Perioperative nutrition is still a surgical orphan

Objective: To assess if screening programs and treatment of preoperative malnutrition have been implemented into surgical practice to decrease morbidity. There is strong evidence that postoperative morbidity can be minimized by early identifying and treating patients at nutritional risk before major surgery.The validated nutritional risk score (NRS) is recommended by the European Society of Parenteral and Enteral Nutrition for nutritional screening. It remains unclear whether routine preoperative nutritional assessment and perioperative nutrition is widely implemented.Methods: A survey was conducted in 173 Swiss and Austrian surgical departments. Implementation of nutritional screening, perioperative nutrition, and estimated impact on clinical outcome were assessed. Non-responders were repeatedly contacted by the authors.Results: The overall response rate was 55%, whereby 69% (54/78) of Swiss and 44% (42/95) of Austrian centers responded. Despite 80% and 59% of the responding centers are aware of a reduced complication rate and shortened hospital stay, respectively, only 20% of them implemented routine nutritional screening. Financial (49%) and logistic restrictions (33%) are the predominant reasons against the routine clinical use. Screening is mainly performed either in the outpatient's clinic (52%) or during admission (54%). The NRS is only used by 14%. Instead, various clinical (78%), e.g. BMI and laboratory findings (56%), e.g. albumine, are used. Indication for perioperative nutrition is based on preoperative screening in 49%.While 23% use preoperative nutrition, 68% apply nutritional support pre- and postoperatively. Preoperative nutritional treatment ranged from three days (33%), to five days (31%) and even seven days (20%).Conclusion: Despite malnutrition is well recognized as major risk factor for increased postoperative morbidity, the majority of surgeons are reluctant to implement routine screening and nutritional support. If nutritional assessment is performed, local institutional screening parameters are still preferred. It remains difficult to overcome traditions, and to change surgeon's mind.

Report on Special Investigation of the Glenwood Resource Center, For the period June 21, 2002 through December 24, 2003

State Agency Audit Report

The application of Fick's law to evaluate the period of stay of mega-olivines in alkaline lavas

The integration of the differential equation of the second law of Fick applied to the diffusion of chemical elements in a semi-infinite solid made it easier to estimate the time of stay of olivine mega-cristals in contact with the host lava The results of this research show the existence of two groups of olivine. The first remained in contact with the magmatic liquid during 19 to 22 days, while the second remained so during only 5 to 9 days. This distinction is correlative to that based on the qualitative observation.

EU cohesion aid to Spain: a data set. Part II: 1994-99 planning period

In this paper we construct a data set on EU cohesion aid to Spain during the planning period 1994-99. The data are disaggregated by region, year and function and attempt to approximate the timing of actual executed expenditure on assisted projects.

Report on Special Investigation of the Central Point Coordination for Calhoun and Pocahontas Counties for the Period July 1, 1998 through May 31, 2004

Report on a Special Investigation of the Central Point Coordination for Calhoun and Pocahontas Counties.

Report on Special Investigation of the City of Bussey Library, For the period July 1, 2003 through March 15, 2004

City Audit Report - Special Investigation

A-H-S-T Community School District, Auditor of State's Report on Reaudit, For the Period July 1, 2002 through June 30, 2003

Community School District Audit Report - Reaudit

City of Spirit Lake, Auditor of State's Report on Reaudit, For the Period, July 1, 2001 through June 30, 2003

City Audit Report - Reaudit

Special Investigation of the Iowa Department of Public Health, For the Period July 1, 2001 through February 29, 2004

State Agency Audit Report - Special Investigation

A Review of the State of Iowa Procurement Card Program, For the Period July 1, 2000 through June 30, 2003

Other Audit Reports - Performance Investigation

Special Investigation of Certain Grants Administered by The Department of Curriculum and Instruction, College of Education, Iowa State University of Science and Technology, For the Period September 1, 1999 through November 30, 2003

State University Audit Report - Special Investigation

Special Investigation of Certain Grants Administered by The Department of Curriculum and Instruction, College of Education, Iowa State University of Science and Technology, For the Period September 1, 1999 through November 30, 2003

State University Audit Report - Special Investigation

Report on Special Investigation of the City of Liscomb, For the Period June 1, 2002 through November 30, 2004

City Audit Report - Special Investigation

Report on Special Investigation of Before and After School Services, For the Period July 1, 2000 through December 31, 2004

Other Audit Reports - Special Investigation

Report on the Special Investigation of the City of Mt. Vernon Fire Department, For the Period January 1, 2003 through March 31, 2005

Other Audit Reports - Special Investigation