title: Simple training tool is insufficient for appropriate diagnosis and treatment of malnutrition: A pre-post intervention study in a tertiary center.
abstract: OBJECTIVE
  To improve malnutrition awareness and management in our department of general internal medicine; to assess patients' nutritional risk; and to evaluate whether an online educational program leads to an increase in basic knowledge and more frequent nutritional therapies.
  
  
  METHODS
  A prospective pre-post intervention study at a university department of general internal medicine was conducted. Nutritional screening using Nutritional Risk Score 2002 (NRS 2002) was performed, and prescriptions of nutritional therapies were assessed. The intervention included an online learning program and a pocket card for all residents, who had to fill in a multiple-choice questions (MCQ) test about basic nutritional knowledge before and after the intervention.
  
  
  RESULTS
  A total of 342 patients were included in the preintervention phase, and 300 were in the postintervention phase. In the preintervention phase, 54.1% were at nutritional risk (NRS 2002 ≥3) compared with 61.7% in the postintervention phase. There was no increase in the prescription of nutritional therapies (18.7% versus 17.0%). Forty-nine and 41 residents (response rate 58% and 48%) filled in the MCQ test before and after the intervention, respectively. The mean percentage of correct answers was 55.6% and 59.43%, respectively (which was not significant). Fifty of 84 residents completed the online program. The residents who participated in the whole program scored higher on the second MCQ test (63% versus 55% correct answers, P = 0.031).
  
  
  CONCLUSIONS
  Despite a high ratio of malnourished patients, the nutritional intervention, as assessed by nutritional prescriptions, is insufficient. However, the simple educational program via Internet and usage of NRS 2002 pocket cards did not improve either malnutrition awareness or nutritional treatment. More sophisticated educational systems to fight malnutrition are necessary.
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address: carla.aeberhard@insel.ch.
authors.forename: Carla
authors.initials: C
authors.lastname: Aeberhard
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Birrenbach
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Maya
authors.initials: M
authors.lastname: Joray
authors.affiliation: Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mühlebach
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Perrig
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital and University of Bern, Bern, Switzerland; Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Zeno
authors.initials: Z
authors.lastname: Stanga
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D015596:Nutrition Assessment; D044623:Nutrition Therapy / Q000379:methods; D009752:Nutritional Status; D011446:Prospective Studies
keywords: Educational intervention; Malnutrition management; Online learning program; Protein energy malnutrition