scholarly journals Risk Factors for Malnutrition among IBD Patients

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4098
Author(s):  
Larisa Einav ◽  
Ayal Hirsch ◽  
Yulia Ron ◽  
Nathaniel Aviv Cohen ◽  
Sigalit Lahav ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Status ◽  
Screening Tool ◽  
Medical Center ◽  
Screening Tools ◽  
Disease Phenotype ◽  
Retrospective Case ◽  
Related Risk ◽  
Bowel Diseases ◽  
Surgical History

(1) Background: Malnutrition is a highly prevalent complication in patients with inflammatory bowel diseases (IBD). It is strongly associated with poor clinical outcomes and quality of life. Screening for malnutrition risk is recommended routinely; however, current malnutrition screening tools do not incorporate IBD specific characteristics and may be less adequate for screening these patients. Therefore, we aimed to identify IBD-related risk factors for development of malnutrition. (2) Methods: A retrospective case-control study among IBD patients attending the IBD clinic of the Tel-Aviv Medical Center for ≥2 consecutive physician consultations per year during 2017–2020. Cases who had normal nutritional status and developed malnutrition between visits were compared to matched controls who maintained normal nutritional status. Detailed information was gathered from medical files, including: demographics, disease phenotype, characteristics and activity, diet altering symptoms and comorbidities, medical and surgical history, annual healthcare utility, nutritional intake and the Malnutrition Universal Screening Tool (MUST) score. Univariate and multivariate analyses were used to identify malnutrition risk factors. The independent risk factors identified were summed up to calculate the IBD malnutrition risk score (IBD-MR). (3) Results: Data of 1596 IBD patients met the initial criteria for the study. Of these, 59 patients developed malnutrition and were defined as cases (n = 59) and matched to controls (n = 59). The interval between the physician consultations was 6.2 ± 3.0 months, during which cases lost 5.3 ± 2.3 kg of body weight and controls gained 0.2 ± 2.3 kg (p < 0.001). Cases and controls did not differ in demographics, disease duration, disease phenotype or medical history. Independent IBD-related malnutrition risk factors were: 18.5 ≤ BMI ≤ 22 kg/m2 (OR = 4.71, 95%CI 1.13–19.54), high annual healthcare utility (OR = 5.67, 95%CI 1.02–31.30) and endoscopic disease activity (OR = 5.49, 95%CI 1.28–23.56). The IBD-MR was positively associated with malnutrition development independently of the MUST score (OR = 7.39, 95%CI 2.60–20.94). Among patients with low MUST scores determined during the index visit, identification of ≥2 IBD-MR factors was strongly associated with malnutrition development (OR = 8.65, 95%CI 2.21–33.82, p = 0.002). (4) Conclusions: We identified IBD-related risk factors for malnutrition, highlighting the need for a disease-specific malnutrition screening tool, which may increase malnutrition risk detection.

scholarly journals Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

2020 ◽  
Vol 74 (11) ◽  
pp. 1519-1535 ◽  
Author(s):  
Alex F. Bullock ◽  
Sarah L. Greenley ◽  
Gordon A. G. McKenzie ◽  
Lewis W. Paton ◽  
Miriam J. Johnson
Keyword(s):  
Older Adults ◽  
Food Intake ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Screening Tool ◽  
Meta Analysis ◽  
Screening Tools ◽  
Narrative Synthesis ◽  
Markers Of Inflammation ◽  
Risk Of Cancer

Abstract Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

scholarly journals Relationship between falls and Fall Risk Increasing Drugs. A retrospective case control study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
N Tiwana ◽  
A Pietronigro ◽  
M Mosillo ◽  
N Principi ◽  
D Carnevali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fall Risk ◽  
Case Control Study ◽  
Holistic Approach ◽  
Case Control ◽  
Assessment Tools ◽  
Screening Tools ◽  
Risk Of Falling ◽  
Retrospective Case ◽  
Control Study

Abstract Background Falls and fall-related injuries are a major public health issue which needs global attention due to its clinical and socioeconomic impact. Inpatient falls are the most common adverse event in hospital. Important risk factors for falls are polypharmacy and the assumption of so-called Fall Risk Increasing Drugs (FRIDs). Aims of our study were to investigate the associations between falls and the use of medications among inpatients by conducting a retrospective case-control study in a rehabilitation hospital in Northern Italy in 2018. Methods Three unique control for each faller, matched by age, sex and hospitalization ward, were selected. A Conditional Logistic Regression was performed to analyze the impact that 13 types of FRIDs individually and the number of administrated FRIDs had on the risk of falling. A second regression model was obtained adjusting the case-control matching for CIRS, Morse and Barthel scores. Results We identified 148 cases and 444 controls. 3 types of FRIDs were significantly correlated (p &lt; 0,05) with an increased risk of falling: Antipsychotics [OR:1,98;CI 95%:1,01-3,89], Antidepressants [OR:2,18;CI 95%:1,32-3,59], Diuretics [OR:1,71;CI 95%:1,09-2,68]. Antidepressants were the only type of FRID significantly correlated (p = 0,008) even in the model adjusted for CIRS, Morse and Barthel scores [OR:2,00;CI 95%:1,20-3,34]. The unadjusted model showed that the addition of one type of FRID to therapy was significantly associated with the fall event (p &lt; 0.05) [OR:1.21;CI 95%: 1.05 - 1.40]. Conclusions Assumption of drugs and polypharmacy could play a role in hospital falling. Recently developed fall risk assessment tools suffer from low specificity and sensitivity and do not assess these risk factors. A holistic approach with a multidimensional evaluation of the patient through screening tools, functional assessment tools and a full medical evaluation should be improved. Key messages Drugs may represent an important variable in determining the risk of falls in hospitalized patients, but they should not be considered alone. Screening tools for fall risk should take into account polypharmacy such as other intrinsic and extrinsic risk factors within an holistic approach.

scholarly journals P569 The role of multidrug-resistant infections in IBD patients undergoing surgery

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S480-S480
Author(s):  
F Colombo ◽  
G M B Lamperti ◽  
S Antinori ◽  
M Corbellino ◽  
G Maconi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Status ◽  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Tertiary Care Centre ◽  
Bowel Diseases ◽  
Resistant Infection ◽  
Few Data ◽  
The Impact

Abstract Background Inflammatory bowel diseases (IBD) patients are particularly vulnerable to an increased incidence of infections, due to both innate characteristics and prolonged pharmacological therapies as steroids, biologics and antibiotics. Very few data are available in the literature about multidrug-resistant (MDR) infections and previous studies have not taken into account the impact of the surgical treatment on infections. We focused on the identification of risk factors for the development of MDR infections in IBD patients undergoing surgical procedures, we investigated the involved microorganisms, and finally, we proceeded to a costs/complications analysis of the treatment. Methods 472 consecutive, unselected IBD patients (285 Crohn’s disease and 187 ulcerative colitis) undergoing surgery from 2016 to 2018 in our Tertiary Care Centre were divided into three groups: MDR infections, antibiotics sensitive infections (no-MDR) and no infections. Results In 37 CD patients nutritional status (p &lt; 0.0008), preoperative biologics (p &lt; 0.008) and antibiotic therapy (p &lt; 0.001), duration of surgical procedure (p &lt; 0.0001) and preoperative hospitalisation length (p &lt; 0.0001) were risks factors for MDR infection development. In 14 UC patients multidrug-resistant infection was related to age at surgery (p &lt; 0.003), disease duration (p &lt; 0.008), inflammatory/nutritional status (p &lt; 0.04), preoperative antibiotic therapy (p &lt; 0.04), and suture leakage (p &lt; 0,01). In the MDR CD group Gram + cocci (54%) were the most implicated pathogens, with a prevalence of 19% of Enterococcus faecium; while in MDR UC patients Gram – bacilli (59%) were the most involved pathogens, with prevalence of Escherichia coli ESBL+ (47%). The antibiotic therapy cost for the CD group was higher in MDR (3249 €) and no-MDR (924 €) groups vs. non-infected patients (41€). In UC we found higher cost only in the MDR group (1408€ vs. 33€). Conclusion Preoperative risk factors involved in the development of MDR infections in IBD patients undergoing surgery were identified. Some factors, such as nutritional status or preoperative antibiotic therapy, were found to be common between CD and UC patients, while some others were found to be specific for UC or CD. Some of these elements appear to be non-modifiable, while some others are part of the multidisciplinary approach, for which further studies are needed to improve the preoperative ‘patient optimisation’ in order to reduce surgical complications.

scholarly journals Intestinal parasite infections in immigrant children in the city of Rome, related risk factors and possible impact on nutritional status

2012 ◽  
Vol 5 (1) ◽  
pp. 265 ◽  
Author(s):  
Laura Manganelli ◽  
Federica Berrilli ◽  
David Di Cave ◽  
Lucia Ercoli ◽  
Gioia Capelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Status ◽  
Intestinal Parasite ◽  
Immigrant Children ◽  
Related Risk ◽  
Parasite Infections ◽  
The City

scholarly journals Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

2021 ◽  
pp. 219256822110357
Author(s):  
Eric Y. Montgomery ◽  
Mark N. Pernik ◽  
Zachary D. Johnson ◽  
Luke J. Dosselman ◽  
Zachary K. Christian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Medical Center ◽  
Lumbar Fusion ◽  
Academic Medical Center ◽  
Opioid Use ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Chronic Opioid Use

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

Changing Epidemiology of Community-Onset Methicillin-Resistant Staphylococcus aureus Bacteremia

2003 ◽  
Vol 24 (6) ◽  
pp. 431-435 ◽  
Author(s):  
Leonard B. Johnson ◽  
Arti Bhan ◽  
Joan Pawlak ◽  
Odette Manzor ◽  
Louis D. Saravolatz
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Electric Fields ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Facility ◽  
Retrospective Case ◽  
Term Care ◽  
Methicillin Resistant ◽  
Community Onset

AbstractObjectives:To review cases of community-onset Staphylococcus aureus bacteremia and to evaluate whether the risk factors and epidemiology of methicillin-resistant S. aureus (MRSA) bacteremia have changed from early reports.Design:Retrospective case-comparison study of community-onset MRSA (n - 26) and methicillin-susceptible S. aureus (MSSA) (n = 26) bacteremias at our institution.Setting:A 600-bed urban academic medical center.Patients:Twenty-six patients with community-onset MRSA bacteremia were compared with 26 patients with community-onset MSSA bacteremia. Molecular analysis was performed on S. aureus isolates from the 26 MRSA cases as well as from 13 cases of community-onset S. aureus bacteremia from 1980 and 9 cases of nosocomial S. aureus bacteremia from 2001.Results:The two groups were similar except that patients with MRSA bacteremia were more likely to have presented from a long-term-care facility (26.9% vs 4%; P = .05) and to have had multiple admissions within the preceding year (46% vs 15%; P = .03). Clamped homogeneous electric fields analysis of MRSA isolates from 1982 revealed predominantly that one clone was the epidemic strain, whereas there were 14 unique strains among current community-onset isolates. Among current nosocomial isolates, 3 patterns were identified, all of which were present in the community-onset cases.Conclusions:Previously described risk factors for MRSA acquisition may not be helpful in predicting disease due to the polyclonal spread of MRSA in the community. Unlike early outbreaks of MRSA in patients presenting from the community, current acquisition appears to be polyclonal and is usually related to contact with the healthcare system.

Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy

2021 ◽  
pp. 112972982110093
Author(s):  
Paul R Ingram ◽  
Sinead Kilgarriff ◽  
Michael Grzelak ◽  
Gavin Jackson ◽  
Peter Carr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Retrospective Case ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Related Risk ◽  
Reduction Strategies ◽  
Tertiary Hospitals ◽  
Catheter Tip ◽  
Clinically Significant ◽  
Catheter Related Thrombosis

Background: Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. Methods: Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. Results: Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). Conclusions: Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.

Using patient factors to predict obstetric complaints and litigation: A mixed methods approach to quality improvement

2018 ◽  
Vol 23 (5) ◽  
pp. 185-199 ◽  
Author(s):  
Benjamin M Nowotny ◽  
Erwin Loh ◽  
Miranda Davies-Tuck ◽  
Ryan Hodges ◽  
Euan M Wallace
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Screening Tool ◽  
Care Quality ◽  
Screening Tools ◽  
University Hospital ◽  
Stepwise Logistic Regression ◽  
Maternity Service ◽  
Patient Complaints ◽  
Proactive Management

Background Traditionally, managing patient complaints and medicolegal claims has been largely a reactive process. However, attention has recently turned to systematically learning from complaints and litigation to prevent recurrence. Within a high-volume maternity service, we explored whether developing predictive tools for patient complaints and litigation to support proactive management was feasible. Objectives To develop and assess two screening tools to predict the likelihood of (i) patient complaints and/or (ii) medicolegal claims arising from maternity care and to assess practitioner awareness of patient risk factors. Methods Births between 1 April 2011 and 30 April 2016 at a university hospital maternity service in Melbourne, Australia were considered. Univariate binary logistic regression was performed to identify the variables contributing to complaints and claims. Backwards-stepwise logistic regression was applied to develop each screening tool. Clinicians completed a survey to assess awareness of identified risk factors. Results In the study period, there were 41,443 births, 173 complaints and 19 claims. The complaints tool had only fair predictive capacity (receiver operating characteristic 0.72, p < 0.001) and the claims tool failed. Neither approach afforded sufficient discrimination to be useful in routine predictive modelling. One hundred and one practitioners completed the survey (response rate 15.7%). Practitioners were better at recognising risk factors for legal claims than for patient complaints. Conclusion Whilst new risk factors for patient complaints and medicolegal claims were identified, we were unable to develop a screening tool that was sufficiently discriminatory to be useful in routine predictive triaging. However, increasing practitioner awareness of key risk factors may afford opportunities to improve care quality.

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