Energy expenditure of calorically restricted rats is higher than predicted from their altered body composition

Debate exists over the impact of caloric restriction (CR) on the level of energy expenditure. At the whole animal level, CR decreases metabolic rates but in parallel body mass also declines. The question arises whether the reduction in metabolism is greater, smaller or not different from the expectation based on body mass change alone. Answers to this question depend on how metabolic rate is normalized and it has recently been suggested that this issue can only be resolved through detailed morphological investigation. Added to this issue is the problem of how appropriate the resting energy expenditure is to characterize metabolic events relating to aging phenomena. We measured the daily energy demands of young and old rats under ad libitum (AD) food intake or 40% CR, using the doubly labeled water (DLW) method and made detailed morphological examination of individuals, including 21 different body components. Whole body energy demands of CR rats were lower than AD rats, but the extent of this difference was much less than expected from the degree of caloric restriction, consistent with other studies using the DLW method on CR animals. Using multiple regression and multivariate data reduction methods we built two empirical predictive models of the association between daily energy demands and body composition using the ad lib animals. We then predicted the expected energy expenditures of the CR animals based on their altered morphology and compared these predictions to the observed daily energy demands. Independent of how we constructed the prediction, young and old rats under CR expended 30 and 50% more energy, respectively, than the prediction from their altered body composition. This effect is consistent with recent intra-specific observations of positive associations between energy metabolism and lifespan and theoretical ideas about mechanisms underpinning the relationship between oxygen consumption and reactive oxygen species production in mitochondria.     

Education of garment workers: prevention of work related musculoskeletal disorders.

This educational intervention was designed as part of a garment worker occupational health and safety initiative, with the goal to reduce musculoskeletal symptoms in this monolingual Cantonese speaking population. Using risk communication and the Chinese concepts of yin and yang, the class curriculum was designed to be participatory. It focused on linking symptoms to high risk work activities; explaining the nature of musculoskeletal injury; and encouraging compliance with self care measures of ice, stretching, and early symptom reporting. A total of 21 women completed the Healthy Work Classes, with an increase in perceived levels of energy measured after each class. Additionally, contingency contracting for both individual and workplace change was piloted. This curriculum was revised to become a "train the trainer" program, with training of garment worker leaders and the goal to disseminate this prevention based curriculum to garment workers in the Oakland, California community.     

The development of an accredited bowel-management course

Bowel management--particularly digital rectal examination (DRE) and the manual removal of faeces--has been a contentious issue for some time. In the past few years this has been brought to the fore by a number of cases of professional misconduct by nurses.     

Clinical skills: evidence-based nursing care of people with rheumatoid arthritis

Rheumatoid arthritis is a complex inflammatory disease with an unknown cause, uncertain prognosis and no known cure. The physical symptoms of this chronic disease can impact on the patient's psychological state and also affect the family unit and social/economic viability. Nursing patients with such a multifaceted illness is a skilled and complex task and it is imperative that the care provided is optimal, timely and underpinned by patient education. Evidence-based nursing care founded on an in-depth knowledge of the disease and its treatments will help to achieve optimal patient outcome.     

Discharge planning: a collaboration between provider and payer case managers using Medicare's Conditions of Participation

Discharge planning is a legally mandated function for hospitals and is one of the "basic" hospital roles as outlined in Medicare's Conditions of Participation. This article will define discharge planning; describe the steps in the discharge planning process; list rules and regulations that influence discharge planning in hospitals; and compare hospital-based actions with payer-based actions when planning discharges. Case managers who work for payers interact with hospital-based case managers to facilitate the discharge planning process for patients. Those who form this patient-provider-payer triangle will benefit by reviewing the dynamics of the discharge planning process.     

Coding for effective denial management

Nearly everyone will agree that accurate and consistent coding of diagnoses and procedures is the cornerstone for operating a compliant practice. The CPT or HCPCS procedure code tells the payor what service was performed and also (in most cases) determines the amount of payment. The ICD-9-CM diagnosis code, on the other hand, tells the payor why the service was performed. If the diagnosis code does not meet the payor's criteria for medical necessity, all payment for the service will be denied. Implementation of an effective denial management program can help "stop the bleeding." Denial management is a comprehensive process that works in two ways. First, it evaluates the cause of denials and takes steps to prevent them. Second, denial management creates specific procedures for refiling or appealing claims that are initially denied. Accurate, consistent and compliant coding is key to both of these functions. The process of proactively managing claim denials also reveals a practice's administrative strengths and weaknesses, enabling radiology business managers to streamline processes, eliminate duplicated efforts and shift a larger proportion of the staff's focus from paperwork to servicing patients--all of which are sure to enhance operations and improve practice management and office morale. Accurate coding requires a program of ongoing training and education in both CPT and ICD-9-CM coding. Radiology business managers must make education a top priority for their coding staff. Front office staff, technologists and radiologists should also be familiar with the types of information needed for accurate coding. A good staff training program will also cover the proper use of Advance Beneficiary Notices (ABNs). Registration and coding staff should understand how to determine whether the patient's clinical history meets criteria for Medicare coverage, and how to administer an ABN if the exam is likely to be denied. Staff should also understand the restrictions on use of ABNs and the compliance risks associated with improper use. Finally, training programs should include routine audits to monitor coders for competence and precision. Constantly changing codes and guidelines mean that a coder's skills can quickly become obsolete if not reinforced by ongoing training and monitoring. Comprehensive reporting and routine analysis of claim denials is without a doubt one of the greatest assets to a practice that is suffering from excessive claim denials and should be considered an investment capable of providing both short and long term ROIs. Some radiologists may lack the funding or human resources needed to implement truly effective coding programs for their staff members. In these circumstances, radiology business managers should consider outsourcing their coding.     

Information technology in health professional education: why IT matters

This paper analyses the potential of information technology (IT) to transform the process of learning in higher education, particularly health professional education. It is argued that IT, although very much part of the infrastructure of the modern university has yet to make its full impact on teaching and learning processes. The expectations of students and demands for improved flexibility and access make it inevitable that IT will become an integral part of teaching and learning despite inherent resistance to change. The potential benefits of IT are identified as: transmission of high quality content, support of life-long learning, flexibility of access and enhanced opportunities for communication. These concepts are explored in the context of health professional education. It is argued that universities cannot survive without harnessing the power of IT to improve the educational experience of students but lecturers should ensure that this is underpinned by sound educational theory.     

Assessment and treatment of chest pain

Chest pain is one of the main reasons for emergency admission to hospital in the UK. Jackie Tough examines the causes and treatment of chest pain and offers a structured system for taking the patient's history.     

Errors in weight estimation in the emergency department: comparing performance by providers and patients

To examine biases in weight estimation by Emergency Department (ED) providers and patients, a convenience sample of ED providers (faculty, residents, interns, nurses, medical students, paramedics) and patients was studied. Providers (n = 33), blinded to study hypothesis and patient data, estimated their own weight as well as the weight of 11-20 patients each. An independent sample of patients (n = 95) was used to assess biases in patients' estimation of their own weight. Data are represented as over, under, or within +/- 5 kg, the dose tolerance standard for thrombolytics. Logistic regression analysis revealed that patients are almost nine times more likely to accurately estimate their own weight than providers; yet 22% of patients were unable to estimate their own weight within 5 kg. Of all providers, paramedics were significantly worse estimators of patient weight than other providers. Providers were no better at guessing their own weight than were patients. Though there was no systematic estimate bias by weight, experience level (except paramedic), or gender for providers, those providers under 30 years of age were significantly better estimators of patient weight than older providers. Although patient gender did not create a bias in provider estimation accuracy, providers were more likely to underestimate women's weights than men's. In conclusion, patient self-estimates of weight are significantly better than estimates by providers. Inaccurate estimates by both groups could potentially contribute to medication dosing errors in the ED.