Creating a clinical nutrition registry: prospects, problems, and preliminary results.
ABSTRACT There is a tremendous gap in the information available to support the practice of hospital-based dietitians and to address the issue of how the risk of developing protein-energy malnutrition can be avoided in the majority of patients. This article describes the rationale and benefits of creating a nutrition registry of within-hospital clinical nutrition care. A nutrition registry is made up of observational data, collected on an ongoing basis, of nutritional interventions provided to hospitalized patients. It is the first step in data gathering to demonstrate the effectiveness of clinical nutrition interventions. The methods and preliminary results of a nutrition registry that was established at The University of Illinois Medical Center, Chicago, III, are presented. Using subjective global assessment, 55% (257 of 467) of patients at admission and 60% (280 of 467) of patients at discharge were moderately or severely malnourished. Patients that were normal nourished at admission and became moderately or severely malnourished had higher hospital charges ($40,329 for moderately malnourished patients, $76,598 for severely malnourished patients) than those that remained normal nourished ($28,368). This pattern held independent of admission nutritional status. Major challenges in implementation of a registry into the responsibilities of the staff dietitian are reviewed. The conclusion of this study is that nutrition registries can be established and will provide the much needed baseline data to document the impact of nutrition interventions on outcomes of medical care.
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ABSTRACT: Malnutrition is a costly problem for health care systems internationally. Malnourished individuals require longer hospital stays and more intensive nursing care than adequately nourished individuals and have been estimated to cost an additional £7.3 billion in health care expenditures in the United Kingdom alone. However, treatments for malnutrition have rarely been considered from an economic perspective. The aim of this systematic review was to identify the cost effectiveness of using protein and energy supplementation as a widely used intervention to treat adults with and at risk of malnutrition. Papers were identified that included economic evaluations of protein or energy supplementation for the treatment or prevention of malnutrition in adults. While the variety of outcome measures reported for cost-effectiveness studies made synthesis of results challenging, cost-benefit studies indicated that the savings for the health system could be substantial due to reduced lengths of hospital stay and less intensive use of health services after discharge. In summary, the available economic evidence indicates that protein and energy supplementation in treatment or prevention of malnutrition provides an opportunity to improve patient wellbeing and lower health system costs.European Journal of Clinical Nutrition advance online publication, 30 October 2013; doi:10.1038/ejcn.2013.206.European journal of clinical nutrition 10/2013; · 3.07 Impact Factor
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ABSTRACT: INTRODUCTION: Understanding the consequences of cancer for energy metabolism is required in order to define strategies that both prevent and treat malnutrition. Carnitine is essential for lipid energy metabolism. The objective of this study was to assess presurgical plasma carnitine levels in cancer patients and their association with dietary intake, anthropometry, bioelectrical impedance, indirect calorimetry, plasma amino acid levels, and urinary carnitine and nitrogen values. METHODS: This was a prospective study in which two groups were randomly selected: one consisting of esophageal and gastric cancer patients (n = 24) and the other of healthy volunteers (control group, n = 12). RESULTS: Average plasma and urinary carnitine values ranged from 60 to 80 μM and 78 to 124 μM, respectively, in both groups, with no significant difference between them. Moreover, methionine and lysine levels, as well as resting energy expenditure, did not differ between cancer patients and controls. Plasma free carnitine levels, however, were significantly lower in cancer patients, 80 % (p < 0.05) of whom had deficient urinary carnitine excretion, insufficient dietary protein intake, and low body fat reserves. CONCLUSION: Although cancer patients had carnitine deficiency and lower carnitine stores, these did not affect resting energy expenditure, total food intake, or plasma lysine and methionine levels.Journal of Gastrointestinal Cancer 04/2013;
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ABSTRACT: Introduction: The use of a medical data registry allows institutions to effectively manage information for many different investigations related to the registry, as well as evaluate patient’s trends over time, with the ultimate goal of recognizing trends that may improve outcomes in a particular patient population. Methods: The purpose of this article is to illustrate our experience with a stroke patient registry at a comprehensive stroke center and highlight advantages, disadvantages, and lessons learned in the process of designing, implementing, and maintaining a stroke registry. We detail the process of stroke registry methodology, common data element (CDE) definitions, the generation of manuscripts from a registry, and the limitations. Advantages: The largest advantage of a registry is the ability to prospectively add patients, while allowing investigators to go back and collect information retrospectively if needed. The continuous addition of new patients increases the sample size of studies from year to year, and it also allows reflection on clinical practices from previous years and the ability to investigate trends in patient management over time. Limitations: The greatest limitation in this registry pertains to our single-entry technique where multiple sites of data entry and transfer may generate errors within the registry. Lessons Learned: To reduce the potential for errors and maximize the accuracy and efficiency of the registry, we invest significant time in training competent registry users and project leaders. With effective training and transition of leadership positions, which are continuous and evolving processes, we have attempted to optimize our clinical research registry for knowledge gain and quality improvement at our center.Medical Student Research Journal. 05/2013; 2(Spring):021.