RESUMO
INTRODUCTION: Malnutrition is associated with an increased risk of mortality and morbidity, longer hospital stays and general loss of quality of life. The aim of this study is to assess the impact of dietary counseling for malnourished hospital patients. PATIENTS AND METHODS: Prospective, randomized, open-label study of 106 hospital patients with malnutrition (54 in the control group and 52 in the intervention group). The intervention group received dietary counseling, and the control group underwent standard treatment. We determined the patients' nutritional state (body mass index, laboratory parameters, malnutrition universal screening tool), degree of dependence (Barthel index), quality of life (SF-12), degree of satisfaction (CSQ-8), the number and length of readmissions and mortality. RESULTS: The patients who underwent the "intervention" increased their weight at 6 months, while the controls lost weight (difference in body mass index, 2.14kg/m(2); p<.001). The intervention group had better results when compared with the control group in the Malnutrition Universal Screening Tool scores (difference, -1.29; p<.001), Barthel index (difference, 7.49; p=.025), SF-12 (difference, 13.72; p<.001) and CSQ-8 (difference, 4.34, p<.001) and required fewer readmissions (difference, -0.37; p=.04) and shorter stays for readmissions (difference, -6.75; p=.035). Mortality and laboratory parameters were similar for the 2 groups. CONCLUSIONS: Nutritional counseling improved the patients' nutritional state, quality of life and degree of dependence and decreased the number of hospital readmissions.
RESUMO
Patients with inflammatory arthritis and eligible for immunosuppressive therapy account for more than 1% of general population, and represents a significant workload on family doctors. They are prone to other comorbidities, with an increased cardiovascular risk and a higher incidence of infections than the general population, especially skin infections and pneumonitis. This comorbidity can be considered vulnerable to a prevention program-prevention of cardiovascular risk, cancer screening, vaccination schedule for adults. As for prevention through vaccination, importance should be given to pneumococcal infection - significant in adults aged 50 or over, especially amongst immunosuppressed patients. The 13-valent conjugate vaccine, which has been recently approved for adults, must be considered. An attempt has been made to write a simple, applicable document on preventive measures that should be implemented both at primary and secondary care level for those adults.
Assuntos
Vacinas Pneumocócicas , Streptococcus pneumoniae , Artrite , Doenças Cardiovasculares , Humanos , Infecções Pneumocócicas/prevenção & controle , Fatores de Risco , VacinaçãoRESUMO
BACKGROUND: Today, there is a discussion on the importance of the utilization of the nursing diagnosis: This makes convenient to evaluate the principal two existing methodological alternatives, that they are: 1) the problems identification, 2) the diagnoses statement of the NANDA within process nursing. The study is centered on the risk diagnoses. OBJECT: 1) To know which the two work methodologies is more effective. 2) To know if exist economic differences. METHODS: It is accomplished a cohorts study, in a population of user included in Program of Handicapped. These were studied during a year. RESULTS: In the group of patients without diagnoses the incidence rate was of 0.64 conversions/person-year), in the group with diagnoses was of 0.22 (p < 0.001). The mean of visits after that the is made real, in the group with diagnoses was of 0.35, in the group without diagnoses of 1.69 (p = 0.012). DISCUSSION: The analysis cost-efficiency of the two work methodologies is clearly more favorable for the methodology than states nursing diagnosis of the taxonomy of the NANDA.
