Improving Documentation of Pediatric Height, Weight, and Body Mass Index by Primary Care Providers.

The regular documentation of anthropometric data in an electronic medical record (EMR) is one tracking method used by primary care providers to follow the growth trajectory and development of children in their health care practices. EMR reminders have been proposed as a method to increase recording of pediatric height and weight by primary care providers, leading to potentially better detection and management of children classified as overweight or obese. The aim of this pre-post study was to improve a Family Health Team's physician documentation of pediatric height and weight through the implementation of an EMR reminder alert tool. The documentation rate for children 4-7 years old in the 6 months before intervention was 36% of children seen. After implementation of EMR reminder alerts, primary care physicians' documentation rate rose to 45% (9% increase; P < 0.01), but it was below the 15% target increase. Better documentation of pediatric height and weight by family physicians is needed to improve monitoring of children's growth trajectories. Additional strategies to increase documentation rates are needed.

Companion-Animal Caregiver Knowledge, Attitudes, and Beliefs Regarding End-of-Life Care.

Although awareness of end-of-life care is growing within the veterinary field and there appears to be consumer demand for these services, it is unclear exactly what caregivers know about end-of-life options for their companion animals. Are companion-animal caregivers aware of the range of options for their nonhuman animals? What do they value most highly for their nonhuman animals at the end of life? Answers to these and other related questions about caregiver perceptions are important because what they know about end-of-life care and how they approach decision-making for their companion animals will shape the kind of care an animal receives. This article presents the results of a large survey exploring companion-animal caregivers' knowledge, attitudes, and beliefs about end-of-life care, including in-home euthanasia, hospice and palliative care, financial commitment to end-of-life care, insurance usage, and level of comfort in providing care (e.g., subcutaneous fluids) in the home.

Effect of grape and other berries on cardiovascular health.

Cardiovascular disease is a leading cause of death globally. Many cardiovascular risk factors can be modified through lifestyle modification, including dietary patterns that emphasize daily consumption of a variety of fruits and vegetables. Recent observational and clinical studies suggest that flavonoids, especially those abundant in grapes and other berries, may be associated with health benefits, particularly cardiovascular benefits. Human clinical data support cardioprotective benefits of grapes through inhibition of platelet aggregation, decreased low-density lipoprotein (LDL) oxidation, reduction in oxidative stress and improvements in endothelial function. Emerging evidence suggests that grapes may also have a favorable effect on blood lipids, decrease inflammation and reduce blood pressure in certain populations. Studies to date have shown that berries can have a beneficial effect on reducing LDL oxidation. Limited data suggest that berries may have a favorable effect on endothelial health and blood pressure. This review summarizes the current literature on human clinical studies examining the cardioprotective benefits of grapes and berries. Collectively, these data support the recommendation to incorporate products made with grapes and other berries into a heart-healthy diet.

Electronic access to food and cash benefits.

The authors' purpose was to examine access to Family Independence Program and Food benefits in relation to customer service and an automated helpline. In addition, participants identified impediments and limitations to the receipt of services. Two hundred forty-four surveys were mailed to recipients of over-the-counter electronic benefit transfer cards; 58 were returned. The findings indicate that when customers (age 21-92) received assistance navigating the electronic benefits transfer system from local office staff, they were able to obtain benefits successfully. Negative credit/debit card history and touchtone phones were related to difficulty using the system. The results suggest that the local office and the contracted service provider (automatic helpline) need to provide assistance that promotes greater autonomy for the customer to make successful transitions to benefits that are delivered electronically.

The frailty syndrome: a comprehensive review.

The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.

Polypharmacy and nutritional status in older adults: a cross-sectional study.

BACKGROUND: Older adults have more chronic medical conditions, and the level of polypharmacy increases with advancing age. Malnutrition and drug nutrient interactions are of concern in this population. OBJECTIVES: The aims of this cross-sectional study were to examine nutritional status, the use of medications, and drug-nutrient interactions in older adults. METHODS: Interviewer-administered surveys were conducted in 1100 community-dwelling older (age >65 years) adults. Information regarding demographics, nutritional status, medical history and medication usage was obtained. Self-reported data were verified by third parties when feasible. Informed consent and Human Subjects Committee approval were obtained. A pilot conducted prior to the onset of the study revealed high rates of inter-rater reliability. Data were recorded and entered into Excel spreadsheets for coding and cleaning and transferred to SPSS v. 17.0 for analyses. RESULTS: The respondents' mean age was 75.5 years. The top six most frequently used classes of medications were gastrointestinal agents, antihypertensives, diuretics, analgesics, ß-adrenoceptor antagonists and antihyperlipidaemics. The prevalence of polypharmacy among the participants was 43.4%, with 51.1% of those participants using five or more medications. Most notable was the statistically significant inverse correlation between increasing number of medications and intake of fibre. Intake of cholesterol, glucose and sodium were positively associated with increasing medication use. A trend was also observed for increased phosphorus intake and increased number of medications used. Intake of fat-soluble vitamins, B vitamins, carotenoids and minerals was lower in those with increasing number of medications. Decrements in physical health were associated with decreasing intake of many fat-soluble and water-soluble vitamins, major minerals, trace minerals and electrolytes. Excessive macronutriture, specifically relating to the intake of saturated fats, refined carbohydrates and cholesterol, along with decreased intake of fibre and bioavailable protein sources, was also associated with poor physical health. CONCLUSIONS: The number of medications used by older adults in this convenience sample was associated with poorer nutritional status. Decrements in physical health have a statistically significant effect on nutrient intake. Further research into these issues is required.

Artificial nutrition and hydration at the end of life.

Considerable controversy surrounds the issue of care at the end of life (EOL) for older adults. Technological advances and the legal, ethical, clinical, religious, cultural, personal, and fiscal considerations in the provision of artificial hydration and nutrition support to older adults near death are presented in this comprehensive review.

Predictive equations for energy needs for the critically ill.

Nutrition may affect clinical outcomes in critically ill patients, and providing either more or fewer calories than the patient needs can adversely affect outcomes. Calorie need fluctuates substantially over the course of critical illness, and nutrition delivery is often influenced by: the risk of refeeding syndrome; a hypocaloric feeding regimen; lack of feeding access; intolerance of feeding; and feeding-delay for procedures. Lean body mass is the strongest determinant of resting energy expenditure, but age, sex, medications, and metabolic stress also influence the calorie requirement. Indirect calorimetry is the accepted standard for determining calorie requirement, but is unavailable or unaffordable in many centers. Moreover, indirect calorimetry is not infallible and care must be taken when interpreting the results. In the absence of calorimetry, clinicians use equations and clinical judgment to estimate calorie need. We reviewed 7 equations (American College of Chest Physicians, Harris-Benedict, Ireton-Jones 1992 and 1997, Penn State 1998 and 2003, Swinamer 1990) and their prediction accuracy. Understanding an equation's reference population and using the equation with similar patients are essential for the equation to perform similarly. Prediction accuracy among equations is rarely within 10% of the measured energy expenditure; however, in the absence of indirect calorimetry, a prediction equation is the best alternative.

Alcohol and the older adult: a comprehensive review.

Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of "boomers" who believe that alcohol intake improves health comes of age.

Relation of blood homocysteine and its nutritional determinants to age-related maculopathy in the third National Health and Nutrition Examination Survey.

BACKGROUND: Blood homocysteine and its nutritional determinants folate and cyanocobalamin (vitamin B-12) have been shown to affect the risk of vascular disease. The pathogenesis of age-related maculopathy (ARM) is related to adverse vascular changes. OBJECTIVE: The objective was to evaluate the associations between homocysteine, its nutritional determinants, and ARM in persons aged >or= 40 y participating in the third National Health and Nutrition Examination Survey. DESIGN: A nonmydriatic fundus photograph of one eye, taken in a mobile examination center, was used to ascertain ARM status. Phlebotomy was performed for measurement of homocysteine, cyanocobalamin, and erythrocyte folate in participants of phase 2 of the survey (n = 3828). Logistic regressions were used to compute odds ratios and 95% CIs by quintile of serum analyte by using sample weights and jackknife replication methods to adjust for the complex survey design. The final analyses were adjusted for potential risk factors that influenced odds ratios. RESULTS: Total serum homocysteine, red blood cell folate, and serum cyanocobalamin were unrelated to ARM in the overall sample. However, red blood cell folate was inversely related to one type of early ARM lesion (soft drusen) in non-Hispanic blacks. CONCLUSIONS: ARM does not appear to be associated with homocysteine or its dietary determinants in this survey. There is a need for further investigation to rule out potential associations in subgroups with low folate status that may not have been detected because of the cross-sectional survey design.