ISSN:0884-5336    

DOI:10.1177/0115426594009006205

出版商:Sage Publications    

年代:1994

数据来源: WILEY

摘要:

There have been increasing efforts to manage quality and costs in health care. Two tools that are used to do this are practice parameters and outcome measurements. Practice parameters are strategies for patient management to assist clinicians in clinical decision making. Outcome measurements inform clinicians and the public about performance in the delivery of care. Federal and state health care legislation make use of these two concepts as a way to monitor and improve quality and costs, reduce liability, and in some cases, promote competition. Practice guidelines are more limiting to clinicians, but may reduce their liability and help some meet expected clinical outcomes. Outcome criteria alone provide more flexibility to clinicians in deciding how to improve clinical outcome and reduce costs, and enable patients to select care givers on the basis of performance.

ISSN:0884-5336    

DOI:10.1177/0115426594009006207

出版商:Sage Publications    

年代:1994

数据来源: WILEY

摘要:

Many hospitals have strong political leaders who question the need for a nutrition support service.1,2In addition, the pressures of economic and health care reform are forcing administrators to cut unnecessary and unproven, albeit beneficial, services.3,4The challenge for nutrition support services is clear‐cut: in order to survive, nutrition support teams must understand the changes in health care and must learn how to adapt to them. This article clarifies the issues and assists nutrition support teams in establishing a new direction.

ISSN:0884-5336    

DOI:10.1177/0115426594009006217

出版商:Sage Publications    

年代:1994

数据来源: WILEY

摘要:

This article relates the collective wisdom of five nutrition support professionals who share their experience in starting a nutrition support team. These professionals describe how to navigate the administrative— and political—waters, which are often murky and filled with obstacles. In addition, a hospital administrator discloses what CEO types look for when clinicians propose starting up a nutrition support team in their institutions. The upshot: In this rapidly changing environment, nutrition support professionals would do well to hone their political skills and use them to persuade their administrators that nutrition support is indeed a cost‐effective therapy that benefits patients—and that it is best delivered in an interdisciplinary approach.

ISSN:0884-5336    

DOI:10.1177/0115426594009006221

出版商:Sage Publications    

年代:1994

数据来源: WILEY

摘要:

Nutrition support teams today are being buffeted by the winds of change in the health care system. With the emphasis shifting from whether to deliver care tohowto do so and to how much that care will cost, nutrition support professionals must stay attuned to their institution's needs—and be prepared to adapt to those needs. This article reviews the types of data collection necessary for teams to remain solid as well as offering tips from experts about ways to harness, and even capitalize on, the changes.

ISSN:0884-5336    

DOI:10.1177/0115426594009006226

出版商:Sage Publications    

年代:1994

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/0115426594009006233

出版商:Sage Publications    

年代:1994

数据来源: WILEY

摘要:

Lung transplantation has emerged as an established and accepted therapy for patients with end‐stage pulmonary disease. Very little information has been published about the nutrition management of these patients during the period after transplantation. We conducted a retrospective review of the nutrition support records of 52 adult patients who had undergone lung transplantation at our institution. In addition to patient demographics, data were collected on baseline nutritional status, energy and protein goals, type of specialized nutrition support therapy, length of therapy, and incidence of metabolic complications. More than 50% of the patients receiving lung transplants had a diagnosis of cystic fibrosis. Compared with patients having other diagnoses, this group of patients had a greater incidence of malnutrition. The mean energy goal was 127% ± 0.07% of basal energy expenditure, and the protein goal was 1.37% ± 0.25 g/kg/d. All patients received parenteral nutrition therapy, which was begun by postoperative day 2 for more than 70% of the patients. Therapy was short‐term (mean, 9 days), and patients then received oral diet. The most common metabolic complications were azotemia, hyperglycemia, and hypomagnesemia. Our experience should provide assistance to other health care professionals who are involved in the nutrition and metabolic management of patients undergoing lung transplantation.

ISSN:0884-5336    

DOI:10.1177/0115426594009006235

出版商:Sage Publications    

年代:1994

数据来源: WILEY

摘要:

An accurate and reliable method of determining resting energy expenditure in the critical care setting is crucial because inadequate caloric intake and excessive caloric intake are both associated with a number of complications. Energy requirements were determined by three different methods in a group of 25 post‐cardiac surgery patients in the intensive care unit. Patients were intubated and had a thermodilution pulmonary artery catheter in place. The first method measured resting energy expenditure by indirect calorimetry. For the second method, the results of blood gases drawn at the same time that indirect calorimetry was measured were used in the Fick equation. In the third method, a registered dietitian assessed each patient by using the Harris‐Benedict equation with stress factor modification. Indirect calorimetry was considered the standard with which the other two methods were compared. The results showed that, compared with calorimetry, both the Fick equation and the Harris‐Benedict equation underestimated resting energy needs. Statistically, only the difference between the Fick equation method and indirect calorimetry was significant. Clinically, however, both methods seem to have applicability.

ISSN:0884-5336    

DOI:10.1177/0115426594009006241

出版商:Sage Publications    

年代:1994

数据来源: WILEY

摘要:

A 51‐year‐old obese woman was transferred to our hospital for management of a complicated laparoscopic cholecystectomy accompanied by fever and malaise. A liver abscess was discovered. On postoperative day 52 it was noted that the patient's tongue was magenta and sore and that she had altered taste, pallor, severe weight loss, diarrhea, and poor appetite and mood. A dermatology consult suggested that her tongue abnormalities were most likely nutrition‐related, and a hematologic blood smear was suggestive of folate deficiency. Premorbidly, the patient had consumed a diet chronically low in folate and had received estrogen therapy for 15 years. Throughout the patient's hospitalization, she had bouts of fever and received numerous antibiotics. Within a month of initiating nutrition support and vitamin/ mineral supplements, her nutritional status improved dramatically. This patient's poor diet, long‐term estrogen use, surgical stress, infection, and lack of early nutrition support may have contributed to her possible folate deficiency and her prolonged hospital stay.

ISSN:0884-5336    

DOI:10.1177/0115426594009006247

出版商:Sage Publications    

年代:1994

数据来源: WILEY

ISSN:0884-5336    

DOI:10.1177/088453369400900610

出版商:Sage Publications    

年代:1994

数据来源: WILEY