Estimation of Total Body and Extracellular Water Using Single-and Multiple-Frequency Bioimpedance

1994 ◽  
Vol 28 (5) ◽  
pp. 565-569 ◽  
Author(s):  
Rakesh V. Patel ◽  
James R. Matthie ◽  
Paul O. Withers ◽  
Edward L. Peterson ◽  
Barbara J. Zarowitz
Keyword(s):  
Deuterium Oxide ◽  
Acute Care Hospital ◽  
Single Frequency ◽  
Care Hospital ◽  
Extracellular Water ◽  
Multiple Frequency ◽  
Open Label ◽  
For Profit ◽  
The Mean ◽  
Total Body

OBJECTIVE: To determine the precision and bias of single- and multiple-frequency bioimpedance estimates of total body water (TBW) and extracellular water (ECW) volumes in comparison with the true values for these volumes established by gold standard dilution techniques. DESIGN: Controlled, prospective, open-label investigation. SETTING: Private, not-for-profit university-affiliated, acute care hospital. PARTICIPANTS: Normal, healthy men (n=8) and women (n=6) volunteers, 25–46 years of age. INTERVENTIONS: A single oral dose of a mixture of deuterium oxide 10 g and bromine 30 mmol; bioimpedance analysis pre- and three hours postrnixture administration. MAIN OUTCOME PARAMETERS: TBW and ECW volumes established by deuterium oxide and bromine dilutional spaces (gold standards), respectively, and single- and multiple-frequency bioimpedance estimates of those same volumes. RESULTS: The mean multiple-frequency bioimpedance (MFB) and single frequency bioimpedance (SFB) estimates of TBW, 41.2 and 42.1 L, respectively, were not statistically different (NS) from the 41.2 L deuterium oxide value. Although the two methods had similar precision (NS), MFB was less biased. For ECW, the mean MFB and SFB values of 19.5 and 24.8 L, respectively, were significantly different from the bromine value of 18.8 L (p=0.013 and p=0.001, respectively). MFB was the more precise and less biased predictor of ECW. CONCLUSIONS: Compared with SFB, the MFB approach is a more precise and less biased predictor of TBW and ECW volumes in young, healthy adults, and may offer more accurate assessment in subjects with aberrant physiology.

Abstract WP399: Reduced Cost and Decreased Length of Stay Associated with Acute Ischemic Stroke Care Provided by Nurse Practitioners: A Single Primary Stroke Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Leah Roering ◽  
Michelle Peterson ◽  
Muhammad Shah Miran ◽  
Melissa Freese ◽  
Kenneth Shea ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Nurse Practitioners ◽  
Acute Care Hospital ◽  
Stroke Care ◽  
Care Hospital ◽  
Medical Provider ◽  
The Mean ◽  
Stroke Center

Background: Nurse practitioner (NP) have a wider role in modern stroke centers providing quality evidence based care to patients in both in and outpatient settings for acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients. We studied the outcome measures, length of stay (LOS) and cost before and after implementation of nurse practitioners as the primary medical provider in a community based stroke center. Methods: St Cloud hospital is acute care hospital with dedicated stroke service responsible for workup and management of all patients admitted with AIS and TIA. From March 2014-March 2015, all patients were primarily managed by stroke neurologists with or without support of NP, representing physician driven arm. From June 2015-March 2016 all non-critical patients were managed primarily by NP, representing the NP driven arm of care. For this analysis, we excluded all patients with subarachnoid hemorrhage or intracerebral hemorrhage. Using ICD codes, we abstracted LOS and hospitalization cost for all patients, and compared between two arms. Results: A total of 822 patients were included in physician arm and 336 in NP arm. The mean age was 72±14 years for both arms, and 54.4% were male in physician arm and 57.4% were male in NP arm. The mean total LOS for the physician arm was 3.1 ±3.3 days while 2.9±3.6 for NP arm (p=0.6). The total cost for physician arm was $11,286.70 ±$10,920.90 while the NP arm was $10,277.30± $10,142.30 (p=0.1). Conclusion: There is a trend towards lower cost and length of stay with implementation of NP as primary stroke provider for patients admitted with acute ischemic stroke.

Analytic assessment of the various bioimpedance methods used to estimate body water

1998 ◽  
Vol 84 (5) ◽  
pp. 1801-1816 ◽  
Author(s):  
J. Matthie ◽  
B. Zarowitz ◽  
A. De Lorenzo ◽  
A. Andreoli ◽  
K. Katzarski ◽  
...  
Keyword(s):  
Body Water ◽  
Intracellular Water ◽  
Single Frequency ◽  
Fluid Distribution ◽  
Good Prediction ◽  
Extracellular Water ◽  
Tissue Change ◽  
Water Compartments ◽  
Water Conduction ◽  
Total Body

Knowledge of patient fluid distribution would be useful clinically. Both single-frequency (SF) and impedance modeling approaches are proposed. The high intercorrelation between body water compartments makes determining the best approach difficult. This study was conducted to evaluate the merits of an SF approach. Mathematical simulation was performed to determine the effect of tissue change on resistance and reactance. Dilution results were reanalyzed, and resistance and parallel reactance were used to predict the intracellular water for two groups. Results indicated that the amount of intracellular and extracellular water conduction at any SF can vary with tissue change, and reactance at any SF is affected by all tissue parameters. Modeling provided a good prediction of dilution intracellular and extracellular water, but an SF method did not. Intracellular, extracellular, and total body water were equally predicted at all frequencies by SF resistance and parallel reactance. Extracellular and intracellular water are best measured through modeling, because only at the zero and infinite frequencies are the results sensitive only to extracellular and intracellular water. At all other frequencies there are other effects.

scholarly journals Variation in Long-Term Acute Care Hospital Use After Intensive Care

2012 ◽  
Vol 69 (3) ◽  
pp. 339-350 ◽  
Author(s):  
Jeremy M. Kahn ◽  
Rachel M. Werner ◽  
Shannon S. Carson ◽  
Theodore J. Iwashyna
Keyword(s):  
Intensive Care ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Patient Characteristics ◽  
Hierarchical Regression ◽  
Care Hospital ◽  
Hospital Size ◽  
For Profit ◽  
Medicare Claims Data

Long-term acute care hospitals (LTACs) are an increasingly common discharge destination for patients recovering from intensive care. In this article the authors use U.S. Medicare claims data to examine regional- and hospital-level variation in LTAC utilization after intensive care to determine factors associated with their use. Using hierarchical regression models to control for patient characteristics, this study found wide variation in LTAC utilization across hospitals, even controlling for LTAC access within a region. Several hospital characteristics were independently associated with increasing LTAC utilization, including increasing hospital size, for-profit ownership, academic teaching status, and colocation of the LTAC within an acute care hospital. These findings highlight the need for research into LTAC admission criteria and the incentives driving variation in LTAC utilization across hospitals.

A comparison of bioimpedance methods for detection of body cell mass change in HIV infection

2000 ◽  
Vol 88 (3) ◽  
pp. 944-956 ◽  
Author(s):  
Carrie P. Earthman ◽  
James R. Matthie ◽  
Phyllis M. Reid ◽  
Ingeborg T. Harper ◽  
Eric Ravussin ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cell Mass ◽  
Body Cell Mass ◽  
Extracellular Water ◽  
Multiple Frequency ◽  
Body Cell ◽  
Immunodeficiency Virus ◽  
Measuring Change ◽  
Before And After ◽  
Total Body

The maintenance of body cell mass (BCM) is critical for survival in human immunodeficiency virus (HIV) infection. Accuracy of bioimpedance for measuring change (Δ) in intracellular water (ICW), which defines BCM, is uncertain. To evaluate bioimpedance-estimated ΔBCM, the ICW of 21 weight-losing HIV patients was measured before and after anabolic steroid therapy by dilution (total body water by deuterium − extracellular water by bromide) and bioimpedance. Multiple-frequency modeling- and dilution-determined ΔICW did not differ. The ΔICW was predicted poorly by 50-kHz parallel reactance, 50-kHz impedance, and 200 − 5-kHz impedance. The ΔICW predicted by 500 − 5-kHz impedance was closer to, but statistically different from, dilution-determined ΔICW. However, the effect of random error on the measurement of systematic error in the 500 − 5-kHz method was 12–13% of the average measured ΔICW; this was nearly twice the percent difference between obtained and threshold statistics. Although the 500 − 5-kHz method cannot be fully rejected, these results support the conclusion that only the multiple-frequency modeling approach accurately monitors ΔBCM in HIV infection.

scholarly journals An Examination of the Mediating Role for a Nursing Information System

2017 ◽  
Vol 21 ◽  
Author(s):  
Lemai Nguyen ◽  
Nilmini Wickramasinghe
Keyword(s):  
Information System ◽  
Activity Theory ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Nursing Documentation ◽  
For Profit ◽  
Mediating Role ◽  
Not For Profit ◽  
Nursing Information System

This paper reports on findings from an examination of a nursing information system through the lens of Activity Theory. The information system was designed to support real-time nursing documentation in acute care hospital contexts. The objective was to enable superior nursing care to ensue by providing nurses with the opportunity to document patient care data into a tablet computer located at the patient bedside. The system was evaluated in a not-for-profit acute care hospital’s wards during its implementation. Nurses’ interactions with the system and their perceptions were collected and analysed through the lens of Activity Theory. The analysis highlighted nurses’ positive attitude towards the system and identified potential mediation capabilities as well as areas for improvements. Activity Theory was found to be useful to examine the positive and potentially problematic aspects of this new nursing information system.

scholarly journals TO EVALUATE EFFICACY AND SAFETY OF RUPATADINE, BILASTINE, AND LEVOCETRIZINE IN ALLERGIC RHINITIS AT TERITARY CARE HOSPITAL, TELANGANA

2021 ◽  
pp. 140-143
Author(s):  
NAGUR SHARONE GRACE ◽  
SYED ARSHADDUDDIN AHMED ◽  
BHUVANESWARI E ◽  
SYED HAMZA QUADRI ◽  
VEENA B ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Adverse Events ◽  
Nasal Congestion ◽  
Care Hospital ◽  
Efficacy And Safety ◽  
Open Label ◽  
Once Daily ◽  
Significant Difference ◽  
The Mean ◽  
The Government

Objective: Allergic rhinitis (AR) is a heterogeneous disorder characterized by symptoms – sneezing, itching, nasal congestion, and rhinorrhea. The aim of the study is to evaluate the efficacy and safety of rupatadine, bilastine, and levocetirizine in AR. Methods: A prospective, open-label, comparative study was conducted at the Government ENT Hospital, Hyderabad, Telangana. Ninety patients diagnosed with AR were randomized, of whom Group 1 received oral tab. bilastine 20 mg once daily, Group 2 received oral tab. levocetirizine 5 mg once daily, and Group 3 received oral tab. rupatadine with a dose of 10 mg once daily for 2 weeks. The reduction in total nasal symptom score (TNSS) and absolute eosinophil counts (AECs) was compared with baseline and at 2 weeks. Safety was assessed according to adverse events reported during the study period. An analysis of variance was used as a test of significance for the three groups. Results: Overall, 90 cases were included in the study, with 48% of males and 52% of females. All three drugs significantly reduced the TNSS and AEC after treatment compared to before treatment (p<0.05). The mean difference in TNSS and AEC showed no statistically significant difference among the three groups (TNSS: p>0.908 and AEC: p>0.967). In terms of safety, all three drugs showed nearly similar adverse events. Conclusion: In this study, after 2 weeks of follow-up, the three drugs (bilastine, levocetirizine, and rupatadine) showed significant improvement clinically, but the mean reduction in the score of symptoms and AEC was not statistically significant in the treatment of AR.

Human hydrometry: comparison of multifrequency bioelectrical impedance with2H2O and bromine dilution

1998 ◽  
Vol 85 (3) ◽  
pp. 1056-1062 ◽  
Author(s):  
Kenneth J. Ellis ◽  
William W. Wong
Keyword(s):  
Impedance Spectroscopy ◽  
Traditional Method ◽  
Healthy Subjects ◽  
Bioelectrical Impedance ◽  
Extracellular Water ◽  
Males And Females ◽  
The Mean ◽  
Total Body ◽  
Mean Differences ◽  
Age Range

The traditional method of assessing total body water (TBW), extracellular water (ECW), and intracellular water (ICW) has been the use of isotopes, on the basis of the dilution principle. Although the development of bioelectrical impedance techniques has eliminated many of the measurement constraints associated with the dilution methods, the degree of interchangeability between the two methods remains uncertain. We used multifrequency bioelectrical impedance spectroscopy (BIS),2H2O dilution, and bromine dilution to assess TBW, ECW, and ICW in 469 healthy subjects (248 males, 221 females) aged 3–29 yr. We found that the TBW, ECW, and ICW estimates for the BIS and dilution methods were significantly correlated ( r 2 = 0.80–0.96, P < 0.0001, SE of the estimate = 2.3–2.7 liters). On the basis of population, the constants used in the BIS analysis could be adjusted so that the mean differences with the dilution methods would become zero. The SD values for the mean differences between the dilution and BIS methods, however, remained significant for both males and females: TBW (±2.1–2.8 liters), ECW (±1.4–1.6 liters), and ICW (2.0–3.1 liters). To improve the accuracy of the BIS measurement for an individual within the age range we have examined, further refinement of the constants used in the BIS analysis is needed.

Predicting body cell mass with bioimpedance by using theoretical methods: a technological review

1997 ◽  
Vol 82 (5) ◽  
pp. 1542-1558 ◽  
Author(s):  
A. De Lorenzo ◽  
A. Andreoli ◽  
J. Matthie ◽  
P. Withers
Keyword(s):  
Deuterium Oxide ◽  
Cell Mass ◽  
Mixture Theory ◽  
The Body ◽  
Body Cell Mass ◽  
Extracellular Water ◽  
Theoretical Methods ◽  
Body Cell ◽  
Total Body ◽  
Cole Model

De Lorenzo, A., A. Andreoli, J. Matthie, and P. Withers.Predicting body cell mass with bioimpedance by using theoretical methods: a technological review. J. Appl. Physiol. 82(5): 1542–1558, 1997.—The body cell mass (BCM), defined as intracellular water (ICW), was estimated in 73 healthy men and women by total body potassium (TBK) and by bioimpedance spectroscopy (BIS). In 14 other subjects, extracellular water (ECW) and total body water (TBW) were measured by bromide dilution and deuterium oxide dilution, respectively. For all subjects, impedance spectral data were fit to the Cole model, and ECW and ICW volumes were predicted by using model electrical resistance terms RE and RI in an equation derived from Hanai mixture theory, respectively. The BIS ECW prediction bromide dilution was r = 0.91, standard error of the estimate (SEE) 0.90 liter. The BIS TBW prediction of deuterium space was r = 0.95, SEE 1.33 liters. The BIS ICW prediction of the dilution-determined ICW was r = 0.87, SEE 1.69 liters. The BIS ICW prediction of the TBK-determined ICW for the 73 subjects was r = 0.85, SEE = 2.22 liters. These results add further support to the validity of the Hanai theory, the equation used, and the conclusion that ECW and ICW volume can be predicted by an approach based solely on fundamental principles.

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