ISSN:0884-5336    

DOI:10.1177/011542659601100387

出版商:Sage Publications    

年代:1996

数据来源: WILEY

摘要:

A history of the goals, activities, and accomplishments of the Nutrition Screening Initiative (NSI) is provided. A commentary on the development and intended use of the NSI's self‐assessment and screening tools is given to facilitate selection of feeding devices for older Americans who need nutrition care. Additional questionnaires and interventions designed to address the needs identified through the NSI's standardized, interdisciplinary approach to the assessment of nutritional risk are described and their use encouraged. Legislative and public policy advocacy is summarized. A systemic approach to the assessment and maintenance of optimal nutritional health in the older population will have a profound effect on health care delivery systems.

ISSN:0884-5336    

DOI:10.1177/011542659601100389

出版商:Sage Publications    

年代:1996

数据来源: WILEY

摘要:

Keystone 65, the Medicare Program of Keystone Health Plan East, has designed case management programs around the needs of America's seniors. Keystone 65 utilizes a health risk assessment tool to aid in determining a member's health risk profile. This tool, the Health Risk Assessment Form, consists of the Short Form 36, the Nutrition Screening Initiative Nutrition Checklist, self‐reported disease questions, and questions related to the health plan. Preliminary analysis has led Keystone to believe that the use of such an assessment tool will aid in identifying those members who need proactive case management and intervention. The increased use of the Checklist may provide the case management department with an important element in the assessment of Keystone 65 members.

ISSN:0884-5336    

DOI:10.1177/011542659601100395

出版商:Sage Publications    

年代:1996

数据来源: WILEY

摘要:

Resting metabolic rate (RMR) is commonly predicted using the Harris‐Benedict (HB) equations, but an overestimation of 10% to 15% is normally found. More recent studies have proposed equations with a better predictive value. In this study, we explore the relationship between measured RMR and HB in 67 healthy volunteers and in a data set from the literature and compared measured RMR with six more recent equations. Mean differences between RMR and HB were 21%, 12%, 10%, and 4% for the lowest to the highest RMR quartile, respectively, and 20%, 8%, 6%, and ‐4% for Owen's subjects. Among the six recent equations, only the World Health Organization (WHO) equations predicted RMR within 10% in 100% of the cases. Our results suggest that overestimation of RMR by HB is not a homogenous finding but is inversely related to RMR. This may have important implications for predicting RMR in women and in patients with diminished lean body mass. In addition, the WHO equations appear more precise than the HB equations.

ISSN:0884-5336    

DOI:10.1177/011542659601100399

出版商:Sage Publications    

年代:1996

数据来源: WILEY

摘要:

Occlusion of feeding tubes is a common and costly complication of enteral feeding. Although the composition of feeding formulas, the size, design, and material of the feeding tube, and the rate of delivery have been considered as factors that determine the rate of tube occlusion, little information is available on the effect of the luminal content of the gut on tube occlusion. Enteral feeding tubes are placed either in the stomach or postpylorically, in the small intestine. The chemical composition of these regions including acidity and bile salt concentration may vary. Since acidity has been shown to promote tube occlusion and bile salts have detergent‐like properties, these chemical differences in the luminal environment may be important to tube occlusion. To test the idea that bile salt inhibits acid‐promoted occlusion of feeding tubes, in an in vitro study, we compared the time‐to‐complete occlusion of four groups of formula‐filled feeding tubes (six tubes in each group) immersed in an acidic solution (pH 3.0) containing 0 (control), 10, 20, or 40 mM of taurocholate. We found that although 33% of the feeding tubes were occluded within 12 hours in the absence of exposure to bile salt, none were occluded when 20 or 40 mM of taurocholate was added to the acidic solution. After 24 hours, 40 mM of taurocholate inhibited acid‐promoted occlusion of 67% of the feeding tubes. Thus 0 to 40 mM of taurocholate still inhibited acid‐promoted tube occlusion in a dose‐dependent fashion (p<.05). Acidity and the concentration of bile salt may work together, but in opposite directions, as luminal factors that determine the rate of occlusion of feeding tubes.

ISSN:0884-5336    

DOI:10.1177/0115426596011003105

出版商:Sage Publications    

年代:1996

数据来源: WILEY

摘要:

This report summarizes data obtained via a mailed questionnaire from 129 Department of Veterans Affairs (VA) hospitals regarding current practices in the care of central venous catheters (CVCs) used for total parenteral nutrition (TPN). The size of VA hospitals' acute medical‐surgical beds ranged from 14 to 1320 (median 168) beds. Over 6000 patients annually received CVCs for TPN. Hospitals reported using triple‐lumen catheters most frequently as their CVC for TPN (80.3%). A povidone‐iodine scrub was used to prepare the skin for CVC insertion by 72.6% of reporting hospitals. Sixty percent of hospitals used transparent polyurethane dressings. Care of CVCs varied among hospitals. Catheter‐related infection and sepsis rates were within the national average, although<50% of responding hospitals provided data on these outcomes. The results of this survey point to the need for a national standardized database relative to patients receiving TPN via a CVC.

ISSN:0884-5336    

DOI:10.1177/0115426596011003109

出版商:Sage Publications    

年代:1996

数据来源: WILEY

摘要:

A 43‐year‐old patient with adult respiratory distress syndrome, alcoholic hallucinosis, and delirium required significant amounts of lorazepam, morphine, and midazolam for management of agitation and increased peak airway pressures. Broad‐spectrum antibiotics and intermittent pancuronium therapy were instituted. A nasoenteral feeding tube was placed for nutrition and medication administration during mechanical ventilation. Tube feedings were well tolerated except for intermittent bouts of large amounts of diarrhea.Clostridium difficileculture and toxin results were negative. Lorazepam and morphine administration were converted from the IV to enteral route to decrease the amount of fluid administered. The tube feeding was changed to an electrolyte rehydration solution and eventually discontinued. A search for drug‐related contributing factors to the diarrhea revealed polyethylene glycol present in the lorazepam solution. It was postulated that this could be a contributing cause to the diarrhea. The lorazepam solution was changed to enterally administered crushed tablets with subsequent resolution of diarrhea.

ISSN:0884-5336    

DOI:10.1177/0115426596011003117

出版商:Sage Publications    

年代:1996

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/088453369601100308

出版商:Sage Publications    

年代:1996

数据来源: WILEY

摘要:

In response to numerous changes in reimbursement for physician services, a survey was conducted of physician directors of nutrition support services to obtain information about current physician billing practices and reimbursement for nutrition support. Demographic data were obtained concerning the type of practice and institution, percent of time and income derived from nutrition support, and the source of individual billing practices. Responses to six clinical scenarios provided information about billing practices. The responses were collated, analyzed, and then compared with those of a senior official at the Health Care Financing Administration (HCFA). This report summarizes the results of the survey and the responses from HCFA. It is hoped that this information will be useful to nutrition support practitioners and administrators in understanding various aspects of billing for physician services for nutrition support.

ISSN:0884-5336    

DOI:10.1177/0115426596011003121

出版商:Sage Publications    

年代:1996

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/0115426596011003127

出版商:Sage Publications    

年代:1996

数据来源: WILEY