A Two-Step Process for Nutrition Care using Subjective Global Assessment

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The objective of assessing nutritional status in acute care is to identify an individual who needs nutritional support, its urgency and route. In order to achieve these objectives, the assessment has to evaluate, in a holistic way, nutrient intake and absorption on the one hand and requirements based on metabolic needs and effect of illness on the other. The urgency and extent of intervention is based on the trajectory of weight change and functional status. Subjective Global Assessment (SGA) is a bedside, clinically validated way of meeting these objectives. Numerous studies have shown that it identifies increased risk of complications, increased hospital stay and identification of patients responding to nutritional therapy not attained by use of anthropometrics and serum protein measurements alone. SGA is used in the Integrated Nutrition Pathway for Acute Care (INPAC) developed as a feasible pathway for nutrition care in hospital. This is an evidence-informed, consensus-based algorithm that recommends a two-step process for detection using screening and Subjective Global Assessment. Screening will result in false positives which need to be identified prior to undertaking treatment. Dietitian training to complete SGA is a key initiative of the Canadian Malnutrition Task Force. INPAC is currently being implemented in five diverse hospitals in Canada and evaluation will demonstrate resource utilization with this two-step diagnostic process.

Dr. Khursheed Jeejeebhoy
Director of the Home Parenteral Nutrition Program and Staff Physician
St. Michael's Hospital

Dr. Khursheed Jeejeebhoy received his medical degree from the Christian Medical College Hospital in Vellore, India in 1959. Dr. Jeejeebhoy was the past Division Director of Gastroenterology at the University of Toronto and the Toronto General Hospital where he established and directed a program for the postgraduate training of clinical and academic gastroenterologists. Currently, Dr. Jeejeebhoy is Director of the Home Parenteral Nutrition Program and Staff Physician at St. Michael's Hospital. He is also an Emeritus Professor of Medicine, cross appointed to the Department of Nutritional Sciences at the University of Toronto. He continues to practice gastroenterology at the Polyclinic and continues his research interests through his position on the executive of the Canadian Malnutrition Task Force and as a committee member of the Canadian Clinical Practice Guidelines for Nutrition in Intensive Care. Dr. Jeejeebhoy has published over 500 peer-reviewed articles, abstracts and book chapters to date and continues to actively publish. He has received numerous awards throughout his career including the McCollom award from the American Society of Clinical Nutrition, the British Society of Gastroenterology, a Research Awards from the Department of Medicine, University of Toronto, and the Canadian Association of Gastroenterology and Distinguished Service Award from the Ontario Association of Gastroenterology. He has been elected senior member of the Canadian Medical Association. In 2010, he received the Gold medal from the Canadian Association of Physicians of Indian Origin, Association of Physicians of Indian Origin. The Canadian Nutrition Society established the Khursheed Jeejeebhoy Award for excellence in Clinical Nutrition. In 2011 he received the Mentor award from the American Gastroenterological Association Institute.

***Original Source: "2016 CNS Annual Conference", Friday May 6, 2016

Length: 22:21

Type: Video

Last Updated: May 30, 2016

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A Two-Step Process for Nutrition Care using Subjective Global Assessment Video
Implementing Malnutrition Diagnostic Criteria: The CMTF Perspective File
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