scholarly journals Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 722
Author(s):  
Yusuke Ito ◽  
Hidetaka Wakabayashi ◽  
Shinta Nishioka ◽  
Shin Nomura ◽  
Ryo Momosaki

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

2014 ◽  
Vol 111 (11) ◽  
pp. 1977-1984 ◽  
Author(s):  
Alan C. Tsai ◽  
Wei-Chung Hsu ◽  
Jiun-Yi Wang

The present study determined the ability of the Mini Nutritional Assessment (MNA) to predict care need in older people. We analysed the datasets of the Taiwan Longitudinal Study on Aging. The 1999 survey containing the MNA items served as the baseline and the 2003 survey served as the endpoint. Of the 4440 participants, 2890 were aged  ≥ 65 years and served as subjects in the present study. After excluding 150 subjects having incomplete data, 2740 were rated for nutritional status with the normalised long-form (LF) and short-form (SF) MNA-Taiwan version 1 (T1) and version 2 (T2) and evaluated with logistic regression analysis for cross-sectional associations of the rated nutritional status with care need, controlled for age, sex, education level, living arrangement and physical activity. Receiver operating characteristic curves were generated for evaluating the ability of the MNA to predict care need. After further excluding 250 subjects who had care need at baseline and seventy-six who were lost to follow-up, 2414 were evaluated for the ability of the MNA to predict subsequent care need with logistic regression analysis. The results demonstrated that all the MNA predicted concurrent and subsequent care need well. The OR for needing subsequent care in the ‘at-risk’ and ‘malnourished’ groups were, respectively, 2·04 and 3·33 for the MNA-T1-LF, 2·10 and 5·35 for the MNA-T2-LF, 1·49 and 2·48 MNA-T1-SF, and 1·80 and 3·44 for the MNA-T2-SF (allP< 0·05), and the respective NagelkerkeR2values were 0·190, 0·191, 0·184 and 0·192. In conclusion, all the four MNA have the ability to predict future care need, including the MNA-T2-SF, which appears to have great potential for practical applicability.


2021 ◽  
Vol 12 ◽  
pp. 215145932199616
Author(s):  
Robert Erlichman ◽  
Nicholas Kolodychuk ◽  
Joseph N. Gabra ◽  
Harshitha Dudipala ◽  
Brook Maxhimer ◽  
...  

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.


2015 ◽  
Vol 43 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Cheng-Yu Li ◽  
Shiao-Yuan Lu ◽  
Bi-Kun Tsai ◽  
Keh-Yuan Yu

In recent years, personality variables, such as extraversion and sensation seeking, have been used to investigate tourist preferences and behaviors. For this study, we classified tourist roles into three types: the familiarized mass tourist, the organized mass tourist, and the independent tourist. We investigated the impact of extraversion and sensation seeking on tourist roles in a large-scale survey of Taiwanese citizens (N = 1,249) aged 20 years and older. Using logistic regression analysis, the results indicated that sensation seeking was a significant predictor of tourist role, but extraversion was not. Compared to familiarized mass tourists, people who are sensation-seeking are more likely to become independent tourists rather than organized mass tourists. We provide suggestions for tourism marketing.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong-Joon Lee ◽  
Yang-Ha Hwang ◽  
Ji Man Hong ◽  
Jin Wook Choi ◽  
Dong-Hun Kang ◽  
...  

Introduction: Given the recent positive endovascular therapy trials for acute ischemic stroke (AIS), this therapeutic strategy is now being increasingly incorporated into routine clinical practice. Identifying prognostic factors among AIS patients receiving endovascular revascularization treatments (ERT) in the real world could be important for clinicians and patients. While the impact of diabetes mellitus (DM) on IV thrombolytic outcomes after AIS has been extensively investigated, there is a paucity of data assessing effects of DM on ERT outcomes after AIS. We evaluated the impact of comorbid DM on ERT for AIS. Methods: From Jan 2011 to Feb 2016, patients with AIS who underwent ERT for cervicocephalic occlusions were consecutively enrolled into the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention - Korean Retrospective (ASIAN KR) registry from 3 hospitals. Patients were excluded if onset to puncture time over 8 hours, in-hospital stroke, or unavailable 3-month mRS. DM was diagnosed if a patient had the history, or hemoglobin A1c on admission was over 6.5. Univariate analysis was performed to compare the characteristics between DM and non-DM population. Multiple logistic regression analysis was used to validate the effect of comorbid DM on 3 month outcomes. Results: Of 721 patients, 667 (93%) were finally included, with 233 DM patients and 434 non-DM patients. In the univariate analysis, comorbidity with hypertension (71.2% vs. 58.3%, p=0.001) and dyslipidemia (36.7% vs. 26.7%, p=0.012) were more frequent in the DM population. Periprocedural factors such as target vessels, intravenous thrombolysis, and final reperfusion grades did not differ. Good outcomes with mRS 0-2 were less frequent in the DM population (43.3% vs. 53.7%, p=0.011). In the logistic regression analysis adjusting age, male sex, initial NIHSS, premorbid mRS, hypertension history, atrial fibrillation, intravenous thrombolysis, onset to puncture time and successful reperfusion, DM was an independent predictor of poor outcomes (mRS 3-6; 1.933, 1.274-2.933, p=0.002). Conclusion: In patients receiving ERT for AIS due to cervicocephalic artery occlusions, the presence of DM as a comorbidity confers greater odds of a poor functional outcome.


Author(s):  
Jisu Jeong ◽  
Seunghui Han

PurposeCitizen trust in police is important in terms of citizen consent to government policies and of police achieving their organizational goals. In the previous study, improvements in police policy, organizational operation and policing activities were developed to clarify which factors influence trust in police and how trust can be improved. This research raises the question, would changes in trust in police have an impact on trust in government? In this paper, this research question is discussed theoretically and the causal relationship analyzed empirically by applying OLS, ordered logistic, 2SLS and logistic regressions.Design/methodology/approachThe basic analysis methods are to apply the OLS and the ordered logistic regression. OLS regression analysis is an analytical method that minimizes an error range of a regression line. The assumptions for OLS are: linearity, independence, equilibrium, extrapolation and multicollinearity issues. These problems were statistically verified and analyzed, in order to confirm the robustness of the analysis results by comparing the results of the ordered logistic regression because of the sequence characteristic of the dependent variable. The data to be used in this study is the Asia Barometer Survey in 2013.FindingsTrust in police and citizen perception of safety are analyzed as important factors to increase trust in the government. The effects of trust in police are more significant than the effects of control variables, and the direction and strength of the results are stable. The effect of trust in police on trust in government is strengthened by the perception of safety (IV). In addition, OLS, ordered logistic regression analysis, which analyzed trust in central government and local government, and logistic regression analysis categorized by trust and distrust show the stability.Research limitations/implicationsThis paper has implications in terms of theoretical and empirical analysis of the relationship between trust in police and trust in government. In addition, the impact of perception of safety on trust in police can be provided to police officers, policymakers and governors who are seeking to increase trust in government. This paper is also meaningful in that it is the microscopic research based on the citizens' survey. One of the limitations of macroscopic research is that it does not consider the individual perceptions of citizens.Practical implicationsThe results of this paper can confirm the relationship of the virtuous cycle, which is perception of safety – trust in police – trust in government. The police will need to provide security services to improve citizens' perception of safety and make great efforts to create safer communities and society. Trust in police formed through this process can be an important component of trust in government. By making citizens feel safer and achieving trust in police, ultimately, trust in government will be improved.Originality/valueThe police perform one of the essential roles of government and are one of the major components of trust in government, but the police sector has been neglected compared to the roles of the economic and political sectors. These influences of macro factors are too abstract to allow specific policy directions to be suggested. If we consider trust in police, and factors that can improve trust in government, we can suggest practical policy alternatives.


Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2855
Author(s):  
Miriam Urquiza ◽  
Naiara Fernandez ◽  
Ismene Arrinda ◽  
Irati Sierra ◽  
Jon Irazusta ◽  
...  

Nutritional status is relevant to functional recovery in patients after an acute process requiring rehabilitation. Nevertheless, little is known about the impact of malnutrition on geriatric rehabilitation. This study aimed to determine the association between nutritional status at admission and the evolution of functional and physical outcomes, as well as the capability of nutritional status to identify fallers among patients admitted to geriatric rehabilitation for different reasons. This was a retrospective cohort study of 375 patients. Data collected included age, gender, diagnosis at admission, comorbidities, cognitive and nutritional status, functional and physical measurements, length of stay, mortality and falls. Orthogeriatric patients with worse nutritional status according to the Mini Nutritional Assessment-Short Form (MNA-SF) had a significantly lower Barthel Index at admission and discharge with worse functional gain and poorer outcomes in the Short Physical Performance Battery (SPPB). However, in hospital-deconditioned patients, the MNA-SF score was not significantly associated with functional and physical recovery. Poor nutritional status at admission increased the risk of experiencing at least one fall during rehabilitation in orthogeriatric patients. However, hospital-deconditioned patients who fell had better SPPB scores than those who did not fall. Our results demonstrate the importance of nutritional status in the clinical evolution of orthogeriatric patients throughout the rehabilitation process.


BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  

Abstract Background Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU). Methods Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade. Results Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52). Conclusion Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.


2019 ◽  
Vol 50 (2) ◽  
pp. 118-128
Author(s):  
Matthew E. Sprong ◽  
Bryan K. Dallas ◽  
Kara Hennenfent ◽  
Brianna Cerrito ◽  
Frank Buono

The purpose of the current study was to explore how students at a Midwestern University rated the fairness of a student with a disability receiving specific educational accommodations when controlling for the race of the student requesting the accommodation. We were also interested in exploring the impact of disability status and educational level of the student participants on their perception of how fair it would be for the student with the disability in the scenario to receive specific educational accommodations. A logistic regression analysis revealed that the race of the hypothetical student with a disability was not a significant predictor of whether a student deserved educational accommodations. Additionally, participants that disclosed that they had a disability thought the student in the disability-related case scenarios were more deserving of accommodations compared to participants that did not disclose having a disability.


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