scholarly journals 3423 Poorer Outcomes Among Septic Patients with Protein Energy Malnutrition

2019 ◽  
Vol 3 (s1) ◽  
pp. 124-124
Author(s):  
Adeyinka Charles Adejumo ◽  
Olalekan Akanbi ◽  
Lydie Pani
Keyword(s):  
Clinical Outcomes ◽  
Primary Care Physicians ◽  
Protein Energy Malnutrition ◽  
Community Dwelling ◽  
P Value ◽  
Protein Energy ◽  
Propensity Matching ◽  
Study Population ◽  
Clinical Conditions ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: Protein Energy Malnutrition (PEM) could compromise the body’s defense systems resulting in sepsis, which further depletes calorie stores. Among hospitalized patients, we investigate 1) the relationship between PEM and sepsis, 2) the impact of PEM on trends in mortality from sepsis, and 3) the influence of PEM on clinical outcomes of sepsis. METHODS/STUDY POPULATION: Using the 2014 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (NIS) patient’s discharge records, we identified patients with sepsis, PEM, and other clinical conditions with ICD-9-CM codes. After stratifying sepsis into two: uncomplicated (without shock) and complicated (with shock), we estimated the adjusted odds (aOR) of developing sepsis (total, uncomplicated and complicated) with PEM. Then, we selected hospitalizations with sepsis from 2007-2014 years of the HCUP-NIS, and calculated the trend in mortality from sepsis, stratified by PEM status, as an effect modifier. Finally, we matched PEM to no PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the effect of having mortality, complicated sepsis and 10 other clinical outcomes and healthcare utilization (SAS 9.4). RESULTS/ANTICIPATED RESULTS: PEM was associated with higher odds for sepsis (aOR:3.97[3.89-4.05]), and complicated vs. uncomplicated sepsis (1.74[1.67-1.81]). Although mortality in sepsis has been trending down from 2007-2014 (−1.19%/year, p-trend<0.0001), the decrease was less pronounced among those with PEM vs. no-PEM (−0.86%/year vs. −1.29%/year, p-value < 0.0001). After propensity matching, PEM was associated with higher mortality (1.35[1.32-1.37]), cost ($160,724[159,517-161,940] vs. $86,650[85,931-87,375]), length of stay (14.76[14.68-14.84] vs. 8.49[8.45-8.56] days), and worse outcomes in general. DISCUSSION/SIGNIFICANCE OF IMPACT: PEM is a risk factor of sepsis and associated with poorer outcomes among septic patients. A concerted effort involving primary care physicians, nutritionists, nurses in identifying, preventing, and treatment of PEM in the community-dwelling individuals before hospitalization might mitigate against these devastating outcomes.

scholarly journals 3417 Impact of Protein-Energy Malnutrition on Outcomes of Heart Failure Hospitalizations

2019 ◽  
Vol 3 (s1) ◽  
pp. 123-123
Author(s):  
Adeyinka Charles Adejumo ◽  
Olumuyiwa Ogundipe
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Protein Energy Malnutrition ◽  
Low Grade ◽  
Protein Energy ◽  
The Us ◽  
Study Population ◽  
Comorbidity Index ◽  
The Impact ◽  
Low Grade Inflammation

OBJECTIVES/SPECIFIC AIMS: Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. METHODS/STUDY POPULATION: From the 2012-2014 Nationwide Inpatient Sample (NIS) patient’s discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). RESULTS/ANTICIPATED RESULTS: There were 32,771 (~163,885) cases of PEM among the 541,679 (~2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs. no-PEM:72 years), Whites (70.75% vs. 67.30%), and had higher comorbid burden, with Deyo-comorbidity index >3 (31.61% vs. 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48[2.31-2.66]), cardiogenic shock (3.11[2.79-3.46]), cardiac arrest (2.30[1.96-2.70]), acute kidney failure (1.49[1.44-1.54]), acute respiratory failure (1.57[1.51-1.64]), mechanical ventilation (2.72[2.50-2.97]). PEM also resulted in higher non-routine discharges (2.24[2.17-2.31]), hospital cost ($80,534[78,496-82,625] vs. $43,226[42,376-44,093]) and longer duration of admission (8.61[8.49-8.74] vs. 5.28[5.23-5.34] days). DISCUSSION/SIGNIFICANCE OF IMPACT: In the US, PEM is a common comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in heart failure subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM.

scholarly journals Study on impact of protein energy malnutrition on development in children

2019 ◽  
Vol 6 (6) ◽  
pp. 2566
Author(s):  
Dhara Patel ◽  
Greeshma Issac
Keyword(s):  
Protein Energy Malnutrition ◽  
Fine Motor ◽  
Maximum Effect ◽  
P Value ◽  
Normal Children ◽  
Social Domain ◽  
Gross Motor ◽  
Protein Energy ◽  
Grade 3 ◽  
The Impact

Background: Majority of the children in India who live below the poverty line in an environment of deprivation and starvation have physical and developmental retardation. The Objective of this study to study the impact and comparison of protein energy malnutrition on the development with normal children.Methods: This was a hospital based cross sectional study in which total 128 cases of protein energy malnutrition and 30 normal children were enrolled from nutritional rehabilitation center and in patients wards. The study population comprised of children less than 5 years of age, having weight for height/length ≤3 SD, with visible wasting, or bipedal oedema, with mid arm circumference <11.5 cm were assessed for their development in all four domains using Denver II developmental Screening Test (DDST-II).Results: The gross motor milestones are affected in 62.5% with grade4 PEM & 42.85% with grade 3, the fine motor component is affected more in grade 4 with other domains less affected, no significant relation of language delay with PEM was observed in this study, 40% of children with grade 4 PEM shows delay in social domain while 18.18% of the patients with grade 3 PEM show delay in social domain. No patients with grade 1 or grade 2 PEM showed delay in social domain. All four domains are affected in PEM with a maximum effect in gross motor, but the difference does not seem to be significant as the p value is 0.3 i.e.  >0.05 which is insignificant.Conclusions: My study on the effect of protein energy malnutrition on development proves that there in increasing delay in all the domains of development with increasing grade of malnutrition. Early detection of malnutrition in community can cause early intervention and increase the productivity of nation.

scholarly journals Successful Transitions to Remote Assessments and Technology Installations due to COVID-19: The I-CONECT Project

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 958-958
Author(s):  
Khoa Nguyen ◽  
Mattie McDonald ◽  
Colton Scavone ◽  
Nora Mattek ◽  
Jeffrey Kaye ◽  
...  
Keyword(s):  
Social Interaction ◽  
Community Dwelling ◽  
Controlled Clinical Trial ◽  
Cognitive Assessments ◽  
Video Chat ◽  
Remote Assessment ◽  
Study Population ◽  
Support Team ◽  
Socially Isolated ◽  
The Impact

Abstract I-CONECT is a randomized controlled clinical trial to examine the impact of social interaction delivered via video-chat on cognitive function (clinicaltrials.gov number: NCT02871921, project website: www.I-CONECT.org ). We aimed to enroll 320 community-dwelling socially isolated older adults (age &gt;=75 years). The recruitment of participants has started in 2018 and was ongoing when COVID-19 pandemic began. Video chat and telephone-based social interaction interventions did not change during COVID-19. However, new recruitment and cognitive assessments, which require in-person contact and deployment and retrieval of video chat devices in participant homes, were suspended due to the nature of our study population (i.e., older age, higher likelihood of comorbidities). Recently we were able to successfully switch to complete remote assessments including 1) telephone-based cognitive assessments using T-COG (Telephone Cognitive Assessment battery), and 2) contactless delivery of our study devices (Chrome books and electronic pill boxes) for subject self-installation. Our creative approach to self-installations includes color coded pictures and an easy-to-follow installation manual, accompanied by remote instruction and support via telephone. This poster introduces our remote assessment and installation protocol and participant and technical support team feedback regarding this new contactless protocol. This presentation provides useful guidance for future studies considering completely remote assessment and telemedicine approaches.

scholarly journals Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

2019 ◽  
Vol 45 (3) ◽  
pp. 640-660 ◽  
Author(s):  
Johanna T. Dwyer ◽  
Jaime J. Gahche ◽  
Mary Weiler ◽  
Mary Beth Arensberg
Keyword(s):  
Older Adults ◽  
Predictive Validity ◽  
Screening Tool ◽  
Protein Energy Malnutrition ◽  
The United States ◽  
Community Dwelling ◽  
Screening Tools ◽  
World Health ◽  
Community Settings ◽  
Protein Energy

Abstract Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

scholarly journals 342 The Association Between Benzodiazepine Use and Falls, and the Impact of Sleep Quality on this Association: Data from TILDA

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Louise Marron ◽  
Ricardo Segurado ◽  
Paul Claffey ◽  
Rose Anne Kenny ◽  
Triona McNicholas
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Effect Size ◽  
Community Dwelling ◽  
Public Health Issue ◽  
P Value ◽  
Poor Sleep ◽  
Daytime Somnolence ◽  
Falling Asleep ◽  
The Impact

Abstract Background Benzodiazepines (BZD) are associated with adverse effects, particularly in older adults. Previous research has shown an association between BZDs and falls and BZDs have been shown to impact sleep quality. The aim of this study is to assess the association between BZD use and falls, and the impact of sleep quality on this association, in community dwelling adults aged over 50. Methods Data from the first wave of The Irish Longitudinal Study on Ageing were used. Participants were classed as BZD users or non-users and asked if they had fallen in the last year, and whether any of these falls were unexplained. Sleep quality was assessed via self-reported trouble falling asleep, daytime somnolence, and early-rising. Logistic regression assessed for an association between BZD use and falls, and the impact of sleep quality on this association was assessed by categorising based on BZD use and each sleep quality variable. Results Of 8,175 individuals, 302 (3.69%) reported taking BZDs. BZD use was associated with falls, controlling for con-founders (OR 1.40; 1.08, 1.82; p-value 0.012). There was no significant association between BZDs and unexplained falls, controlling for con-founders (OR 1.41; 95% CI 0.95, 2.10; p-value 0.09), however a similar effect size to all falls was evident. Participants who take BZDs and report daytime somnolence (OR 1.93; 95% CI 1.12, 3.31; p-value 0.017), early-rising (OR 1.93; 95% CI 1.20, 3.11; p-value 0.007) or trouble falling asleep (OR 1.83; 95% CI 1.12, 2.97; p-value 0.015), have an increased odds of unexplained falls. Conclusion BZD use is associated with falls, with larger effect size in BZD users reporting poor sleep quality in community dwelling older adults. Appropriate prescription of and regular review of medications such as BZDs is an important public health issue.

scholarly journals KADAR TRIGLISERIDA DAN STATUS GIZI PADA KLIEN TUBERKULOSIS

2017 ◽  
Vol 5 (2) ◽  
pp. 101
Author(s):  
Noor Diani ◽  
Devi Rahmayanti
Keyword(s):  
Nutritional Status ◽  
Protein Energy Malnutrition ◽  
The Body ◽  
Nutrition Status ◽  
P Value ◽  
Cross Sectional ◽  
Protein Energy ◽  
Tnf Α ◽  
Relationship Of ◽  
The Relationship

Abstrak Tuberkulosis (TBC) mengakibatkan penurunan asupan dan malabsorbsi nutrien serta metabolisme tubuh berubah sehingga terjadi massa otot dan lemak menurun akibat mekanisme malnutrisi dari energi protein. Malnutrisi pada TBC berpengaruh terhadap prognosis dan tingkat kematian. Peningkatan produksi IFNl- γ dan IL-6, TNF α menghambat dari aktivitas Lipo Protein Lipase (LPL) dijaringan lemak. Enzim LPL berperan dalam proses bersihan trigliserida. Peningkatan ini meningkatkan trigliserida sehingga proses sintesis lemak menurun dan proses lipolisis lemak meningkat di jaringan. Tujuan penelitian ini menganalisis hubungan trigliserida dan status gizi pada klien TBC. Metode penelitian ini korelasi analitik dengan pendekatan cross-sectional, sampel 25 orang, dengan uji korelasi Pearson-Product Moment. Hasil penelitian status gizi dibawah normal 56%, normal 40% dan kelebihan berat badan 4%. Kadar Trigliserida normal 84%, trigliserida tinggi 16%. Kesimpulan ada hubungan antara kadar trigliserida dan status gizi yakni r hitung sebesar 0,5: r tabel = 0,396 sehingga r hitung > r tabel dengan korelasi positif.Kata Kunci : Trigliserida, Status Gizi, Tuberkulosis.AbstractTuberculosis(TB) resulting the decreasing of nutrient intake and malabsorbsi as well as changing the metabolism of the body. The wasthing are decreased protein energy. Malnutrition on TB affects the prognosis of the treatment and death rates. The increase TNF α will inhibit the enzyme activity of Lipoprotein Lipase (LPL) in the fat tissue. LPL enzyme plays a role in cleavage process of triglycerides. This research was to analyze the relationship of triglycerides and nutrition status on the client with tuberculosis. The design was cross-sectional approach. The respondents were gathered from 25 newly TB patients. The analyzed using Pearson Product-Moment correlation. The results showed 56% respondents undernutrition, and normal 40% and over nutrition 4%. Most triglyceride level of the respondent were normal (84). The concluded was a relationship between triglycerides and the nutritional status with a positive correlation ( P value 0,396).Keywords : Triglycerides, Nutritional Status, Tuberculosis

scholarly journals Serum albumin as predictor of post-operative morbidity and mortality

2017 ◽  
Vol 4 (3) ◽  
pp. 1078
Author(s):  
Latika Sharma ◽  
Poojan M. Purohit ◽  
Dharmendra Pipal ◽  
Saurabh Kothari ◽  
Harshit Srivastava ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Protein Energy Malnutrition ◽  
Organ System ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
P Value ◽  
Age Group ◽  
Operative Morbidity ◽  
Medical College ◽  
Protein Energy

Background: Protein energy malnutrition affects every organ system. So correct assessment of nutritional status is important as malnourishment is a risk factor for morbidity and morality in surgical patients. In our study, serum albumin has been taken as parameter for nutritional assessment.Methods: Study is conducted on 50 patients admitted in Department of General Surgery, Dr. Sampurnanand Medical College and associated Hospital, Jodhpur, Rajasthan, India for surgeries during January 2014-December 2015. Data was analyzed using Z-test and Fischer exact t-test and p value was calculated. P value <0.05 is considered statistically significant.Results: Patients with serum albumin <3gm/dl had more complications with maximum number of complications in age group of 41-60 year group. This finding was statistically significant.Conclusions: Low serum albumin patients has more post-operative complication than those with normal level and so is a good indicator of post-operative morbidity and mortality.

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