Assessment of nutritional risks and nutritional status in patients with lower limb amputation

Uvod: Prevalenca z boleznijo povezane podhranjenosti ostaja velika in se ocenjuje, da je 15–60 % pacientov prizadetih že ob sprejemu v ustanovo. Poleg tega je podhranjenost povezana z višjo obolevnostjo, daljšo hospitalizacijo in z višjimi stroški oskrbe. Poznamo veliko orodij za prehransko presejanje, s katerimi hitro ugotovimo prehransko ogroženost ali že nastalo podhranjenost pri pacientu. Namen: Namen diplomskega dela je ugotoviti, kakšna so prehranska tveganja in prehransko stanje kirurško zdravljenih pacientov med hospitalizacijo v eni izmed slovenskih bolnišnic. Metode: V empiričnem delu je bila izvedena študija primerov, ki je vključevala 11 pacientov, ki so bili hospitalizirani zaradi amputacije spodnjega uda. Podatke smo zbrali s pomočjo prehranske anamneze. Ob sprejemu sta bila opravljena začetno in končno prehransko presejanje z orodjem Nutritional Risk Screening 2002. Ob sprejemu in odpustu smo opravili meritev električne bioimpedance, s katero smo pridobili meritev faznega kota in oceno bazalnih energijskih potreb pacienta. Med hospitalizacijo se je ocenjeval dejanski energijski vnos s pomočjo pettočkovne lestvice za ocenjevanje zaužite hrane. Rezultati: Rezultati so pokazali, da je bil po oceni z orodjem Nutritional Risk Screening 2002 prehransko ogrožen le en pacient od 11. Indeks telesne mase se je v povprečju zmanjšal, kar nakazuje na izgubo telesne mase med hospitalizacijo. Parameter električne bioimpedance, fazni kot, se med hospitalizacijo v povprečju ni spremenil, vendar je glede na začetne zastavljene spodnje mejne vrednosti še vedno nakazoval na slabo prehransko stanje pacientov. Ocenjen realen energijski vnos je zadostoval za pokritje bazalnih energijskih potreb le pri enem pacientu od 11. Energijska vrednost predpisane diete je glede na ocenjene bazalne potrebe ustrezala pri 6 pacientih (54,6 %), pri preostalih petih pacientih energijska vrednost ni bila zadostna. Realen energijski vnos pa glede na ocenjene dnevne energijske potrebe ni bil pokrit pri nobenem izmed preiskovancev. Razprava in sklep: Menimo, da je prehransko stanje pacientov z amputacijo spodnjega uda skrb vzbujajoče. Tudi predhodne raziskave v slovenskem prostoru s področja prehranske ogroženosti pacientov so pokazale, da je veliko pacientov v prehranskem tveganju ali pa imajo že nastalo podhranjenost. Nekateri avtorji navajajo, da so osebe, ki so podhranjene ali nimajo svojih zalog energije, v večjem tveganju za daljše celjenje ran, kar pa je pri pacientih z amputacijo spodnjega uda pomemben dejavnik. Pri prehrani pacienta prehranski tim igra ključno vlogo. Pomembno je dobro povezovanje med zdravniki in medicinskimi sestrami, ki so največ v stiku s pacientom in z dietetiki, ki sestavljajo jedilnike, saj bomo le tako lahko učinkovito ukrepali zoper podhranjenost in prehranska tveganja pri pacientih z amputacijo spodnjega uda. Pri vsem tem pa bi potrebovali podporo zdravstvene ustanove, saj potrebujemo dejansko aplikacijo boljše prehranske podpore v vsakdanjo prakso in spremljanje prehranjenosti.Introduction: Prevalence of disease-related malnutrition in health settings remains high and it is estimated that 15–60 % of the patients are already affected at the time of admission to the care setting. In addition, malnutrition is associated with higher morbidity, longer hospitalization and higher costs of care. Many nutritional screening tools are used for quickly identification of nutritional risks or malnutrition in the patient. Purpose: The purpose of the diploma work is to determine the nutritional risks and nutritional status of surgically treated patients during hospitalization in one of the Slovenian hospitals. Methods: In the empirical part, a case study was conducted involving 11 patients who were hospitalized due to lower limb amputation. Data was collected using a nutritional anamnesis. At hospital admission initial and final nutrition screening were performed using the Nutritional Risk Screening 2002 tool. Beside Nutritional Risk Screening 2002 we performed the measurement of bioelectrical impedance analysis at admission and discharge, through which we acquired assessment of the phase angle and basal metabolic energy needs of the patient. During hospitalization actual energy intake was evaluated using a five-point scale for assessing food intake. Results: The results have shown that only 1 patient of 11 was at nutritional risk using Nutritional Risk Screening 2002 tool. Body mass index of the patients decreased during hospitalization, which indicates body weight loss during hospitalization. The electrical bioimpedance analysis parameter, the phase angle levels on average did not change during hospitalization period but in view of initial set lower cut-off value they still indicate a poor nutritional status of the patients. The estimated actual energy intake was sufficient to cover the estimated basal energy needs in only 1 patient of 11. The energy value of prescribed diet was sufficient considering to estimated basal energy needs in 6 patients (54,6 %), while in the other 5 patients the energy value of the prescribed diet was not sufficient to cover their basal energy needs. The actual energy intake considering the estimated daily energy needs was not covered by any of the subjects. Discussion and conclusion: We believe that the nutritional status of patients with lower limb amputation is worrisome. Also preliminary studies in Slovenia in the field of nutritional risks have shown that a large number of patients are at nutritional risk or malnourished. Some authors quote that people who are malnourished or do not have body energy reserves are at greater risk for longer wound healing, which in patients with lower limb amputation is an important factor. In the diet of the patient, the nutrition team has a key role. Good collaboration between physicians, registered nurses - who are most in contact with the patient and dieticians, who design the menus, is essential. In addition, the support of a health institution is needed to help the patients actually implement better nutritional support in everyday practice and monitoring of nourishment

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

ResultsFINALJune202016

This is a CSV database containing the results of parameter sweeps with the model described above. It contains 13 columns and 48,001 rows (1 header row plus 48,000 rows of data). Descriptions of Column Headings: Replicate = the number of the particular simulation run Strategy = female mate choice strategy; may be BestOfN, MinThresh, or Random Parameter = the particular setting for a strategy parameter; the n in the BestOfN strategy or the threshold theta in the MinThresh strategy; the Random strategy has no additional parameter values NumFemales = number of female agents in the simulation; varied from 5 to 20 in increments of 5 MalePulses = the mean of the normally distributed population of pulse numbers from which the individual male agent pulse numbers are drawn MaleDistribution = the type of spatial distribution of male agents used in the particular simulation run; may be random, Gaussian, or inverse Gaussian NumMated = the number of female agents that mate before the end of the simulation run AvgMatedPulsesPerCall = the average number of pulses per call across all male agents that mated AvgMateTime = the average time to mating for female agents that mate (search time for those that do not mate is not included) AvgDistanceTraveled = the average distance traveled by all female agents in the simulation, including those that mate and those that do not AvgFemalesSwitches = the average number of times each female agent switched from one target male to another AvgPulseNumber = the average number of pulses per call across all male agents in the simulation, including those that mate and those that do not LastCycle = the time step at which the simulation run came to an en

She’-E-O Compensation Gap: A Role Congruity View

Is there a compensation gap between female CEOs (She’-E-Os) and male CEOs? If so, are there mechanisms to mitigate the compensation gap? Extending role congruity theory, we argue that the perception mismatch between the female gender role (that assumes communal traits) and the leadership role (that assumes agentic traits) may lead to lower compensation to female CEOs, resulting in a gender compensation gap. Nevertheless, the compensation gap may be narrowed if female CEOs display agentic traits through risk-taking, or alternatively, work in female-dominated industries where communal traits are valued. Additionally, we expect that female CEOs’ risk-taking is less effective in reducing the gender compensation gap in female-dominated industries due to the conflicting emphases on agentic and communal traits. Leveraging a sample of Chinese publicly listed firms, we find support for our hypotheses. Overall, this study contributes to the ethics literature on income inequality issues, by highlighting the effectiveness of potential mechanisms to close the gender compensation gap between female and male CEOs