A participatory assessment of dietary patterns and food behavior in Pohnpei, Federated States of Micronesia.

Non-communicable diseases are escalating rapidly within the Pacific region, including Pohnpei, Federated States of Micronesia. A shift in dietary patterns from indigenous, high fiber, healthy local food to energy-dense, imported food with low nutritional value, and increased sedentary lifestyles are expediting this process. Essential to counteract this trend is an understanding of how people make food decisions. This participatory assessment utilized a quantitative and qualitative approach to capture diet patterns and knowledge, attitudes, beliefs and practices of food consumption. A structured 7-day food frequency questionnaire (FFQ) was used to quantify the diets of 293 adult Pohnpeian women attending an island-wide education/disability screening program. An ethnographic approach, including in-depth interviews, informal focus groups and observations documented food behavior practices and contributed to the design of the FFQ. Of those responding to the FFQ, 96% reported eating rice frequently (3-7 days/week) whereas 75% reported eating locally grown carbohydrate foods frequently. Factors associated with culture change, including availability, affordability, convenience, and status of food items were found to determine food decisions. Food-based, culturally sensitive and innovative strategies that utilize existing resources are required to promote local food production and consumption. Prevention programs with an information, education and communication (IEC) approach are needed to provide accurate and available health and nutrition knowledge and to increase the demand for local foods. Behavior modification requires the continued collaboration of the national, state, and community organizations that partnered on this research to strategize programs in order to target individual food choices and to transform the environment to support these decisions.

The financial impact of heparin-induced thrombocytopenia.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that increases patient morbidity and mortality. The financial impact of HIT to an institution is thought to be significant. The objective of this study was to evaluate the financial impact of HIT. METHODS: A case-control study was employed. Case patients were identified as newly diagnosed HIT patients. Control subjects were matched by diagnosis-related group, primary diagnosis code, primary procedure code, and hospital admission date. The financial/decision support database of the hospital was queried to identify the matched control subjects, total cost, and reimbursement. The determination of financial impact included the total profit or (total loss) and the backfill effect (ie, the lost operating margin resulting from increased length of stay). Length of stay and mortality were compared. RESULTS: Data from 22 case patients and 255 control subjects were analyzed. On average, HIT case patients incurred a financial loss of $14,387 per patient and an increase in length of stay of 14.5 days. When confining the analysis to only Medicare case patients (n = 17) and Medicare control subjects, case patients incurred a financial loss of $20,170 per case and an increase in length of stay of 15.8 days. Depending on the occupancy rate of the institution, additional financial loss could result from the backfill effect. Mortality was not significantly affected. CONCLUSION: For an institution that sees 50 new cases of HIT per year, the projected annual financial impact ranges from approximately $700,000 to $1 million. Institutions with high bed occupancy rates may see an additional loss from the backfill effect.

An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial.

STUDY OBJECTIVE: To determine whether transient ischemic attack patients treated with an accelerated diagnostic protocol in an emergency department (ED) observation unit will experience shorter lengths of stay, lower costs, and comparable clinical outcomes relative to patients with traditional inpatient admission. METHODS: A prospective randomized study of ED transient ischemic attack patients with a normal head computed tomography scan, ECG, and laboratory test results and no known embolic source. Patients were randomized to an inpatient bed or to accelerated diagnostic protocol care. Both groups had orders for serial clinical examinations, a neurology consultation, carotid Doppler tests, echocardiography, and cardiac monitoring. Accelerated diagnostic protocol patients with positive testing results were admitted. Study outcomes were length of stay, 90-day total direct cost, recidivism, and clinical outcome. RESULTS: One hundred forty-nine transient ischemic attack patients were randomized to the accelerated diagnostic protocol (75) or admission (74), with both groups similar in age, percentage of male patients, and stroke risk factors. Accelerated diagnostic protocol patient median length of stay was lower (25.6 hours [interquartile range 21.9 to 28.7 hours] versus 61.2 hours [interquartile range 41.6 to 92.2 hours]), and their 90-day costs were less ($890 [interquartile range $768 to 1,510] versus $1,547 [interquartile range $1,091 to 2,473]). Fifteen percent of accelerated diagnostic protocol patients were admitted, with all positive clinical outcomes occurring while patients were in the observation unit. More accelerated diagnostic protocol patients received carotid imaging (97% versus 91%) and in less time (median 13.0 hours versus 25.2 hours), and more received echocardiography (97% versus 73%) in less time (median 19.1 versus 43.0 hours). Both groups had comparable rates of related return visits (12% each), subsequent strokes (3 versus 2), and major clinical event (4 each). CONCLUSION: A diagnostic protocol for transient ischemic attack using an accelerated diagnostic protocol is more efficient and less costly than traditional inpatient admission and demonstrated clinical outcomes comparable to those of traditional inpatient admission.