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Biomedical subjects

C S Chima

Publications and source records attributed to C S Chima.

7 recordsLinked to original sources
PubMed1997

Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service.

OBJECTIVE: This study was conducted to determine the relationship, if any, between nutritional status, length of stay (LOS) in hospital, discharge placement, readmission rates, and hospital costs and charges in patients hospitalized in the medicine service. DESIGN: Data regarding medical diagnosis, LOS, hospital costs, charges, discharge destination, and readmission rates were collected prospectively from medical records and through patient interviews on patients admitted to the medical service who were classified to be at risk or not at risk for malnutrition on the basis of established criteria (weight for height < 75% ideal body weight, admission serum albumin level < 30 g/L, or > or = 10% unintentional weight loss within 1 month before admission). SUBJECTS: All patients admitted directly to any of three medicine units during December 1994 who met study criteria were included in the study. Off-service patients, transfer patients, and patients discharged before screening (usually admitted and discharged within 72 hours) were excluded. Data were collected on 173 patients. STATISTICAL ANALYSIS PERFORMED: At-risk and not at-risk patients were compared for LOS, costs and reimbursement, and discharge placement (to home, to home with home health care services, or to another facility for further care). Two sample t tests and alpha survival analysis technique were used to compare continuous variables between the two study cohorts. Nonparametric tests were used for LOS and readmission data. chi 2 Tests were used for categoric variables. An alpha level of .05 was used throughout to determine statistical significance. RESULTS: Median LOS in the not-at-risk population (n = 56) was significantly greater than in the not-at-risk population (n = 117): 6 days (25th percentile = 4 days, 75th percentile = 8 days) vs 4 days (25th percentile = 3 days, 75th percentile = 7 days) (P < .01). Mean hospitalization cost per patient was also higher in the at-risk group ($6,196 vs $4,563, P < .02). Readmission rate per month of follow-up was not significantly different. At-risk patients were significantly less likely to be discharged home with self-care (23[41%] vs 77 [66%], P < .05). At-risk patients were significantly more likely to use home health care service than not-at-risk patients (17[31%] vs 14 or [12%], P < .001). APPLICATIONS: Patients at risk for malnutrition had significantly higher LOS, costs, and home health care needs, despite the fact that 51, or 91%, received nutrition intervention while hospitalized. Further research should explore the use of nutrition screening and intervention before, during, and after hospitalization to ensure that appropriate nutrition intervention, as indicated by medical patients' clinical condition and nutritional risk status, is initiated and continued.

Cohort Studies↗
PubMed1997

Computerized patient record: are we prepared for our future practice?

OBJECTIVE: To survey members of The American Dietetic Association (ADA) regarding care documentation systems, computerization of patient care records, and factors to be considered in developing a documentation system compatible with a computer-based patient record. DESIGN: The survey instrument was developed in conjunction with a survey consultant/statistician, then mailed to the study sample. SUBJECTS/SETTING: The sample of 500 was drawn from three ADA dietetic practice groups expected to include a high percentage of clinical practitioners. STATISTICAL ANALYSIS PERFORMED: Basic frequency displays were used on all questionnaire items. Pearson correlation coefficients were used among numeric variables, and oneway analysis of variance was used for categoric variables with quantitative variables. RESULTS: A total of 171 usable surveys were returned (34%), primarily from dietitians working in an acute-care inpatient environment. The SOAP format (subjective, objective, assessment, and plan) was used by 60% of respondents to document nutrition assessments, although a number of other documentation formats were reported. Most commonly used data in nutrition decision making were medical diagnosis, diet order, anthropometric data, and laboratory values. Most commonly used outcomes measures included laboratory values, tolerance of the nutrition regimen, weight changes, and intake changes. Only 15% of respondents reported that they currently used a computerized patient record. Ninety-three percent of respondents favored standardized nutrition diagnoses, and 95% believed standardized nutrition interventions would prove useful. APPLICATIONS/CONCLUSIONS: We recommend that dietitians evaluate, standardize, and streamline their documentation to prepare for implementation of computerized systems. The diagnoses and interventions presented in this study could be a starting point.

Data Collection↗
PubMed1993

Protein catabolic rate in patients with acute renal failure on continuous arteriovenous hemofiltration and total parenteral nutrition.

Continuous arteriovenous hemofiltration (CAVH) has been used to provide nutrition support to critically ill patients in acute renal failure (ARF). Limited information exists regarding protein needs of these patients. Nineteen postoperative patients in ARF and on CAVH and total parenteral nutrition (TPN) were studied (10 men; 9 women; mean age, 65 yr) to determine protein needs (protein catabolic rate; PCR), urea nitrogen appearance (UNA), and total nitrogen appearance (TNA). TPN was adjusted to meet the needs estimated by the Harris-Benedict and Long equations. A total of 38 24-h studies were conducted on the 19 subjects. TNA, UNA, and PCR were determined by direct measurement of body losses and calculation of body pool nitrogen changes. Patients received an average of 93.9 +/- 30.5 g of protein (1.4 g/kg) and 2,600 +/- 534 kcal/day in TPN. Mean PCR was 117.5 +/- 42.8 g/day; UNA was 18.3 +/- 6.9 g/day. TNA and UNA were strongly correlated (r = 0.99; P < 0.001). PCR was less strongly correlated with estimated protein needs (r = 0.35; P = 0.03). A regression equation was developed describing the relationship between TNA and UNA as follows: TNA = 1.895 + 0.9444 (UNA) or UNA = 0.1602 (PCR) - 0.916. On the basis of this study, CAVH permits the provision of adequate nutrition support to critically ill, unstable patients. It appears that the protein needs of patients in ARF on CAVH can be accurately estimated by determining UNA through the measurement of urea losses and urea body pool changes and by regression equations to calculate PCR.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗