ABSTRACT
BACKGROUND: Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system. METHODS: The present study is carried out as an open, controlled, randomized study on patients that were admitted to the Internal Medicine and the General and Digestive Surgery ward; the patients were randomized to either a control or an intervention group (n = 824, thereof 412 patients in each of the two study arms). The control group underwent usual inpatient clinical care, while the intervention group was evaluated with the CIPA screening tool for early detection of malnutrition and treated accordingly. CIPA nutrition screening was performed upon hospital admission and classified positive when at least one of the following parameters was met: 72 h food intake control < 50%, serum albumin < 3 g/dL, body mass index < 18.5 kg/m2 (or mid-upper arm circumference ≤ 22.5 cm). In this case, the doctor decided on whether or not providing nutrition support. The following variables will be evaluated: hospital length of stay (primary endpoint), mortality, 3-month readmission, and in-hospital complications. Likewise, the quality of life questionnaires EQ-5D-5 L are being collected for all patients at hospital admission, discharge, and 3 months post-discharge. Analysis of cost-effectiveness will be performed by measuring effectiveness in terms of quality-adjusted life years (QALYs). The cost per patient will be established by identifying health care resource utilization; cost-effectiveness will be determined through the incremental cost-effectiveness ratio (ICER). We will calculate the incremental cost per QALY gained with respect to the intervention. DISCUSSION: This ongoing trial aims to evaluate the cost-effectiveness of implementing the malnutrition screening tool CIPA in a tertiary hospital. TRIAL REGISTRATION: Clinical Trial.gov ( NCT02721706 ). First receivevd: March 1, 2016 Last updated: April 8, 2017 Last verified: April 2017.
Subject(s)
Cost-Benefit Analysis , Early Diagnosis , Hospitalization , Malnutrition/diagnosis , Malnutrition/prevention & control , Nutrition Assessment , Aged , Body Mass Index , Female , Humans , Indoles , Length of Stay , Male , Middle Aged , Patient Discharge , Propionates , Quality of Life , Quality-Adjusted Life Years , Risk , Spain , Surveys and QuestionnairesABSTRACT
Este artículo es un ensayo sobre la urgencia de comprender e investigar los fenómenos de cambio social y participación política, identificando los procesos y las condiciones para que estos se desarrollen desde una perspectiva interdisciplinar. En ese sentido, se postula la necesidad de una nueva postura frente al conocimiento, de carácter distinto a las tradiciones disciplinarias que marcaran los fines del siglo XIX y buena parte del siglo XX. Lo que debería habilitar a los investigadores de estas temáticas en el siglo XXI para la producción de un conocimiento válido en su complejidad, sería la capacidad de dialogar y transitar en las fronteras del conocimiento de modo de indicar los agentes, las estructuras y las responsabilidades diferenciadas que concurren para establecer las dinámicas (permanencias y/ó mutabilidades) de los diversos ámbitos de la vida humana y de los colectivos en que ellas se realizan. Dicho conocimiento, sea con propósitos de localizar o situar la intervención (profesional, voluntaria) en tales dinámicas, o con propósitos de producir, o revisar sistematizaciones que contribuyan para la comprehensión de esos caminos, ha de abordar la temática "Cambio Social y Participación Política", como un campo interdisciplinar de investigación académico-científica que orienta y aglutina la acción político-institucional y académico-profesional de diversos científicos y profesionales.
This article is an essay on the urgency of understanding and investigating the phenomena of social change and political participation, identifying the processes and conditions for them to be developed from an interdisciplinary perspective. In this sense, it is postulated the need for a new position in the face of knowledge, of a character different from the disciplinary traditions that marked the end of the 19th century and a good part of the 20th century. What should enable researchers of these issues in the XXI century for the production of a valid knowledge in its complexity, would be the ability to dialogue and transit at the frontiers of knowledge in order to indicate the agents, structures and differentiated responsibilities that concur to establish the dynamics (permanence and / or mutability) of the different spheres of human life and of the collectives in which they are carried out. Such knowledge, whether for the purpose of locating or situating the intervention (professional, voluntary) in such dynamics, or for purposes of producing, or revising systematizations that contribute to the understanding of these paths, must address the theme "Social Change and Political Participation" ", As an interdisciplinary field of academic-scientific research that guides and agglutinates the political-institutional and academic-professional action of various scientists and professionals.
Este artigo é um ensaio sobre a urgência de compreender e investigar os fenômenos de mudança social e participação política, identificando os processos e as condições para que eles se desenvolvam a partir de uma perspectiva interdisciplinar. Nesse sentido, postulase a necessidade de uma nova postura diante do conhecimento, de caráter diferente das tradições disciplinares que marcaram o final do século XIX e boa parte do século XX. O que deve possibilitar aos pesquisadores destas questões, no século XXI, a produção de um conhecimento válido em sua complexidade, seria a capacidade de dialogar e transitar nas fronteiras do conhecimento, a fim de indicaros agentes, estruturas e responsabilidades diferenciadas, que concorrem para estabelecer a dinâmica (permanência e / ou mutabilidade) das diferentes esferas da vida humana e dos coletivos em que são realizadas. Tal conhecimento, seja com o propósito de localizar ou situar a intervenção (profissional, voluntária) em tal dinâmica, ou para fins de produção, ou revisão de sistematizações que contribuam para a compreensão desses caminhos, deve abordar o tema "Mudança Social e Participação Política". "Como um campo interdisciplinar de pesquisa académico-científica que orienta e aglutina a ação político-institucional e académico-profissional de vários cientistas e profissionais.
