This study evaluates the concurrent validity of five malnutrition screening tools to identify older hospitalized patients against the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria as limited evidence is available. The screening tools Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Mini Nutritional Assessment—Short Form (MNA-SF), and the Patient-Generated Subjective Global Assessment—Short Form (PG-SGA-SF) with cut-offs for both malnutrition (conservative) and moderate malnutrition or risk of malnutrition (liberal) were used. The concurrent validity was determined by the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the level of agreement by Cohen’s kappa. In total, 356 patients were included in the analyses (median age 70 y (IQR 63–77); 54% male). The prevalence of malnutrition according to the GLIM criteria without prior screening was 42%. The conservative cut-offs showed a low-to-moderate sensitivity (32–68%) and moderate-to-high specificity (61–98%). The PPV and NPV ranged from 59 to 94% and 67–86%, respectively. The Cohen’s kappa showed poor agreement (k = 0.21–0.59). The liberal cut-offs displayed a moderate-to-high sensitivity (66–89%) and a low-to-high specificity (46–95%). The agreement was fair to good (k = 0.33–0.75). The currently used screening tools vary in their capacity to identify hospitalized older patients with malnutrition. The screening process in the GLIM framework requires further consideration.
Review: With great interest we have read the paper “Pregnancy Screening before Diagnostic Radiography in Emergency Department; an Educational Review” by A.I. Abushouk et al. (1). We agree with the authors that unnecessary fetal radiation exposure should be avoided and that pregnancy screening can be a means to accomplish this. However, in their paper the authors suggest in several instances that radiological imaging during pregnancy can lead to teratogenic effects. In the Abstract it is stated: “Radiation exposure during pregnancy may have serious teratogenic effects to the fetus. Therefore, checking the pregnancy status before imaging women of child bearing age can protect against these effects.”, and in the Introduction: “Therefore, checking the pregnancy status before imaging women of child bearing age can protect against radiation teratogenic effects.” We strongly disagree with these statements: common radiological imaging will usually not give rise to fetal radiation doses high enough to lead to teratogenesis. The statements in the paper may lead to unnecessary worrying of pregnant women and it may discourage themfrom undergoing medically necessary radiological examinations.
In recent years, the fight against (violent) extremism has focused more on anticipating the threats that they pose. Therefore, early detection of undemocratic ideas by local professionals has become an important part of the preventive approach in counter terrorism radicalisation. Frontline workers who operate in the arteries of society are encouraged to identify processes toward violent behaviour at an early stage. To date, however, little is known about how these professionals take on this screening task at their own discretion. The analysis of 55 interviews with youth workers, municipality civil servants, and community police officers, show that they tended to be insufficiently equipped in general to detect radicalisation towards (violent) extremism at the local level in the Netherlands. Firstly, this is due to varying contents and qualities of training courses which are not suited to building up solid expertise. Secondly, and most importantly, the recognising of deviant behaviour is presumably carried out with a one-sided focus on personal norms and values rather than structured judgements about pathways towards risky behaviour. Various value systems seem to influence the norm for early detection, which means that there is, in practice, a lack of clear indicators.
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Over a million people in the Netherlands have type 2 diabetes (T2D), which is strongly related to overweight, and many more people are at-risk. A carbohydrate-rich diet and insufficient physical activity play a crucial role in these developments. It is essential to prevent T2D, because this condition is associated with a reduced quality of life, high healthcare costs and premature death due to cardiovascular diseases. The hormone insulin plays a major role in this. This hormone lowers the blood glucose concentration through uptake in body cells. If an excess of glucose is constantly offered, initially the body maintains blood glucose concentration within normal range by releasing higher concentrations of insulin into the blood, a condition that is described as “prediabetes”. In a process of several years, this compensating mechanism will eventually fail: the blood glucose concentration increases resulting in T2D. In the current healthcare practice, T2D is actually diagnosed by recognizing only elevated blood glucose concentrations, being insufficient for identification of people who have prediabetes and are at-risk to develop T2D. Although the increased insulin concentrations at normal glucose concentrations offer an opportunity for early identification/screening of people with prediabetes, there is a lack of effective and reliable methods/devices to adequately measure insulin concentrations. An integrated approach has been chosen for identification of people at-risk by using a prediabetes screening method based on insulin detection. Users and other stakeholders will be involved in the development and implementation process from the start of the project. A portable and easy-to-use demonstrator will be realised, based on rapid lateral flow tests (LFTs), which is able to measure insulin in clinically relevant samples (serum/blood) quickly and reliably. Furthermore, in collaboration with healthcare professionals, we will investigate how this screening method can be implemented in practice to contribute to a healthier lifestyle and prevent T2D.
