Influence of weekday of admission and level of distress on length of hospital stay in patients with low back pain: a retrospective cohort study

Background: Low back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. Providing inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during weekends. Delays in therapeutic procedures may result in a prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates the influence of weekday of admission and distress on LoS of inpatients with LBP. Methods: This retrospective cohort study was conducted between 1 February 2019 and 31 January 2020. In part 1, a negative binomial model was fitted to LoS with weekday of admission as a predictor. In part 2, the same model included weekday of admission, distress level, and their interaction as covariates. Planned contrast was used in part 1 to estimate the difference in log-expected LoS between group 1 (admissions Friday/Saturday) and the reference group (admissions Sunday-Thursday). In part 2, the same contrast was used to estimate the corresponding difference in (per-unit) distress trends. Results: We identified 173 patients with LBP. The mean LoS was 7.8 days (SD = 5.59). Patients admitted on Friday (mean LoS = 10.3) and Saturday (LoS = 10.6) had longer stays, but not those admitted on Sunday (LoS = 7.1). Analysis of the weekday effect and planned contrast showed that admission on Friday or Saturday was associated with a significant increase in LoS (log ratio = 0.42, 95% CI = 0.21 to 0.63). A total of 101 patients (58%) returned questionnaires, and complete data on distress were available from 86 patients (49%). According to the negative binomial model for LoS and the planned contrast, the distress effect on LoS was significantly influenced (difference in slopes = 0.816, 95% CI = 0.03 to 1.60) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday). Conclusions: Delays in interdisciplinary LBP management over the weekend may prolong LoS. This may particularly affect patients reporting high levels of distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals

No effect of short-term amino acid supplementation on variables related to skeletal muscle damage in 100 km ultra-runners - a randomized controlled trial

Background: The purpose of this study was to investigate the effect of short-term supplementation of amino acids before and during a 100 km ultra-marathon on variables of skeletal muscle damage and muscle soreness. We hypothesized that the supplementation of amino acids before and during an ultra-marathon would lead to a reduction in the variables of skeletal muscle damage, a decrease in muscle soreness and an improved performance. Methods: Twenty-eight experienced male ultra-runners were divided into two groups, one with amino acid supplementation and the other as a control group. The amino acid group was supplemented a total of 52.5 g of an amino acid concentrate before and during the 100 km ultra-marathon. Pre- and post-race, creatine kinase, urea and myoglobin were determined. At the same time, the athletes were asked for subjective feelings of muscle soreness. Results: Race time was not different between the groups when controlled for personal best time in a 100 km ultra-marathon. The increases in creatine kinase, urea and myoglobin were not different in both groups. Subjective feelings of skeletal muscle soreness were not different between the groups. Conclusions: We concluded that short-term supplementation of amino acids before and during a 100 km ultra-marathon had no effect on variables of skeletal muscle damage and muscle soreness

Nutrition in Gastrointestinal Disease: Liver, Pancreatic, and Inflammatory Bowel Disease

Liver, pancreatic, and inflammatory bowel diseases are often associated with nutritional difficulties and necessitate an adequate nutritional therapy in order to support the medical treatment. As most patients with non-alcoholic fatty liver disease are overweight or obese, guidelines recommend weight loss and physical activity to improve liver enzymes and avoid liver cirrhosis. In contrast, patients with alcoholic steatohepatitis or liver cirrhosis have a substantial risk for protein depletion, trace elements deficiency, and thus malnutrition. Patients with chronic pancreatitis and patients with inflammatory bowel disease have a similar risk for malnutrition. Therefore, it clearly is important to screen these patients for malnutrition with established tools and initiate adequate nutritional therapy. If energy and protein intake are insufficient with regular meals, oral nutritional supplements or artificial nutrition, i.e., tube feeding or parenteral nutrition, should be used to avoid or treat malnutrition. However, the oral route should be preferred over enteral or parenteral nutrition. Acute liver failure and acute pancreatitis are emergencies, which require close monitoring for the treatment of metabolic disturbances. In most patients, energy and protein requirements are increased. In acute pancreatitis, the former recommendation of fasting is obsolete. Each disease is discussed in this manuscript and special recommendations are given according to the pathophysiology and clinical routine

NRS-2002 components, nutritional score and severity of disease score, and their association with hospital length of stay and mortality

BACKGROUND Malnutrition is a substantial issue in hospitals, leading to prolonged length of hospital stay, increased perioperative morbidity and increased mortality. There are several validated screening tools for malnutrition, one of which is the Nutritional Risk Screening 2002 (NRS). It screens patients based on recent weight loss, reduction of recent food intake, body mass index (BMI), severity of disease and age. Higher NRS scores have been shown to be negatively associated with patients’ outcomes such as increased morbidity and mortality. OBJECTIVES The aim of the study was to evaluate how the two NRS components Nutritional Score (NS) and Severity of Disease Score (SDS) are associated with patients’ length of hospital stay and mortality. METHODS All patients admitted to the medical department of a large community hospital in Switzerland were screened for malnutrition using the nutrition screening NRS during the years 2014 to 2017. Data on patients’ NRS, primary diagnosis, number of secondary diagnoses, mortality, length of stay (LOS), discharge, sex and age were collected. The association between the NRS components and LOS/mortality was estimated using a linear mixed-effects regression model and a logistic regression model, respectively, with adjustment for confounders (age, sex, comorbidity, diagnosis group, mode of discharge and year of hospitalisation). RESULTS The evaluation of the outcomes of 21,855 hospitalisations demonstrated that the NS was associated with an increment in the LOS of 5.5–12.3% per score point, depending on the diagnosis group. An increase in the SDS by one point was associated with an increase in the LOS of 2.2–11.3%. The odds for all-cause in-hospital mortality were increased by 44.1% (95% confidence interval [CI] 33.7–55.2%) per point in the NS, and by 73% (95% CI 57.5–90.1%) per point in the SDS. CONCLUSIONS Increases in both components of the NRS are associated with longer LOS. The NS has a slightly stronger impact on LOS compared to the SDS and its effect is dependent on the patient’s diagnosis group. Increases in the SDS are linked to a higher mortality than increases in the NS

Does a multi-stage ultra-endurance run cause de- or hyper hydration?

We investigated the changes in body mass and parameters of both renal function and fluid metabolism in a case study in a female ultra-endurance runner during the longest multi-stage mountain ultra-marathon in Europe, the ‘Swiss Jura Marathon’ in 2008. The female ultra-runner performed the 7 stages with a total distance of 175 km, a total ascent of 5,000 m, and a total descent of 8,000 m within 23:11 h: min, finishing as second female runner. By the end of the race, body mass decreased by 0.3 kg, fat mass by 1.2 kg and skeletal muscle mass by 0.7 kg. Haemoglobin and haematocrit decreased by 4.5% and 7.5 %, respectively, and plasma volume increased by 10 %. Serum osmolality decreased by 3.3%. Parameters of myocellular damage increased substantially (CK + 630 %, LDH + 178 % and GOT + 181 %). Creatinine continuously increased in plasma (+ 23 %) and urine (+ 47 %). Creatinine clearance (– 18.7 %), glomerular filtration rate (– 19.4 %) and serum albumin (– 10.6 %) decreased. Urinary specific gravity decreased after each stage and was increased before each stage. Urinary osmolality decreased after each stage and was increased before each stage. The average daily fluid intake from stage 1 to stage 7 (during performance and rest) was 4.9 l per day. Total body water increased by 1.2 l by the end of the race. The potassium-to-sodium ratio in urine was increased after each stage. We assume that the increase in total body water was due to an increased activity in the renin-angiotensin-aldosterone-system as evidenced by the change in urinary electrolytes after the stages and an increased activity of vasopressin as evidenced by increase of urinary osmolality before the stages

Risikofaktoren für Stürze und sturzbedingte Verletzungen im Akutspital – Eine retrospektive Fall-Kontroll-Studie

Falls in patient are a major problem in acute care institutions because of direct and indirect consequences. The objectives of the present retrospective case control study were to explore predictors of falls and fall-related injuries in hospitalised patients in a department of internal medicine at a Swiss acute care hospital. The sample included 228 hospitalised patients with a fall and 228 patients without a fall as control subjects, matched by age, gender and medical diagnosis. The cases were further analysed, whereby injured patients were compared with uninjured ones. Data were obtained from patient records and the hospital information system (HIS). Patients with a previous fall, mobility disorders, altered cognition, altered urinary and fecal excretions, intake of sedativa or other psychotropic drugs, a higher amount of comorbidities and case mix, as well as a prolonged length of stay were significantly more frequent in the cases than in the controls. Patients with falls and controls showed no differences in terms of impaired vision, intake of five and more medications, or diuretica. Analysis by logistic regression revealed mobility disorder (OR 5,2; 95 % VI 2.39-11.44) and altered excretions (OR 1,8; 95 % VI 1.02-3.31) as significant main effects and there also were significant interactions between previous falls, intake of sedativa or other psychopharmaca and altered cognition. No difference could be seen in any variable between patients with a fall-related injury and no injury. Therefore a predictive profile could be found for patients at risk to fall which might be helpful for further prevention strategies. However, no predictive marker for fall-related injuries could be defined in the present study

Enhanced synthesis of albumin and fibrinogen at high altitude

Contains fulltext : mmubn000001_191159018.pdf (publisher's version ) (Open Access)Promotores : P. Simons en R. Lambérigts337 p