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Validation of online training of renal dietitians for preformance of subjective global assessment
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A MULTICENTER STUDY OF SUBJECTIVE GLOBAL ASSESSMENT (SGA) VALIDITY AND RELIABILITY IN THE HEMODIALYSIS (HD) POPULATION. Alison Steiber, Janeen Leon, Ash Sehgal, Donna Secker, Maureen McCarthy, Kamyar Kalantar-Zadeh, Linda McCann. SGA is a nutritional assessment tool recommended by the NKF K/DOQI guidelines. However, the validity and reliability of this tool have not been established in HD patients. The purpose of this observational study was to determine the reliability and validity of SGA in HD patients. Renal dietitians (RD) were recruited to perform SGA (7-point scale version) and collect data from 3 HD patients at 0 and 6 months on demographics, clinical status, biochemistries, dietary intake, and quality of life (Medical Outcomes Short Form-36, SF36). To test inter-rater reliability, SGA was performed by a 2nd RD (RD #2) at baseline and to test intra-rater reliability, the original RD (RD #1) repeated SGA at 1 month. RDs were trained for data collection via an SGA website created for this study. RDs (n=54) collected data at HD facilities in the US (109 patients), Canada (35 patients) and New Zealand (9 patients). Of the 155 patients, 46% were female, 64% were Caucasian, 6% Hispanic, 21% African American, and 6% Asian. The primary etiologies were: 10% type 1 diabetes mellitus (DM), 27% type 2 DM, 33% hypertension, and 10% glomerular nephritis; and 59% had documented cardiovascular disease. The mean age, BMI, serum albumin, and duration on HD were: 64+14 years (mean+SD), 28+7kg/m2, 3.7+0.4 mg/dL, and 41+34 months, respectively. SGA scores were: well nourished (7)-30%, mildly malnourished (MN-6)41%, moderately MN (5-3) 5-21%, 4-7%, and 3-2%, severely MN (2&1)-0%. Inter-rater reliability had a weighted Kappa of 0.5 and Spearman’s Rho of 0.7, and inner-rater reliability had a weighted Kappa of 0.7 and Spearman’s Rho of 0.8, all at p<0.001. Validity determined using BMI and serum albumin was statistically significant for the 5 categories of SGA documented (7-28+7, 6-29+7, 5-28+8, 421+4, and 3-24+2-p<0.05 and 7-3.8+0.3, 6-3.8+0.4, 5-3.7+.05, 43.4+.07, 3-2.9+1.2-p<0.001, respectively). SGA did not differ significantly by ethnicity or nationality but did by gender (p<0.05). In conclusion, the 7 point scale SGA is a reliable and valid tool for nutritional assessment in adults on hemodialysis.
VALIDATION OF ONLINE TRAINING OF RENAL DIETITIANS FOR PREFORMANCE OF SUBJECTIVE GLOBAL ASSESSMENT. Alison Steiber, Janeen Leon, Donna Secker, and Linda McCann. Conducting studies utilizing renal dietitians (RDs) as a source of data collection from multiple sites presents a unique challenge. The RDs need to receive consistent, high quality training on data collection techniques which is often expensive and time consuming. The purpose of this analysis was to determine whether online training to instruct RDs, in multiple facilities across the United States (US), Canada (Ca) and New Zealand (NZ), in the proper technique for performing Subjective Global Assessment (SGA) was effective. A specific webpage was designed which included reading material, flow diagrams, algorithms, and pictures of specific body parts with different degrees of somatic wasting. RDs were recruited by mail to collect data from 3 HD patients on demographics, clinical status, biochemistries, SGA, dietary intake, and quality of life (Medical Outcomes Short Form-35, SF36). All RDs who agreed to participate received instructions on entering the SGA webpage and took a pretest designed to assess their SGA knowledge. Following the pretest, RDs were required to review detailed instructions on conducting SGA and then complete a posttest. Participating RDs were from US (n=38), Ca (n=13) and NZ (n=3). The RDs (n=54) had 11+9 (mean+SD) years experience, worked an average of 34+9 hours per week, were responsible for 118+57 total dialysis patients, and 106+52 HD patients in their facilities. There were significant differences between countries in total patient load per RD (US-103+49, Ca-140+54, NZ-207+75) and total HD patients per RD (US-95+56, Ca-113+56, NZ-250+0). However, no differences were found between pre and posttest scores. The mean pretest and posttest scores for all participants were: 69+12 and 87+4 with a mean change of 17%+12; when a paired t-test was applied to the data a significant increase was found in the change from pretest to posttest scores (p<0.05). A positive correlation was determined between years of renal nutrition experience and posttest score (r=0.3, p=0.05). In conclusion, the online training was effective in increasing posttest scores of participants in this research project indicating the online training was effective.
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A MULTICENTER STUDY OF SUBJECTIVE GLOBAL ASSESSMENT (SGA) VALIDITY AND RELIABILITY IN THE HEMODIALYSIS (HD) POPULATION. Alison Steiber, Janeen Leon, Ash Sehgal, Donna Secker, Maureen McCarthy, Kamyar Kalantar-Zadeh, Linda McCann. SGA is a nutritional assessment tool recommended by the NKF K/DOQI guidelines. However, the validity and reliability of this tool have not been established in HD patients. The purpose of this observational study was to determine the reliability and validity of SGA in HD patients. Renal dietitians (RD) were recruited to perform SGA (7-point scale version) and collect data from 3 HD patients at 0 and 6 months on demographics, clinical status, biochemistries, dietary intake, and quality of life (Medical Outcomes Short Form-36, SF36). To test inter-rater reliability, SGA was performed by a 2nd RD (RD #2) at baseline and to test intra-rater reliability, the original RD (RD #1) repeated SGA at 1 month. RDs were trained for data collection via an SGA website created for this study. RDs (n=54) collected data at HD facilities in the US (109 patients), Canada (35 patients) and New Zealand (9 patients). Of the 155 patients, 46% were female, 64% were Caucasian, 6% Hispanic, 21% African American, and 6% Asian. The primary etiologies were: 10% type 1 diabetes mellitus (DM), 27% type 2 DM, 33% hypertension, and 10% glomerular nephritis; and 59% had documented cardiovascular disease. The mean age, BMI, serum albumin, and duration on HD were: 64+14 years (mean+SD), 28+7kg/m2, 3.7+0.4 mg/dL, and 41+34 months, respectively. SGA scores were: well nourished (7)-30%, mildly malnourished (MN-6)41%, moderately MN (5-3) 5-21%, 4-7%, and 3-2%, severely MN (2&1)-0%. Inter-rater reliability had a weighted Kappa of 0.5 and Spearman’s Rho of 0.7, and inner-rater reliability had a weighted Kappa of 0.7 and Spearman’s Rho of 0.8, all at p<0.001. Validity determined using BMI and serum albumin was statistically significant for the 5 categories of SGA documented (7-28+7, 6-29+7, 5-28+8, 421+4, and 3-24+2-p<0.05 and 7-3.8+0.3, 6-3.8+0.4, 5-3.7+.05, 43.4+.07, 3-2.9+1.2-p<0.001, respectively). SGA did not differ significantly by ethnicity or nationality but did by gender (p<0.05). In conclusion, the 7 point scale SGA is a reliable and valid tool for nutritional assessment in adults on hemodialysis.
VALIDATION OF ONLINE TRAINING OF RENAL DIETITIANS FOR PREFORMANCE OF SUBJECTIVE GLOBAL ASSESSMENT. Alison Steiber, Janeen Leon, Donna Secker, and Linda McCann. Conducting studies utilizing renal dietitians (RDs) as a source of data collection from multiple sites presents a unique challenge. The RDs need to receive consistent, high quality training on data collection techniques which is often expensive and time consuming. The purpose of this analysis was to determine whether online training to instruct RDs, in multiple facilities across the United States (US), Canada (Ca) and New Zealand (NZ), in the proper technique for performing Subjective Global Assessment (SGA) was effective. A specific webpage was designed which included reading material, flow diagrams, algorithms, and pictures of specific body parts with different degrees of somatic wasting. RDs were recruited by mail to collect data from 3 HD patients on demographics, clinical status, biochemistries, SGA, dietary intake, and quality of life (Medical Outcomes Short Form-35, SF36). All RDs who agreed to participate received instructions on entering the SGA webpage and took a pretest designed to assess their SGA knowledge. Following the pretest, RDs were required to review detailed instructions on conducting SGA and then complete a posttest. Participating RDs were from US (n=38), Ca (n=13) and NZ (n=3). The RDs (n=54) had 11+9 (mean+SD) years experience, worked an average of 34+9 hours per week, were responsible for 118+57 total dialysis patients, and 106+52 HD patients in their facilities. There were significant differences between countries in total patient load per RD (US-103+49, Ca-140+54, NZ-207+75) and total HD patients per RD (US-95+56, Ca-113+56, NZ-250+0). However, no differences were found between pre and posttest scores. The mean pretest and posttest scores for all participants were: 69+12 and 87+4 with a mean change of 17%+12; when a paired t-test was applied to the data a significant increase was found in the change from pretest to posttest scores (p<0.05). A positive correlation was determined between years of renal nutrition experience and posttest score (r=0.3, p=0.05). In conclusion, the online training was effective in increasing posttest scores of participants in this research project indicating the online training was effective.