Nurse-friendly nutritional screening for patient benefit

Screening for undernutrition is highly important and may reduce morbidity and mortality. The Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) is a nutritional screening tool specifically developed for use by nurses. Here, we describe the translation, performance and appropriateness of the MEONF-II for the UK. Following translation from Swedish to British English, the user-friendliness and appropriateness of the British MEONF-II was tested by 29 registered nurses and final year student nurses on 266 hospital inpatients. The new British MEONF-II was perceived as highly user-friendly and appropriate. They found the MEONF-II to compare favourably to other similar tools in terms of preference, usefulness and helpfulness in providing good nutritional care. Dependency in activities and poorer subjective health were associated with a higher undernutrition risk. These findings support the appropriateness of the British MEONF-II version and suggest it may act as a user-friendly facilitator towards good nutritional nursing care

Parenting a moving target: understanding how young people’s lives are changing

How are young people’s lives changing, particularly in the digital age? Ann Hagell and John Coleman share insights from the Key Data on Adolescence report and look at changes currently impacting young people. Every two years, the Association for Young People’s Health (AYPH) publishes a compendium of publically available statistics about young people’s health, which provides a unique picture of their lives in the round. Ann is a chartered psychologist with a special interest in adolescence and research lead at the AYPH. John is the AYPH Chair, a clinical psychologist, and senior research fellow in the Department of Education at the University of Oxford

Electric Versus Manual Tooth Brushing among Neuroscience ICU Patients: Is it Safe?

Poor oral hygiene has been associated with ventilator-acquired pneumonia. Yet providing oral care for intubated patients is problematic. Furthermore, concerns that oral care could raise intracranial pressure (ICP) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses. Evidence is needed to support the safety of toothbrushing during oral care. We therefore evaluated ICP and cerebral perfusion pressure (CPP) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit (ICU). As part of a larger 2-year, prospective, randomized clinical trial, 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush. ICP and CPP were recorded before, during, and after oral care over the first 72 h of admission. Groups did not differ significantly in age, gender, or severity of injury. Of 807 ICP and CPP measurements obtained before, during, and after oral care, there were no significant differences in ICP (P = 0.72) or CPP (P = 0.68) between toothbrush methods. Analysis of pooled data from both groups revealed a significant difference across the three time points (Wilks' lambda, 12.56; P < 0.001; partial eta(2), 0.36). ICP increased significantly (mean difference, 1.7 mm Hg) from before to during oral care (P = 0.001) and decreased significantly (mean difference, 2.1 mm Hg) from during to after oral care (P < 0.001). In the absence of preexisting intracranial hypertension during oral care, tooth brushing, regardless of method, was safely performed in intubated neuroscience ICU patients

Population genetic patterns among social groups of the endangered Central American spider monkey (Ateles geoffroyi) in a human-dominated landscape

Spider monkeys (Genus: Ateles) are a widespread Neotropical primate with a highly plastic socioecological strategy. However, the Central American species, Ateles geoffroyi, was recently re-listed as endangered due to the accelerated loss of forest across the subcontinent. There is inconsistent evidence that spider monkey populations could persist when actively protected, but their long-term viability in unprotected, human-dominated landscapes is not known. We analyzed noninvasive genetic samples from 185 individuals in 14 putative social groups on the Rivas Isthmus in southwestern Nicaragua. We found evidence of weak but significant genetic structure in the mitochondrial control region and in eight nuclear microsatellite loci plus negative spatial autocorrelation in Fst and kinship. The overall pattern suggests strong localized mating and at least historical female-biased dispersal, as is expected for this species. Heterozygosity was significantly lower than expected under random mating and lower than that found in other spider monkey populations, possibly reflecting a recent decline in genetic diversity and a threat from inbreeding. We conclude that despite a long history of human disturbance on this landscape, spider monkeys were until recently successful at maintaining gene flow. We consider the recent decline to be further indication of accelerated anthropogenic disturbance, but also of an opportunity to conserve native biodiversity. Spider monkeys are one of many wildlife species in Central America that is threatened by land cover change, and an apt example of how landscape-scale conservation planning could be used to ensure long-term persistence

Engaging young people in NHS service delivery and development : A scoping review of the evidence

Commissioned by the NHS England, alongside a survey and interviews with NHS staff, this review found that while there is widespread support for youth participation in the development and delivery of healthcare services, it is not very clear what is actually being undertaken in practice within the NHS, or what the evidence is for good practice. We do have a fairly extensive literature on models of participation more generally that can be usefully applied to this context, and a developing sense of the categories of engagement that are being employed in developing and monitoring health services for young people. However, this scoping review concluded that, in terms of good practice and what works, there is much less evidence available, and we know very little about how engagement ‘works’ for the young people involved. What does exist in the research literature suggests that much of what is going on is piecemeal, short lived, or lacking clear aims and outcomes. While there may be a fair amount of consulting and informing taking place, truly empowering models of participation are rarely documented. There is clearly a need for more evidencing, both in terms of a description of what is undertaken, but also analysis of impact. Finding ways to improve the evidence base is now critical if participation is going to have the transformative impact on the system that it has the potential to achieve

Engaging young people in NHS service delivery and development : Recommendations from a scoping review and research project

Young people need to be involved at all levels of our healthcare system, from shaping the care they are receiving at the front line right up to co-designing and inputting to strategic change. What we mean by health services in this context is any NHS funded or branded service that manages the health and wellbeing of young people (10-25 year olds), ranging from primary care, through secondary and tertiary services, and including community services, mental health services, and allied health professional services such as physiotherapy and occupational health. NHS England is committed to working in partnership with young people but this requires planning, resources and guidance. There is high level policy support for this, and anecdotal accounts of good work going on in practice on the ground. However, despite high levels of commitment to working together with young people and representing their voice in policy and planning, our understanding of what is actually happening on the ground within the system is somewhat lacking. NHSE’s children and young peoples’ transformation team commissioned the authors to map the territory and provide an understanding of what we do and do not know about best practice in this area. As a result of an evidence scope and our own research into what is happening in the system, we concluded that very limited progress had been made in developing this workstream in recent years. Echoing other reports dating back two decades, our conclusions were that we need better accounts of what is going on, more resources dedicated to these kinds of activities, and some serious investment in evaluating impact. These conclusions do not need repeating and provide us with nothing new. What we need now is action to improve the evidence base. This document, linked to reports on the associated research and scoping review lists recommendations for taking forward work in this area

Psychometric properties of a Swedish version of the Pearlin Mastery Scale in people with mental illness and healthy people.

Background: Mastery refers to the degree to which people perceive that they can control factors that influence their life situation, and has been found important for people's quality of life and well-being. It is thus essential to be able to measure mastery in a valid and reliable way. Aim: This study aimed at using the Rasch measurement model to investigate the psychometric properties of a Swedish version of the Pearlin Mastery Scale (Mastery-S). Methods: A sample of 300 healthy individuals and 278 persons with mental illness responded to the Mastery-S. Item responses were Rasch analysed regarding model fit, response category functioning, differential item functioning (DIF) and targeting, using the partial credit model. Results: The Mastery-S items represented a logical continuum of the measured construct but one item displayed misfit. Reliability (Person Separation Index) was 0.7. The response categories did not work as expected in three items, which could be corrected for by collapsing categories. Three items displayed DIF between the two subsamples, which caused a bias when comparing mastery levels between subsamples, suggesting the Mastery-S is not truly generic. Conclusions: The Mastery-S may be used to obtain valid and reliable data, but some precautions should be made. If used to compare groups, new analyses of DIF should first be made. Users of the scale should also consider exempting item 6 from the scale and analyse it as a separate item. Finally, rewording of response categories should be considered in order to make them more distinct and thereby improve score reliability

Engaging young people in NHS service delivery and development : Results from a sector survey and interviews

Despite considerable and growing support for public and patient participation with young people in the development and delivery of health services, what is actually being done in practice across the country is not widely known or shared. In order to present an overview of current practice we undertook a scoping exercise, including a survey and interviews. The overall picture was positive, in that there is clear ambition and commitment to broadening the participation of young people in health services design and delivery, and many examples of work ongoing. There is consensus on the essential building blocks, and the challenges and barriers. However, the work is sketchy, patchy, and happening in silos. The extent to which individual attempts are successful, enduring and meaningful varies hugely and many fail for lack of resources and staff capacity or skills. The work is often under recognised and under resourced. There is clearly room for guidance across the health system to help people decide what kind of participation work is feasible and appropriate for them, and to provide some pointers to good practice

Validity and user-friendliness of the minimal eating observation and nutrition form – version II (MEONF – II) for undernutrition risk screening

Objective: To analyze the criterion-related validity and user-friendliness of the Minimal Eating Observation and Nutrition Form &#x2013; Version II (MEONF &#x2013; II) and Malnutrition Universal Screening Tool (MUST) in relation to the Mini Nutritional Assessment (MNA). In addition, the effect of substituting body mass index (BMI) with calf circumference (CC) was explored for the MEONF-II. Methods: The study included 100 patients who were assessed for nutritional status with the MNA (full version), considered here to be the gold standard, and screened with the MUST and the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, BMI (or calf circumference), eating difficulties, and presence of clinical signs of undernutrition. Results: The MEONF-II sensitivity (0.73) and specificity (0.88) were acceptable. Sensitivity and specificity for the MUST were 0.57 and 0.93, respectively. Replacing the BMI with CC in the MEONF-II gave similar results (sensitivity 0.68, specificity 0.90). Assessors considered MEONF-II instructions and items to be relevant, easy to understand and complete (100%), and the questions to be relevant (98%). MEONF-II and MUST took 8.8 and 4.7 minutes to complete, respectively, and both were considered relevant and easy to finish. In addition, MEONF-II was thought to reveal problems that allows for nursing interventions. Conclusions: The MEONF-II is an easy to use, relatively quick, and sensitive screening tool to assess risk of undernutrition among hospital inpatients, which allows for substituting BMI with CC in situations where measures of patient height and weight cannot be easily obtained. High sensitivity is of primary concern in nutritional screening and the MEONF-II outperforms the MUST in this regard

Cut-off scores for the Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) among hospital inpatients

The newly developed Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) has shown promising sensitivity and specificity in relation to the Mini Nutritional Assessment (MNA). However, the suggested MEONF-II cut-off scores for deciding low/moderate and high risk for undernutrition (UN) (>2 and >4, respectively) have not been decided based on statistical criteria but on clinical reasoning. The objective of this study was to identify the optimal cut-off scores for the MEONF-II in relation to the well-established MNA based on statistical criteria.Cross-sectional study.The study included 187 patients (mean age, 77.5 years) assessed for nutritional status with the MNA (full version), and screened with the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, Body Mass Index (BMI) (or calf circumference), eating difficulties, and presence of clinical signs ofUN. MEONF-II data were analysed by Receiver Operating Characteristics (ROC) curves and the area under the curve (AUC); optimal cut-offs were identified by the Youden index (J=sensitivity + specificity–1).According to the MEONF-II, 41% were at moderate or high UN risk and according to the MNA, 50% were at risk or already undernourished. The suggested cut-off scores were supported by the Youden indices. The lower cut-off for MEONF-II, used to identify any level of risk for UN (>2; J=0.52) gave an overall accuracy of 76% and the AUC was 80%. The higher cut-off for identifying those with high risk for UN (>4; J=0.33) had an accuracy of 63% and the AUC was 70%.The suggested MEONF-II cut-off scores were statistically supported. This improves the confidence of its clinical use