Documentation of anthropometrics in people with cancer: a cross-site collaboration audit in four hospital settings in the UK

Background: Malnutrition is a significant risk for patients during cancer treatment. Neglecting to monitor or provide timely dietetic support can result in lower tolerance to treatments and reduced quality of life. This audit aimed to assess the completeness and accuracy of the documentation of anthropometric measurements in medical records and dietetic referral practices across four day-treatment units (DTUs) in England. Methodology: Data were collected from electronic patient records of 100 patients in each DTU attending for systemic anti-cancer treatment (SACT) over a 2-week period. Data collected included patients’ demographics, anthropometric data, referrals to dietitians, and whether the patients referred had a MUST score ≥ 2, which was calculated by the authors. Results: Findings revealed that weights and heights were documented for 58–85% and 94–98% of patients attending DTUs, respectively. On average, 55% (range of 7–85%) of patients had their body mass index (BMI) documented on the day of SACT. The Malnutrition Universal Screening Tool (MUST) was rarely completed (≤ 3% in each centre). Dietetic referral practices varied across centres. Conclusions: Findings highlight the need to improve anthropometric documentation practices in cancer centres, in order to allow better monitoring of malnutrition risk and early nutritional support interventions when needed

Documentation of anthropometrics in people with cancer : a cross-site collaboration audit in four hospital settings in the UK

Background. Malnutrition is a significant risk for patients during cancer treatment. Neglecting to monitor or provide timely dietetic support can result in lower tolerance to treatments and reduced quality of life. This audit aimed to assess the completeness and accuracy of the documentation of anthropometric measurements in medical records and dietetic referral practices across four day-treatment units (DTUs) in England. Methodology. Data were collected from electronic patient records of 100 patients in each DTU attending for systemic anti-cancer treatment (SACT) over a 2-week period. Data collected included patients’ demographics, anthropometric data, referrals to dietitians, and whether the patients referred had a MUST score ≥ 2, which was calculated by the authors. Results. Findings revealed that weights and heights were documented for 58–85% and 94–98% of patients attending DTUs, respectively. On average, 55% (range of 7–85%) of patients had their body mass index (BMI) documented on the day of SACT. The Malnutrition Universal Screening Tool (MUST) was rarely completed (≤ 3% in each centre). Dietetic referral practices varied across centres. Conclusions. Findings highlight the need to improve anthropometric documentation practices in cancer centres, in order to allow better monitoring of malnutrition risk and early nutritional support interventions when needed

Case report on a multidisciplinary approach to address malnutrition and improve a patient’s fitness for treatment

Approximately 5,700 people are diagnosed with myeloma each year in the UK. The standard of care is to receive an autologous stem cell transplant after completion of induction therapy. There are no specific dietary recommendations for people with myeloma, however they are at risk of malnutrition due to symptoms and side effects of treatments. This report describes the journey of a 73-year-old male diagnosed with immunoglobulin A (IgA) lambda myeloma in April 2021. The patient lost 23% of his body weight during 6 months of systemic anti-cancer treatment (SACT), resulting in postponing his transplant twice due to reduced fitness. This report describes an effective, although late, multidisciplinary intervention which was successful for the patient who managed to reestablish a healthy weight and good quality of life. The patient received his transplant in January 2023. This case highlights two important aspects of patient care that should not be underestimated in dietetic clinical practice: early screening and multidisciplinary collaboration. Monitoring the nutritional status of patients and providing early nutrition support can prevent hospital admissions, treatment delays and reduce the associated costs. Multidisciplinary teamwork can improve patient care and clinical outcomes, and it is fundamental to strengthen communication and collaboration among clinical disciplines

Multiresponsive Star-Graft Quarterpolymer Monolayers

Multifunctional star-graft quarterpolymers PS_<i>n</i>[P2VP-<i>b</i>-(PAA-<i>g</i>-PNIPAM)]_<i>n</i> with two different arm types, shorter PS arms and longer P2VP-<i>b</i>-PAA block copolymer arms with grafted PNIPAM chains, were studied in terms of their ability to form micellar structures at the air/water and air/solid interfaces. Because of the pH-dependent ionization of P2VP and PAA blocks, as well as thermoresponsiveness of PNIPAM chains, these multifunctional stars have multiple responsive properties to pH, temperature, and ionic strength. We observed that the molecular surface area of the stars is the largest at basic pH, when the PAA blocks are strongly charged and extended, and PNIPAM chains are spread at the interface. At acidic conditions, the molecular surface area is the smallest because the P2VP blocks submerge into the water subphase and the PAA blocks are contracted and form hydrogen bonding with grafted PNIPAM chains. The molecular surface area of the stars at the air/water interface gradually increases at elevated temperature. We suggest that the transition across lower critical solution temperature (LCST) results in the emerging of PNIPAM chains from the water subphase to the interface due to the hydrophilic to hydrophobic transition. Moreover, at higher surface pressure, the stars tend to form intermolecular micellar aggregates above LCST. The graft density of PNIPAM chains as well as the arm number was also found to have strong effects on the thermo- and pH-response. Overall, this study demonstrates that the star block copolymer conformation and aggregation are strongly dependent on the intramolecular interactions between different blocks and spatial distribution of the arms, which can be controlled by the external conditions, including pH, temperature, ionic strength, and surface pressure

Right Ventricular and Right Atrial Strain Are Associated with Kidney Dysfunction in Acute Heart Failure

Background: In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF. Methods and Results: A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR 2 were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR ≥ 45 mL/min/1.73 m2. Patients with lower eGFR had lower cardiac output, higher mean E/e’ ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not. Conclusions: Impaired RV and RA longitudinal strain were independently associated with eGFR 2 in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output