Biomedical subjects

D R Thomas

Publications and source records attributed to D R Thomas.

186 records · Page 11Linked to original sources

PubMedDate not supplied

Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay.

OBJECTIVE: To determine whether or not the development of a Stage II or greater pressure ulcer in-hospital is associated with increased hospital costs and length of stay after adjusting for admission severity of illness, comorbidities, nosocomial infections, and other hospital complications. DESIGN: Prospective, inception cohort study. SETTING: Tertiary care, urban, university teaching hospital. PARTICIPANTS: 286 patients identified within 3 days of admission to a tertiary care, urban teaching hospital were enrolled in a prospective, inception cohort study. Patients were age 55 or greater; expected to be confined to bed or chair or with a hip fracture; and expected to remain in hospital at least 5 days. MEASUREMENTS: Baseline data were collected within 3 days of admission. Weekly skin assessments were performed by study nurses to document the development of pressure ulcers. Medical record reviews, patient exams, and physician and nurse interviews were used to obtain baseline demographic, medical, functional, nutritional, and global measures of disease severity. The incidence of nosocomial infections and the number of other hospital complications were monitored by medical record reviews. Hospital costs were estimated using category-specific cost-to-charge ratios. Diagnostic-related group (DRG) adjusted length of stay was calculated by subtracting the mean length of stay for assigned DRGs from actual stays. RESULTS: Incident pressure ulcers were associated with significantly higher mean unadjusted hospital costs ($37,288 vs $13,924, P = 0.0001) and length of stay (30.4 vs 12.8 days, P = 0.0001). In addition to pressure ulcers, other independent predictors of hospital costs and length of stay after multivariable analyses included: admission to an intensive care unit or surgical service, younger age, nosocomial infection, the physician assessment of disease severity, and the number of other hospital complications. Compared with those who did not develop pressure ulcers, patients who developed pressure ulcers also were more likely to develop nosocomial infections (45.9% [17/37] vs 20.1% [50/249], P = 0.001) and other hospital complications (86.5% [32/37] vs 43.0% [107/249], P < 0.001). After adjusting for only the admission predictors of costs and length of stay by multivariable analyses, hospital costs, and length of stay for those who developed pressure ulcers remained significantly greater than for those who did not develop pressure ulcers ($14,260 vs $12,382, P = 0.03, and 16.9 vs 12.9 days, P = 0.02, respectively). The differences in costs and length of stay for those with and without incident pressure ulcers were even greater when adjusted for admission predictors and also the occurrence of nosocomial infections and other complications ($29,048 vs $13,819, P = 0.002, and 20.9 vs 12.7 days, P = 0.0001, respectively). CONCLUSION: Incident pressure ulcers are associated with substantial and significant increases in hospital costs and length of stay. Nosocomial infections and other hospital complications are additional significant independent predictors of health care utilization among patients at risk for pressure ulcers.

Aged↗

PubMedDate not supplied

Are all pressure ulcers avoidable?

A quality of care debate centers on whether pressure ulcers result from factors largely dependent on caregivers, or whether pressure ulcers result from factors associated with patient morbidity. A reduction in incidence, defined as the development of a new pressure ulcer, is the focus of prevention strategies. Yet epidemiological data demonstrates a stability in the incidence of pressure ulcers despite drastic improvements in understanding of pressure ulcers, increased regulatory oversight, and improvements in technologies available for prevention of pressure ulcers. The explanation for this stable incidence of pressure ulcers includes a failure of known effective preventive treatment to be applied or the failure of prevention strategies to be effective in spite of being applied. No intervention strategy has been reported that consistently and reproducibly reduces the incidence of pressure ulcers to zero. The published data on prevention of pressure ulcers do not support an assumption that all pressure ulcers are preventable. An effective prevention strategy demonstrated to eliminate pressure ulcers across healthcare settings is lacking.

Journal Article↗

PubMedDate not supplied

A prospective, randomized clinical study of adjunctive peripheral parenteral nutrition in adult subacute care patients.

BACKGROUND: A number of frail, older, undernourished patients cannot maintain adequate oral intake to meet protein-calorie needs after an illness, even when high-density nutritional supplements are added. Tolerance to enteral nutrition by gastric tube is poor in this group of patients. Peripheral parenteral nutrition is an effective method of administering nutritional support to patients with mild to moderate nutritional deficiencies who are unable to receive enteral nutrition or for whom enteral nutrition alone cannot meet energy needs. However, no data exists for the use of peripheral parenteral nutrition longer than two weeks and overall there are remarkably few studies on the efficacy of peripheral parenteral nutrition. METHODS: A Phase 4, single center, prospective, randomized, parallel group design clinical trial was conducted to evaluate long-term safety of peripheral parenteral nutrition in post-acute patients receiving inadequate enteral nutrition. Nutritional status was measured by the Mini-Nutritional Assessment and functional status by the Functional Inventory Measure. Subjects received a mean duration for peripheral parenteral nutrition of 15.8 +/- 6.7 days (range 8-23). RESULTS: The peripheral parenteral nutrition group demonstrated several trends towards improvement in prealbumin, CD4 cell count, and functional status compared to the untreated control group. Two patients in the peripheral parenteral nutrition group developed low-grade phlebitis; however, this did not result in discontinuing intravenous therapy. No other adverse events occurred. This study demonstrates that peripheral parenteral nutrition is feasible and safe in postacute care. CONCLUSIONS: We conclude that peripheral parenteral nutrition can be safely administered in post-acute settings with a low rate of complications.

Aged, 80 and over↗

PubMedDate not supplied

Changes in coronary bypass surgery leading to improved survival.

Coronary bypass surgery was performed on 439 patients between the years 1969 and 1973 (group A) and on 1,760 patients between the years 1974 and 1979 (group B). The operative mortality for group A was 3.9%; for group B, 1.3%; four-year survival for group A patients was 88.9% +/- 1.5% (mean +/- SE); for group B patients, 92.5% +/- 0.9%. The difference between the relative four-year survival rates (based on age- and sex-matched Oregon population) between group B and A was 6.2%; the lower operative mortality would account for only 2.6%. We conclude that the results of coronary bypass surgery have improved because of (1) a lower operative mortality, and (2) other factors that cannot be precisely defined at the present time but probably are the long-term result of better and more complete operative and perioperative techniques.

Adult↗

PubMedDate not supplied

Specific nutritional factors in wound healing.

Provision of a nutritionally complete diet provides the optimum environment for recovery and healing. Clinical research and experience suggest that several nutritional factors may be associated with impaired wound healing, including vitamin C, vitamin A, vitamin E, zinc, protein, and individual amino acids. Studies have shown that supplementing specific nutrients to patients who are not clinically deficient has little effect on pressure ulcer healing. Inexpensive, nontoxic nutritional supplements may not harm the patient, however, some nutritional supplements are expensive or potentially toxic. Before routine use of these nutrients can be justified, further research is required.

Humans↗

PubMedDate not supplied

Obstacles and opportunities for the multidisciplinary wound care team. A report for the clinical symposium on wound management.

On the last day of the 12th Annual Clinical Symposium on Wound Management, a panel of clinicians from various disciplines, and with diverse experience in wound management, discussed the challenges and rewards of being part of a multidisciplinary team caring for patients with wounds. Panelists included Sharon Baranoski, MSN, RN, CETN; C. Andrew Salzberg, MD; Marlys J. Staley, MS, PT; and David R. Thomas, MD, FACP. Elizabeth A. Ayello, PhD, RN, CS, CETN, was the moderator. An excerpt from this session is published here.

Humans↗