Conclusions - Election-Attack Complexity for More Natural Models

assessment. Serum albumin should probably be considered as an indicator of illness or as a prognostic factor, predicting complications and mortality, and not as a major indicator of nutritional status.

4. The total quality of life scores for malnourished patients were low. The health and functioning as well as the social and economic subscales were particularly affected.

5. Malnutrition also contributes to poor Karnofsky score, more hospital admissions and longer periods of hospitalization.

6. Reduced daily protein intakes; as well as loss of appetite, vomiting and use of phosphate binder medications are the commonest factors predisposing to malnutrition in the population studied.

constipation and swallowing disturbances, must be considered when planning dietary or medical interventions.

5. A social support system should be encouraged for all CRF patients as this improves their purchasing power, compliance to haemodialysis prescription, nutritional status and ultimately quality of life.

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43. Burrowes J.D., Cockram D.B., Dwyer J.T., et al. Cross-sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger haemodialysis patients.

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44. Yeun J.Y. and Kaysen G.A. Factors influencing serum albumin in dialysis patients. Am J Kidney Dis 1998; 32 (4): S118 – 25

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1251 – 1263

48. Spreedhara R., Avram M.M., Blanco M., et al. Prealbumin is the best nutritional predictor of survival in haemodialysis and peritoneal dialysis. Am J Kidney Dis 1996; 28: 937-942.

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CAPD patients: an international study. Am J Kidney Dis 1991; 17: 462-471

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60. Winbor A.L., Banaszek N.K., Freed B.A., et al. A protocol for nutritional assessment in a community hospital. J. Am Diet Assoc. 1981; 78: 129-34 61. Blackburn G.L., Bistrian B.R., Maini B.S., et al. Nutritional and metabolic

assessment of the hospitalized patient. J. Parenter Enteral Nutr 1977; 1: 11-22.

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68. Kenneth E.C., Michael H.C., Robert M.P., et al. Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: Different sides of different coins? Journal American Geriatric society 2002; 50: 631-637

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94 APPENDIX I

CONSENT FORM Purpose of the Study

Malnutrition is a common problem in most chronic illnesses. This includes chronic renal failure. Many factors may be responsible for this malnutrition. These include loss of appetite, dietary restriction, medications and the stress associated with haemodialysis. It is easier and cheaper to prevent malnutrition than to treat it. One of the aims of treating chronic renal failure is to improve the quality of life of patients. The aim of this study is to determine the nutritional status of our patients and to relate it to their quality of life. This will help us to determine the extent of the problem of malnutrition or over nutrition and the quality of life of our patients. This will help us in the future management of chronic renal failure patients.

CONSENT TO PARTICIPATE IN THE STUDY

I __________________________________________________ Hospital Number ____________

With _____________________________________________ (name of Hospital), do hereby Consent to participate in a study titled ‘ A cross sectional study of Nutritional status and its relationship to quality of life in a sample of chronic renal failure patients’.

I was made to understand that the study will be carried out by Dr H.M.Liman, under the supervision of Dr E.A.Anteyi and Professor E.Oviasu.

I have been assured that all information obtained from me will be treated with utmost confidentiality. I have the right to withdraw my consent at any stage of the study.

I was also made to understand that no additional expenses will be incurred by me, as a result of the study, other than the routine expenses associated with my routine health care and follow up.

I make this declaration willingly and upon my honour.

The above has been explained to me in ……….(language) Signed………

Date ………..

In the presence of:

Interpreter/Witness

Full Name ……….

Relationship to patient……….

Signature………..

95 Date……….

APPENDIX II QUESTIONNAIRE

NUTRITIONAL STATUS AND QUALITY OF LIFE IN CHRONIC RENAL FAILURE PATIENTS

1. Hospital:

2. Patient’s full Name:

3. Hospital Number:

4. Sex:

5. Age:

6. Marital status:

7. Educational level:

8. Occupation:

9. Date of diagnosis of chronic renal failure:

10. Duration of illness:

11. Coexisting illnesses with dates of diagnosis: a.

12. Haemodialysis: YES  NO  13. Date of initiation of haemodialysis:

14. Duration on haemodialysis:

15. Frequency of dialysis:  thrice weekly  twice weekly  once weekly  others ___________________

16. Average duration of dialysis per session: 3hrs  4hrs 

96 17. NUTRITIONAL ASSESSMENT

A. SUBJECTIVE GLOBAL ASSESSMENT

Parameter Value Date

Overall subjective global assessment Rating (see appendix III)

b) ANTHROPOMETRIC PARAMETERS

Parameter Weight

Date Present weight Four weeks ago Six months ago Pre-diagnosis Weight

% Weight loss

Parameter Value Normal Date

Height BMI MUAC

Triceps skin fold thickness

c) LABORATORY NUTRITIONAL INDICES

Parameter Value Normal Date

Albumin Creatinine Urea

d) FUNCTIONAL CAPACITY/ QUALITY OF LIFE INDICATORS

Parameter Value

Modified Karnofsky score (see Appendix III) Total quality of life score (see Appendix IV) No. of hospital admissions (previous 6 months) Duration of hospital stay (previous 6 months)

Decrease in Income since renal failure  full time work

 part time work

 unemployed

 unable to work

 home duties

 retired

APPENDIX II

Subjective Global Assessment Rating Form Medical History

WEIGHT/WEIGHT CHANGE

Baseline Wt: __________ (dry weight from 6 months ago) Current Wt: __________ (dry weight today)

Actual Wt loss/ past 6 mths: __________ %loss _______ (actual loss/baseline) Weight change over past 2 weeks _____________ No change _____________ Increase _____________ Decrease

Rating (A, B or C)

(note: recent significant gain may negate previous loss) DIETARY INTAKE

No Change: ____________ Adequate ______________ Inadequate __________

Change: Duration ___________

Suboptimal Intake _______

Full Liquid _______

Hypocaloric liquid _______

Starvation _______

GASTROINTESTINAL SYMPTOMS:

Symptom: Frequency : Duration  ________ None __________ _________

________ Anorexia __________ _________

________ Nausea __________ _________

________ Vomiting __________ _________

________ Diarrhoea __________ _________

 Never, daily, 2-3times/wk, 1-2 times/wk > 2 wks, < 2 wks FUNCTIONAL CAPACITY

Description: Duration:

_________ change in function _________

_________ Difficulty with ambulation _________

_________ Difficulty with normal activity _________

_________ Light activity _________

_________ Bed/ chair-ridden with little or

no activity __________

_________ Improvement in function __________

DISEASE STATE/COMORBIDITIES-RELATIONSHIP TO NUTRITIONAL NEEDS Primary diagnosis:___________________________________________________

Comorbidities: _____________________________________________________

Normal requirements ______________ Increased requirements ______________

Acute metabolic stress: None _______ Low ______ High ___________________

Rating Rating (A, B or C)

PHYSICAL EXAMINATION

__ Loss of subcutaneous fat (below eye, triceps, biceps, chest): ___some areas __ All areas

__ Muscle wasting (temple, clavicle, scapula, ribs, quadriceps, calf, knee, interosseous):

___________ Some areas _________ All areas

__ Edema (related to under nutrition)

__ Ascites (haemodialysis pts only, related to under nutrition) OVERALL SGA RATING

A = Well nourished (“ A” rating in most categories or significant improvement) B = Mild-to-moderately malnourished (neither “A” nor “C” is clearly indicated)

C = Severely malnourished (“C” ratings in most categories; significant physical signs)

100 APPENDIX II

MODIFIED KARNOFSKY PERFORMANCE SCALE

101

ACTIVITY SCORE

Normal function, no disability 96-100

Minor signs and symptoms, full activity 91-95

Usual activities with effort 81-90

Independent, most out of home activities 76-80

Independent, limited to home 70-75

Needs assistance with errands 65-69

Needs assistance with meal preparation 60-64

Needs assistance with bathing/dressing 55-59

Home attendant, not totally disabled 50-54

Disabled, living at home 45-49

Nursing home for chronic care 40-44

Hospitalized, fair condition 35-39

Hospitalized, poor condition 30-34

Hospitalized, progressive fatal process < 30

Ferrans and Powers

QUALITY OF LIFE INDEX © DIALYSIS VERSION - III

102

PART 1. For each of the following, please choose the answer that best describes how satisfied you are with that area of your life. Please mark your answer by circling the number. There are no right or wrong answers.

HOW SATISFIED ARE YOU WITH:

1. Your health? 1 2 3 4 5 6

2. Your health care? 1 2 3 4 5 6 1 2 3 4 5 6 3. The amount of energy you have for everyday activities? 1 2 3 4 5 6 4. Your ability to take care of yourself without help? 1 2 3 4 5 6 5. The likelihood you will get a kidney transplant? 1 2 3 4 5 6 6. The changes you have had to make in your life because

of kidney failure (such as diet and need for dialysis)?

1 2 3 4 5 6

7. The amount of control you have over your life? 1 2 3 4 5 6 8. Your chances of living as long as you would like? 1 2 3 4 5 6

9. Your family’s health? 1 2 3 4 5 6

10. Your children? 1 2 3 4 5 6

11. Your family’s happiness? 1 2 3 4 5 6

12. Your sex life? 1 2 3 4 5 6

13. Your spouse, lover, or partner? 1 2 3 4 5 6 14. The emotional support you get from your family? 1 2 3 4 5 6

15. Your friends? 1 2 3 4 5 6

(Please Go To Next Page)

Very Dissatisfied Moderately Dissatisfied Slightly Dissatisfied Slightly Satisfied Moderately Satisfied Very Satisfied

103 HOW SATISFIED ARE YOU WITH:

16. The emotional support you get from people other than your family?

1 2 3 4 5 6

17. Your ability to take care of family responsibilities? 1 2 3 4 5 6 18. How useful you are to others? 1 2 3 4 5 6 19. The amount of worries in your life? 1 2 3 4 5 6

20. Your neighborhood? 1 2 3 4 5 6

21. Your home, apartment, or place where you live? 1 2 3 4 5 6 22. Your job (if employed)? 1 2 3 4 5 6 23. Not having a job (if unemployed, retired, or disabled)? 1 2 3 4 5 6

24. Your education? 1 2 3 4 5 6

25. How well you can take care of your financial needs? 1 2 3 4 5 6 26. The things you do for fun? 1 2 3 4 5 6 27. Your chances for a happy future? 1 2 3 4 5 6

28. Your peace of mind? 1 2 3 4 5 6

29. Your faith in God? 1 2 3 4 5 6

30. Your achievement of personal goals? 1 2 3 4 5 6 31. Your happiness in general? 1 2 3 4 5 6 32. Your life in general? 1 2 3 4 5 6 33. Your personal appearance? 1 2 3 4 5 6

34. Yourself in general? 1 2 3 4 5 6

(Please Go To Next Page)

104

PART 2. For each of the following, please choose the answer that best describes how important that area of your life is to you. Please mark your answer by circling the number. There are no right or wrong answers.

HOW IMPORTANT TO YOU IS:

1. Your health? 1 2 3 4 5 6

2. Your health care? 1 2 3 4 5 6

3. Having enough energy for everyday activities? 1 2 3 4 5 6 4. Taking care of yourself without help? 1 2 3 4 5 6 5. Getting a kidney transplant? 1 2 3 4 5 6 6. The changes you have had to make in your life because of

kidney failure (such as diet and need for dialysis)?

1 2 3 4 5 6

7. Having control over your life? 1 2 3 4 5 6 8. Living as long as you would like? 1 2 3 4 5 6

9. Your family’s health? 1 2 3 4 5 6

10. Your children? 1 2 3 4 5 6

11. Your family’s happiness? 1 2 3 4 5 6

12. Your sex life? 1 2 3 4 5 6

13. Your spouse, lover, or partner? 1 2 3 4 5 6 14. The emotional support you get from your family? 1 2 3 4 5 6

15. Your friends? 1 2 3 4 5 6

16. The emotional support you get from people other than your family?

1 2 3 4 5 6

(Please Go To Next Page)

Very Unimportant Moderately Unimportant Slightly Unimportant Slightly Important Moderately Important Very Important

105 HOW IMPORTANT TO YOU IS:

17. Taking care of family responsibilities? 1 2 3 4 5 6 18. Being useful to others? 1 2 3 4 5 6

19. Having no worries? 1 2 3 4 5 6

20. Your neighborhood? 1 2 3 4 5 6

21. Your home, apartment, or place where you live? 1 2 3 4 5 6 22. Your job (if employed)? 1 2 3 4 5 6 23. Having a job (if unemployed, retired, or disabled)? 1 2 3 4 5 6

24. Your education? 1 2 3 4 5 6

25. Being able to take care of your financial needs? 1 2 3 4 5 6 26. Doing things for fun? 1 2 3 4 5 6 27. Having a happy future? 1 2 3 4 5 6

28. Peace of mind? 1 2 3 4 5 6

29. Your faith in God? 1 2 3 4 5 6

30. Achieving your personal goals? 1 2 3 4 5 6 31. Your happiness in general? 1 2 3 4 5 6 32. Being satisfied with life? 1 2 3 4 5 6 33. Your personal appearance? 1 2 3 4 5 6

34. Are you to yourself? 1 2 3 4 5 6

Very Unimportant Moderately Unimportant Slightly Unimportant Slightly Important Moderately Important Very Important

106 ADDENDUM

Total Quality of life score Health and functioning subscale Social and economic subscale Psychological/Spiritual subscale Family subscale

D) Factors related to malnutrition

1. Estimated daily protein intake __________________________(g/day)

2. Poor appetite Yes ______ No ______

3. Nausea Yes ______ No ______

4. Vomiting Yes ______ No ______

5. Diarrhoea Yes ______ No ______

6. Poor social support Yes ______ No ______

7. Poor purchasing power Yes ______ No ______

8. Phosphate binder medications Yes ______ No ______

9. Food allergies Yes ______ No ______

10. Others ____________________________________

107

NATIONAL HOSPITAL ABUJA

INITIAL NUTRITION HISTORY AND ASSESSMENT

Patient’s Name__________________________________Date________________________

Date of birth________________Sex_______Hosp. No.__________Height_______________

I. Diet order_________________________________________________________________

II. Current intake and time of meals

Breakfast/ Time Lunch/Time Dinner/Time

DAY ONE_______________ _______________ __________________

_______________ _______________ __________________

Estimated daily protein intake (gram/day) ______________________________________

Breakfast/Time Lunch/Time Dinner/Time

DAY TWO_______________ _______________ __________________

_______________ _______________ __________________

Estimated daily protein intake (gram/day) ______________________________________

Breakfast/Time Lunch/Time Dinner/Time

DAY THREE_____________ _______________ __________________

_______________ _______________ __________________

Estimated daily protein intake (gram/day) ______________________________________

III. AVERAGE TOTAL DAILY PROTEIN INTAKE (gram/day)___________________

IV. Diet related information

Appetite____________________________ Vomiting____________________________

Nausea_____________________________ Diarrhoea____________________________

Constipation_________________________ Food allergies________________________

In document Election-Attack Complexity for More Natural Models (Page 43-47)