2012 April 17

Clostridium difficile infection in hospitalized liver transplant patients: A nationwide analysis.

Apr 172012

Clostridium difficile infection in hospitalized liver transplant patients: A nationwide analysis.

Liver Transpl. 2012 Apr 14;

Authors: Ali M, Ananthakrishnan AN, Ahmad S, Kumar N, Kumar G, Saeian K

Abstract
INTRODUCTION: Incidence of Clostridium difficile infection (CDI) is increasing among hospitalized patients. Liver transplant patients are at higher risk for acquiring CDI. Small, single-center studies, but no nation-wide analyses, have assessed this association. METHODS: We used the Healthcare Cost and Utilization Project- Nationwide Inpatient Sample (HCUP-NIS) from years 2004-2008 for this retrospective cross sectional study. Patients with any discharge diagnosis of liver transplant comprised the study population and were identified using ICD-9-CM codes. Those with a discharge diagnosis of CDI were considered cases. Our primary outcomes were prevalence of CDI and effect of CDI on inpatient mortality. Our secondary outcomes included length of stay and hospitalization charges. Regression analysis was used to derive odds ratios adjusted for potential confounders. RESULTS: There were 193,714 discharges with a diagnosis of liver transplant from 2004-2008. Prevalence of CDI was 2.7% in liver transplant population compared to 0.9% in non liver transplant population (p <0.001). Most of the liver transplant patients were in the 50-64 age group. Liver transplant patients were at higher odds of developing CDI (OR 2.88, 95% CI 2.68-3.10). Increasing age, increasing comorbidity, IBD and NG tube placement were also independent risk factors for CDI. CDI in liver transplant was associated with a higher mortality, 5.5% as compared to 2.3% in liver transplant only population (adjusted OR 1.7, 95% CI 1.3-2.2). CONCLUSIONS: Liver transplant patients have a higher prevalence of CDI as compared to non liver transplant patients (2.7% vs. 0.9%).CDI was an independent risk factor for mortality in liver transplant population. © 2012 American Association for the Study of Liver Diseases.

PMID: 22505356 [PubMed - as supplied by publisher]

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Depressive symptoms among the medically hospitalized older individuals – a 1-year follow-up study.

Int J Geriatr Psychiatry Start a Discussion »

Apr 172012

Depressive symptoms among the medically hospitalized older individuals - a 1-year follow-up study.

Int J Geriatr Psychiatry. 2012 Apr 16;

Authors: Helvik AS, Engedal K, Selbaek G

Abstract
AIM: The present follow-up study of older medically hospitalized patients from a rural area in Norway assessed the prevalence of depressive symptoms at 1-year follow-up and furthermore explored whether depressive symptoms at follow-up was associated with change in the medical, functional or emotional situation between baseline and follow-up. METHODS: A 1-year follow-up study included 363 (175 men) older medical inpatients with age range 65-98 (mean?=?80.2; standard deviation (SD)?=?7.5) years. Information was collected at baseline and follow-up using the Hospital Anxiety and Depression scale (HAD), the Mini-Mental State Examination, Lawton and Brody's scales for physical self-maintenance and performance of the instrumental activities of daily living. RESULTS: The prevalence of depressive symptoms, as defined by a score???8 at HAD-D, was 10% at baseline and 7% at follow-up. Of those with depressive symptoms at baseline, 78% had experienced remission. The incidence of depressive symptoms at follow-up was 5%. In logistic regression analyses adjusted for age, gender, and depressive symptoms at baseline, becoming or being in need of assistance from nursing or social services (odds ratio (OR)?=?8.1, 95% CI: 1.9-34.2 and OR?=?4.4, 95% CI: 1.1-17.4, respectively), having a cognitive decline (OR?=?1.1, 95% CI: 1.0-1.3), and exhibiting poorer physical self-maintenance (OR?=?1.2, 95% CI: 1.0-1.3), becoming vision impaired (OR?=?8.3, 95% CI: 2.8-25.0), and with increased anxiety (OR?=?1.2, 95% CI: 1.0-1.3) during follow-up was associated with depressive symptoms at follow-up. CONCLUSION: The 1-year follow-up study of older medical inpatients contributes to the research body regarding risk factors of depression in older people. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22505371 [PubMed - as supplied by publisher]

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Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature.

ann nutr metab Start a Discussion »

Apr 172012

Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature.

Ann Nutr Metab. 2011;59(2-4):96-106

Authors: Gupta D, Vashi PG, Lammersfeld CA, Braun DP

Abstract
BACKGROUND: Length of stay (LOS) has been used as a surrogate marker for patients' well-being during hospital treatment. We systematically reviewed all pertinent literature on the role of nutritional status in predicting LOS in cancer.
METHODS: A systematic search of human studies published in English was conducted using the MEDLINE data base (all articles published as of December 2010). We searched using the terms 'nutritional status' and 'nutritional assessment' and 'nutritional screening' and 'malnutrition' in combination with the following terms: length of stay, length of hospital stay, duration of stay, and duration of hospitalization together with 'cancer' or 'oncology'.
RESULTS: The MEDLINE search identified a total of 149 articles, of which only 21 met the selection criteria. Of the 21 studies, 10 studies investigated gastrointestinal cancer patients, 4 gynecological cancer, and 7 heterogeneous cancer. Eight studies used subjective global assessment (SGA) or patient-generated SGA (PG-SGA), 9 used serum albumin and/or BMI, and 4 used other methods of nutritional assessment.
CONCLUSIONS: Validated nutritional tools such as SGA/PG-SGA are better predictors of LOS in gastrointestinal cancers requiring surgery than in nonsurgical gastrointestinal cancer patients. Correcting malnutrition may decrease the LOS and perhaps even lower the rate of hospital readmissions in this population.

PMID: 22142719 [PubMed - indexed for MEDLINE]

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Computed tomography measurements of parapneumonic effusion indicative of thoracentesis.

Eur Respir J Start a Discussion »

Apr 172012

Computed tomography measurements of parapneumonic effusion indicative of thoracentesis.

Eur Respir J. 2011 Dec;38(6):1406-11

Authors: Moffett BK, Panchabhai TS, Anaya E, Nakamatsu R, Arnold FW, Peyrani P, Wiemken T, Guardiola J, Ramirez JA

Abstract
Patients with parapneumonic effusions (PPE) measuring <1 cm by lateral decubitus radiograph (LDR) or <5 cm by lateral erect radiograph (LER) do not require thoracentesis. No such data exist for chest computed tomography (CCT). The objective of this study was to identify a PPE measurement by CCT that indicates the need for thoracentesis. A secondary data analysis of two pneumonia databases was conducted to identify patients with PPE. Measurements of PPE using LDR, LER and CCT were correlated by linear regression analysis. The clinical outcome of community-acquired pneumonia patients managed with the newly defined CCT measurement was evaluated. PPE was identified in 419 out of 1,460 patients with possible pneumonia. PPE measurements of 1 cm and 5 cm by LDR and LER, respectively, correlated with a measurement of 2.5 cm by CCT. Out of 95 patients with CCT measurements <2.5 cm, 31 poor clinical outcomes were reported: outcome was PPE related (n = 1); outcome was PPE unrelated (n = 26); and outcome was not evaluable (n = 4). The single case of poor outcome also measured <1 cm by LDR. This study indicates that patients with community-acquired pneumonia and a PPE measuring <2.5 cm by CCT can be managed without the need for thoracentesis.

PMID: 21622586 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

April 2012
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