RESUMO
BACKGROUND: In Brazil hospital malnutrition is highly prevalent, physician awareness of malnutrition is low, and nutrition therapy is underprescribed. One alternative to approach this problem is to educate health care providers in clinical nutrition. The present study aims to evaluate the effect of an intensive education course given to health care professionals and students on the diagnosis ability concerning to hospital malnutrition. MATERIALS AND METHODS: An intervention study, based on a clinical nutrition educational program, offered to medical and nursing students and professionals, was held in a hospital of the Amazon region. Participants were evaluated through improvement of diagnostic ability, according to agreement of malnutrition diagnosis using Subjective Global Assessment before and after the workshop, as compared to independent evaluations (Kappa Index, k). To evaluate the impact of the educational intervention on the hospital malnutrition diagnosis, medical records were reviewed for documentation of parameters associated with nutritional status of in-patients. The SPSS statistical software package was used for data analysis. RESULTS: A total of 165 participants concluded the program. The majority (76.4%) were medical and nursing students. Malnutrition diagnosis improved after the course (before k = 0.5; after k = 0.64; p < 0.05). A reduction of false negatives from 50% to 33.3% was observed. During the course, concern of nutritional diagnosis was increased (chi2 = 17.57; p < 0.001) and even after the course, improvement on the height measurement was detected (chi2 = 12.87; p < 0.001). CONCLUSIONS: Clinical nutrition education improved the ability of diagnosing malnutrition; however the primary impact was on medical and nursing students. To sustain diagnostic capacity a clinical nutrition program should be part of health professional curricula and be coupled with continuing education for health care providers.
Assuntos
Pacientes Internados , Desnutrição/diagnóstico , Desnutrição/terapia , Avaliação Nutricional , Ciências da Nutrição/educação , Brasil , Distribuição de Qui-Quadrado , Estudos Transversais , Interpretação Estatística de Dados , Humanos , Tempo de Internação , Prontuários Médicos , Estado Nutricional , Recursos Humanos em Hospital , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Redução de PesoRESUMO
UNLABELLED: Changes in nutritional status are important in clinical practice because they relate to an increase in morbidity and mortality. Studies about nutritional problems in hospitalized adults have been reported since the 1970s. The prevalence of malnutrition has varied from 10 to 70%, depending on the diagnostic criteria used. The hospital studied and the duration of admission. AIM: To assess, in the first day of hospital stay, the nutritional status of adults admitted to undergo elective surgery in a public hospital of the State of Acre, Amazon Region, Brazil. STUDY DESIGN: Sectional study from April 7 to May 22, 2002. PATIENTS AND METHODS: 155 consecutive nutritional evaluations were performed using several parameters-global subjective assessment (GSA), anthropometric measurement and some laboratory tests. For the diagnosis of malnutrition the Index Suggestive of Malnutrition (ISM), as proposed by Waitzberg, was adopted. In the evaluation of obesity the BMI (Body Mass Index), with cutoffs suggested by WHO was used. RESULTS: 75.2% were women. Average age was 34.4 +/- 10.1 years. Mulatto (63.1%) was the prevailing racial group. Gynecological (43.6%) was the most frequent surgery. ISM disclosed a 12.1% prevalence of malnutrition. BMI classified 2.0% of the patients as grade I overweight and 15.4% as being obese. Among 76 patients classified as normal by BMI, 15 (19.7%) were considered malnourished by ISM criteria. Concordance between ISM and BMI was weak (k = 0.07). GSA classified 100% of the cases as well nourished. CONCLUSION: Lack of a golden standard to make the diagnosis of changes in nutritional status has been one of the determinants of the wide variations observed in the pertinent literature and it has hindered valid comparisons. The present study suggests that BMI should be used as an indicator of proportion and not of nutritional status. GSA underestimates the diagnosis of malnutrition. This paper concludes that establishing uniform standards for diagnostic criteria for malnutrition is urgently required and suggests preferring IMS (Index Suggestive of Malnutrition) because of its easy use, low coast and high sensitivity.