Clinical indicators for oncology, cardiovascular, and surgical patients: report of the ADA Council on Practice Quality Assurance Committee.

Clinical indicators were developed as an ADA project for use by the membership and the Joint Commission on Accreditation of Healthcare Organizations as part of its Agenda for Change. This 3-year project involved three clinical indicator task forces who developed clinical indicators for oncology, cardiovascular, and surgical adult acute-care setting patient populations. The task forces developed clinical indicators that were revised after an extensive field review and validation by field test. The following indicators were recommended: Cardiovascular--Patients at high risk for impaired nutritional status receive nutrition intervention within 5 days of admission or within consecutive 5 days on clear liquid diet/nothing by mouth; Patients make food choices consistent with therapeutic diet. Oncology--No patient is on clear-liquid diet/nothing by mouth without nutrition support for more than 5 days; All patients at moderate or high risk are identified by screening and assessed within 72 hours of admission; Patients at moderate or high risk are able to implement nutrition care plan at discharge. Surgery--No patient is on clear-liquid diet/nothing by mouth without nutrition support for more than 7 days; No patient has weight loss greater than 10% of admission weight at discharge; calorie and protein and/or volume goals for patients on enteral or parenteral nutrition are documented in the medical record; Patients on enteral or parenteral nutrition receive at least 1,000 kcal/day by the fourth day after an operation.

The effects of spacing protein intake on nitrogen balance and plasma amino acids in a child with propionic acidemia.

The effect of protein distribution on nitrogen balance and the plasma aminogram was studied in a 34-month-old male child with propionic acidemia. Protein provided 4.8% of energy of which high biological value protein was given either as a bolus or evenly distributed in three meals per day. Analysis of nitrogen balance including estimated sweat nitrogen losses revealed no major difference between the two diets. No marked differences in the fasting plasma concentrations of essential amino acids were noted with protein distribution. A generalized increase in concentration of all nonessential amino acids except taurine and ornithine was noted when protein was evenly distributed throughout the day. The ratio of nonessential to essential amino acids was higher after even protein distribution than when protein was given as a bolus. The data suggests that a low protein diet (206 mg nitrogen/kg/day) with adequate energy intake used in managing this child with propionic acidemia provided adequate amounts of total nitrogen and essential amino acids for normal growth regardless of protein distribution.