[Significance and diagnosis of malnutrition in the elderly]

Design of Infertility Monitoring System: Minimum Data Set Approach

Reproductive health is vital for human and infertility is also one of the most important challenges in the reproductive system. Infertility is one of the most common chronic health disorders, regardless of age. The Minimum Data Set (MDS) helps to manage infertility by monitoring and evaluating infertility interventions based on collecting data.

The development of MDS is an essential objective in order to implement an infertility monitoring system for the creation of standardized and effective data management through the provision of comprehensive and identical data elements for infertility.

This is a descriptive cross-sectional study conducted in 2017. The data has been collected from infertility clinics in the world, as well as WHO, CDC, ASRM, and ESHRE reports.

In order to decide on data elements, the Delphi technique was used using a questionnaire that contained data elements which were distributed among 12 experts including one reproductive endocrinology and infertility fellow, six obstetrician-gynecologists, two reproductive biologists, two urologists and one community medicine specialist using the 5 point Likert scale. The questionnaire was divided into two categories: managerial and clinical, each with 4 sections, and 60 and 940 data elements, respectively.

MDS is an essential tool for evaluating the infertility process. Using this tool will provide an opportunity to develop a set of quality care criteria that can be used to ensure the quality of infertility care.

Development of a Minimum Data Set (MDS) for C-Section Anesthesia Information Management System (AIMS)

Background

Caesarean section, also known as C-section, is a very common procedure in the world. Minimum data set (MDS) is defined as a set of data elements holding information regarding a series of target entities to provide a basis for planning, management, and performance evaluation. MDS has found a great use in health care information systems. Also, it can be considered as a basis for medical information management and has shown a great potential for contributing to the provision of high quality care and disease control measures.

Objectives

The principal aim of this research was to determine MDS and required capabilities for Anesthesia information management system (AIMS) in C-section in Iran.

Methods

Data items collected from several selected AIMS were studied to establish an initial set of data. The population of this study composed of 115 anesthesiologists was asked to review the proposed data elements and score them in order of importance by using a five-point Likert scale. The items scored as important or highly important by at least 75% of the experts were included in the final list of minimum data set.

Results

Overall 8 classes of data (consisted of 81 key data elements) were determined as final set. Also, the most important required capabilities were related to airway management and hypertension and hypotension management.

Conclusions

In the development of information system (IS) based on MDS and identification, because of the broad involvement of users, IS capabilities must focus on the users’ needs to form a successful system. Therefore, it is essential to assess MDS watchfully by considering the planned uses of data. Also, IS should have essential capabilities to meet the needs of its users.

Anthropometric parameters of nutritional assessment as predictive factors of the Mini Nutritional Assessment (MNA) of hospitalized elderly patients

OBJECTIVE

The objective of this study was to identify nutritional indicators that predict MNA (mini nutritional assessment) classification in hospitalized elderly patients.

METHOD

This cross-sectional study assessed the nutritional status of 109 elderly patients at the beginning of their hospital stay with anthropometric and laboratory indicators and the MNA. Habitual energy intake (HEI) was also determined. The assessed nutritional indicators were investigated by univariate and multivariate logistic regression analysis to verify if they can predict MNA classification. The odds ratio (OR) and its respective confidence interval (CI) of 95% were also calculated, and the significance level was set at 5% (p < 0.05).

RESULTS

The nutritional status of most patients (61.47%) was appropriate but 30.28% were at risk of malnourishment and 8.26% were malnourished. Statistical differences were found for those aged more than 70 years and for arm circumference, body mass index, calf circumference, triceps skinfold thickness and mid-arm muscle circumference. Initially, the predictive factors identified by univariate logistic regression were body mass index (BMI) (p=0.0001; OR=0.825), calf circumference (CC) (p=0.0026; OR=0.832), arm circumference (AC) (p < 0.0001; OR=0.787), triceps skinfold thickness (TST) (p=0.0014; OR=0.920) and mid-arm muscle circumference (MAMC) (p=0.0003; OR=0.975); later, multiple logistic regression analyses revealed that first AC (p=0.0025; OR=0.731 (0.597 - 0.895)), then BMI (p= < 0.0001; OR=10.909 (3.298 - 36.085)) and finally TST (p=0.0040; OR=0.924 (0.876 - 0.975)) and MAMC (p=0.0010; OR=0.976 (0.962 - 0.990)) were factors that predict MNA classification.

CONCLUSION

In the conditions of this study, first AC, then BMI and finally TST and MAMC together were capable of predicting MNA classification.

Nutritional status and functional capacity of hospitalized elderly

Background

The nutritional status of the aging individual results from a complex interaction between personal and environmental factors. A disease influences and is influenced by the nutritional status and the functional capacity of the individual. We asses the relationship between nutritional status and indicators of functional capacity among recently hospitalized elderly in a general hospital.

Methods

A cross-sectional study was done with 240 elderly (women, n = 127 and men, n = 113) hospitalized in a hospital that provides care for the public and private healthcare systems. The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The functional autonomy indicators were obtained by the self-reported Instrumental Activity of Daily Living (IADL) and Activity of Daily Living (ADL) questionnaire. The chi-square test was used to compare the proportions and the level of significance was 5%.

Results

Among the assessed elderly, 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. All the IADL and ADL variables assessed were significantly more deteriorated among the malnourished individuals. Among the ADL variables, eating partial (42.9%) or complete (12.9%) dependence was found in more than half of the malnourished elderly, in 13.4% of those at risk of malnutrition and in 2.5% of those without malnutrition.

Conclusion

There is an interrelationship between the nutritional status of the elderly and reduced functional capacity.