Nutritional care of medical inpatients: a health technology assessment

BACKGROUND: The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement. METHODS: Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care. RESULTS: The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of medical patients in Denmark is estimated to hold a cost savings potential reaching approximately USD 22 million. CONCLUSION: Every hospital and every bed ward has its strengths and weaknesses, but none of the participating bed wards fully satisfy nutritional care success criteria. All organisational levels have a significant potential for improvements of nutritional care of medical inpatients

Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure

PROTOCOL: Are clinical trial participants informed about potential benefits and harms? A comparison of informed consent materials and trial protocols

This is a protocol for the project entitled: 'Are clinical trial participants informed about potential benefits and harms? A comparison of informed consent materials and trial protocols.'</jats:p

The dietary and fluid intake practices of male participants in a multi-day canoeing event

Dietary record-keeping was used to determine intake of food, fluid, alcohol and nutritional supplements in 35 male canoeists during the 24 hours prior to, the three days of and day following the 1998 Dusi Canoe Marathon. Control data were obtained from 13 male, age-matched sedentary control subjects during the three days of the event. These data were coded and analysed using a computerised dietary analysis programme. Changes in body mass were used to assess hydration status. In the canoeists, mean total daily energy consumption from a combination of diet, liquid and supplement consumption over the 5-day period, ranged from 14.0 ±0.70 MJ to 14.6 ±1.45 MJ and was significantly higher (

Takotsubo cardiomyopathy:An important differential diagnosis to acute myocardial infarction

Udgivelsesdato: 2009-AugINTRODUCTION: Sparse information with regard to the electrocardiographic (ECG) changes in Takotsubo cardiomyopathy (TC) is available. The purpose of this study was to describe the clinical characteristics and electrocardiographic changes in a Danish cohort of patients with TC. We discuss the potential pathophysiological mechanisms of TC. METHODS: Cases were registered during a three year period. Patients who were hospitalized at Skejby Hospital suspected of acute myocardial infarction in whom coronary angiography was performed in the acute or subacute phase were registered. Data were obtained retrospectively from medical records and the hospitals laboratory database. RESULTS: Seven patients with TC were identified comprising six females and one male (mean age 70, range 53-81 years). In the acute phase all patients had ECG changes compatible with ST-elevation acute myocardial infarction (STEMI), as well as profound impaired left ventricular function with apical ballooning. At follow-up (range 1-82 weeks), both ECG and left ventricular function were normalized in all patients. CONCLUSION: In the acute phase symptoms and ECG changes resemble those in patients with STEMI, hence acute coronary angiography is indicated in most cases. Pathophysiological aspects are discussed

Takotsubo cardiomyopathy:An important differential diagnosis to acute myocardial infarction

Udgivelsesdato: 2009-AugINTRODUCTION: Sparse information with regard to the electrocardiographic (ECG) changes in Takotsubo cardiomyopathy (TC) is available. The purpose of this study was to describe the clinical characteristics and electrocardiographic changes in a Danish cohort of patients with TC. We discuss the potential pathophysiological mechanisms of TC. METHODS: Cases were registered during a three year period. Patients who were hospitalized at Skejby Hospital suspected of acute myocardial infarction in whom coronary angiography was performed in the acute or subacute phase were registered. Data were obtained retrospectively from medical records and the hospitals laboratory database. RESULTS: Seven patients with TC were identified comprising six females and one male (mean age 70, range 53-81 years). In the acute phase all patients had ECG changes compatible with ST-elevation acute myocardial infarction (STEMI), as well as profound impaired left ventricular function with apical ballooning. At follow-up (range 1-82 weeks), both ECG and left ventricular function were normalized in all patients. CONCLUSION: In the acute phase symptoms and ECG changes resemble those in patients with STEMI, hence acute coronary angiography is indicated in most cases. Pathophysiological aspects are discussed