Status Of Inpatients Research Articles

The Association of Judgement Ability and Functional Status in Older Adult Rehabilitation Inpatients

Purpose: Older adults have an increased likelihood of requiring rehabilitative care due to cognitive and physical risk factors. Research has found a link between executive functioning performance and functional outcomes; however, there is a dearth of research on the assessment of judgement ability. In the current pilot study, we investigated the clinical utility of the Test of Practical Judgment (TOP-J) in an older adult rehabilitation sample.Methods: Inpatients of mixed diagnoses (n= 25, mean age = 72.60) completed the TOP-J and Functional Independence Measure (FIM). We assessed TOP-J performance in the entire sample and in those with intact vs. impaired global cognition (on the Mini-Mental State Examination; MMSE). Correlational analyses were conducted between the TOP-J, MMSE and relevant FIM items.Results: TOP-J performance fell between the means typically observed in individuals with mild cognitive impairment and mild Alzheimer's disease. Participants with intact global cognition obtained significantly higher TOP-J scores than those with impaired global cognition. Moderate to strong positive correlations emerged between TOP-J, MMSE and FIM items of problem solving, comprehension and memory.Conclusions: Results provide support for the clinical utility and validity of the TOP-J among older adults in the rehabilitation setting. Administering the TOP-J may help identify patients at risk for future injury and facilitate role transitions.

Effect of Complementary Spiritist Therapy on emotional status, muscle tension, and wellbeing of inpatients with HIV/AIDS: A randomized controlled trial - single-blind.

Background Complementary Spiritist Therapy includes prayer, Spiritist "passe", fluid therapy (fluidic water or magnetized water), and spiritual education, among other therapeutic resources. The objective of this study was to evaluate the effects of Complementary Spiritist Therapy with conventional treatment on emotional status, muscle tension and wellbeing of hospitalized patients with HIV/AIDS. Methods Patients were randomly assigned into either the experimental (3 days [10 mins per day/session] of Complementary Spiritist Therapy alongside conventional treatment; n=20) or control (conventional treatment alone; n=21) group. The primary outcome were positive and negative affects evaluated by the Subjective Wellbeing Scale. The secondary outcome were muscle tension, and wellbeing were assessed by visual analogue scales. Results Significant reductions in negative effects (p=0.045), and muscle tension (p=0.022), along with significant increases in wellbeing (p=0.041) were recorded in the experimental group (Complementary Spiritist Therapy). Conclusions Reductions in negative effects and muscle tension, along with increased perceived wellbeing, were observed in hospitalized patients with HIV/AIDS exposed Complementary Spiritist Therapy combined conventional treatment compared to conventional treatment alone.

The association of serum leptin levels with food addiction is moderated by weight status in adolescent psychiatric inpatients.

Leptin is essential for the control of energy homeostasis and eating behaviour. We investigated potential associations between serum leptin levels and food addiction in adolescent psychiatric inpatients (n=228). The most frequent psychiatric diagnoses were mood disorders, anxiety disorders, and substance use disorders. More than three quarters of the study group suffered from more than one psychiatric disorder. Food addiction was assessed with the Yale Food Addiction Scale. Leptin was determined in serum. Analyses were conducted for the whole body weight range and for distinct weight categories to evaluate a potential impact of known nonlinearity between leptin levels and satiety due to leptin resistance in obese. A weak negative association between food addiction and leptin in normal weight patients (ß=-0.11, p=.022) was detected. In contrast, food addiction was associated with a significantly higher serum leptin (ß=0.16. p=.038) in overweight patients. Food addiction in normal weight patients might be associated with restrained eating, previously shown to involve reduced leptin levels. The small positive association of food addiction with higher serum leptin in overweight patients might reflect leptin resistance and overeating.

Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in aradiation oncology department.

The nutritional status of inpatients influences the therapeutic outcome. Malnutrition is acommon comorbidity in oncological patients. Both radio- and radiochemotherapy may contribute to the additional deterioration of the nutritional status. The aim of this study was to evaluate the impact of specialized treatment of malnutrition as aclinical routine. The nutritional status of inpatients was assessed by the Nutritional risk screening (NRS-2002) on the day of admission to the University Department of Radiation Oncology. In case of significantly elevated NRS-2002 (NRS ≥ 3), aguideline-compliant, individual nutritional treatment was initiated by aspecialized nutrition support team. The influence of the nutritional status and nutritional treatment on length of stay and complication rate was assessed. Of 840 included patients, 344patients (40.95%) were at risk for malnutrition. Malnutrition was asignificant, independent risk factor for both prolonged hospital stay, represented by the deviation between the actual length of stay and the DRG-associated mean length of stay (dLOS at risk: 0.88 days, dLOS not at risk: -0.88 days, p = 0.0047), as well as for the occurrence of complications (OR: 1.758 CI: [1.286-2.402], p = 0.0006). In the group of 337 (40.12%) rehospitalized patients the nutritional management was able to assimilate the values of length of stay as well as the complication rates to standard values. The high risk for malnutrition and the negative consequences for patients and hospitals underline the urgent need for malnutrition screening on admission and treatment of malnutrition. Aspecialized, interdisciplinary nutrition support team positively influences patient outcome and should be established routinely in all oncological disciplines.

Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma

Geriatric nutritional risk index (GNRI) is a novel and useful screening tool for evaluating nutritional status in elderly in-patients. We aimed to investigate whether the preoperative GNRI could be a predictive factor for outcomes in patients over 65 years of age with a diagnosis of hepatocellular carcinoma (HCC). We retrospectively enrolled 261 consecutive HCC patients after hepatectomy and classified them into four risk groups based on the GNRI values: high risk (GNRI, <82), moderate risk (GNRI, 82–92), low risk (GNRI, 92–98), and normal (GNRI, >98). We found that the lower GNRI value was significantly associated with severe postoperative complications (P < 0.001) and liver failure (P < 0.001). By multivariate logistic regression analysis, high risk- and moderate risk GNRI groups were identified as independent risk factors for postoperative serve complications and liver failure. Multivariate Cox regression analysis revealed preoperative GNRI (P < 0.001) adversely affected overall survival. In conclusion, preoperative GNRI could predict severe postoperative complications included liver failure, and the lower GNRI value was associated with worse overall survival after hepatectomy in elderly HCC patients.

Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department

The nutritional status of inpatients influences the therapeutic outcome. Malnutrition is a common comorbidity in oncological patients. Both radio- and radiochemotherapy may contribute to the additional deterioration of the nutritional status. The aim of this study was to evaluate the impact of specialized treatment of malnutrition as a clinical routine. The nutritional status of inpatients was assessed by the Nutritional risk screening (NRS-2002) on the day of admission to the University Department of Radiation Oncology. In case of significantly elevated NRS-2002 (NRS ≥ 3), a guideline-compliant, individual nutritional treatment was initiated by a specialized nutrition support team. The influence of the nutritional status and nutritional treatment on length of stay and complication rate was assessed. Of 840 included patients, 344 patients (40.95%) were at risk for malnutrition. Malnutrition was a significant, independent risk factor for both prolonged hospital stay, represented by the deviation between the actual length of stay and the DRG-associated mean length of stay (dLOS at risk: 0.88 days, dLOS not at risk: −0.88 days, p = 0.0047), as well as for the occurrence of complications (OR: 1.758 CI: [1.286–2.402], p = 0.0006). In the group of 337 (40.12%) rehospitalized patients the nutritional management was able to assimilate the values of length of stay as well as the complication rates to standard values. The high risk for malnutrition and the negative consequences for patients and hospitals underline the urgent need for malnutrition screening on admission and treatment of malnutrition. A specialized, interdisciplinary nutrition support team positively influences patient outcome and should be established routinely in all oncological disciplines.

Investigation on the frailty status of the elderly inpatients in Shanghai using the FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire.

This study was to investigate the frailty status of inpatients older than 65 years old in Shanghai.A 6-month cross-sectional survey was conducted using FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Totally 587 patients were included. The data, including demographic characteristics, constipation, urinary retention, urinary incontinence, grip strength, and muscle strength, were collected. The data of serum prealbumin, serum albumin, serum total protein, and hemoglobin were obtained from laboratory blood tests.The incidence of nonfrailty, prefrailty, and frailty was 0.249, 0.417, and 0.334, respectively. The high incidence age of frailty was 86 to 90 years old (0.342), and the high incidence age of prefrailty was 65 to 70 years old (0.282). There was significant difference in the grip strength among different degrees of frailty (P < .01). The influencing factors related to prefrailty included prealbumin, grip strength, urinary retention, constipation and education level of illiterate (P < .05). The populations with high prealbumin level, high grip strength and illiteracy population were not easy to enter the prefrailty period, while those with constipation (OR (odds ratio) = 1.867, 95% CI (confidence interval): 1.046–3.330) and urinary retention (OR = 7.007, 95% CI: 1.137–2.757) were more likely to enter the prefrailty period. Factors associated with frailty included age, prealbumin, grip strength, muscle strength, urinary incontinence, urinary retention, and constipation (P < .05). The populations with high prealbumin level, high grip strength, and high muscle strength were not easy to enter frailty period, while those with older age (OR = 1.141, 95% CI: 1.085–1.200), urinary incontinence (OR = 10.314, 95% CI: 1.950–54.548), urinary retention (OR = 3.058, 95% CI: 1.571–5.952), and constipation (OR = 3.004, 95% CI: 1.540–5.857) were easy to enter frailty period.The high incidence ages of frailty and prefrailty are 86 to 90 years old and 65 to 70 years old, respectively. Age, low education level, low grip strength, low muscle strength, low serum prealbumin, urinary retention, urinary incontinence, and constipation are the risk factors of frailty. It is recommended to include frailty as an indicator in the existing assessment to rate the disease and develop a disease observation plan.

Functional status of patients with metastatic spinal cord compression

This prospective study was conducted to evaluate the functional status and clinical features of inpatients with metastatic spinal cord compression and to explore possible associated factors and the correlation with neurological deficits. Cases were identified through an active search in the hospital units of the National Cancer Institute. For 47 patients, clinical and demographic characteristics were collected; functional status was measured by the Functional Independence Measure; modified Tokuhashi score was used to predict survival time; neurological deficits were measured using the American Spinal Injury Association Impairment Scale; and general condition was evaluated using the Karnofsky Performance Status Scale. The correlation between the level of neurological deficits and functional status was calculated using the Spearman correlation test. The difference in the functional independence score according to neurological status was assessed with the Kruskall-Wallis test. The degree of functional status was associated with Karnofsky Performance Status, level of neurological deficits, ability to walk, survival time, and skin color (p<0.05). There was difference in the functional status (p= 0.004) and in the motor domain (p= 0.001) according to the level of neurological deficits. The correlation of the Functional Independence Measure with level of neurological deficits and with Karnofsky Performance Status was moderate (r= 0.46, p< 0.02). The Functional Independence Measure was adequate for evaluating the functional status of patients with metastatic spinal cord compression. Palliative rehabilitation should be integrated early and strategies should be linked to the prognosis of survival.

NUTRITIONAL STATUS OF INPATIENTS IN HUE UNIVERSITY HOSPITAL

Background: Nutritional status is a set of functional, structural and biochemical characteristics that reflect the level of nutritional needs of the body. Both undernutrition and overnutrition affect human health in general and the health of patients in particular. Malnutrition prolongs hospital stay, reduces resistance and increases the risk of complications. Therefore, screening and evaluating the nutrition status of patients is important in the treatment process. Objectives: 1. To screen and assess the nutritional status of inpatients at the Hue University Hospital; 2. To find out some factors related to the patient’s nutritional status. Methodology: A cross-sectional study was carried out on 700 inpatients at departments of internal medicine and surgery, Hue University Hospital. NRS2002 tool was used for screening nutritional risk, Body Mass Index (BMI) was used for assessing nutritional status and questionnaires was used to understand some of the risk factors. Results: Prevalence of inpatients had nutritional risk was 37.4%, in which 38.1% at internal medicine department and 36.8% at surgery departments. Assessment of nutritional status by using BMI showed that 28.1% of inpatients was undernutrition (24.2% at internal medicine departments, and 32.4% at surgery departments); Some risk factors for undernutrition of inpatients were old age (≥ 60 group was higher than &lt;60 (p &lt;0.001), smoking (smokers were at higher risk than patients used to smoke and nonsmokers (p&lt;0.001); living place (patients who live in rural areas had a 1.6 times higher risk of undernutrition than those living in urban areas (p&lt;0.001). Conclusions: Prevalence of inpatients with nutritional risk in internal medicine and surgery was quite high. All inpatients should be screened for nutritional status for better treatment.

Factors Contributing to Hydration, Fluid Intake and Health Status of Inpatients With and Without Dysphagia PostStroke.

Dysphagia has been strongly associated with poor hydration in acute stroke settings. However, in sub-acute settings, the contribution to dehydration of dysphagia in combination with other common stroke comorbidities has not been explored. The aim of this study was to investigate which demographic and stroke comorbidities, including dysphagia, contribute most significantly to oral fluid intake, hydration status and specific adverse health outcomes for patients in sub-acute rehabilitation following stroke. Data from 100 inpatients from three Australian rehabilitation facilities (14 with confirmed dysphagia and 86 without dysphagia) were analysed. Hierarchical multiple regressions were conducted to determine which demographic or stroke comorbidities were most predictive of each outcome: average daily fluid intake; Blood urea nitrogen/creatinine (BUN/Cr) ratio as an index of hydration and medically diagnosed adverse events of pneumonia, dehydration, urinary tract infection or constipation. Average daily beverage intake (M=1448ml, SD 369ml) was significantly and independently predicted by Functional Independence Measure (FIM) at admission (F change=9.212, p=0.004). BUN/Cr ratio (M=20, SD 5.16) was predicted only by age (F change=4.026, p=0.049). Adverse health events, diagnosed for 20% of participants, were significantly predicted by Admission FIM (OR 1.040, 95% CI 1.001, 1.081, p=0.047). Dysphagia was not a significant predictor of any of the outcomes measured. Rather, overall functional dependency was the most significant predictor of poor oral fluid intake and fluid-related adverse health outcomes in sub-acute stroke. Clinical Trial number: Data for the post hoc analysis presented in this article came from the registered trial ACTRN12610000752066.

A multi-center survey on dietary knowledge and behavior among inpatients in oncology department.

To investigate the current associated factors of dietary knowledge and behavior, the intake and nutritional status in malignancy Chinese inpatients, and the malnutrition causes involved in dietary nutrition knowledge level and behavior, providing recommendations to patients for nutrition education and intervention. Five hundred and thirty-five participants from 18 hospitals were investigated by a questionnaire related to dietary knowledge and behavior. Physicians asked and recorded the level of dietary intake and appetite scoring of the participants. The nutritional risk screening with the Nutritional Risk Screening 2002 (NRS-2002) and the dietary survey by 24h dietary recalls were completed by a dietitian. Besides, the target energy intake and the target protein intake were calculated by the "rule of thumb" recommended by ESPEN guideline, comparing the difference between the actual intake and target intake. According to the questionnaire, 95.2% of participants thought it was important to have a good dietetic habit, and nearly half of them have searched for guides on how to diet; 70% of the patients had no clear idea of what was a scientific diet; 82% of patients had contradictory dietary knowledge; 64.2% of patients would listen to the opinion of the attending physician when a contradiction happened. The main three ways of learning about healthy diet were attending physician, network, and TV, respectively, with the values 26.0, 18.5, and 16.1%. Importantly, 99.6% of patients have made mistakes about dietary knowledge, for example, crab, chicken, lamb, fish, and prawns should not be eaten in their concept. In addition, more than 90% of participants have taken Ganoderma lucidum spore powder, sea cucumber, ginseng, Cordyceps sinensis, and so on. Ninety-three percent of the patients never reached a qualified nutrition education. Besides, 15.6% of the participants had nutritional risk (NRS-2002 ≥ 3). The actual daily energy intake was 1169.20 ± 465.97kcal, which was significantly less than target energy intake (P < 0.01), amounting to 65.3% of the target requirements. The actual daily protein intake was 46.55 ± 21.40g, which was significantly less than target protein intake (P < 0.01), amounting to 74.44%. On the other hand, 69% of the participants were "Not too bad, Ok, Good, or Very good" according to the records of physicians, while 34% of them did not reach 60%of the target requirements through dietary survey. The survey indicated that cancer patients had poor understanding of the scientific dietary nutrition and were in low level of normative nutritional education among Chinese malignancy inpatients. Dietary intake of most cancer patients decreased, and the actual intake cannot be revealed by NRS-2002 score or the physicians' inquiry. It is necessary to enhance the cooperation between dietitians and physicians and develop nutrition education to improve the level of dietary knowledge.

Assessment of psychological status of inpatients with head and neck cancer before surgery

Objective: To investigate the prevalence and psychosocial characteristics in inpatients with head and neck cancer before surgery. Method: From September 2015 to December 2016, 237 consecutive inpatients with head and neck cancer who had been scheduled for surgery were prospectively enrolled in Department of Head and Neck Surgery of Shanxi Provincial Tumor Hospital. Mental health symptoms were systematically investigated using three psychological instruments: symptom checklist-90 (SCL-90), Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS). SPSS 17.0 software was used to analyze the data. And he results of SCL-90, SAS and SDS were compared with the Chinese norm. For all statistical analyses, a P value <0.05 was considered statistically significant. Result: Of 237 patients, 228 (96.2%) completed all the questionnaire. The scores of SCL-90 (1.60±0.44), SAS (46.67±8.51)and SDS(47.50±11.43)in patients with head and neck cancer were significantly higher than those of Chinese norm (t=3.093, t=17.29, t=4.29 respectively and P=0.003, P=0.001, P=0.001 respectively). Positive proportion identified by three measure tools are 32.9%, 35.5% and 36.8% respectively. And 42 patients (18.4%) suffered from both anxiety and depression. The SCL-90 scores were significantly higher than those of the normal standard population, including dimension of somatization obsessive-compulsive, anxiety, hostility, phobic-anxiety and psychoticism (t=4.47, 3.04, 2.87, 2.58, 5.46, 4.15 respectively, all P<0.05). Conclusions: This study offers important information regarding psychological status in inpatients with head and neck cancer before surgery. Identifying these patients using proper screening instrument is of great important clinical implications for the early detection, management, and reduction of the distress associated with head and neck cancer.

Oral Health Status and Treatment Needs of Inpatients at a Medical College Hospital in Haryana

ABSTRACT Aim To assess the oral health status and felt needs of patients admitted to medical/surgical wards. Materials and methods The cross-sectional study included 346 patients who were recruited from medical/surgical wards. Dental parameters were recorded using the World Health Organization (WHO) Oral Health Assessment Form for Adults, 2013. Results Mean age of patients was 40.77 [standard deviation (SD) ± 14.4] years; 36.4% aged &gt; 45 years and 32.9% educated beyond 10 years of education. 77.2% used toothbrush and 75.7% toothpaste for cleaning of teeth. 91% brushed their teeth at least once a day and 77.7% performed tongue cleaning. Greater number of decayed teeth (3.43 ± 3.38) were seen in those educated ≤ 10 years when compared with those educated beyond this level (2.43 ± 2.55). Participants with low education attainment and higher age group (&gt;45 years) had significantly more teeth missing due to caries/other reasons, and with deeper periodontal disease. Conversely, higher educated and younger aged group (&lt;45 years) participants had significantly greater mean number of sound teeth and teeth without gingival and periodontal abnormalities. There was no significant difference between smokers and nonsmokers, those who ever visited a dentist or not, practicing or not practicing oral hygiene, using tobacco or not, those with diabetes mellitus and/or hypertension or without these conditions. Nearly 80% of the patients felt no requirement for dental treatment. Conclusion Despite adherence to oral hygiene practices, the oral health status of patients admitted to medical/surgical wards was poor. How to cite this article Avasthi A, Sogi GM, Veeresha KL. Oral Health Status and Treatment Needs of Inpatients at a Medical College Hospital in Haryana. J Postgrad Med Edu Res 2018;52(1):5-11.

Evaluation of frailty and influencing factors in old people in hospital institution: Evidence for a phenotype of frailty.

We assessed the frailty status of inpatients and analyzed the factors influencing frailty status to explore the reasons for frailty and identify feasible intervention strategies.A total of 1494 geriatric patients aged ≥60 years were recruited as subjects. All patients were hospitalized between September 2014 and August 2015 in the internal medicine units of 3 hospitals in Chongqing and Zunyi in the southwestern area of China. Patients’ frailty status was evaluated using the Phenotype of Frailty scale, via face-to-face interviews coupled with physical examinations using simple equipment.Of the 1494 cases, 1400 (93.71%) were eligible for analysis. Participants’ mean age was 75.52 ± 9.28 years. The overall prevalence of frailty was 18.0%, and was higher for frail females (9.4%) than males (8.6%). Increasing age and body mass index, low income (<1000 Ren Min Bi for per month), poor self-rated health, cognitive impairment, depression, polypharmacy (≥5 medications), disability, and a history of fall in the past 1 year were independently significantly correlated with frailty (P < .05 for each comparison).Numerous factors were associated with frailty. As treatment for frailty is focused on prevention in this study, intervention strategies should target a comprehensive list of physiological and psychological aspects of the older people.

Handgrip Strength as a Predictor of Nutritional Status in Chinese Elderly Inpatients at Hospital Admission

ObjectiveTo assess nutritional status and define gender- and age-specific handgrip strength (HGS) cut-point values for malnutrition or nutritional risk in elderly inpatients. MethodsA cross-sectional study of 1,343 elderly inpatients was conducted in the Chinese PLA General Hospital. Nutrition Risk Screening (NRS 2002) and Subjective Global Assessment (SGA) were administered. Anthropometric measurements and blood biochemical indicators were obtained using standard techniques. The gender- and age-specific receiver operating characteristic (ROC) curves were constructed to evaluate the HGS for nutritional status by SGA and NRS 2002. Sensitivity, specificity, and areas under the curves (AUCs) were calculated. ResultsAccording to NRS 2002 and SGA, 63.81% of elderly inpatients were at nutritional risk and 28.22% were malnourished. Patients with higher HGS had an independently decreased risk of malnutrition and nutritional risk. The AUCs varied between 0.670 and 0.761. According to NRS 2002, the optimal HGS cut-points were 27.5 kg (65-74 years) and 21.0 kg (75-90 years) for men and 17.0 kg (65-74 years) and 14.6 kg (75-90 years) for women. According to SGA, the optimal HGS cut-points were 24.9 kg (65-74 years) and 20.8 kg (75-90 years) for men and 15.2 kg (65-74 years) and 13.5 kg (75-90 years) for women. ConclusionElderly inpatients had increased incidence of malnutrition or nutritional risk. HGS cut-points can be used for assessing nutritional status in elderly inpatients at hospital admission in China.

Impact of pharmacist intervention on influenza vaccine assessment and documentation in hospitalized psychiatric patients.

Results of an initiative to improve assessment and documentation of the influenza vaccination status of adult psychiatric inpatients are reported. A prospective quality-improvement study was conducted at a large, tertiary care academic medical center with the aim of improving compliance with the Influenza Immunization (IMM-2) quality measure, which was added to the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program in 2015 and requires assessment and documentation of influenza vaccination status in specified groups of psychiatric inpatients. The primary objective was to improve the IMM-2 IPFQR compliance rate to 100% during the 2015-16 influenza season from a rate of 55% during the 2014-15 influenza season through pharmacist interventions; secondary objectives included analysis of types of pharmacist interventions, rates of influenza vaccination status assessment and ordering, and rates of vaccine refusal by psychiatric disease state. With pharmacist interventions, the IMM-2 IPFQR compliance rate was increased to 99% during the 2015-16 influenza season. Of the 1,413 patients included in the study population, 45% (n = 646) were targeted for pharmacist intervention. Influenza vaccine was ordered for 61% of the study population (n = 867 patients), with an overall refusal rate of 74% (n = 642). Differences in refusal rates by psychiatric diagnosis were not significant. Pharmacist-conducted education of nurses and interventions to ensure completion of influenza vaccine assessments and documentation led to an improved IMM-2 IPFQR compliance rate at the study site.

Plasma Insulin Level Correlation to Metabolic Parameter Shifts in Hospitalized Psychiatric Patients.

To identify potential correlations between baseline plasma insulin level and shifts in metabolic status in psychiatric inpatients. A population of 75 patients was identified for this single-center, retrospective study conducted at a state psychiatric hospital in Kansas City, Missouri. Patients were selected on the basis of presence of a baseline fasting plasma insulin level drawn at admission; duration of stay ≥ 12 weeks between August 1, 2013, and December 31, 2015; and presence of metabolic laboratory and weight measurements at baseline and 3 months. Total initial plasma insulin level (≥ 19 µIU/mL or < 19 µIU/mL) was compared to shifts in metabolic laboratory measurements and weight. A secondary analysis was performed to detect association between the numerical values of assessed parameters and the numerical values for plasma insulin measurements. The primary analysis found no correlation between plasma insulin level and changes in any metabolic parameter category at 3 (n = 75) or 6 months (n = 30) after admission. Secondary analysis found significant correlations between the numerical values of baseline total plasma insulin level and fasting plasma glucose level at baseline (r = 0.492, P < .001), 3 months (r = 0.247, P = .035), and 6 months (r = 0.723, P < .001). Secondary analysis demonstrated a significant correlation between baseline total plasma insulin level and hemoglobin A1c values at baseline (r = 0.329, P = .004), 3 months (r = 0.455, P < .001), and 6 months (r = 0.517, P = .003). Baseline total plasma insulin levels were strongly correlated with parameters affected directly by alterations in glucose up to 6 months after admission but were weakly correlated or not correlated with other metabolic parameters. The results do not support routine use of plasma insulin as a predictor for shifts in metabolic parameters in patients receiving antipsychotic medications.

The Status, Change and Health Issues of Inpatients' Sixth Vital Sign in a Medical Center

Hospitalized patients generally have elevated levels of emotional distress. Gaining a better under-standing of the problem of emotional distress among hospitalized patients is conducive to providing appropriate emotional care and promoting their recovery. To analyze the scores for the "sixth vital sign" (i.e., emotional distress), diversification, and the health-related problems of hospitalized patients at a medical center in Taiwan. The results may offer an important reference for providing effective emotional care to hospitalized patients. A retrospective descriptive research design was used. Data were collected from all of the 27,885 inpatients that were registered at the target hospital in 2013. Further, a total of 245,814 attendance records were assessed to extract the data that were relevant to emotional distress. The findings revealed that 58.3% of hospitalized patients had earned a sixth vital sign score ≥ 1 and that 0.8% of these patients had earned a score ≥ 4. On the whole, the sixth vital sign scores of hospitalized patients were found to decrease progressively with the number of hospitalization days except for hematology and oncology, neurosurgery, and plastic surgery patients. The highest emotional distress scores were found among family medicine, dermatology, and plastic surgery patients. Moreover, emotional distress scores were significantly higher in patients who had health problems that involved pain, anxiety, or sleep disorder. The present study suggests that improving the emotional care of hematology, oncology, neurosurgery, family medicine, dermatology, and plastic surgery patients and of patients with health problems involving pain, anxiety, or sleep disorder may significantly improve the quality of inpatient holistic healthcare. Only 0.8% of the subjects in the present study had an emotional distress score ≥ 4, which is significantly lower than the level reported in other similar studies. Our findings suggest that related education and training for nursing staffs may improve their assessment and care practices in caring for patients with emotional distress. Furthermore, using more appropriate words, methods, and environments to evaluate the emotional distress of patients holds the potential to improve assessment and care for these patients.

P376 Assessment of nutritional status and food related experience of adult inflammatory bowel disease inpatients

P376 Assessment of nutritional status and food related experience of adult inflammatory bowel disease inpatients

Effects of InterRAI comprehensive evaluation and intervention on nutritional status of aged inpatients

Objective To expore the effects of international resident assessment instruments (InterRAI) comprehensive evaluation and intervention on nutritional status of aged inpatients. Methods Totally 235 aged inpatients of a tertiary hospital from February to December 2015 were selected, and 126 cases of them had nutritional risk after the test of NRS 2002. Patients with nutritional risk were randomly divided into the intervention group and the control group, with 63 cases in each group. Patients in two groups were all given dietary estimation, nutritional education, and enteral or parenteral nutrition; besides, patients in the intervention group also received InterRAI comprehensive evaluation and intervention. At the first day and three months after intervention, Inbody 720 body composition analyzer was used to test the protein, body fat, skeletal muscle and BMI, and the second nutritional evaluation was conducted through blood nutrition indicators (plasma total protein concentration, serum albumin, prealbumin and transferrin) . SPSS 17.0 software was used to analyze the data, and measurement data adopted two independent samples to design the t test. Results At the first day after admission, there were no differences in body composition index and blood nutrition indicators between two groups (P>0.05) . Reexamination after three months showed that, the protein (8.5±0.7) kg, body fat (16.5±4.8) kg, skeletal muscle (24.2±4.0) kg and BMI (17.2±5.6) kg/m2 in the intervention group, were all higher than the protein (6.6±0.9) kg, body fat (20.2±5.6) kg, skeletal muscle (18.5±3.1) kg and BMI (16.5±6.1) kg/m2 in the control group (t=9.595, 8.055, 11.331, 2.015; P<0.05) . and blood nutrition indicators in the intervention group, were better than that in the control group (P<0.05) . The plasma total protein concentration (67.1±6.9) g/L, serum albumin (44.3±7.4) g/L, prealbumin (245.1±15.4) mg/L and transferrin (2 530.3±190.5) mg/L in the intervention group, were all higher than the plasma total protein concentration (55.6±7.2) g/L, serum albumin (32.5±6.3) g/L, prealbumin (210.1±16.8) mg/L and transferrin (2 001.1±169.8) mg/L in the control group (t=12.805, 7.890, 9.421, 14.427; P<0.05) . Conclusions The InterRAI comprehensive evaluation and intervention can effectively improve the nutritional status and the quality of life in the elderly, and reduce the nutritional risk. Key words: Aged; Nutritional status; InterRAI comprehensive evaluation