsible for the top 25% of M-CVIA-C scores. Conclusion: Content validity of methods that assess malnutrition in cancer patients varies widely and is unacceptable in terms of M-CVIA-C. MNA, NSQ and PG-SGA showed highest scores in terms of content validity. Conflict of interest: None.
