Malnutrition prevalence in a medical assessment and planning unit and its association with hospital readmission

2013 ◽  
Vol 37 (5) ◽  
pp. 636 ◽  
Author(s):  
Marte Ulltang ◽  
Angela P. Vivanti ◽  
Eryn Murray
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Hospital Readmission ◽  
Nutritional Risk ◽  
Medical Assessment ◽  
Medical Unit ◽  
Planning Unit ◽  
Acute Medical Unit ◽  
Increased Risk ◽  
Prospective Longitudinal

Objective To investigate malnutrition prevalence on presentation to a Medical Assessment and Planning Unit (MAPU) in a setting designed to prevent hospital admission, the association of nutritional status with hospital readmission at 90 days, and agreement of nutritional risk between the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA). Methods Prospective longitudinal cohort study of consecutive patients admitted to MAPU during the first 6 weeks of operation. The main outcome measures were prevalence of malnutrition and hospital readmission at 90 days. Sensitivity and specificity of the MST was assessed against the criterion standard of SGA. Results The mean participant age was 62 years (n = 153, s.d. 17.4 years) with 50% male (77/153, 95% CI 42–58%). According to the SGA, 17% (95% CI 8–26%) were assessed as malnourished on admission. The MST identified that 18% (95% CI 12–24%) were at nutritional risk, and participants screening positive for nutritional risk had significantly increased odds of hospital readmission at 90 days (OR 3.4, 95% CI, 1.3–9.1, P < 0.029). The MST was practical and successfully identified patients assessed as malnourished within the MAPU setting (sensitivity 73%, specificity 76%, negative predictive value 93%, positive predictive value 38%). Conclusions Malnutrition is a significant problem in a MAPU setting, and patients screened at nutritional risk are at significantly higher risk of hospital readmission within 90 days. What is known about the topic? The prevalence of malnutrition in Australian hospitals is estimated to be between 30 and 53%. It is important to identify malnutrition, given that the consequences contribute to increased morbidity, mortality, length of hospital stay, readmission and healthcare costs. Malnutrition screening is strongly advocated as the first step to routinely identify nutritional problems early in acute care settings. To date only one Australian study has documented the prevalence of malnutrition in an acute medical unit setting, estimating it to be 53%. What does this paper add? The acute medical unit in the previous study operates under a different model of care acute assessment unit, in which patients are triaged to the wards, and no known study to date has investigated the prevalence of malnutrition in a MAPU setting aiming to avoid hospital admissions. Furthermore, no other studies have explored malnutrition and its association with risk of hospital readmission in these settings. Our study reveals that malnutrition is a problem in MAPU settings, demonstrating the important role malnutrition screening plays in identifying malnutrition risk in a MAPU setting due to the increased risk of readmission at 90 days evident in this group. What are the implications for practitioners? The study identified that malnutrition risk significantly increased the odds of hospital readmission at 90 days. The MST was confirmed as a practical tool for use in the MAPU setting, showing acceptable sensitivity and specificity. Incorporation of malnutrition screening and timely intervention may increase the overall effectiveness of the MAPU clinic through avoidance of hospital readmission at 90 days.

scholarly journals Predicting Disease in Transition Dairy Cattle Based on Behaviors Measured Before Calving

Animals ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 928
Author(s):  
Mohammad W. Sahar ◽  
Annabelle Beaver ◽  
Marina A. G. von Keyserlingk ◽  
Daniel M. Weary
Keyword(s):  
Dairy Cattle ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Predictive Value ◽  
Predictive Ability ◽  
Training Dataset ◽  
Test Dataset ◽  
Increased Risk ◽  
High Prevalence ◽  
Random Method

Dairy cattle are particularly susceptible to metritis, hyperketonemia (HYK), and mastitis in the weeks after calving. These high-prevalence transition diseases adversely affect animal welfare, milk production, and profitability. Our aim was to use prepartum behavior to predict which cows have an increased risk of developing these conditions after calving. The behavior of 213 multiparous and 105 primiparous Holsteins was recorded for approximately three weeks before calving by an electronic feeding system. Cows were also monitored for signs of metritis, HYK, and mastitis in the weeks after calving. The data were split using a stratified random method: we used 70% of our data (hereafter referred to as the “training” dataset) to develop the model and the remaining 30% of data (i.e., the “test” dataset) to assess the model’s predictive ability. Separate models were developed for primiparous and multiparous animals. The area under the receiver operating characteristic (ROC) curve using the test dataset for multiparous cows was 0.83, sensitivity and specificity were 73% and 80%, positive predictive value (PPV) was 73%, and negative predictive value (NPV) was 80%. The area under the ROC curve using the test dataset for primiparous cows was 0.86, sensitivity and specificity were 71% and 84%, PPV was 77%, and NPV was 80%. We conclude that prepartum behavior can be used to predict cows at risk of metritis, HYK, and mastitis after calving.

scholarly journals TIME to think about delirium: improving detection and management on the acute medical unit

2018 ◽  
Vol 7 (3) ◽  
pp. e000200 ◽  
Author(s):  
Yehudit Bauernfreund ◽  
Matthew Butler ◽  
Sumathi Ragavan ◽  
Elizabeth L Sampson
Keyword(s):  
Screening Tool ◽  
Hospital Setting ◽  
Education Programme ◽  
Junior Doctors ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Increased Risk ◽  
National Guidance ◽  
Risk Of Falls ◽  
Personal Orientation

Delirium affects 18%–35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients and their families. We used quality improvement tools and a multicomponent intervention to promote detection and improve management of delirium on the acute medical unit (AMU). We reviewed whether a delirium screening tool (4AT) had been completed for all patients aged over 65 years admitted to the AMU over 1 week. If delirium was detected, we assessed whether investigation and management was adequate as per national guidance. After baseline data collection, we delivered focused sessions of delirium education for doctors and nursing staff, including training on use of the 4AT tool and the TIME (Triggers, Investigate, Manage, Engage) management bundle. We introduced TIME checklists, an online delirium order set and created a bedside orientation tool. We collected data following the interventions and identified areas for further improvement. Following our first PDSA (Plan, Do, Study, Act) cycle, use of the 4AT screening tool improved from 40% to 61%. Adequate assessment for the causes of and exacerbating factors for delirium increased from 73% to 94% of cases. Use of personal orientation tools improved from 0% to 38%. In summary, a targeted staff education programme and practical aids for the ward have improved the screening and management of delirium on the AMU. This may be improved further through more frequent training sessions to account for regular change-over of junior doctors and through implementing a nursing champion for delirium.

scholarly journals Acute medical unit clinical skills lab

2019 ◽  
Vol 6 (Suppl 1) ◽  
pp. 140-140
Author(s):  
Sarb Clare ◽  
Joe Wheeler
Keyword(s):  
Clinical Skills ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Skills Lab

scholarly journals Evaluation of the Diagnostic Accuracy of the Interview and Physical Examination in the Diagnosis of Endometriosis as the Cause of Chronic Pelvic Pain

2021 ◽  
Vol 18 (12) ◽  
pp. 6606
Author(s):  
Jolanta Nawrocka-Rutkowska ◽  
Iwona Szydłowska ◽  
Aleksandra Rył ◽  
Sylwester Ciećwież ◽  
Magdalena Ptak ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Pelvic Pain ◽  
Predictive Value ◽  
Chronic Pelvic Pain ◽  
Reproductive Age ◽  
Pelvic Surgery ◽  
History Of Surgery ◽  
Previous Surgery ◽  
History Of

Background: Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20–40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12–18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination. Materials and methods: The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated. Results: After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosis without coexisting adhesions was more often diagnosed in women without previous surgery (34.9%), compared to 10.58% in the group with a history of surgery (p < 0.05). Conclusions: Intraperitoneal adhesions are most common in women after pelvic surgery and with chronic ailments. The best results for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of endometriosis are found in women with irregular menstruations during which the pain increases. Laparoscopy still remains the primary diagnostic and therapeutic method for these women.

scholarly journals 270. Clinical Outcomes of Ceftriaxone versus Penicillin G for Complicated Viridans Group Streptococci Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Stephanie Wo ◽  
Yanina Dubrovskaya ◽  
Justin Siegfried ◽  
John Papadopoulos ◽  
Shin-Pung Jen
Keyword(s):  
Clinical Outcomes ◽  
Hospital Readmission ◽  
Protective Factor ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Penicillin G ◽  
Eligibility Criteria ◽  
Extended Spectrum Beta Lactamase ◽  
Increased Risk ◽  
Viridans Group Streptococci

Abstract Background Viridans group streptococci (VGS) is an infrequent yet significant cause of bloodstream infections, and complicated cases may require prolonged antibiotic therapy. Ceftriaxone (CTX) and penicillin G (PCN G) are both considered first line options for VGS infections, but comparisons between these agents are limited. We evaluated the clinical outcomes amongst patients treated with CTX and PCN G for complicated VGS bacteremia. Methods This was a single-center, retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in PCN G arm) between January 2013 and June 2019. The primary outcome was a composite of safety endpoints, including hospital readmission due to VGS or an adverse event (AE) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to an antibiotic-related AE, and development of extended-spectrum beta lactamase resistance. Secondary outcomes included the individual safety endpoints, VGS bacteremia recurrence, hospital readmission, and all-cause mortality. Results Of 328 patients screened for inclusion, 94 patients met eligibility criteria (CTX n= 64, PCN G n=34). Median age was 68 years (IQR 56–81) and 68% were male. Study patients did not present with critical illness, as reflected by a median Pitt bacteremia score of 0 in the CTX and 1 in the PCN G arms, P=0.764. Streptococcus mitis was the most common VGS isolate and infective endocarditis (IE) was the predominant source of infection. CTX was not significantly associated with increased risk of the primary outcome (14% vs. 27%; P= 0.139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. Results were similar in the subgroup of patients with IE (12.5% vs. 23.5%). No secondary endpoints differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary outcome (OR 0.1; 95% CI 0.020–0.6771; P= 0.017). Conclusion Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate a higher rate of treatment failure, adverse events, or resistance. These findings warrant further exploration. Disclosures All Authors: No reported disclosures

scholarly journals Causes of discharge delays from the acute medical unit (AMU) in a tertiary level teaching hospital, Brunei Darussalam

2021 ◽  
pp. 201010582110061
Author(s):  
Dayang Nur Hilmiyah binti Awang Husaini ◽  
Justin Fook Siong Keasberry ◽  
Khadizah Haji Abdul Mumin ◽  
Hanif Abdul Rahman
Keyword(s):  
Observational Study ◽  
Discharge Planning ◽  
Patient Factors ◽  
Medical Unit ◽  
Prolonged Length ◽  
Acute Medical Unit ◽  
Brunei Darussalam ◽  
Medical Issues ◽  
Hospital Factors ◽  
Prolonged Hospital

Background: Many patients admitted to the acute medical unit experience a prolonged length of stay in hospital due to discharge delays. Consequently, this may impact the patients, healthcare institution and national economy in terms of patient safety, decreased hospital capacity, lost patient workdays and financial performance. Objectives: The main aim of this observational study was to identify the causes of discharge delays among acute medical unit patients admitted in the Raja Isteri Pengiran Anak Saleha Hospital, Brunei. Methods: A retrospective observational study, with data of patients admitted to the acute medical unit collected from Brunei Health Information Systems between September and December 2018. Statistical analyses were performed to obtain relevant results and any statistically significant associations. Results: A total of 357 patients were admitted to the acute medical unit over the 4-month period; 218 patients (61.1%) experienced discharge delays. Of these 218 patients, 158 patients (72.5%) encountered discharge delays mainly due to intrinsic patient factors, while the discharge delays in 88 patients (40.4%) were attributed to hospital factors. The main reason for discharge delays for patient factors was slow recovery among 67 patients (30.7%), whereas for hospital factors it was the weekend limitation of services available in 23 patients (10.6%). Conclusions: There were various causes of discharge delays identified among the 218 acute medical unit patients who experienced discharge delays. Older patients with frailty, polypharmacy and complex medical issues were more likely to have a prolonged hospital stay in the acute medical unit. Stringent inclusion criteria, increasing discharge planning as well as an effective multidisciplinary approach will aid in reducing discharge delays from the acute medical unit.

scholarly journals Screening for aneurysms of the abdominal aorta using a simple screening device

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
J. W. Brakel ◽  
T. A. Berendsen ◽  
P. M. C. Callenbach ◽  
J. van der Burgh ◽  
R. J. Hissink ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Abdominal Aorta ◽  
Predictive Value ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Predictive Values ◽  
Bladder Scan ◽  
Health Council ◽  
Screening Device

Abstract Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.

scholarly journals P82 NUn score validation at a district general hospital

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Positive Predictive Value ◽  
Anastomotic Leak ◽  
Confidence Intervals ◽  
Predictive Value ◽  
External Validation ◽  
District General Hospital ◽  
Anastomotic Leaks ◽  
Upper Gi ◽  
Increased Risk ◽  
Operative Complications

Abstract Introduction The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of &gt; 10 was used to predict an increased risk. In this study we attempt validation. Methods A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications. Results A total of 12 patients had a NUn score of &gt; 10 (16.67%). There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks. From our data Conclusion From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.

scholarly journals Validation of the SavvyCheckTM Vaginal Yeast Test for Screening Pregnant Women for Vulvovaginal Candidosis: A Prospective, Cross-Sectional Study

2021 ◽  
Vol 7 (3) ◽  
pp. 233
Author(s):  
Philipp Foessleitner ◽  
Herbert Kiss ◽  
Julia Deinsberger ◽  
Julia Ott ◽  
Lorenz Zierhut ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Predictive Value ◽  
Point Of Care ◽  
Cross Sectional Study ◽  
Control Group ◽  
Gram Stain ◽  
Cross Sectional ◽  
Point Of Care Test ◽  
Increased Risk ◽  
Vulvovaginal Candidosis

Pregnant women have an increased risk of vulvovaginal candidosis. Recurrent candidosis is under debate as a contributor to preterm birth, and vertical transmission may cause diaper dermatitis and oral thrush in the newborn. Apart from cultural methods, the gold standard for diagnosing candidosis is Gram staining, which is time-consuming and requires laboratory facilities. The objective of this prospective study was to validate a point-of-care vaginal yeast detection assay (SavvyCheckÔ Vaginal Yeast Test) and to evaluate it in asymptomatic pregnant women. We enrolled 200 participants, 100 of whom had vulvovaginal candidosis according to Gram stain (study group) and 100 were healthy pregnant controls (control group). Of these, 22 participants (11%) had invalid test results. The point-of-care test of the remaining 85 and 93 study participants in the study and control groups, respectively, showed a sensitivity of 94.1%, specificity of 98.9%, positive predictive value of 90.3%, and negative predictive value of 99.4% when compared with Gram stain. In conclusion, we found a high correlation between the SavvyCheckÔ Vaginal Yeast Test and Gram-stained smears during pregnancy. This suggests a potential role of this point-of-care test as a screening tool for asymptomatic pregnant women in early gestation.

Sign in / Sign up

Export Citation Format

Share Document