CorrespondenceMrs F. Bryan, Background Adults with learning disabilities have a greater incidence of health problems than the general population. It is now well established that they are a nutritionally vulnerable group with polarized weight distributions.Aim This study was undertaken to investigate the nutritional consequences of the closure of a large learning disabilities hospital and the resettlement of clients in small community homes.Methods The nutritional changes were measured using a locally devised nutrition screening form. This had previously been tested for reliability and validity.Clients were screened in the month prior to their discharge from Stallington Hall and at 1 year post-discharge. The two screening forms for each client were then compared.The screening form assessed risk in three areas: nutritional adequacy, weight and nutrition-related problems.Results A number of significant increases in risk between the two screens were seen. In particular, there was an increase in overall risk relating to food groups, unintentional weight gain and loss and overall risk relating to weight.At the first screen, 70% of the women and 55% of the men were outside the normal weight ranges and by the second screen these percentages had increased to 82% and 60%, respectively. It was not possible to weigh 15% of the study participants at the second screen because suitable scales were not available.
ConclusionsThe study confirms the nutritional vulnerability of the participants and highlights a number of adverse nutritional changes. It supports the need for regular screening and dietetic input.
Background: People with learning difficulties are nutritionally vulnerable for many reasons. There is a need for a nutrition screening tool (NST) to enable carers to identify those at nutritional risk. However, a validated NST for clients with learning difficulties does not exist. Aim: To assess the reliability and validity of a NST being used in a long-stay hospital in North Staffordshire for people with learning difficulties. The NST investigates three areas of risk: nutritional adequacy (food groups), weight and nutrition-related problems such as dysphagia or gastrointestinal disorders. Method: Thirty-six subjects were randomly selected. The reliability of the NST was assessed by three nurses familiar with the participants. Each subject was independently screened using the NST. Validity was assessed by forming an expert panel of three dietitians. Each participant's nutritional status for each of the three risk areas was assessed independently by the dietitians using their own methods. A comparison of the majority opinion of the dietitians with that of the nurses gave an indication of validity. Results: Reliability was analysed using variance component models and indices of agreement. There was good agreement between nurses in the assessment of risk relating to nutrition adequacy (r=0.658), moderate agreement in the assessment of nutrition-related problems (r=0.576), but only fair agreement in the assessment of weight-related risk (r=0.263). Validity was assessed using Cohen's kappa statistic. There was good agreement between the majority opinions of the nurses and dietitians for the assessment of nutritional adequacy-related risk (r=0.708) and for nutrition-related problems (r=0.691), but only fair agreement for weight (r=0.300). Conclusion: Use of the NST in the area of nutrition adequacy gave good repeatability and validity.Similarly, there was good validity in the area of nutrition-related problems. The NST was not satisfactory in assessing weight-related risk and further work is needed in this risk area. There was also a suggestion from the results of the study that the dietitians differed in their approach to assessing nutritional risk.
The importance of resident wellbeing is increasingly recognized by the ACGME as essential. While prior studies have quantified wellbeing/burnout, few have defined wellbeing from the resident–physician perspective. A REDCap® survey was distributed to residents in various programs, responses were grouped by theme, and data analyzed via chi-square. From 19 institutions, 53/670 responded, from university (34.0%), community (30.2%), and community/university-affiliated (30.2%) programs, mostly surgical (84.9%), followed by medical (9.4%). Wellbeing was defined by mental and spiritual/religious health (33.8%), overall health (23.0%), free time/time management (23.0%), and job/salary satisfaction (18.9%). Proposed changes to traditional training included fewer hours and more schedule flexibility (38.2%), and increased/improved support/feedback (14.7%). Nearly half of the respondents perceived lacking education on career longevity. Wellbeing is paramount to the personal/professional development of residents. Data on resident-defined wellbeing are lacking. The improved understanding of wellbeing defined here can be used to improve residency training programs.
SIR,-As a friendly opponent may I be permitted to add my encoiniums to the memory of one who, by his tactful and manly bearing, has endeared himself liot only to IhiL coliagues, but-to his rivals in work and sport ?
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