Julia Kelly, Sandra K Oza, Richard Feinn, Todd Cassese
Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program
MedEdPORTAL : the journal of teaching and learning resources
insufficient screening management malnutrition leads increase morbidity mortality evaluate characteristics clinical outcomes malnourished patients referred specialized outpatient clinic management malnutrition primary compare latter according malnutrition severity determine factors associated severe malnutrition mortality compare consistency decided medical nutrition therapy european society clinical nutrition metabolism espen guidelines secondary retrospective observational study included malnourished adults referred first time specialized nutrition consultation teaching university hospital 50 months malnutrition diagnosed according global leadership initiative malnutrition criteria including body composition assessment bioimpedance analysis chi2 fisher student wilcoxon ranksum tests multivariable logistic regression assess factors associated severe malnutrition mortality 108 malnourished adults included 74 severe malnutrition main secondary diagnosis digestive cancer 482 followup median 70 days first nutritional consultation 11 patients admitted hospital 19 infections 231 died without difference according malnutrition severity severely malnourished patients lower body mass index smaller fat mass index fmi 46 18 vs 60 25 kgm2 p 001 higher level total body water 647 71 vs 606 54 p 002 compared moderately malnourished individuals low fmi odds ratio 072 054096 factor significantly associated severe malnutrition find factor associated mortality moderate consistency 471 decided medical nutrition therapy espen guidelines nutritional care adults referred first time specialized nutritional consultation present mostly severe malnutrition risk significant complications leading high mortality rate population low fmi associated severe malnutrition earlier diagnosis care malnutrition earlier referral clinical nutrition units would improve outcomes