ABSTRACT
BACKGROUND: Several studies have cited the incidence of malnutrition in hospitals, which is correlated to negative clinical outcomes, to be up to 60%. Data in Singapore, however, are scarce. Its impact on casemix funding is not known. AIMS: The aims of the present study were to determine the prevalence of malnutrition, the predisposing risk factors and the impact of documentation and coding of malnutrition on casemix funding in a local population in Singapore. METHODS: Patients admitted to selected wards over a 1-month period were screened for malnutrition. Those at risk were further assessed using subjective global assessment. Logistic regression was used to ascertain the impact of identified factors on malnutrition. Financial impact analysis of coding of malnutrition as a comorbidity was carried out and tested with Wilcoxon signed rank tests. RESULTS: Six hundred and fifty-eight patients were eligible for screening. The overall prevalence of malnutrition in the selected wards was 14.7% (95% confidence interval (CI): 12.0-17.4%). Old age, the occurrence of cancer and the admitting unit were statistically significant in explaining the occurrence of malnutrition. Coding of malnutrition was found to significantly increase the complexity of 24 of 105 episodes (22.9%) of patient care as measured by expected cost weights (P < 0.001) and expected lengths of stay (P < 0.001). As a result, the expected financing for these 24 patients increased by 59.7%. CONCLUSIONS: Malnutrition is prevalent in hospitalised medical and surgical patients. Certain clinical factors should heighten awareness and prompt detection for malnutrition. Coding for malnutrition impacts favourably on casemix funding for a subset of malnourished patients.
Subject(s)
Insurance, Health, Reimbursement/statistics & numerical data , Malnutrition/diagnosis , Malnutrition/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Causality , Female , Forms and Records Control , Hospitalization/economics , Humans , Inpatients , Male , Mass Screening/methods , Middle Aged , Prevalence , Singapore/epidemiologyABSTRACT
The structure of the capsular polysaccharide from Escherichia coli O8:K44 (A):H- (K44 antigen) has been established using the techniques of methylation, beta-elimination, deamination, and Smith degradation. N.m.r. spectroscopy (13C and 1H) was used extensively to establish the nature of the anomeric linkages of the polysaccharide and of oligosaccharides derived through degradative procedures. The K antigen is comprised of repeating units of the linear tetrasaccharide shown. This acidic polysaccharide represents the first instance of an E. coli K antigen in this series (group A) that has been found to contain two different 2-acetamido-2-deoxyhexoses.
Subject(s)
Escherichia coli/immunology , Polysaccharides, Bacterial/analysis , Carbodiimides , Chromates , Deamination , Magnetic Resonance Spectroscopy , Methylation , Oxidation-Reduction , Periodic Acid , SerotypingABSTRACT
The structures of the capsular polysaccharides elaborated by Klebsiella types 8 (K8) and 82 (K82) have been reinvestigated. N.m.r. spectroscopy of the original and chemically modified polysaccharides was the principal method used. It is concluded that the polysaccharides are composed of repeating units having the following structures. (Formula: see text). The presence of L-glutamic acid, linked as an amide to the carboxyl group of a uronic acid, has not been observed hitherto in bacterial polysaccharides.
Subject(s)
Klebsiella/immunology , Polysaccharides, Bacterial , Carbohydrate Conformation , Carbohydrate Sequence , Magnetic Resonance Spectroscopy , Molecular Sequence DataABSTRACT
The structure of the capsular polysaccharide from Klebsiella K79 was determined by the techniques of methylation, periodate oxidation, beta-elimination, chromic acid oxidation, and partial hydrolysis. N.m.r. spectroscopy (1H and 13C) was used extensively to establish the nature of the anomeric linkages of the polysaccharide and of oligosaccharides derived through degradative procedures. The polysaccharide was found to have the heptasaccharide, "5 + 2" repeating unit: (Formula: see text).
Subject(s)
Klebsiella/immunology , Polysaccharides, Bacterial , Carbohydrate Conformation , Carbohydrate Sequence , Indicators and Reagents , Magnetic Resonance Spectroscopy , Methylation , Oligosaccharides/analysis , Oxidation-ReductionABSTRACT
The structure of the capsular polysaccharide (K antigen) of Klebsiella K35 has been established as having the pentasaccharide repeating unit shown ("four plus one" type). The structural investigation utilized the techniques of methylation, beta-elimination, Smith degradation, and partial hydrolysis. N.m.r. spectroscopy (1H and 13C) was used extensively to establish the configurations of the anomeric linkages and to delineate the sequence of the sugars in the structure of the polysaccharide. (Formula: see text).
