Schedule: Grand Rounds

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Past Rounds -Recognizing & Tackling Malnutrition
 

Title: “Malnutrition in Hospitalized Patients: Boosting Screening and Ensuring Patient Outcomes”
June 21, 2023, 9:00 - 10:00am ET - Department of Medicine Rounds, St. Joseph’s Health Centre, Toronto ON
Speaker: Dr. Christopher Wang, MD, FRCPC, Department of Medicine, Division of Gastroenterology, St. Joseph’s Health Centre, Toronto, ON
Total number of attendees:  49 (open to St. Joseph’s Health centre Staff only)
Questions and comments included:
- St. Joseph’s Health Centre has used the nutrition screening tool as part of the nursing assessment for more than 10 years.
- nutrition screening is now being done in all patients at St. Joseph’s by a dedicated diet technician
- hospital food acceptability is an issue due to limited food choices on menu, short times for delivery and no snacks (due to staffing restraints)
- need for culturally acceptable foods to be offered in hospitals
- there is heavy reliance on family members to bring in suitable foods for patients and restrictions on this can impact malnutrition

June 9, 2023, 12:00 - 1:00pm PT - Fraser Health BC, Internal Medicine Rounds
Speaker: Dr. Barbara Bielawska MD MSc FRCPC, Assistant Professor, University of Ottawa
Total number of attendees:  80 attendees
Questions and comments included:
- Fraser Health referral processes for dietitians re: patients with chylothorax
- How to expedite Fraser Health referrals for SLP swallowing assessments for high risk respiratory patients
- Concern re: fish oils supplements having lower EPA/DHA and more oxidants than label claims  (New Zealand Study https://www.nature.com/articles/srep07928)
- Should nutrition screening in the community be done and if so what tools?
- Treatment goals in the sarcopenic obese patient

November 16 2022, 7:00 - 8:00 am EST-Health Sciences North Grand Rounds, Sudbury
Speaker: Dr. Barbara Bielawska, MD MSc FRCPC, Assistant Professor University of Ottawa
Total number of attendees: 37
Questions and comments included:
- Multivitamins or Vitamin D could be prescribed for those at risk for poor food intake or malabsorption but still need better nutrition intake 
- Encouraging families to bring in patient’s preferred foods is encouraged. Easy access to snacks at the bedside is also recommended
- Costs for prescribed Oral Nutrition Supplements (ONS) can be covered IF sole source of nutrition 
- Food insecurity is a huge challenge that needs a multifaceted approach; lobbying for ONS costs coverage could be one small part of the solution 
- CMTFs SGA Video Collection is a great educational tool 

September 13, 2022, 8:00am - 9:00am ADT - Department of Medicine, Nova Scotia Health Authority

Speaker: Dr. Leah Gramlich, MD, FRCP, Professor Medicine, University of Alberta
Total number of attendees: 130

Pediatric Grand Rounds Malnutrition in Hospitalized children: screening, treatment & prevention 
September 8, 2022, 12:00pm - 1:00pm NDT - Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland
Speaker: Dr. Valerie Marchand, MD, FRCPC, Department of Paediatrics, Ste-Justine UHC, University of Montreal , Quebec
Total number of attendees: 54

Questions and comments included:
- Lack of malnutrition screening in Newfoundland, challenges, and opportunities for improvement 
- What supports are available to train Dietitians/Clinicians to conduct Pediatric Subjective Global Assessment?
- Challenges of tracking longitudinal growth charts in an electronic format
- Data on increased workload to the Dietitian that is required because of implementing the malnutrition screen
- Financial implications associated with malnutrition screening and hiring additional staff

June 17, 2022, 12:00pm - 1:00pm - Department of Medicine, Halton Health Care, Ontario
Speaker: Dr. Barb Bielawska, MD, MSc, FRCPC
Total number of attendees: 26

Questions and comments included:
- increased awareness of malnutrition in Canadian hospitals
- quality of hospital food is a barrier to better nutrition
- poor food choices and food expenses may contribute to risk of malnutrition
- highlighted role of registered dietitians and need for referrals
- CRP, albumin, and prealbumin are markers of inflammation vs. markers of nutritional status

Recording available at:  https://vimeo.com/728835286/01740eade0

April 27, 2022 - Division of Family Practice Hospitalists, Pasqua Hospital, Saskatchewan Health Authority (by invite only)
Speaker: Dr. Don Duerksen 
Total number of attendees: 25

Questions and comments included:
- use of Subjective Global Assessment & bloodwork to support diagnosis
- use of enteral nutrition when po intake is poor
- lack of access to services in the community  
- interest in resources and patient tools & high protein, high energy diet

January 20, 2022, 8:30am - 10:00am MST - Family Medicine Rounds, University of Alberta, Edmonton
Speaker: Dr. Leah Gramlich
Total number of attendees: 110

Generated interest for:
- Family MDs being aware of malnutrition and identifying patients
- including nutrition status in hospital discharge summary plan
- CMTF Primary Care Malnutrition Toolkit


Questions included:
- Quantity of ONS consumed by patients with poor oral intake
- access to resources and programs within AHS for those with malnutrition 
- recommended blood work to support malnutrition diagnosis 

January 13, 2022, 8:00am - 9:00am ET - Medicine Grand Rounds, Hamilton Health Sciences, Ontario
Speaker: Dr. Leah Gramlich
Total number of attendees: 74

Questions and comments included:
- Protein requirements and quality of protein 
- Appropriateness of initiating enteral nutrition in those in whom goals of care are not defined 
- Hamilton Health Sciences RDs efforts at implementing best evidences related to malnutrition (Med Pass and INPAC adoption)

Recording available at:  https://www.youtube.com/channel/UCvF2UX6pA0Yr8IEgA1O5AKQ

November 2, 2021, 12:00pm - 1:00pm ET - Department of Medicine Grand Rounds, Ottawa
Speaker: Dr. Leah Gramlich, MD, FRCPC
Total number of attendees: 103

Generated interest for:
- de-escalating use of medications that suppress appetite. 
- continued work on improving nutrition screening and assessment practices
- training in nutrition care-request from a hospital in Trinidad and Tobago

Recording available at: https://vimeo.com/641955585/08c33f8635

For Health Professionals in Newfoundland and Labrador ONLY
October 22, 2021, 12:00pm - 1:00pm NLT - Medical Grand Rounds, Memorial University, Newfoundland
Speaker: Dr. Donald Duerksen, MD, FRCPC
Total number of attendees: 102

Generated interest for:
-impact of disease related malnutrition
-the double burden of obesity & malnutrition
-food first approaches to address malnutrition in a hospital setting

September 23, 2021, 12:00pm - 1:00pm ET - CHUM (Centre hospitalier de l'Université de Montréal)  
Speaker: Dr. Johane P. Allard, FRCPC, AGAF/CACF
Total number of attendees: 102

Recording available at: https://vimeo.com/646646061

March 2, 2021, 7:00pm - 8:00pm MST - Primary Care Rounds, Office of Lifelong Learning, University of Alberta, Edmonton
Speaker: Dr. Leah Gramlich, MD, FRCPC
Total number of attendees: 176

Poll responses in session:
- 83% thought malnutrition was a significant concern in their primary care setting 
- 60% to 70% needed information on how to identify patients or what to do if a patient is at risk
- 60% have limited or no access to a registered dietitian or did not have enough time 
 

April 29, 2021, 8:00am - 9:00am MST - Medicine Grand Rounds, Royal Alexandra Hospital, Edmonton
Speaker: Dr. Leah Gramlich, MD, FRCPC
Total number of attendees: 104

Recording available at: https://drive.google.com/file/d/19tWG1NFG09ipl15ZpSM_NxBly1wNT0Zd/view