Energy Expenditure After Liver Resection: Validation of a Mobile Device for Estimating Resting Energy Expenditure and an Investigation of Energy Expenditure Change After Liver Resection.

BACKGROUND: Resting energy expenditure (REE) is the major component of total energy expenditure. REE is traditionally performed by indirect calorimetry (IC) and is not well investigated after liver surgery. A mobile device (SenseWear Armband [SWA]) has been validated when estimating REE in other clinical settings but not liver resection. The aims of this study are to validate SWA vs IC, quantify REE change following liver resection, and determine factors associated with REE change. MATERIALS AND METHODS: Patients listed for open liver resection prospectively underwent IC and SWA REE recordings pre- and postoperatively. In addition, the SWA was worn continuously postoperatively to estimate daily REE for the first 5 postoperative days. To determine acceptability of the SWA, validation analysis was performed. To assess REE change, peak postoperative REE was compared with preoperative levels. Factors associated with REE change were also analyzed. RESULTS: SWA showed satisfactory validity compared with IC when estimating REE, although postoperatively, the 95% levels of agreement (-5.56 to 3.18 kcal/kg/d) may introduce error. Postoperative REE (median, 23.5 kcal/kg/d; interquartile range [IQR], 22.6-25.7 kcal/kg/d) was significantly higher than predicted REE (median, 19.7 kcal/kg/d; IQR, 19.1-21.0 kcal/kg/d; P < .0001). Median REE rise was 11% (IQR, -1% to 25%). Factors associated with REE rise of >11% were age ( P = .017) and length of operation ( P = .03). CONCLUSIONS: SWA offers a suitable alternative to IC when estimating postoperative REE, but the magnitude of the error (8.74 kcal/kg/d) could hinder its accuracy. REE quantification after liver resection is important to identify patients who could be prone to energy imbalance and therefore malnutrition.

The relationship between income and oral health among people with intellectual disabilities: a global perspective.

BACKGROUND: The scientific literature cites wide health disparities for people with intellectual disabilities compared to the general population. This study seeks to gain an understanding of the effects of income status on oral health in a global population of people with intellectual disabilities. METHODS: Eighty-two thousand five hundred and seventy Special Olympics athletes were screened and eligible for inclusion in this study. The main exposure (income status) and selected oral health signs and symptoms (missing teeth, untreated decay, injury, gingivitis, and mouth pain) were used to conduct a cross-sectional analysis. Prevalence odds ratios were obtained through logistic regression. RESULTS: Study participants from low-income countries experienced adverse health outcomes at a lower rate than expected. Study participants from upper middle, lower middle, and low-income countries had higher odds of mouth pain and untreated decay, yet lower odds of missing teeth, injury, and gingivitis, than participants from high-income countries. Overall, a great number of individuals from every income group required maintenance or urgent care. CONCLUSION: Oral health problems are not exclusive to low-income study participants. Unexpectedly high odds of missing teeth, injury, and gingivitis in high-income countries may be attributed to the high proportion of participants from the United States, which is considered a high-income country but has large income disparities. Health-determining circumstances in low-income countries provide some protection from the hypothesized gradient of oral health for all measured outcomes.

Quantitative assessment of diagnostic radiation doses in adult blunt trauma patients.

STUDY OBJECTIVE: Many emergency departments and trauma centers utilize extensive radiologic studies during the assessment of trauma patients. A point of concern arises about the possible biological effects of these cumulative radiation doses. The objective of this study is to determine the amount of ionizing radiation received by adult blunt trauma patients at a Level I trauma center during the first 24 hours of their care. METHODS: This nonconcurrent case series reviewed the first 100 consecutive adult blunt trauma patients who presented to a Level I trauma center in 2006. All patients met hospital standards for the less acute major triage criteria. Individual radiation dose reports calculated by the computed tomography (CT) scanner were used to determine the radiation doses from each CT procedure. Standardized tables were used to determine radiation dose for plain radiographs. The median effective dose of radiation (millisieverts) was calculated for the first 24 hours of hospitalization. RESULTS: A total of 100 eligible patients presented between January 1, 2006, and March 20, 2006. Eighty-six patients had complete radiologic records available. The median age was 32 years, with an intraquartile range of 23 to 46 years; the median Injury Severity Score was 14, with an intraquartile range of 9 to 29; and the median number of CT scans was 3, with an intraquartile range of 3 to 4. The median effective total dose of ionized radiation was 40.2 mSv, with an intraquartile range of 30.5 to 47.2 mSv. A dose of 40.2 mSv is the equivalent of approximately 1,005 chest radiographs. CONCLUSION: Trauma patients meeting the less acute major triage criteria are exposed to clinically important radiation doses from diagnostic radiographic imaging during the first 24 hours of their care.