Definição de protocolo para triagem nutricional: estratégia no cuidado do paciente com Esclerose Lateral Amiotrófica (ELA)
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2019-08-30
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Universidade Federal de Goiás
Resumo
The quality of health care is a major factor for patient safety and a major challenge for the multiprofessional team in health services. The importance of institutional changes in the service provided and the incorporation of the educational process in the learning environment is fundamental for solving existing daily problems. Among the various problems that affect the patient with ALS, malnutrition stands out. The health care team should be aware of its onset as early as possible. Thus, it is necessary to identify a better nutritional screening method to predict the nutritional risk of these patients. The aim of the study was to compare two nutritional screening instruments for predictive capacity of malnutrition and functional capacity in ALS patients, aiming at a better performance of the multidisciplinary team of an outpatient rehabilitation service. Cross-sectional study, carried out at the outpatient clinic of a referral center for rehabilitation and readaptation of Goiás, from February to June 2018, with a total sample of 57 patients with ALS. Sociodemographic, economic, weight, height, triceps skinfolds, arm circumference, 24-hour recall in three days were collected. Handgrip strength, bioimpedance and albumin, hemoglobin and lymphocytes were also collected. Two methods of nutritional screening were applied: Nutritional Risk Screening (NRS 2002) and Universal Malnutrition Screening Tool (MUST). The Global Subjective Assessment (SGA) was considered the reference method to evaluate the performance of other nutritional assessment techniques. The comparison between the methods was performed by the Kappa test. Sensitivity and specificity analysis was performed using Receiver Operating Characteristics (ROC) curves. Of the total sample, most were female (57.89%), with more than eight years of schooling (70.18%), white (68.42%), socioeconomic status with class A and B (57 90 %). The type of non-bulbar ALS was the most prevalent (73.68%). 68.42% of the patients were on an oral diet and walked (56.14%). The prevalence of malnutrition, according to the Body Mass Index (BMI), was higher in females (39.39%). Most patients had low functional capacity (70.18%), assessed by handgrip strength and low cell integrity (82.45%), assessed by phase angle. The nutritional risk was present in 54.39% and 64.91% of the patients, according to the NRS and MUST classifications, respectively. The frequency of malnutrition according to SGA was present in 36.84% of patients. There was good agreement between NRS and ASG (kappa = 0.409) in females and between MUST and ASG moderate agreement (kappa = 0.440) in males. NRS and MUST had high sensitivity (85.71% and 90.48%, respectively) to identify nutritional risk, but specificity was reasonable for NRS (63.89%) and weak for MUST (50%). It is concluded that for the evaluated sample there is a high prevalence of malnutrition and low functional capacity, being the nutritional screening tool NRS 2002 the best predictive ability to identify the nutritional risk in patients with ALS. The multidisciplinary team was offered a nutritional screening protocol for patients with outpatient ALS.
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MANSO, C. S. Definição de protocolo para triagem nutricional: estratégia no cuidado do paciente com Esclerose Lateral Amiotrófica (ELA). 2019. 150 f. Dissertação (Mestrado em Ensino na Saúde) - Universidade Federal de Goiás, Goiânia, 2019.