Utilizing laboratory parameters to monitor effectiveness of nutritional support.
Explore the source record for details and available documents.
Biomarkers↗
Biomedical subjects
L H Bernstein
Publications and source records attributed to L H Bernstein.
Effect of nutrition status and other factors on length of hospital stay after major gastrointestinal surgery.
Various factors may prolong postoperative recovery and the length of stay (LOS) in the hospital. In a retrospective study of 245 adult patients who had no oral intake for 5 days after major gastrointestinal surgery, we used a correlation matrix to describe the population and determine the effects of the following factors on LOS: malnutrition, complication status, stress level, type of surgery, pathology, period of inadequate nutrient intake, and use of nutritional support. LOS was markedly prolonged in malnourished patients compared with those who were not (23.5 +/- 16.5 vs. 16.5 +/- 10.7 days, means +/- SD, p < 0.001). Patients were then grouped into those who had nutritional support and those who had not, and a nutrition classification was derived by examining the uncertainty (entropy) in the data matrix that allowed separation of the population into distinct groups. Nutrition and complication status and days without oral nutrient intake were discriminative. Analysis of variance and multivariate studies were also used to determine whether the presence of malnutrition, complications, both together, or neither could predict LOS and to determine the confounding effect of nutritional support on LOS. A significantly extended LOS persisted for patients with malnutrition or complications and was most prolonged for those with both, but patients who received nutritional support had a greater LOS than those who did not. In addition to the effects of nutritional support, malnutrition, and complication status, LOS correlated with the duration of the postoperative period without oral nutrient intake. We therefore recommend systematic and early nutritional intervention for selected gastrointestinal surgical patients.
Aged↗
Amniotic fluid polarization of fluorescence and lecithin/sphingomyelin ratio decision criteria assessed.
A negative finding of amniotic fluid (AF) phosphatidyl glycerol (PG) does not eliminate the need for determining the lecithin/sphingomyelin ratio (LSR). We use a novel approach to classify fetal lung maturity (FLM) data, and to validate the fluorescence polarization (FP) surfactant assay (Abbott), which replaces the PG assay and reduces the frequency of repeat LSR. This method finds the values (decision points) of these tests that allow for classifying the data with least errors. These tests best identify the risk of respiratory distress syndrome (RDS) from fetal lung immaturity. We find the decision values for tests by exploring the data for information content and optimize their selection using group-based reference. We previously defined normal reference as the maximum entropy set with no information. The uncertainty resolved by information provided in the data allows formation of syndromic classes. This is greatest at the values for the variables (decision-points) associated with the greatest decrease in entropy. Decision-values found for PF, EGA, PG, LSR that classify amniotic fluids into the mature and not-mature classes are in agreement with the results of ROC analysis. We validate the replacement of PG by the PF method. We also find a level of FP below which LSR might be required to resolve uncertainty and above which the FP indicates maturity. We confirm the ability to evaluate fetal maturity methods using information analysis.
Amniotic Fluid↗
Bridgeport Hospital autologous blood donation experience from 1992 to 1996.
The safety of the blood supply, an issue in the 1970s and 1980s, created an increased need to screen the blood supply for HIV-1 and hepatitis C virus infections. The possibility exists that other contamination could again affect the blood supply. This has resulted in the increased use of strategies to minimize the transfusion of allogeneic blood, such as autologous blood predeposit for elective surgical procedures. Many studies indicate, however, that autologous blood donation is overutilized so that half of the blood withdrawn for autologous use is discarded. Cost-effectiveness studies have indicated that autologous blood donation has little benefit compared with many medical procedures, from which one might conclude that the procedure could be eliminated. Alternatively, the benefit could be improved by reducing the wastage of autologous donated blood. This wastage must occur only because of a premise that autologous blood is obtained to ensure avoidance of a homologous transfusion. This results in an amount of blood withdrawn that is more than is used in an uncomplicated procedure. We examined the transfusion requirements in surgical procedures for which there is autologous blood donation to establish the optimum amount of blood to be taken based on expected blood use. The transfusion records of 493 patients who donated blood preoperatively (340 orthopedic, 69 urological and 83 gynecological, in the years 1992 and 1993) were audited to determine the characteristics of the transfusion practices associated with the surgical procedures. The study sample underwent 182 total knee and 123 total hip arthroplasties, 33 laminectomies with fusion and three without, 83 hysterectomies and myomectomies, 59 radical retropubic prostatectomies and 10 nephrectomies and lymph node resections. Data used for evaluation were age, sex, units donated and transfused, predonation hemoglobin concentration, initial and final hemoglobin concentration, surgical procedure and surgical blood loss. The study suggests that autologous predeposit is not indicated for hysterectomies because of the low likelihood of transfusion. Even when a transfusion is likely according to the surgical blood order schedule, predonation is greater than actual use. Use of predonation hemoglobin could facilitate better efficiency of use for procedures where use is anticipated, thereby significantly reducing a wastage near 50 percent.
Blood Donors↗