TranslateThe purpose of this Question Verification Form is to enable Priority Setting Partnerships (PSPs) to describe clearly how they checked that their questions were unanswered, before starting the interim prioritisation stage of the process.
The JLA requires PSPs to be transparent and accountable in defining their own scope and evidence checking process. This will enable researchers and other stakeholders to understand how individual PSPs decided that their questions were unanswered, and any limitations of their evidence checking.
Name of the PSP
Nutritional screening and Malnutrition PSP
Please describe the scope of the PSP
For the purposes of this work we are only focussing on undernutrition (including undernutrition in obesity) and nutritional screening. Undernutrition can be difficult to recognise, especially in people who are overweight or obese to start with. Some symptoms may include:
- loss of appetite
- weight loss – clothes, rings, jewellery, dentures may become loose
- tiredness, loss of energy
- reduced ability to perform normal tasks
- reduced physical performance
- altered mood
- poor concentration
This project will consider malnutrition across all diseases, in all settings, and in the adult population (18 yrs and over). Malnutrition in children is a large field of study and would benefit from its own separate PSP and so will not be included here. Malnutrition in specific groups will be included in this PSP, including but not limited to:
- the elderly
- those with difficulties accessing food
- Black, Asian and Minority Ethnic (BAME) groups
- travelling communities
- those who are homeless
- those in secure units and prisons
- refugees
- those with social and psychological issues
- those with mental health issues or conditions, some of which may be severe.
Treatments for malnutrition that will be included in this work must be a strategy involving combinations of macro and micronutrients aiming to improve nutritional intake using the oral route. Therefore any oral, supplementary, and alternative therapy treatment for malnutrition will be included; any treatment that is considered artificial (i.e. feeding via a tube or vein) will be out of scope.
This project will not include malnutrition issues relating to specific diseases, but will take a generic approach across all disease states. Parenteral and enteral (artificial tube feeding) treatments and single nutrient treatments for malnutrition will be excluded. Issues relating to access to health care and health care services will be excluded. Any questions that are asking for help, advice and access to services will be out of scope (if possible signposting will be implemented for these responses).
Please provide a brief overview of your approach to checking whether the questions were unanswered
A review of the literature was undertaken on the current evidence on malnutrition and identified areas of uncertainty in the evidence base. Following this an umbrella review of systematic reviews was conducted along with a scoping exercise of relevant studies.
Please list the type(s) of evidence you used to verify your questions as unanswered
- Systematic reviews which had reviewed randomised controlled trials (RCTs), quasi RCTs, cluster RCTs, cohort studies, cross-sectional studies, qualitative literature, and validation studies with interventions relating to nutritional screening tools and the treatment of malnutrition. We excluded case series and case reports.
Please list the sources that you searched in order to identify that evidence
MEDLINE, EMBASE, CINAHL, Web of Science, The Cochrane register of systematic reviews, DARE, and Joanne Briggs Institute of systematic reviews. In addition, reference list of included papers were hand searched for any additional reviews meeting the inclusion criteria.
What search terms did you use?
1. Nutrition disorders/ or malnutrition/ or deficiency diseases/ or starvation/
2. Nutritional Status/ or Nutrition Assessment/ or Nutrition Disorders/ or malnutrition screening.mp. or Anthropometry/
3. 1 and 2
4. PARENTERAL NUTRITION, HOME/ or NUTRITION POLICY/ or NUTRITION THERAPY/ or ENTERAL NUTRITION/ or PARENTERAL NUTRITION SOLUTIONS/ or NUTRITION SURVEYS/ or PARENTERAL NUTRITION/ or PARENTERAL NUTRITION, TOTAL/
5. treat.mp.
6. PATIENT OUTCOME ASSESSMENT/ or NURSING ASSESSMENT/ or NEEDS ASSESSMENT/ or SYMPTOM ASSESSMENT/ or HEALTH IMPACT ASSESSMENT/ or assessment.mp. or NUTRITION ASSESSMENT/
7. Checklist.mp.
8. Questionnaire.mp. or "Surveys and Questionnaires"/
9. Diet/ or DIETARY SUPPLEMENTS/ or supplement.mp.
10. ENERGY INTAKE/ or ENERGY METABOLISM/ or energy.mp. or PROTEIN-ENERGY MALNUTRITION/
11. 4 or 5 or 6
12. 7 or 8
13. 9 or 10
14. 3 and 11 and 12 and 13
15. Systematic review/ or meta-analysis.mp.
Please describe the parameters of the search (eg time limits, excluded sources, country/language) and the rationale for any limitations
The search strategy was limited to reviews that were published after 2000 in order to identify reviews that related to nutritional screening in the UK after the implementation of MUST. We included:
- Reviews including adults >18 years old who were identified as having or being at risk of malnutrition.
- Reviews that included studies which:
- Included malnourished participants or were assessing outcomes from dietary or oral interventions for the treatment of malnutrition
- Included a dietary or oral intervention of any food substance, which was added to a mixed diet to increase energy or protein intake, or included any nutritional supplement taken orally, which provides both macro- (fat, carbohydrate and protein) and micro-nutrients. Studies with supplements providing one singular macronutrient or micronutrient will be excluded
- Assessed the validity and reliability of nutrition screening tools for adults
- Assessed outcomes of nutritional screening interventions
Names of individuals who undertook the evidence checking
- Debra Jones
- Sorrel Burden
On what date was the question verification process completed?
26 March 2019
Any other relevant information
None
Version 1. Date 26 June 2019