Influence of Nutritional Management and Rehabilitation on Physical Outcome in Japanese Intensive Care Unit Patients: A Multicenter Observational Study

2018 ◽  
Vol 74 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Tomoaki Yatabe ◽  
Moritoki Egi ◽  
Masahiko Sakaguchi ◽  
Takashi Ito ◽  
Nobuhiro Inagaki ◽  
...  
Keyword(s):  
Caloric Intake ◽  
Secondary Outcome ◽  
Nutritional Management ◽  
Physical Status ◽  
The Poor ◽  
Good Group ◽  
Icu Discharge ◽  
Poor Group ◽  
The Impact ◽  
Median Amount

Background: There is lack of evidence regarding nutritional management among intensive care unit (ICU) patients in a population with relatively low body mass index. Therefore, we conducted an observational study to assess the nutritional management in Japanese ICUs. Also, we investigated the impact of nutritional management and rehabilitation on physical outcome. Methods: The study population comprised 389 consecutive patients who received mechanical ventilation for at least 24 h and those admitted to the ICU for > 72 h in 13 hospitals. The primary outcomes were caloric and protein intake in ICU on days 3 and 7, and at ICU discharge. The secondary outcome was the impact of nutritional management and rehabilitation on physical status at ICU discharge. We defined good physical status as more than end sitting and poor physical status as bed rest and sitting. We divided the participants into 2 groups, namely, the good physical status group (Good group) and poor physical status group (Poor group) for analysis of the secondary outcome. Data were expressed as median (interquartile range). Results: The median amount of caloric intake on days 3 and 7, and at ICU discharge via enteral and parenteral routes were 8.4 (3.1–15.6), 14.9 (7.5–22.0), and 11.2 (2.5–19.1) kcal/kg/day, respectively. The median amount of protein intake on days 3 and 7, and at ICU discharge were 0.2 (0–0.5), 0.4 (0.1–0.8), and 0.3 (0–0.7) g/kg/day, respectively. The amount of caloric intake on day 3 in the Poor group was significantly higher than that of the Good group (10.1 [5.8, 16.2] vs. 5.2 [1.9, 12.4] kcal/kg/day, p < 0.001). The proportion of patients who were received rehabilitation in ICU in the Good group was significantly higher than that of the Poor group (92 vs. 63%, p < 0.001). The multivariate analysis revealed that caloric intake on day 3 and rehabilitation in ICU were considered independent factors that affect physical status (OR 1.19; 95% CI 1.05–1.34; p = 0.005 and OR 0.07; 95% CI 0.01–0.34; p = 0.001). Conclusions: The caloric and protein intakes in Japanese ICUs were 15 kcal/kg/day and 0.4 g/kg/day, respectively. In addition, critically ill patients might benefit from low caloric intake (less than 10 kcal/kg/day) until day 3 and rehabilitation during ICU stay.

The Impact of the Thai Flood of 2011 on the Rural Poor Population Living on the Flood Plain

2017 ◽  
Vol 12 (1) ◽  
pp. 147-157 ◽  
Author(s):  
Yukiko Tahira ◽  
◽  
Akiyuki Kawasaki ◽  
Keyword(s):  
Economic Status ◽  
Group Living ◽  
Flood Plain ◽  
Early Warning Systems ◽  
The Poor ◽  
Income Ratio ◽  
Prone Area ◽  
Poor Group ◽  
Flood Prone Area ◽  
The Impact

Poor and non-poor groups from two flood-prone villages in central Thailand were compared following the flood of 2011. The results showed that the damage/income ratio was higher among persons in the poor group living in old, high-pillared houses near the river. Although this group was not as well prepared and experienced less damage than the non-poor group, they had fewer resources for recovery. The study examined household history, networks, and socio-economic status, as well as the local history. The poor group’s socio-economic characteristics may limit their capacity to resettle, as they have lived in the flood-prone area for generations. Proposals to address this included improving dykes and early warning systems as well as offering compensation for lost earnings.

scholarly journals DISTRIBUSI ZAKAT UNTUK GOLONGAN FAQIR UZUR PADA LEMBAGABAITUL MAL DI ACEH

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
. Ida Friatna
Keyword(s):  
Old Age ◽  
The Other ◽  
The Poor ◽  
Poor Group ◽  
The Government ◽  
The Impact

This is an obligation to a certain Muslim who meet the requirement to pay zaka. In the other side, the government needs to operate an authorized institution to manage this kind of alms, including infaq and other Muslim’s alms. Int this case, the government of Aceh has established a kind of Islamic treasury office named Baitul Mal which mandated to preserve, manage, and develop the zaka, infaq, waqf, and other alms in Islam, including the preservation of Islamic custody. This study examines the zaka distribution by Baitul Mal office to the old poor beneficiary group. Islam basically distinguishes between miskin and faqir based on their different level, where the faqr is they are in a poorer condition. Currently, the Baitul Mal office separates the poor group into two types, namely the old poor (Faqir uzur) and the normal poor (Non-old faqir). The old poor is defined as people with old age, long sickness, and permanent disable, or with other condition they become not productive. The catagorization has consequences to the distribution portion. The Baitul Mal decided monthly consumptive distribution to the old poor group and to the normal poor is also giving incidentally by the consumptive method. This arrangement is aimed to be a guidance for all the Baitul Mal around the regencies level in targeting those types of faqr. So, here are main questions why do the Baitul Mal make this distinction and what is the impact to both type of faqr life. This study found that the Baitul mal wanted to be committed to elevating the faqr life through zaka distribution, especially to the faqr uzur that considered unproductive people and the distribution was chosen by consumptive way. This study learned that the Baitul Mal also considered to distributing part of zaka productively. The study uses the literatures and also the Baitul Mal official data.Keywords: zaka distribution, faqr uzur, Baitul Mal

scholarly journals Efficacy and safety of nivolumab for advanced gastric cancer patients with poor performance statuses

2020 ◽  
Author(s):  
Toshihiko Matsumoto ◽  
Yosuke Yamamoto ◽  
Yusuke Kurioka ◽  
Ukyo Okazaki ◽  
Shogo Kimura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Advanced Gastric Cancer ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Efficacy And Safety ◽  
The Poor ◽  
Good Group ◽  
Poor Group

Abstract Background: Nivolumab has changed the treatment of advanced gastric cancer (AGC). Nivolumab shows better outcomes compared to best supportive care among AGC patients who received at least two prior regimens. However, there are no reliable data regarding AGC patients with poor performance status (PS) who received nivolumab. We investigated the efficacy and safety of nivolumab among AGC patients with poor PS. Methods: We retrospectively collected clinicopathologic data from patients with AGC who underwent nivolumab monotherapy at our institution from October 2017 to June 2019. Results: Forty-nine AGC patients who received nivolumab were assessed. Twenty-seven patients had PS 0 or 1 (Good group) and 22 had PS 2 or 3 (Poor group). The median progression-free survival and overall survival durations were 61 and 180 days in the Good group, respectively, and 36 and 85 days in the Poor group, respectively. The overall survival was significantly shorter in the Poor group (180 vs 85 days, p =0.0255). The disease control rates were 23% and 9% in the Good and Poor groups, respectively. Thirty-three percent of patients experienced immune-related adverse events in the Good group, and 18% in the Poor group. Conclusion: Nivolumab has a modest effect and is feasible as third- or later-line treatment for AGC patients.

scholarly journals Radiographic assessment of factors associated with poor outcomes after osteochondral autograft transplantation for capitellar osteochondritis dissecans

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0037
Author(s):  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
Yusuke Ueda ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Radial Head ◽  
Articular Surface ◽  
Radiographic Findings ◽  
The Poor ◽  
Good Group ◽  
Poor Group ◽  
The Mean ◽  
Poor Outcomes

Objectives: Osteochondral autograft transplantation (OAT) is a treatment option for large, inviable osteochondritis dissecans (OCD) lesions. Many papers have reported good clinical outcomes after OAT; however, we sometimes experience elbows with poor outcomes that show pain and restricted range of motion. Few articles have investigated factor associated with poor outcomes after OAT. The purpose of this study was to retrospectively investigate the clinical outcome and radiographic findings after OAT in elbows with a large capitellar OCD lesion and to elucidate radiographic factors associated with poor clinical outcomes. Methods: Sixty-nine elbows that underwent OAT for large osteochondral dissecans lesions of the capitellum with a minimum of 2-years follow-up were included in this study. They consisted of 65 males and 4 females with a mean age of 14 (range, 12-15) years at surgery. The mean follow-up was 48 months (range, 24-144). Cylindrical osteochondral grafts were harvested from the lateral condyle of the ipsilateral knee. We usually transplant an 8-mm graft in the lateral part of a lesion and add two 6-mm grafts medial to the initial graft. Clinical outcomes, including elbow range of motion and Timmerman and Andrews clinical rating score (T-A score), were retrospectively investigated. We measured cranial migration of the radial head on the preoperative tangential views. We also evaluated the location and orientation of the most lateral graft on the tangential views at 1 month after OAT: 1) the tilting angle (the angle between the graft axis and the vertical line to the radial articular surface), 2) the distance between the most lateral edge of the graft and the center of radial head, 3) protrusion of the graft from the articular surface of the medial capitellum. The paired t-test and Student’s t-test were used for statistical analysis, and the level of significance was set at p<0.05. Results: The mean elbow extension/flexion significantly improve from preoperative -10/125 to postoperative -5/133 (p<0.001 for each). The mean T-A score significantly improved from preoperative 125±43 to 170±34 at 2 years after surgery (p<0.001). We compared the radiographic findings between good outcomes elbows (T-A score >190, n=33) and poor outcomes elbows (T-A score <150, n=18). The cranial migration of the radial head was 0.2mm and 2.1mm, respectively (p<0.001). The tilting angle was larger in the poor group (18±11 degrees) than the good group (9±8 degrees, p=0.002). The graft was significantly located laterally in the good group (6.8±1.6 mm) than the poor group (3.8±2.3 mm, p<0.001). The protrusion tended to be larger in the poor group (0.2±2.7mm) than the good group (-0.7±1.8mm), but the difference was not significant (p=0.17). Conclusion: The outcomes after OAT was good with significant improvement of range of motion and clinical score, but a quarter of patients showed poorer outcomes. The results of this study indicated that the radial head migration before surgery and the location and orientation of the graft were associated with the clinical outcomes. For better surgical outcomes, OAT should be performed before the radiographic changes progress, and surgeons should be careful about the location and orientation of osteochondral grafts.

scholarly journals Predictive Value of Albumin and Neutrophil Combined Prognostic Grade in Advanced Gastric Cancer Patients Treated With anti-PD-1 Therapy

2021 ◽  
Author(s):  
Yuting Pan ◽  
ZhiKuan Wang ◽  
Guanghai Dai
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Predictive Value ◽  
Intermediate Group ◽  
Risk Of Death ◽  
The Poor ◽  
Good Group ◽  
Poor Group ◽  
Risk Of Disease

Abstract Background The application of immunotherapy is gradually increasing in advanced gastric cancer (AGC), but only some patients could benefit from it. Validated biomarkers can screen out the beneficiaries. The objective of this research is to explore the predictive value of albumin and neutrophil combined prognostic grade ( ANPG) in AGC patients receiving immunotherapy. Methods A total number of 268 AGC patients were included. The cut-off value of albumin was 38 g/L obtained by the median value, and neutrophil was 4.16 g/L estimated by the average value. The high levels of albumin (≥38 g/L) and neutrophil (≥4.16 g/L) were considered to be two risk factors for ANPG. Based on these two risk factors, patients were categorized into 3 groups：the risk factor number for the "good" group was 0, for the "intermediate" group was 1, and for the "poor" group was 2. Results Patients with the good ANPG was related to longer progression free survival (PFS) and overall survival (OS), compared to those with the intermediate and the poor ANPG (5.6 months vs 5.3 months vs 3.4 months, 17.8 months vs 11.8 months vs 8.2 months). The poor group was independently correlated with an over 1.9 times risk of disease progression (HR=1.901; 95% CI, 1.314-2.750; P=0.001) and an over 2 times risk of death (HR=2.003; 95% CI, 1.306-3.072; P=0.001) than the good group. The intermediate group was independently correlated with an over 1.3 times risk of disease progression (HR=1.385; 95% CI, 1.004-1.911; P=0.048) and an over 1.4 times risk of death (HR=1.484; 95% CI, 1.046-2.106; P=0.027) than the good group. Conclusion Our study verifies, for the first time, that ANPG is an independent factor affecting survival of AGC patients receiving immunotherapy. Patients with the good ANPG could benefit from immunotherapy.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

Private Agricultural R&D: Do the Poor Benefit?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jock R. Anderson ◽  
Regina Birner ◽  
Latha Najarajan ◽  
Anwar Naseem ◽  
Carl E. Pray
Keyword(s):  
Poverty Reduction ◽  
Agricultural Research ◽  
Farming Systems ◽  
Agricultural Technologies ◽  
Policy Makers ◽  
The Public ◽  
The Poor ◽  
The World ◽  
Agricultural Research And Development ◽  
The Impact

Abstract Private agricultural research and development can foster the growth of agricultural productivity in the diverse farming systems of the developing world comparable to the public sector. We examine the extent to which technologies developed by private entities reach smallholder and resource-poor farmers, and the impact they have on poverty reduction. We critically review cases of successfully deployed improved agricultural technologies delivered by the private sector in both large and small developing countries for instructive lessons for policy makers around the world.

scholarly journals Impact of price and non-price policies on household cigarette consumption and nutrient intake in smoking-tolerant Indonesia

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e039211
Author(s):  
Triasih Djutaharta ◽  
Nachrowi Djalal Nachrowi ◽  
Aris Ananta ◽  
Drajat Martianto
Keyword(s):  
Protein Intake ◽  
Smoking Prevalence ◽  
National Health Survey ◽  
Secondary Outcome ◽  
Household Expenditure ◽  
Food Groups ◽  
Cigarette Price ◽  
Cross Sectional ◽  
Budget Share ◽  
The Impact

ObjectiveTo examine the impact of cigarette price and smoking environment on allocation of household expenditure and its implication on nutrition consumption.DesignA cross-sectional study was conducted using the 2014 National Socioeconomic Survey (SUSENAS), the 2014 Village Potential Survey (PODES) and the 2013 Basic National Health Survey (RISKESDAS). SUSENAS and PODES data were collected by the Central Bureau of Statistics. RISKESDAS was conducted by National Institute of Health Research and Development (Balitbangkes), Indonesian Ministry of Health (MOH).Setting and participantsThe sample covered all districts in Indonesia; with sample size of 285 400 households. These households are grouped into low, medium and high smoking prevalence districts.Primary and secondary outcome measuresThe impact of cigarette price and smoking environment on household consumption of cigarette, share of eight food groups, as well as calorie and protein intake.Result1% increase in cigarette price will increase the cigarette budget share by 0.0737 points and reduce the budget share for eggs/milk, prepared food, staple food, nuts, fish/meat and fruit, from 0.0200 points (eggs/milk) up to 0.0033 points (fruit). Reallocation of household expenditure brings changes in food composition, resulting in declining calorie and protein intake. A 1% cigarette price increase reduces calorie and protein intake as much as 0.0885% and 0.1052%, respectively. On the other hand, existence of smoke-free areas and low smoking prevalence areas reduces the household budget for cigarettes.ConclusionA pricing policy must be accompanied by non-pricing policies to reduce cigarette budget share.

scholarly journals The Impact of Time Interval between Hepatic Resection and Liver Transplantation on Clinical Outcome in Patients with Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2398
Author(s):  
Matteo Serenari ◽  
Enrico Prosperi ◽  
Marc-Antoine Allard ◽  
Michele Paterno ◽  
Nicolas Golse ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Hepatic Resection ◽  
Primary Outcome ◽  
Polynomial Regression ◽  
Secondary Outcome ◽  
Time Interval ◽  
Comprehensive Complication Index ◽  
Fractional Polynomial ◽  
The Impact

Hepatic resection (HR) for hepatocellular carcinoma (HCC) may require secondary liver transplantation (SLT). However, a previous HR is supposed to worsen post-SLT outcomes. Data of patients treated by SLT between 2000 and 2018 at two tertiary referral centers were analyzed. The primary outcome of the study was to analyze the impact of HR on post-LT complications. A Comprehensive Complication Index ≥ 29.6 was chosen as cutoff. The secondary outcome was HCC-related death by means of competing-risk regression analysis. In the study period, 140 patients were included. Patients were transplanted in a median of 23 months after HR (IQR 14–41). Among all the features analyzed regarding the prior HR, only time interval between HR and SLT (time HR-SLT) was an independent predictor of severe complications after LT (OR = 0.98, p < 0.001). According to fractional polynomial regression, the probability of severe complications increased up to 15 months after HR (43%), then slowly decreased over time (OR = 0.88, p < 0.001). There was no significant association between HCC-related death and time HR-SLT at the multivariable competing risks regression model (SHR, 1.06; 95% CI: 0.69–1.62, p = 0.796). This study showed that time HR-SLT was key in predicting complications after LT, without affecting HCC-related death.

scholarly journals Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048772
Author(s):  
Toby O Smith ◽  
Pippa Belderson ◽  
Jack R Dainty ◽  
Linda Birt ◽  
Karen Durrant ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Online Survey ◽  
Musculoskeletal Diseases ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Healthcare Provision ◽  
Social Restriction ◽  
The Uk ◽  
The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

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