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Liu J, Shafaat O, Bhadra S, Parnell C, Harris A, Summers RM. Improved subcutaneous edema segmentation on abdominal CT using a generated adipose tissue density prior. Int J Comput Assist Radiol Surg 2024; 19:443-448. [PMID: 38233598 PMCID: PMC10881596 DOI: 10.1007/s11548-023-03051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE Edema, or swelling, is a common symptom of kidney, heart, and liver disease. Volumetric edema measurement is potentially clinically useful. Edema can occur in various tissues. This work focuses on segmentation and volume measurement of one common site, subcutaneous adipose tissue. METHODS The density distributions of edema and subcutaneous adipose tissue are represented as a two-class Gaussian mixture model (GMM). In previous work, edema regions were segmented by selecting voxels with density values within the edema density distribution. This work improves upon the prior work by generating an adipose tissue mask without edema through a conditional generative adversarial network. The density distribution of the generated mask was imported into a Chan-Vese level set framework. Edema and subcutaneous adipose tissue are separated by iteratively updating their respective density distributions. RESULTS Validation results on 25 patients with edema showed that the segmentation accuracy significantly improved. Compared to GMM, the average Dice Similarity Coefficient increased from 56.0 to 61.7% ([Formula: see text]) and the relative volume difference decreased from 36.5 to 30.2% ([Formula: see text]). CONCLUSION The generated adipose tissue density prior improved edema segmentation accuracy. Accurate edema volume measurement may prove clinically useful.
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Affiliation(s)
- Jianfei Liu
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Omid Shafaat
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sayantan Bhadra
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Christopher Parnell
- Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Ayden Harris
- Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
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Schläppi K, Reber E, Schönenberger KA, Stanga Z, Kurmann S. The influence of patients' nutritional risk, nutritional status, and energy density in MEDPass versus conventional administration of oral nutritional supplements - A secondary analysis of a randomized controlled trial. J Nutr Health Aging 2024; 28:100170. [PMID: 38308925 DOI: 10.1016/j.jnha.2024.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES The clinical influence of nutritional risk, nutritional status, and energy density of oral nutritional supplements (ONS) in MEDPass versus conventional administration of ONS is currently unknown. The aim of this analysis was to examine whether these variables have an impact on clinical outcomes. METHODS Secondary analysis of the intention to treat dataset of the randomized controlled MEDPass Trial in geriatric and medical inpatients. Patients in the intervention group received 4 × 50 ml ONS during the medication rounds (MEDPass mode), while those in the control group received ONS in a non-standardized manner. The examined endpoints included energy and protein coverage, ONS intake, handgrip strength (HGS), weight, appetite nausea and 30-day mortality. Three subgroup analyses for NRS 2002 total score (3, 4 or 5-7 points), NRS 2002 impaired nutritional status score (0, 1, 2 or 3 points) and energy density of the ONS (1.5 kcal/mL or 2 kcal/mL) were performed using linear and logistic regression with interaction and mixed effect models. RESULTS The data of 202 patients (103 women and 99 men) at nutritional risk (NRS total 2002 score ≥3), mean (SD) age 82.2 (6.5) years were included. There was no significant difference between the groups in the primary endpoint energy coverage in all three subgroup analyses. There were also no significant differences between the groups in the secondary endpoints of protein coverage, ONS intake, HGS, weight, appetite, nausea, and 30-day mortality. CONCLUSION The MEDPass mode of ONS administration was not superior to the conventional mode of administration in this study. ONS with high energy density (≥2 kcal/mL) should be offered since current evidence shows a tendency towards improved appetite, increased ONS and increased energy intake.
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Affiliation(s)
- Karin Schläppi
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Katja A Schönenberger
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Silvia Kurmann
- Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland.
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Osório AF, Ribeiro ÉCT, Parahiba SM, Forte GC, Clausell NO, Souza GC. Prognostic value of nutritional screening tools in hospitalized patients with decompensated heart failure: A systematic review and meta-analysis. Nutr Res 2023; 120:1-19. [PMID: 37871448 DOI: 10.1016/j.nutres.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
Nutritional risk screening is fundamental to prevent undesirable outcomes in heart failure (HF). Current reviews of nutritional screening tools encompass both hospitalized and outpatient settings, which may not be suitable because of different clinical manifestations. We hypothesize that multidimensional tools would better identify prognosis of decompensated patients because the tools assess more than isolated aspects. This systematic review aims to explore the association of multidimensional nutritional risk screening tools and prognosis in patients hospitalized with decompensated HF. Five databases were searched for studies that assessed nutritional risk through multidimensional screening tools and its association with prognosis in adults hospitalized with decompensated HF. The 95% confidence interval and relative risk were computed using a random-effects model. Inverse variance method was used. Thirty-eight studies were included. Most studies demonstrated higher nutritional risk was significantly associated with worse prognosis. Quantitative analysis identified higher nutritional risk by using the Mini Nutritional Assessment Short Form (MNA-SF), Controlling Nutritional Status, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to be associated with all-cause mortality. The MNA-SF demonstrated greater magnitude of association with all-cause mortality in older subjects (relative risk, 4.85; 95% confidence interval, 2.0-11.75). Higher nutritional risk was associated with poor prognosis and higher mortality in patients hospitalized with decompensated HF, especially when screened by MNA-SF. Tools were not directly compared. That might reinforce the importance of evaluating multiple aspects when screening hospitalized HF patients once symptoms associated with decompensation frequently mask the underlying nutritional status and risk. PROSPERO registration number (CRD42021256271).
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Affiliation(s)
- Amanda Farias Osório
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Édina Caroline Ternus Ribeiro
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Suena Medeiros Parahiba
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Nadine Oliveira Clausell
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Corrêa Souza
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Food, Nutrition and Health, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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Rhodes RL, Keller HE, Lensing S, Padala KP, Padala PR, Brown LM, Roberson PK, Sullivan DH. The influence of social determinants of health on post-discharge mortality of veterans who received care in a transitional care unit. J Am Geriatr Soc 2023; 71:3299-3303. [PMID: 37378529 DOI: 10.1111/jgs.18480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Ramona L Rhodes
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hallie E Keller
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - Shelly Lensing
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kalpana P Padala
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Prasad R Padala
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lana M Brown
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Paula K Roberson
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Biostatistics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Dennis H Sullivan
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Risk of Weight Loss in Adult Patients and the Effect of Staffing Registered Dietitians in Kaifukuki (Convalescent) Rehabilitation Wards: A Retrospective Analysis of a Nationwide Survey. Healthcare (Basel) 2021; 9:healthcare9060753. [PMID: 34207324 PMCID: PMC8235006 DOI: 10.3390/healthcare9060753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/02/2021] [Accepted: 06/15/2021] [Indexed: 01/26/2023] Open
Abstract
There is scarce evidence regarding the risk of weight loss and the effect of having registered dietitians (RDs) on staff in rehabilitation wards on weight loss. We aimed to examine the effects of RDs in Kaifukuki (convalescent) rehabilitation wards (KRWs) on the prevention of weight loss in adult patients. Data from 2-year nationwide annual surveys on KRWs in Japan were retrospectively analysed. Weight loss was defined as loss of ≥5% weight during the KRW stay. Risk of weight loss in class 1 KRWs (obligated to provide nutrition care) was compared with that in class 2–6 KRWs (not obligated). Risk of weight loss in class 2–6 KRWs with RDs was compared to those without. Overall, 17.7% of 39,417 patients lost weight. Class 1 KRWs showed a lower risk of weight loss than class 2–6 KRWs (17.3% vs. 18.5%, p = 0.003). KRWs with RDs showed a significantly lower incidence of weight loss than those without RDs (16.1% vs. 18.8%, p = 0.015). Class 1 KRWs and exclusively staffed RDs were independently associated with lower odds of weight loss (odds ratio = 0.915 and 0.810, respectively). Approximately 18% of KRW patients lost weight, and having RDs on staff can lower the risk of weight loss.
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Sullivan DH, Sullivan SC, Bopp MM, Roberson PK, Lensing SY. BUN as an Independent Predictor of Post-Hospital-Discharge Mortality among Older Veterans. J Nutr Health Aging 2018; 22:759-765. [PMID: 30080216 DOI: 10.1007/s12603-018-1065-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES An elevated blood urea nitrogen (BUN) in known to be an important prognostic indicator in patients with end-stage heart or kidney disease or certain other life-threatening illnesses. However, it is less certain as to whether an elevated BUN is an independent predictor of long-term mortality risk in less seriously ill patients. To address this issue, we examined the relationship between BUN and long-term mortality after adjusting for potential confounders and other indicators of health status/disease severity, in a select population of older medically stable Veterans. DESIGN Long-term prospective cohort study. SETTING Outpatient follow-up of patients discharged from a recuperative care and rehabilitation unit (RCRU) of a Department of Veterans Affairs Community Living Center. PARTICIPANTS 383 older Veterans (mean age = 78.6±7.6 years, 98% male, and 87% white) discharged alive and in stable medical condition. MEASUREMENTS At discharge, each subject completed a comprehensive assessment and was then monitored as an outpatient for up to 9.3 years. Associations between blood urea nitrogen at RCRU discharge and mortality were identified utilizing Cox proportional hazards (PH) regression analyses adjusting for conditions known to confound this relationship. RESULTS Within the follow-up period, 255 subjects (67%) died. In the unadjusted Cox PH model, a BUN ≥ 30 mg/dL was associated with a nearly 2-fold increased risk of mortality (hazard ratio 1.90, 95%CI 1.41 - 2.56). The association between BUN and long-term mortality remained highly significant after adjusting for potential confounders (hazard ratio 1.78, 95%CI 1.29 - 2.44). CONCLUSION Our findings support BUN levels as an independent predictor of long-term mortality in older, medically stable Veterans. An elevated BUN may be reflective of global health status rather than solely an indicator of the severity of acute illness or unstable chronic disease.
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Affiliation(s)
- D H Sullivan
- Dennis H. Sullivan, MD, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 3J/NLR, North Little Rock, AR 72114, Office: 501-257-2503, FAX: 501-257-2501,
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Evaluation of an Innovative Method for Calculating Energy Intake of Hospitalized Patients. Nutrients 2016; 8:nu8090557. [PMID: 27618096 PMCID: PMC5037542 DOI: 10.3390/nu8090557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate a multi-component method for capturing nutrient intake, which used observation, photography, and an innovative computer program. To assess reliability and accuracy, multiple responsible employees (REs) independently conducted nutrient intake assessments on simulated meals; each RE's results relating to energy intake were compared to those from the other REs and to those obtained by pre- and post-meal weighing of the food items. System efficiency was assessed by having REs perform independent assessments on the same set of simulated meals using either the new or traditional hospital method for which the REs had to document each food item served and then find the items in a computer database-steps that were automated in the new method. Interrater reliability for energy intake estimated on clinic wards was excellent (intraclass correlation coefficient = 0.975, 95% CI 0.958 to 0.992) and there was a high level of agreement between the REs' estimates and the true values determined by food weighing; per the method of Bland and Altman the mean difference between the two types of estimates was 0.3 kcal (95% CI, -8.1 to 8.7 kcal) with limits of agreement of -79.5 kcal to 80.1 kcal. Compared to the traditional method, energy intake assessments could be completed using the multi-component method in less than a third of the time. These results indicate the multi-component method is an accurate, reliable, and efficient method of obtaining energy intake assessments for hospitalized patients.
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Sullivan SC, Bopp MM, Weaver DL, Sullivan DH. Innovations in Calculating Precise Nutrient Intake of Hospitalized Patients. Nutrients 2016; 8:E412. [PMID: 27384584 PMCID: PMC4963888 DOI: 10.3390/nu8070412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Obtaining a detailed assessment of a hospitalized patient's nutrient intake is often critically important to ensuring the patient's successful recovery. However, this process is often laborious and prone to error. Inaccurate nutrient intake assessments result in the inability of the healthcare team to recognize patients with developing nutritional deficits that contribute to delayed recovery and prolonged lengths of stay. This paper describes an innovative, easy to use system designed to increase the precision of calorie count reports by using a combination of photography, direct observation, and a specially developed computer program. Although the system was designed specifically for use in a Department of Veterans Affairs Hospital, it has the potential to be adapted for use in other hospital environments.
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Affiliation(s)
- Sheila Cox Sullivan
- VISN 16/CAVHS Geriatric Research Education and Clinical Center (GRECC); 2200 Fort Roots Drive, 3J/GRECC; North Little Rock, AR 72114, USA.
| | - Melinda M Bopp
- VISN 16/CAVHS Geriatric Research Education and Clinical Center (GRECC); 2200 Fort Roots Drive, 3J/GRECC; North Little Rock, AR 72114, USA.
| | - Dennis L Weaver
- INFO Development Systems, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Dennis H Sullivan
- VISN 16/CAVHS Geriatric Research Education and Clinical Center (GRECC); 2200 Fort Roots Drive, 3J/GRECC; North Little Rock, AR 72114, USA.
- Donald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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