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Rouse M, Newman JR, Waller C, Fink J. R.I.M.E. and reason: multi-station OSCE enhancement to neutralize grade inflation. Med Educ Online 2024; 29:2339040. [PMID: 38603644 PMCID: PMC11011230 DOI: 10.1080/10872981.2024.2339040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
To offset grade inflation, many clerkships combine faculty evaluations with objective assessments including the Medical Examiners Subject Examination (NBME-SE) or Objective Structured Clinical Examination (OSCE), however, standardized methods are not established. Following a curriculum transition removing faculty clinical evaluations from summative grading, final clerkship designations of fail (F), pass (P), and pass-with-distinction (PD) were determined by combined NBME-SE and OSCE performance, with overall PD for the clerkship requiring meeting this threshold in both. At the time, 90% of students achieved PD on the Internal Medicine (IM) OSCE resulting in overall clerkship grades primarily determined by the NBME-SE. The clerkship sought to enhance the OSCE to provide a more thorough objective clinical skills assessment, offset grade inflation, and reduce the NBME-SE primary determination of the final clerkship grade. The single-station 43-point OSCE was enhanced to a three-station 75-point OSCE using the Reporter-Interpreter-Manager-Educator (RIME) framework to align patient encounters with targeted assessments of progressive skills and competencies related to the clerkship rotation. Student performances were evaluated pre- and post-OSCE enhancement. Student surveys provided feedback about the clinical realism of the OSCE and the difficulty. Pre-intervention OSCE scores were more tightly clustered (SD = 5.65%) around a high average performance with scores being highly negatively skewed. Post-intervention OSCE scores were more dispersed (SD = 6.88%) around a lower average with scores being far less skewed resulting in an approximately normal distribution. This lowered the total number of students achieving PD on the OSCE and PD in the clerkship, thus reducing the relative weight of the NMBE-SE in the overall clerkship grade. Student response was positive, indicating the examination was fair and reflective of their clinical experiences. Through structured development, OSCE assessment can provide a realistic and objective measurement of clinical performance as part of the summative evaluation of students.
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Affiliation(s)
- Michael Rouse
- Internal Medicine, The University of Kansas School of Medicine, Kansas City, USA
| | - Jessica R. Newman
- Internal Medicine, The University of Kansas School of Medicine, Kansas City, USA
| | - Charles Waller
- Evaluation Analyst in the Office of Medical Education, The University of Kansas School of Medicine, Kansas City, MO, USA
| | - Jennifer Fink
- Internal Medicine, The University of Kansas School of Medicine, Kansas City, USA
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Joyce O, Corpman M. Comparison of Sodium Zirconium Cyclosilicate to Sodium Polystyrene Sulfonate in the Inpatient Management of Acute Hyperkalemia. J Pharm Pract 2024; 37:728-735. [PMID: 37254518 DOI: 10.1177/08971900231176462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Background: Oral potassium binders have a role in the management of acute hyperkalemia among hospitalized patients. However, with therapeutic additions to this class, there is insufficient evidence between potassium binders to support a standard of care recommendation for use in this acute setting. Objective: The purpose of this study was to compare the acute potassium lowering effects of sodium zirconium cyclosilicate (SZC) and sodium polystyrene sulfonate (SPS). Methods: A retrospective review of admitted patients who received SZC or SPS was conducted after exemption from the Institutional Review Board. Patients with baseline potassium values less than 5.1 mmol/L or factors contributing to potentially false report of serum potassium were excluded. The primary outcome was the average change in potassium from baseline to 24 hours following potassium binder administration. Secondary outcomes compared changes to potassium from baseline to various time periods after administration, presence of electrolyte changes, and documentation of serious adverse events. Results: A total of 246 patients were included, with 128 receiving SZC and 118 receiving SPS. Mean change in serum potassium (mmol/L) at 24 hours was not significant between binders (-.78 vs -.91; P = .22). Secondary efficacy and safety outcomes were also similar between groups. A total of 5 serious adverse events were reported, occurring only in the SPS group. Conclusion: SZC and SPS have comparable effects in acute potassium reduction, with serious gastrointestinal adverse events documented only in SPS patients. Health systems may consider this data in determining medication formularies or during order set development.
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Affiliation(s)
- Olivia Joyce
- Department of Pharmacy, Forbes Hospital, Monroeville, USA
- Department of Pharmacy, West Penn Hospital, Pittsburgh, USA
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Ebneter AS, Kaya E, Mair P, Affollter B, Eychmueller S. Basic Training in Palliative Medicine for Internal Medicine Residents: Pilot Testing of a Canadian Model in Switzerland. Palliat Med Rep 2024; 5:171-176. [PMID: 38665225 PMCID: PMC11043622 DOI: 10.1089/pmr.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/28/2024] Open
Abstract
Background In Switzerland, palliative care (PC) clinical training is well established at undergraduate and specialist postgraduate levels. However, postgraduate nonspecialist training curricula are less documented. Local Problem A structured curriculum for nonspecialist rotation within internal medicine (IM) in specialized PC wards is lacking. Objective To pilot two versions of a PC nonspecialist curriculum for IM residents in Swiss PC units. Methods In the pilot phase, two curricula-short immersion (3-10 weeks, based on the University of Toronto's Internal-Medicine PC Rotation) and standard nonspecialist (11-18 weeks, based on the Canadian Society of Palliative Care Physician Competencies)-were assessed using a mixed-method online survey. One university and two nonuniversity sites participated. The analysis was descriptive. Results Five residents and eight supervisors of five training rotations (July-October 2023) responded. Overall, curriculum quality and feasibility (content and time) received positive ratings across all groups, with high satisfaction concerning organization, educational design, learning support, climate, experience, and facilities. Nonuniversity sites were generally rated more positively than university sites. Qualitative feedback paralleled these findings, highlighting the curriculum's relevance and fit with learners' needs and suggesting potential simplifications and more personalized planning. Conclusions Establishing short and standard duration curricula for a PC program is viable and well received by nonspecialist trainees. Future implementation should concentrate on personalized learning objectives and streamlining the content and structure of the competencies. Cooperation within various training settings (university and regional hospitals) as well as on an international level (e.g., Canada-Switzerland) may further improve the quality of the proposed training formats.
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Affiliation(s)
- Andreas Samuel Ebneter
- University Center for Palliative Care, University Hospital, Inselspital Bern, Switzerland
| | - Ebru Kaya
- Division of Palliative Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Petra Mair
- Palliative Care Unit, Internal Medicine Clinic, Spital Thun, Thun, Switzerland
| | - Barbara Affollter
- Palliative Care Unit, Internal Medicine Clinic, Spital Emmental, Burgdorf, Switzerland
| | - Steffen Eychmueller
- University Center for Palliative Care, University Hospital, Inselspital Bern, Switzerland
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Ruttmann K, Albaladejo-Fuertes S, Lindenberg N, Kunst C, Mehrl A, Kindl V, Gülow K, Schlosser-Hupf S, Schmid S, Müller M. Relationship between interprofessional collaboration and psychological distress experienced by healthcare professionals during COVID-19: a monocentric cross-sectional study. Front Med (Lausanne) 2024; 11:1292608. [PMID: 38660424 PMCID: PMC11039835 DOI: 10.3389/fmed.2024.1292608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Background Since the onset of the COVID-19 pandemic, global healthcare systems have faced unprecedented challenges, leading to significant psychological distress among healthcare professionals. Recognizing the importance of enhanced interprofessional collaboration in alleviating this burden, as emphasized by the World Health Organization in 2020, we investigated whether such collaboration could mitigate staff psychological distress during crises. To our knowledge, no study has yet explored the role of interprofessional collaboration as a resilience factor in crises. Methods For this monocentric cross-sectional study at a German university hospital, we examined the relationship between the quality of interprofessional collaboration and the psychological distress of healthcare professionals during the initial pandemic wave. We employed validated mental health instruments, such as the GAD-7 and PHQ-2, to assess anxiety and depressive symptoms. Additionally, custom-designed questionnaires evaluated "Pandemic-Associated Burden and Anxiety (PAB; PAA)" and interprofessional crisis management experiences. A novel "Interprofessional collaboration and communication (IPC)" assessment tool was developed based on international competency frameworks, demonstrating strong reliability. Results The study involved 299 healthcare professionals (78.6% in direct contact with COVID-19 patients). Moderate levels of PAB/PAA were reported. However, a significant proportion experienced clinically relevant anxiety, as indicated by GAD-7. Negative IPC perceptions correlated with higher levels of psychological distress. Linear regression analysis showed associations between interprofessional collaboration and anxious and depressive symptoms, and pandemic-related burden. Conclusion Our findings highlight the vital role of enhanced interprofessional collaboration in strengthening the psychological well-being of healthcare professionals during crises. The study underscores the need to foster a collaborative environment and integrate interprofessional education for resilience.
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Affiliation(s)
- Kirstin Ruttmann
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
- Nursing Development Department of the Care Management Head Office, University Hospital Regensburg, Regensburg, Germany
| | - Sheila Albaladejo-Fuertes
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Nicole Lindenberg
- Department of Anaesthesiology, University Hospital of Regensburg, Regensburg, Germany
| | - Claudia Kunst
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Mehrl
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Vera Kindl
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Karsten Gülow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sophie Schlosser-Hupf
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Corcione S, De Benedetto I, Carlin M, Pivetta EE, Scabini S, Grosso C, Shbaklo N, Porta M, Lupia E, De Rosa FG. Real-World Experience of Ceftobiprole for Community- and Hospital-Acquired Pneumonia from a Stewardship Perspective. Microorganisms 2024; 12:725. [PMID: 38674669 PMCID: PMC11051771 DOI: 10.3390/microorganisms12040725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Ceftobiprole is a fifth-generation cephalosporin approved by European and American regulatory agencies for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). Ceftobiprole administration is useful in severe CAP as well as HAP where the potential is to save other β-lactams including carbapenems or linezolid/vancomycin in clinical practice. The aim of this study was to report the real-world evidence of ceftobiprole in patients with CAP and HAP in a single center. In this retrospective study, we included 159 patients with CAP or HAP: 105 (66%) had CAP and 54 (34%) had HAP. The median age was 70 years (IQR 60-77), the median Charlson Comorbidity Index was 5 (IQR 3-7.5) and baseline INCREMENT ESBL score was 8 (IQR 6-11). Ceftobiprole was mostly given as a combination treatment (77%) or as a carbapenem-sparing strategy (44%). There were no differences in mortality between shorter and longer duration of treatment (<7 days compared with ≥7 days (HR 1.02, C.I. 0.58-1.77, p = 0.93) or between first-line (HR 1.00, C.I. 0.46-2.17, p = 0.989) and second-line therapy. Ceftobiprole use in CAP or HAP in the real world is effective as a first- and second-line treatment as well as a carbapenem-sparing strategy. Further studies are needed to explore the full potential of ceftobiprole, including its real-world use in antimicrobial stewardship programs.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (S.S.); (C.G.); (N.S.); (F.G.D.R.)
- Division of Geographic Medicine, Tufts University School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (S.S.); (C.G.); (N.S.); (F.G.D.R.)
| | - Massimiliano Carlin
- Department of Medical Sciences, Internal Medicine, University of Turin, 10126 Turin, Italy; (M.C.); (M.P.)
| | - Emanuele Emilio Pivetta
- Department of Medical Sciences, Emergency Medicine, University of Turin, 10126 Turin, Italy; (E.E.P.); (E.L.)
| | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (S.S.); (C.G.); (N.S.); (F.G.D.R.)
| | - Cecilia Grosso
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (S.S.); (C.G.); (N.S.); (F.G.D.R.)
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (S.S.); (C.G.); (N.S.); (F.G.D.R.)
| | - Massimo Porta
- Department of Medical Sciences, Internal Medicine, University of Turin, 10126 Turin, Italy; (M.C.); (M.P.)
| | - Enrico Lupia
- Department of Medical Sciences, Emergency Medicine, University of Turin, 10126 Turin, Italy; (E.E.P.); (E.L.)
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (S.S.); (C.G.); (N.S.); (F.G.D.R.)
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Harada Y, Kawamura R, Yokose M, Shimizu T, Singh H. Definitions and Measurements for Atypical Presentations at Risk for Diagnostic Errors in Internal Medicine: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e56933. [PMID: 38526541 PMCID: PMC11002735 DOI: 10.2196/56933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Atypical presentations have been increasingly recognized as a significant contributing factor to diagnostic errors in internal medicine. However, research to address associations between atypical presentations and diagnostic errors has not been evaluated due to the lack of widely applicable definitions and criteria for what is considered an atypical presentation. OBJECTIVE The aim of the study is to describe how atypical presentations are defined and measured in studies of diagnostic errors in internal medicine and use this new information to develop new criteria to identify atypical presentations at high risk for diagnostic errors. METHODS This study will follow an established framework for conducting scoping reviews. Inclusion criteria are developed according to the participants, concept, and context framework. This review will consider studies that fulfill all of the following criteria: include adult patients (participants); explore the association between atypical presentations and diagnostic errors using any definition, criteria, or measurement to identify atypical presentations and diagnostic errors (concept); and focus on internal medicine (context). Regarding the type of sources, this scoping review will consider quantitative, qualitative, and mixed methods study designs; systematic reviews; and opinion papers for inclusion. Case reports, case series, and conference abstracts will be excluded. The data will be extracted through MEDLINE, Web of Science, CINAHL, Embase, Cochrane Library, and Google Scholar searches. No limits will be applied to language, and papers indexed from database inception to December 31, 2023, will be included. Two independent reviewers (YH and RK) will conduct study selection and data extraction. The data extracted will include specific details about the patient characteristics (eg, age, sex, and disease), the definitions and measuring methods for atypical presentations and diagnostic errors, clinical settings (eg, department and outpatient or inpatient), type of evidence source, and the association between atypical presentations and diagnostic errors relevant to the review question. The extracted data will be presented in tabular format with descriptive statistics, allowing us to identify the key components or types of atypical presentations and develop new criteria to identify atypical presentations for future studies of diagnostic errors. Developing the new criteria will follow guidance for a basic qualitative content analysis with an inductive approach. RESULTS As of January 2024, a literature search through multiple databases is ongoing. We will complete this study by December 2024. CONCLUSIONS This scoping review aims to provide rigorous evidence to develop new criteria to identify atypical presentations at high risk for diagnostic errors in internal medicine. Such criteria could facilitate the development of a comprehensive conceptual model to understand the associations between atypical presentations and diagnostic errors in internal medicine. TRIAL REGISTRATION Open Science Framework; www.osf.io/27d5m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56933.
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Affiliation(s)
- Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Ren Kawamura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
- Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Sutton RT, Chappell KD, Pincock D, Sadowski D, Baumgart DC, Kroeker KI. The Effect of an Electronic Medical Record-Based Clinical Decision Support System on Adherence to Clinical Protocols in Inflammatory Bowel Disease Care: Interrupted Time Series Study. JMIR Med Inform 2024; 12:e55314. [PMID: 38533825 PMCID: PMC11004614 DOI: 10.2196/55314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024] Open
Abstract
Background Clinical decision support systems (CDSSs) embedded in electronic medical records (EMRs), also called electronic health records, have the potential to improve the adoption of clinical guidelines. The University of Alberta Inflammatory Bowel Disease (IBD) Group developed a CDSS for patients with IBD who might be experiencing disease flare and deployed it within a clinical information system in 2 continuous time periods. Objective This study aims to evaluate the impact of the IBD CDSS on the adherence of health care providers (ie, physicians and nurses) to institutionally agreed clinical management protocols. Methods A 2-period interrupted time series (ITS) design, comparing adherence to a clinical flare management protocol during outpatient visits before and after the CDSS implementation, was used. Each interruption was initiated with user training and a memo with instructions for use. A group of 7 physicians, 1 nurse practitioner, and 4 nurses were invited to use the CDSS. In total, 31,726 flare encounters were extracted from the clinical information system database, and 9217 of them were manually screened for inclusion. Each data point in the ITS analysis corresponded to 1 month of individual patient encounters, with a total of 18 months of data (9 before and 9 after interruption) for each period. The study was designed in accordance with the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) guidelines for health informatics evaluations. Results Following manual screening, 623 flare encounters were confirmed and designated for ITS analysis. The CDSS was activated in 198 of 623 encounters, most commonly in cases where the primary visit reason was a suspected IBD flare. In Implementation Period 1, before-and-after analysis demonstrates an increase in documentation of clinical scores from 3.5% to 24.1% (P<.001), with a statistically significant level change in ITS analysis (P=.03). In Implementation Period 2, the before-and-after analysis showed further increases in the ordering of acute disease flare lab tests (47.6% to 65.8%; P<.001), including the biomarker fecal calprotectin (27.9% to 37.3%; P=.03) and stool culture testing (54.6% to 66.9%; P=.005); the latter is a test used to distinguish a flare from an infectious disease. There were no significant slope or level changes in ITS analyses in Implementation Period 2. The overall provider adoption rate was moderate at approximately 25%, with greater adoption by nurse providers (used in 30.5% of flare encounters) compared to physicians (used in 6.7% of flare encounters). Conclusions This is one of the first studies to investigate the implementation of a CDSS for IBD, designed with a leading EMR software (Epic Systems), providing initial evidence of an improvement over routine care. Several areas for future research were identified, notably the effect of CDSSs on outcomes and how to design a CDSS with greater utility for physicians. CDSSs for IBD should also be evaluated on a larger scale; this can be facilitated by regional and national centralized EMR systems.
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Affiliation(s)
- Reed Taylor Sutton
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kaitlyn Delaney Chappell
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - David Pincock
- Chief Medical Information Office, Alberta Health Services, Edmonton, AB, Canada
| | - Daniel Sadowski
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Ivy Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Rosenberg AGW, Mochèl K, Hähner LM, Ruules L, Davidse K, Bos-Roubos AG, van Dijk SA, Zillikens MC, Taal W, van der Lely AJ, de Graaff LCG. Endocrine and non-endocrine causes of fatigue in adults with Neurofibromatosis type 1. Front Endocrinol (Lausanne) 2024; 14:1119159. [PMID: 38560379 PMCID: PMC10978575 DOI: 10.3389/fendo.2023.1119159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/18/2023] [Indexed: 04/04/2024] Open
Abstract
Context Neurofibromatosis type 1 (NF1) is a complex system disorder, caused by alterations in RAS pathways. NF1 adults often suffer from chronic and severe fatigue, for which they are frequently referred to Internal Medicine/Endocrinology. Seeking medical help often leads to (invasive) diagnostic procedures. To prevent the personal and financial burden of this disabling fatigue, it is crucial to know the causes. Objective To explore somatic causes and provide practical recommendations for the approach to fatigue in adults with NF1. Design Cross-sectional. All adults with NF1 (N = 133) who visited our Endocrinology department underwent a systematic health screening, including a medical questionnaire, structured interview, complete physical examination, biochemical measurements and additional tests if indicated. Main outcome measure Prevalence of endocrine and non-endocrine health problems between NF1 adults with and without fatigue. Results In our cohort, 75% of NF1 adults experienced fatigue. The most frequent endocrine disorders were vitamin D deficiency (28%), obesity (18%) and hypothyroidism (8%). The most frequent non-endocrine internal disorder was high blood pressure (42%). None of the disorders differed significantly between adults with and without fatigue. Conclusions Endocrine and non-endocrine disorders were equally present in our cohort of NF1 adults with and without fatigue. This suggests that the high prevalence of fatigue in NF1 adults is not explained by these somatic disorders. An alternative explanation for fatigue might be deficits in cognitive functioning and other neuropsychological processes in NF1. Based on our results and review of the literature, we provide a clinical algorithm for the approach to fatigue in NF1 adults, including somatic and psychological assessment.
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Affiliation(s)
- Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ké Mochèl
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lorena M. Hähner
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lara Ruules
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anja G. Bos-Roubos
- Center of Excellence for Neuropsychiatry, Vincent van Gogh, Venray, Netherlands
| | - Sarah A. van Dijk
- Department of Neurology/Neuro-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
- ENCORE-Dutch Center of Reference for Neurodevelopmental Disorders, Rotterdam, Netherlands
| | - M. Carola Zillikens
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- ERN BOND, European Reference Network for Rare Bone Diseases, Rotterdam, Netherlands
- ENDO-ERN, European Reference Network on Rare Endocrine Conditions, Rotterdam, Netherlands
- Academic Centre for Rare Bone Disorders, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Walter Taal
- Department of Neurology/Neuro-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
- ENCORE-Dutch Center of Reference for Neurodevelopmental Disorders, Rotterdam, Netherlands
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- ENDO-ERN, European Reference Network on Rare Endocrine Conditions, Rotterdam, Netherlands
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- ENCORE-Dutch Center of Reference for Neurodevelopmental Disorders, Rotterdam, Netherlands
- ENDO-ERN, European Reference Network on Rare Endocrine Conditions, Rotterdam, Netherlands
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Bajaj N, Goyal T, Teo K, Yip G. Impact of a general medicine consultant-led ward round in the emergency department. Intern Med J 2024. [PMID: 38465726 DOI: 10.1111/imj.16362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Patients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward. AIMS To assess the impact of general medicine consultant-led ward rounds (CWRs) in the ED on patient length of stay (LOS). METHODS One-month audit was conducted of all patients admitted to general medicine and awaiting transfer to ward from ED at a metropolitan public hospital in Melbourne. A general medicine CWR was then implemented in the ED, followed by another 1-month audit, with the primary outcome being LOS and the secondary outcome being 30-day readmission rate. Additionally, admitting medical registrars were invited to complete a survey before and after the implementation of CWRs to assess satisfaction rate. RESULTS Data from electronic medical records were analysed for 162 patients (90 preimplementation group and 72 postimplementation group). The median LOS was 6 days in the preimplementation group and 4 days in the postimplementation group (P = 0.014). There was no significant difference in 30-day readmission rates. Surveys showed admitting medical registrars reported a reduced level of stress and fewer barriers to seeking consultant input following implementation. CONCLUSIONS A CWR in the ED has led to decreased LOS for general medicine patients and improved satisfaction among junior medical staff.
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Affiliation(s)
- Nupur Bajaj
- General Medicine Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Tushar Goyal
- General Medicine Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Ken Teo
- General Medicine Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Gary Yip
- General Medicine Unit, Eastern Health, Melbourne, Victoria, Australia
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Montepara CA, Bortmas MR, Cochenour CJ, Fleming MK, Gaffey SH, McQuigg MA, Parisi MK, Zimmerman DE, Covvey JR, Nemecek BD. The effect of potassium supplementation and concomitant medications on potassium homeostasis for hospitalized patients. Am J Health Syst Pharm 2024; 81:183-189. [PMID: 38070196 DOI: 10.1093/ajhp/zxad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
PURPOSE Hospitalized patients receive potassium (K+) supplementation for hypokalemia, with clinicians often estimating a rise in serum K+ levels of 0.1 mEq/L per 10 mEq delivered. However, there is limited evidence to support this expectation. Patients also concomitantly take medications that may alter K+ levels, and it is not known to what degree these may impact interventions to correct K+ levels via supplementation. The objective of this study was to identify the impact of oral and/or intravenous K+ supplementation on serum K+ levels, including the influence of selected concomitant medications, in adult hospitalized patients. METHODS A single-center, retrospective descriptive study of adult hospitalized patients receiving K+ supplementation at a tertiary hospital between 2021 and 2022 was conducted. Patients were included if they received at least one dose of potassium chloride while admitted to the general medicine ward. The primary outcome was the daily median change in serum K+, normalized per 10 mEq of supplementation administered. The secondary outcome was the impact of selected concomitant medication use on supplement-induced changes in serum K+. RESULTS A total of 800 patients and 1,291 daily episodes of K+ supplementation were evaluated. The sample was approximately 53% women, was 78% white, and had a median age of 68 years. The overall daily median change in serum K+ level was 0.05 mEq/L per 10 mEq of supplementation delivered. Patients received a median of 40 mEq of supplementation per day, primarily via the oral route (80.6%). Among the concomitant medications assessed, loop diuretics significantly dampened the impact of K+ supplementation. CONCLUSION Supplementation of K+ in non-critically ill hospitalized patients is variable and dependent on concomitant medication use.
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Affiliation(s)
- Courtney A Montepara
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, PA
- Allegheny General Hospital, Pittsburgh, PA, USA
| | | | | | | | | | | | | | - David E Zimmerman
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, PA, and UPMC Mercy Hospital, Pittsburgh, PA, USA
| | - Jordan R Covvey
- Division of Pharmaceutical, Administrative, and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA, USA
| | - Branden D Nemecek
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, PA, and UPMC Mercy Hospital, Pittsburgh, PA, USA
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Heck J, Höner zu Siederdissen C, Krause O, Schröder S, Schulze Westhoff M, Strunz PP, Schumacher C, Stichtenoth DO, Bosch JJ, Pape T, Koop F, Krichevsky B. Concordance of emergency department physicians' decisions on HIV post-exposure prophylaxis with national guidelines: results from a retrospective cohort study. Int Health 2024; 16:219-226. [PMID: 37624102 PMCID: PMC10911529 DOI: 10.1093/inthealth/ihad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/06/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Post-exposure prophylaxis (PEP) is an effective tool to prevent infection with HIV. Patients seeking PEP after potential HIV exposure usually present to the emergency department (ED). Our study sought to determine the concordance of ED physicians' decisions on HIV-PEP with national guidelines (primary objective) and to assess the clinical relevance of drug-drug interactions (DDIs) between the HIV-PEP regimen and patients' concomitant medication (secondary objective). METHODS We conducted a retrospective cohort study at the ED of Hannover Medical School, Germany. Between 1 January 2018 and 31 December 2019, 113 of 11 246 screened patients presented to the ED after potential HIV exposure and were enrolled in the study. RESULTS The median age of the patients (82.3% male) was 30 y (IQR 25-35.5), 85.8% of potential HIV exposures were characterised as sexual and 85.0% presented within 72 h. ED physicians' decisions on HIV-PEP were concordant with national guidelines in 93.8%. No clinically relevant DDIs were detected. CONCLUSIONS ED physicians' decisions on HIV-PEP were highly concordant with national guidelines. Approximately 1% of patient presentations to the ED were related to HIV exposure; therefore, training ED physicians on HIV transmission risk assessment and indications/contraindications for HIV-PEP is paramount.
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Affiliation(s)
- Johannes Heck
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | | | - Olaf Krause
- Hannover Medical School, Institute for General Practice and Palliative Care, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- DIAKOVERE Henriettenstift, Center for Medicine of the Elderly, Schwemannstr. 19, 30559 Hannover, Germany
| | - Sebastian Schröder
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Schulze Westhoff
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Patrick-Pascal Strunz
- University Hospital Würzburg, Department of Internal Medicine II, Rheumatology and Clinical Immunology, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Carsten Schumacher
- Hannover Medical School, Center for Clinical Trials, Feodor-Lynen-Str. 15, 30625 Hannover, Germany
| | - Dirk O Stichtenoth
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jacobus J Bosch
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Thorben Pape
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Felix Koop
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Technical University of Munich, Department of Internal Medicine II, Division of Clinical Toxicology, Ismaninger Str. 22, 81675 Munich, Germany
| | - Benjamin Krichevsky
- Hannover Medical School, Institute for General Practice and Palliative Care, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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12
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Debaco ISS, Kluck HM, Marx R, da Rosa PRM, Teixeira C. Bacterial coinfections in COVID-19-hospitalized patients. Rev Assoc Med Bras (1992) 2024; 70:e20230469. [PMID: 38451571 PMCID: PMC10913779 DOI: 10.1590/1806-9282.2023469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to assess the rate of bacterial infections in COVID-19-hospitalized patients and to analyze the most prevalent germs, sources, risk factors, and its impact on in-hospital mortality. METHODS This observational retrospective study was conducted on 672 patients hospitalized between April and August 2020 in Nossa Senhora da Conceição Hospital, a public hospital located in Porto Alegre, Brazil. The inclusion criterion was adult patients hospitalized with confirmed COVID-19. Data were collected through chart review. Risk factors for bacterial infection and mortality were analyzed using both univariate and multivariate robust Poisson regression models. RESULTS Bacterial coinfection was observed in 22.2% of patients. Risk factors for bacterial infections were dementia (RR=2.06 (1.18-3.60); p=0.011), cerebrovascular disease (RR=1.75 (1.15-2.67); p=0.009), active cancer (RR=1.52 (1.082-2.15); p=0.01), need for noninvasive ventilation (RR=2.320 (1.740-3.094); p<0.01), invasive mechanical ventilation (RR=4.63 (2.24-9.56); p<0.01), and renal replacement therapy (RR=1.68 (1.26-2.25); p<0.01). In the adjusted model, bacterial infections were not associated with mortality (0.96 (0.75-1.24); p=0.79). The most common source of infection was due to respiratory, blood, and central venous catheters, with 69 (29.36%), 61 (25.96%), and 59 (25.11%) positive cultures, respectively. CONCLUSION We observed a high rate of bacterial infections in COVID-19-hospitalized patients, most commonly of respiratory source. Neurologic and oncologic morbidities and need for ventilation and renal replacement therapy was associated with risk factors for bacterial infections. Nevertheless, an association between bacterial infections and hospital mortality was not established.
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Affiliation(s)
| | - Helena Moreira Kluck
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Rômulo Marx
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Paulo Ricardo Mottin da Rosa
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
- Moinhos de Vento Hospital, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Cassiano Teixeira
- Universidade Federal de Ciências da Saúde de Porto Alegre, Department of Clinical Medicine and Rehabilitation Sciences – Porto Alegre (RS), Brazil
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Choffat D, Rossel JB, Aujesky D, Vollenweider P, Baumgartner C, Méan M. Association of pharmacologic thromboprophylaxis with clinically relevant bleeding and hospital-acquired anemia in medical inpatients: the risk stratification for hospital-acquired venous thromboembolism in medical patients study. J Thromb Haemost 2024; 22:765-774. [PMID: 38072378 DOI: 10.1016/j.jtha.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Pharmacologic thromboprophylaxis (pTPX) might exacerbate the risk of clinically relevant bleeding (CRB) and hospital-acquired anemia (HAA) in older multimorbid inpatients. OBJECTIVES We aimed to evaluate the association of pTPX use with CRB and HAA. METHODS We used data from a prospective cohort study conducted in 3 Swiss university hospitals. Adult patients admitted to internal medicine wards with no therapeutic anticoagulation were included. pTPX use was ascertained during hospitalization. Outcomes were in-hospital CRB and HAA. We calculated incidence rates by status of pTPX. We assessed the association of pTPX with CRB using survival analysis and with HAA using logistic regression, adjusted for infection, length of stay, and the International Medical Prevention Registry on Venous Thromboembolism bleeding risk score. RESULTS Among 1305 patients (mean age, 63.7 years; 44% women, 90% at low risk of bleeding), 809 (62%) received pTPX. The incidence of CRB was 2.4 per 1000 patient-days and was not significantly higher in patients with pTPX than in those without. We found no significant association between pTPX and CRB. HAA was frequent (20.2%) and higher in patients with pTPX than in those without (23.2% vs 15.3%). The incidence of HAA was 21.2 per 1000 patient-days and did not significantly differ between patients with pTPX and those without. We found an association between pTPX and HAA (adjusted odds ratio, 1.4; 95% CI, 1.0-2.1). CONCLUSION Our study confirmed the safety of pTPX in medical inpatients at low risk of bleeding but identified an association between pTPX and HAA. Adherence to guidelines that recommend administering pTPX to medical inpatients at increased venous thromboembolism risk and low bleeding risk is necessary.
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Affiliation(s)
- Damien Choffat
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois [CHUV]), Lausanne, Switzerland.
| | - Jean-Benoît Rossel
- Clinical Trial Unit of the Department of Clinical Research (CTU Bern), University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Vollenweider
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois [CHUV]), Lausanne, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie Méan
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois [CHUV]), Lausanne, Switzerland
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14
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Nikolla DA, Oskvarek JJ, Zocchi MS, Rahman NA, Leubitz A, Moghtaderi A, Black BS, Pines JM. Defining Incidental Versus Non-incidental COVID-19 Hospitalizations. Cureus 2024; 16:e56546. [PMID: 38646211 PMCID: PMC11027788 DOI: 10.7759/cureus.56546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Background Rates of COVID-19 hospitalization are an important measure of the health system burden of severe COVID-19 disease and have been closely followed throughout the pandemic. The highly transmittable, but often less severe, Omicron COVID-19 variant has led to an increase in hospitalizations with incidental COVID-19 diagnoses where COVID-19 is not the primary reason for admission. There is a strong public health need for a measure that is implementable at low cost with standard electronic health record (EHR) datasets that can separate these incidental hospitalizations from non-incidental hospitalizations where COVID-19 is the primary cause or an important contributor. Two crude metrics are in common use. The first uses in-hospital administration of dexamethasone as a marker of non-incidental COVID-19 hospitalizations. The second, used by the United States (US) CDC, relies on a limited set of COVID-19-related diagnoses (i.e., respiratory failure, pneumonia). Both measures likely undercount non-incidental COVID-19 hospitalizations. We therefore developed an improved EHR-based measure that is better able to capture the full range of COVID-19 hospitalizations. Methods We conducted a retrospective study of ED visit data from a national emergency medicine group from April 2020 to August 2023. We assessed the CDC approach, the dexamethasone-based measure, and alternative approaches that rely on co-diagnoses likely to be related to COVID-19, to determine the proportion of non-incidental COVID-19 hospitalizations. Results Of the 153,325 patients diagnosed with COVID-19 at 112 general EDs in 17 US states, and admitted or transferred, our preferred measure classified 108,243 (70.6%) as non-incidental, compared to 71,066 (46.3%) using the dexamethasone measure and 77,399 (50.5%) using the CDC measure. Conclusions Identifying non-incidental COVID-19 hospitalizations using ED administration of dexamethasone or the CDC measure provides substantially lower estimates than our preferred measure.
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Affiliation(s)
- Dhimitri A Nikolla
- Department of Internal Medicine / Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
- Department of Emergency Medicine, Allegheny Health Network, Erie, USA
- US Acute Care Solutions (USACS) Research Group, US Acute Care Solutions, Canton, USA
| | - Jonathan J Oskvarek
- Department of Emergency Medicine, Summa Health System, Akron, USA
- US Acute Care Solutions (USACS) Research Group, US Acute Care Solutions, Canton, USA
| | - Mark S Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, USA
- US Acute Care Solutions (USACS) Research Group, US Acute Care Solutions, Canton, USA
| | - Nishad A Rahman
- Department of Emergency Medicine, LifeBridge Health - Sinai Hospital, Baltimore, USA
- US Acute Care Solutions (USACS) Research Group, US Acute Care Solutions, Canton, USA
| | - Andrew Leubitz
- Department of Emergency Medicine, Adventist HealthCare - Shady Grove Medical Center, Rockville, USA
- US Acute Care Solutions (USACS) Research Group, US Acute Care Solutions, Canton, USA
| | - Ali Moghtaderi
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Bernard S Black
- Pritzker School of Law and Kellogg School of Management, Northwestern University, Chicago, USA
| | - Jesse M Pines
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, USA
- US Acute Care Solutions (USACS) Research Group, US Acute Care Solutions, Canton, USA
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15
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Jaafar N, Sharma R, Parkash N, Nolley EP. Decoding Altered Consciousness: An Artery of Percheron Stroke. Cureus 2024; 16:e55797. [PMID: 38586618 PMCID: PMC10999223 DOI: 10.7759/cureus.55797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
The artery of Percheron (AOP) is a unique variant of the thalamic and midbrain perforating arteries. It originates from the P1 branch of the posterior cerebral artery (PCA) and supplies the bilateral paramedian thalami (BPT) along with variable contributions to the rostral midbrain. Four infarction patterns have been identified as a result of an AOP stroke, each associated with varying prognostic outcomes. We present an 89-year-old female with an AOP infarction and discuss the associated symptoms, implicated anatomy, and prognosis.
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Affiliation(s)
- Nadim Jaafar
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Rahul Sharma
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Neeraj Parkash
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Eric P Nolley
- Critical Care Medicine, Greater Baltimore Medical Center, Towson, USA
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Schlosser-Hupf S, Aichner E, Meier M, Albaladejo-Fuertes S, Ruttmann K, Rusch S, Michels B, Mehrl A, Kunst C, Schmid S, Müller M. Evaluating the impact of interprofessional training wards on patient satisfaction and clinical outcomes: a mixed-methods analysis. Front Med (Lausanne) 2024; 11:1320027. [PMID: 38444410 PMCID: PMC10912604 DOI: 10.3389/fmed.2024.1320027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Interprofessional teamwork is pivotal in modern healthcare, prompting the establishment of interprofessional training wards since 1996. While these wards serve as hubs for optimizing healthcare professional collaboration and communication, research into patient outcomes remains notably sparse and geographically limited, predominantly examining patient satisfaction and sparingly exploring other metrics like mortality or self-discharge rates. This study seeks to bridge this gap, comparing patient outcomes in interprofessional training wards and conventional wards under the hypothesis that the former offers no disadvantage to patient outcomes. Materials and methods We explored patient outcomes within an interprofessional student ward called A-STAR at a University Hospital from October 2019 to December 2022. Engaging with patients discharged between May 2021 and April 2022, we utilized digital and paper-based anonymous questionnaires, catering to patient preference, to gather pertinent data. Results Analysis of outcomes for 1,482 A-STAR (interprofessional student ward) and 5,752 conventional ward patients revealed noteworthy findings. A-STAR patients tended to be younger (59 vs. 61 years, p < 0.01) and more frequently male (73.5% vs. 70.4%, p = 0.025). Vital clinical outcomes, such as discharges against medical advice, complication-driven readmissions, and ICU transfers, were statistically similar between groups, as were mortality rates (1.2% vs. 1.3%, p = 0.468). A-STAR demonstrated high patient satisfaction, underscored by positive reflections on team competence, ward atmosphere, and responsiveness to concerns, emphasizing the value placed on interprofessional collaboration. Patient narratives commended team kindness, lucid explanations, and proactive involvement. Discussion This data collectively underscores the safety and reliability of patient care within training wards, affirming that patients can trust the care provided in these settings. Patients on the interprofessional ward demonstrated high satisfaction levels: 96.7% appreciated the atmosphere and conduct of ward rounds. In comparison, 98.3% were satisfied with the discussion and information about their treatment during their hospital stay.
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Affiliation(s)
- Sophie Schlosser-Hupf
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Elisabeth Aichner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Marcus Meier
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sheila Albaladejo-Fuertes
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Kirstin Ruttmann
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
- Nursing Development Department of the Care Management Head Office, University Hospital Regensburg, Humboldt-Universität zu Berlin, Regensburg, Germany
| | - Sophia Rusch
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Michels
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Mehrl
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Kunst
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Zhang Y, Zhang M, Yang H, Li H, Ma S, Xi L, Li Y, Li X, Fu Z, Zhang Z, Zhang S, Gao Q, Huang Q, Wan J, Xie W, Li J, Yang P, Zhai Z. Serum proteome profiling reveals heparanase as a candidate biomarker for chronic thromboembolic pulmonary hypertension. iScience 2024; 27:108930. [PMID: 38333700 PMCID: PMC10850736 DOI: 10.1016/j.isci.2024.108930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/30/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Determining novel biomarkers for early identification of chronic thromboembolic pulmonary hypertension (CTEPH) could improve patient outcomes. We used the isobaric tag for relative and absolute quantitation approach to compare the serum protein profiles between CTEPH patients and the controls. Bioinformatics analyses and ELISA were also performed. We identified three proteins including heparanase (HPSE), gelsolin (GSN), and secreted protein acidic and rich in cysteine (SPARC) had significant changes in CTEPH. The receiver operating characteristic curve analysis showed that the areas under the curve of HPSE in CTEPH diagnosis were 0.988. Furthermore, HPSE was correlated with multiple parameters of right ventricular function. HPSE concentrations were significantly higher in patients with a low TAPSE/sPAP ratio (≤0.31 mm/mmHg) (65.4 [60.5,68.0] vs. 59.9 [35.9,63.2] ng/mL, p < 0.05). The CTEPH patients treated by balloon pulmonary angioplasty had significantly lower HPSE levels. The study demonstrates that HPSE may be a promising biomarker for noninvasive detection of CTEPH.
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Affiliation(s)
- Yunxia Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Meng Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongwei Yang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haobo Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuangshuang Ma
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Linfeng Xi
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital, Capital Medical University, Beijing, China
| | - Yishan Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xincheng Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Harbin Medical University, Harbin, China
| | - Zhihui Fu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhu Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shuai Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qian Gao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qiang Huang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wanmu Xie
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jifeng Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Department of Respiratory Disease, Capital Medical University, Beijing, China
| | - Peiran Yang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College; National Center for Respiratory Medicine; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Zhenguo Zhai
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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18
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Arsenault AC, Loftus JP, Rishniw M. Short-term parenteral infusions with high-osmolality amino acid solutions can be safely administered through peripheral catheters in dogs treated for hypoaminoacidmia-related conditions. J Am Vet Med Assoc 2024:1-6. [PMID: 38354472 DOI: 10.2460/javma.23.12.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/04/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To compare complications between central and peripheral administration of high-osmolarity (approx 700 to 1,000 mOsm/L) amino acid (± lipid) infusions. ANIMALS 18 client-owned dogs diagnosed with aminoaciduric canine hypoaminoacidemic hepatopathy syndrome or superficial necrolytic dermatitis receiving parenteral amino acid ± lipid infusions. METHODS In this retrospective case series, medical records were reviewed for administration route (central vs peripheral), catheter details and infusion characteristics (product osmolarity, concurrent lipid administration, infusion volume, duration, and rate), and complications for each infusion. RESULTS 18 dogs received 277 infusions (median, 8.5; range, 1 to 84). Effective infusion osmolarities were 683 mOsm/L in 22% of infusions, 791 mOsm/L in 8%, 802 mOsm/L in 2%, 837 mOsm/L in 45%, and 998 mOsm/L in 23% (65% peripheral, 35% central). Most (n = 230 [83%]) infusions were given peripherally. The osmolarities of solutions administered by each route (P = .53), the infusion rate indexed to body weight (P = .17), or the lipid infusion rates indexed to body weight (P = .89) did not differ. One dog suffered 2 complications in 63 infusions-1 mild, 1 severe-both occurring with peripheral infusions. Thus, the overall complication rate was 2 of 277 (0.9%) infusions. CLINICAL RELEVANCE Short-term peripherally administered amino acid ± lipid infusions < 1,000 mOsm/L confer little risk compared to centrally administered infusions. Additional studies are needed to determine the safety of infusions with longer durations. Due to the relative ease of peripheral catheterization, clinicians should consider this route for medically managing aminoaciduric canine hypoaminoacidemic hepatopathy syndrome and superficial necrolytic dermatitis in dogs.
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Pollock AB, Harrell KN, Miles MVP, Garrett ES, Carter BL, Maxwell RA. Increasing the Rate of Venous Thromboembolism Chemoprophylaxis Administration Using the Electronic Medical Record. J Pharm Pract 2024:8971900241232565. [PMID: 38355403 DOI: 10.1177/08971900241232565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Introduction: Venous thromboembolism (VTE) remains a leading cause of preventable harm among hospitalized patients. Pharmacologic VTE prophylaxis reduces the rate of in-hospital VTE by 60%, but medication administration is often missed for various reasons. Electronic medical record (EMR) prompts may be a useful tool to decrease withholding of critical VTE chemoprophylaxis medications. Methods: In August 2021, an EMR prompt was implemented at a tertiary referral academic medical center mandating nursing staff to contact a provider for approval before withholding VTE chemoprophylaxis. A pre-intervention group from August 2020 to August 2021 was compared to a post-intervention group from August 2021 to August 2022. Rates of VTE chemoprophylaxis withholding were compared between the groups with a P < .01 considered significant. Results: A total of 16,395 patients prescribed VTE chemoprophylaxis were reviewed, with 13,395 (81.7%) receiving low molecular weight heparin. Of the 16,395 patients included, 10,701 (65.3%) were medical and 5694 (34.7%) were surgical. Patients in the pre-intervention cohort (n = 8803) and post-intervention cohort (n = 7592) were similar in hospital length of stay and duration of DVT prophylaxis. In the post-intervention group, the frequency of surgical patients with at least one missed dose had increased by 4.2% (P = .002), with the trauma and acute care surgery (TACS) show an increase of 6.6% (P < .001). However, the frequency of medical patients and non-TACS patients with missed doses decreased by 3.1% (P = .002) and 1.0% (<.001), respectively. Conclusions: EMR prompts appear to be a low-cost intervention that increases the rate of VTE prophylaxis administration among medical and elective surgery patients.
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Affiliation(s)
- Aaron B Pollock
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Kevin N Harrell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - M Victoria P Miles
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | | | | | - Robert A Maxwell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
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20
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Schade Skov C, Østervang C, Brabrand M, Lassen AT, Nielsen DS. How do sepsis survivors experience life after sepsis? A Danish qualitative study exploring factors of importance. BMJ Open 2024; 14:e081558. [PMID: 38355189 PMCID: PMC10868268 DOI: 10.1136/bmjopen-2023-081558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Sepsis is a condition associated with high mortality and morbidity, and survivors often experience physical and psychological decline. Previous research has primarily focused on sepsis survivors discharged from the intensive care unit (ICU). We aimed to explore and understand the consequences of sepsis experienced by sepsis survivors in general. DESIGN A qualitative study inspired by a phenomenological hermeneutical approach was conducted. Data were analysed using systematic text condensation. SETTING Patients with sepsis were identified on admission to the emergency department and invited to an interview 3 months after discharge. PARTICIPANTS Sixteen sepsis survivors were purposively sampled and interviewed. Among these survivors, one patient was admitted to the ICU. RESULTS Three main themes were derived from the analysis: new roles in life, cognitive impairment and anxiety. Although many survivors described a physical decline, they experienced psychological and cognitive impairments after sepsis as the most influential factors in daily life. The survivors frequently experienced fatigue, withdrawals from social activities and anxiety. CONCLUSION Sepsis survivors' experiences appeared to overlap regardless of ICU admission or treatment at the general ward. Identifying patients with sepsis-related decline is important to understand and support overall patient processes and necessary in meeting specific needs of these patients after hospital discharge.
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Affiliation(s)
- Camilla Schade Skov
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Susanne Nielsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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21
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Stoppe C, Elke G, Silvstre SCDM, Kappus M. Highlights in the clinical nutrition literature: A critical appraisal of current research. JPEN J Parenter Enteral Nutr 2024. [PMID: 38310478 DOI: 10.1002/jpen.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 02/05/2024]
Abstract
Within the American Society for Parenteral and Enteral Nutrition (ASPEN), the Physician Engagement Committee (PEC) was created in 2017 by the ASPEN Board of Directors with the goal of growing the physician community both nationally and internationally. The PEC meets each month throughout the year to develop educational and research initiatives. In 2022, the PEC began an initiative to systematically review and evaluate practice-changing literature annually with the overall aim to highlight these studies at the annual ASPEN conferences and to critically discuss the potential clinical implications. The objective of the held meeting session was to present identified key papers in the fields of critical care medicine, gastroenterology and hepatology, and adult internal medicine that were published in 2022, which would complement the knowledge of the pathogenesis, diagnosis, and management of nutrition topics as well as to identify areas of future research. Overall, several large-scale randomized controlled studies were identified in each of these sections, with practice-changing major results. This manuscript summarizes the information that was presented and the discussions that followed.
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Affiliation(s)
- Christian Stoppe
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Cardiac Anesthesiology & Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Matthew Kappus
- Division of Gastroenterology and Hepatology, Duke University Health, Durham, North Carolina, USA
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22
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Cho SS, Yin E, Dalton K. Evaluation of Lead-In Direct Oral Anticoagulant Prescribing Practices in Newly Diagnosed Venous Thromboembolism. J Clin Pharmacol 2024; 64:182-188. [PMID: 37740594 DOI: 10.1002/jcph.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
Various lead-in dosing strategies have been used in clinical practice for venous thromboembolism (VTE), and guidelines do not currently address if the full lead-in dosing duration is necessary after receiving parenteral anticoagulation. This study aims to identify whether full lead-in dosing duration surrounding parenteral anticoagulation affects thrombotic and bleeding outcomes. A single-center, retrospective cohort study was conducted of hospitalized patients diagnosed with VTE and treated with apixaban or rivaroxaban. Patients were grouped depending on duration of lead-in dosing, with the full lead-in dosing group considered as the appropriate duration of the direct oral anticoagulant. The primary outcome was the recurrence of VTE within the index admission to 6 months. Secondary outcomes included major bleeding, clinically relevant minor bleeding, and mortality. Ninety-three patients were prescribed full lead-in dosing, while 99 patients received reduced lead-in dosing. The primary outcome of recurrent VTE was similar between the reduced lead-in group compared to the full lead-in group (3% vs 2%; P = 1.0). Major bleeding within the index admission was significantly higher in the reduced lead-in group: 11 versus 2 (P = .02). There were no significant differences in other secondary outcomes. Full lead-in dosing compared to reduced lead-in dosing duration for VTE had similar rates of thrombotic and mortality events. The higher rate of major bleeding in the reduced lead-in dosing group likely reflects the prescribing practices in less stable patients. This study provides evidence to support reduced lead-in dosing duration in high-risk patients without compromising efficacy outcomes.
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Affiliation(s)
- Sarah S Cho
- Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Ellen Yin
- Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Kelci Dalton
- Baylor St. Luke's Medical Center, Houston, TX, USA
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23
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Richardson C, Daniels K, Confer A, Saxon AJ, Gordon AJ, Liberto J, Albanese AP, Renner J, Edens E, Kennedy AJ. Internal Medicine Resident Addiction Training at the Veteran's Health Administration: A Qualitative Evaluation of Site Directors' Response to the 2022 ACGME Requirements. J Gen Intern Med 2024:10.1007/s11606-024-08639-4. [PMID: 38302815 DOI: 10.1007/s11606-024-08639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Substance use disorders (SUDs) are prevalent in the USA yet remain dramatically undertreated. To address this care gap, the Accreditation Council for Graduate Medical Education (ACGME) approved revisions to the Program Requirements for Graduate Medical Education (GME) in Internal Medicine, effective July 1, 2022, requiring addiction medicine training for all internal medicine (IM) residents. The Veterans Health Administration (VHA) is a clinical training site for many academic institutions that sponsor IM residencies. This focus group project evaluated VHA IM residency site directors' perspectives about providing addiction medical education within VHA IM training sites. OBJECTIVE To better understand the current state, barriers to, and facilitators of IM resident addiction medicine training at VHA sites. DESIGN This was a qualitative evaluation based on semi-structured video-based focus groups. PARTICIPANTS Participants were VHA IM site directors based at a VHA hospital or clinic throughout the USA. APPROACH Focus groups were conducted using a semi-structured group interview guide. Two investigators coded each focus group independently, then met to create a final adjudicated coding scheme. Thematic analysis was used to identify key themes. KEY RESULTS Forty-three participants from 38 VHA sites participated in four focus groups (average size: 11 participants). Six themes were identified within four pre-defined categories. Current state of training: most VHA sites offered no formal training in addiction medicine for IM residents. Barriers: addiction experts are often located outside of IM settings, and ACGME requirements were non-specific. Facilitators: clinical champions help support addiction training. Desired next steps: participants desired incentives to train or hire local champions and a pre-packaged didactic curriculum. CONCLUSIONS Developing competent clinical champions and leveraging VHA addiction specialists from non-IM settings would create more addiction training opportunities for IM trainees at VHA sites. These insights can likely be applied to IM training at non-VHA sites.
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Affiliation(s)
- Claire Richardson
- VA Puget Sound Healthcare System, University of Washington School of Medicine, Seattle, WA, USA
| | - Karin Daniels
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Andrea Confer
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Andrew J Saxon
- VA Puget Sound Healthcare System, University of Washington School of Medicine, Seattle, WA, USA
| | - Adam J Gordon
- Vulnerable Veteran Innovative Patient-Aligned-Care-Team (VIP) Initiative, Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City Health Care System, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph Liberto
- Office of Mental Health and Suicide Prevention, Substance Use Disorders, Veterans Health Administration, Washington, DC, USA
| | - Anthony P Albanese
- VA Northern California Healthcare System, UC Davis, School of Medicine, Sacramento, CA, USA
| | - John Renner
- VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Ellen Edens
- VA Connecticut Healthcare System, Yale School of Medicine, New Haven, CT, USA
| | - Amy J Kennedy
- VA Puget Sound Healthcare System, University of Washington School of Medicine, Seattle, WA, USA.
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24
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Tsevat RK, Young P, Zhang E, Baugh S, Pessegueiro AM. Implementation and Evaluation of a Pilot Narrative Medicine Curriculum for Internal Medicine Residents. Cureus 2024; 16:e53396. [PMID: 38435135 PMCID: PMC10908347 DOI: 10.7759/cureus.53396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024] Open
Abstract
Background Narrative medicine has been integrated into medical training to enhance competencies such as observation, reflection, and self-care. However, few studies have assessed the impact of a single narrative medicine session using a pre- and post-test study design. The authors of this study sought to implement a pilot narrative medicine curriculum into a large internal medicine residency program and to evaluate its feasibility and impact. Methodology The curriculum consisted of a one-hour reading and writing workshop held during ambulatory academic half-days from 2021 to 2022. Resident participants completed a retrospective pre- and post-workshop survey evaluating their interest and confidence in practicing narrative medicine skills, as well as their beliefs about the impacts of narrative medicine on patient care and provider well-being. Descriptive statistics evaluated pre- and post-workshop differences using the Wilcoxon signed-rank test. Subgroup analyses were conducted based on postgraduate year, residency track, and workshop setting. Additionally, participants completed open-ended questions that were analyzed qualitatively. Results Of 218 resident participants, 152 (69.7%) completed the post-session survey. Participants noted significantly higher levels of confidence and interest in listening to patient stories, analyzing literary texts, and engaging in reflective writing after the workshop. They also expressed significantly higher levels of agreement that engaging in literary analysis and reflective writing could improve patient care, reduce provider burnout, and strengthen connectedness with colleagues. Qualitative analysis demonstrated that participants found the sessions to be worthwhile and appreciated how narrative medicine could enhance their medical practice. Conclusions Incorporating a brief narrative medicine curriculum into an internal medicine residency program is both feasible and valuable. A single narrative medicine session was practical and well-received by residents, as it promoted self-reflection, observational skills, and connection with colleagues. Future workshops should be customized for different training levels and residency tracks, and additional studies should evaluate whether the outcomes persist over time.
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Affiliation(s)
- Rebecca K Tsevat
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
- Department of Medicine, Division of Internal Medicine-Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
- National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, USA
| | - Peter Young
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Eunice Zhang
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
- Department of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, USA
| | - Samuel Baugh
- Department of Statistics, Penn State University, University Park, USA
- Department of Statistics, University of California, Los Angeles, Los Angeles, USA
| | - Antonio M Pessegueiro
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
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25
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Escobar Gil T, McGeorge KJ, Jones AJ. A Case of Tizanidine Withdrawal and Road to Recovery. Cureus 2024; 16:e53444. [PMID: 38435197 PMCID: PMC10909376 DOI: 10.7759/cureus.53444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
This case report highlights the complexities of tizanidine withdrawal in a 68-year-old woman with chronic pain. Tizanidine, a widely used imidazole-derived muscle relaxant, poses challenges due to the absence of standardized withdrawal protocols. The patient's presentation included hypertension and tachycardia following a gradual reduction in her outpatient tizanidine dose. During the de-escalation of tizanidine, the patient experienced withdrawal symptoms, including severe body aches, hypertension, and tachycardia. Management during withdrawal involved a unique approach using a one-time dose of phenobarbital, a measure that allowed the resolution of hemodynamic instability and pain with complete discontinuation of tizanidine. The ultimate decision to transition the patient to methocarbamol and stop taking tizanidine for pain control highlights the importance of individualized care. The patient has responded to this therapy upon follow-up.
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Affiliation(s)
- Tomas Escobar Gil
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Kevin J McGeorge
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Aaron J Jones
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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26
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Wykowski JH, Kelly ME, Tong HH, Osobamiro OO, Albert TJ. An Opportunity for Change: Principles for Reforming Internal Medicine Inpatient Conferences. J Gen Intern Med 2024; 39:481-486. [PMID: 37989816 PMCID: PMC10897115 DOI: 10.1007/s11606-023-08399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 11/23/2023]
Abstract
Inpatient educational conferences are a key part of internal medicine residency training. Many residencies made conferences virtual during the COVID-19 pandemic, and are now returning to in-person sessions. As we navigate this change, we can seize this opportunity to re-evaluate the role that inpatient conferences serve in resident education. In this paper, we briefly review the history of inpatient educational conferences before offering five recommendations for improvement. Our recommendations include grounding conference formats in educational theory, leveraging the expertise of all potential educators, broadening content to include health equity and justice throughout all curricula, and explicitly focusing on cultivating community among participants. Recognizing that each residency program is different, we anticipate that these recommendations may be implemented differently based on program size, available resources, and current institutional practices. We also include examples of prior successful curricular reforms aligned with our principles. We hope these recommendations ensure inpatient conferences continue to be a central part of residency education for future generations of internal medicine residents.
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Affiliation(s)
- James H Wykowski
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Molly E Kelly
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hao H Tong
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Tyler J Albert
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
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27
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Bedross A, Siraw BB, Alkhidir A, Zaher EA, Patel P, Kumar A, Bostoros P, Sqour H, Kumar P, Eshan SH. The Impact of an Intern's Clinical Guidebook on Easing the Transition of New Interns Into the United States Healthcare System. Cureus 2024; 16:e54874. [PMID: 38533177 PMCID: PMC10964215 DOI: 10.7759/cureus.54874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
This study explores the efficacy of an intern's clinical guidebook in facilitating the transition of categorical internal medicine interns into the United States healthcare system. New interns, particularly foreign medical graduates, face multifaceted challenges during their initial year of residency. The research, conducted at Ascension Saint Joseph Hospital in Chicago, employed a quasi-experimental pre-post design involving 20 interns. Participants were provided with an intern's clinical guidebook, and their knowledge was assessed through pre and post exams. Results demonstrated a statistically significant improvement in overall knowledge, with mean scores increasing from 65% to 77.37%. Subgroup analysis revealed similar improvements among both male and female interns. Data confidentiality and ethical considerations were prioritized, with participant data anonymized and stored securely. Despite limitations, this study highlights the guidebook's potential to enhance intern education and improve the quality of care provided during the crucial transition period. Further research is recommended to validate and extend these findings.
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Affiliation(s)
- Andranik Bedross
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Bekure B Siraw
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Ayah Alkhidir
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Eli A Zaher
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Parth Patel
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Ashok Kumar
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Peter Bostoros
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Hasan Sqour
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Pardeep Kumar
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
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Dugal J, DiCaro MV, Massey B, Gupta N, Choudhury AH. Mid-ventricular Takotsubo Cardiomyopathy With Coexisting Myocardial Bridge. Cureus 2024; 16:e54868. [PMID: 38533150 PMCID: PMC10964836 DOI: 10.7759/cureus.54868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
Typical takotsubo cardiomyopathy (TCM) is a reversible form of myocardial injury that presents with a characteristic ballooning abnormality of the left ventricular apex. Typical TCM has been associated with myocardial bridging; however, mid-ventricular variant TCM has not. We describe a rare case of mid-ventricular variant TCM with a coexisting left anterior descending artery myocardial bridge and discuss management strategies. Furthermore, we propose potential pathophysiological mechanisms that may contribute to the symptomatic presentation of both conditions as a manifestation of common etiological factors.
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Affiliation(s)
- Jasmine Dugal
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
| | - Michael V DiCaro
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
| | - Blaine Massey
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
| | - Neelesh Gupta
- Cardiology, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, USA
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Cazzaniga J, Georgiyeva K, Siguenza A, Gonzalez T, Ferraro P. Using Diagnostic Radiological Imaging Modalities to Explore Neurological Dysfunction and Renal Failure in the Intersection of Hemophagocytic Lymphohistiocytosis, Macrophage Activation Syndrome, and Lupus. Cureus 2024; 16:e54005. [PMID: 38496127 PMCID: PMC10944546 DOI: 10.7759/cureus.54005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/11/2024] [Indexed: 03/19/2024] Open
Abstract
This comprehensive case report and literature review explore the intricate intersection of hemophagocytic lymphohistiocytosis (HLH), macrophage activation syndrome (MAS), and systemic lupus erythematosus (SLE) in a 39-year-old patient, emphasizing the challenging diagnostic and therapeutic landscape. The patient's journey includes neurological dysfunction, renal failure, and clinical complexities, showcasing the rarity of these overlapping conditions. The report explains the diagnostic process, clinical and laboratory findings, specialty consultations, and treatment decisions leading to the diagnosis of SLE with features of MAS overlapping with HLH. By offering insights into the latest research and clinical perspectives, this case report contributes to a deeper understanding of these disorders, aiming to guide clinicians in recognizing and managing such intricate cases effectively.
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Affiliation(s)
- Juliana Cazzaniga
- Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | | | | | | | - Pablo Ferraro
- Hematology and Oncology, Memorial Healthcare System, Pembroke Pines, USA
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Shimoni Z, Gazi M, Froom P. Do Laboratory Blood Tests Change Medical Care in Patients Hospitalized with Community-Acquired Pneumonia? Diagnostics (Basel) 2024; 14:302. [PMID: 38337819 PMCID: PMC10855841 DOI: 10.3390/diagnostics14030302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Background and Objectives: The prevalence of inappropriate laboratory testing is believed to be high, but only a limited number of studies have reviewed medical charts to determine whether tests impact medical care. Materials and Methods: From the electronic database, we selected 500 consecutive patients with community-acquired pneumonia who were hospitalized between January 2020 and October 2021. We excluded eight patients who had COVID-19, but were not identified in the database, and were only identified after chart review. To assess the impact of tests on medical care, we conducted a thorough review of the patients' charts. Results: The age of the patients was 78 ± 16 years, with 42.3% female (n = 208) hospitalized for a median of 4 days (25-75%, 3-6 days). There were 27957 laboratory test results during 2690 hospital days (10.4 tests per day of hospitalization). Of the 2997 tests carried out on admission 5.7% (n = 170) resulted in changes of medical care in 34.5% (170/492) of the patients, nearly all from the results of electrolytes, renal function tests, and serum glucose measurements. Tests that did not lead to any decision on medical care included 75.8% (7181/9478) on admission and 86.0% (15,898/18,479) on repetitive testing, i.e., repetitive testing accounted for 68.9% (15,898/23,079) of tests that did not change medical care. By excluding tests that did not change medical care, the overall testing rate would decrease by 82.6% (23,079/27,947), and from 10.4 tests per day to 2.1 tests per day. Conclusions: We conclude that the estimate of the overuse of laboratory testing, which includes all testing that does not change patient care, is much higher than reported using other methodologies. Most of the overuse was from repetitive testing that included unnecessary testing in patients without admission test results that changed medical care. Further investigation is needed to determine if these findings can be applied to patients with diverse health conditions and in different healthcare settings.
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Affiliation(s)
- Zvi Shimoni
- The Adelson School of Medicine, Ariel University, Ariel 4077625, Israel;
- Sanz Medical Center, Laniado Hospital, Netanya 4244916, Israel;
| | - Muhamad Gazi
- Sanz Medical Center, Laniado Hospital, Netanya 4244916, Israel;
| | - Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya 4244916, Israel
- School of Public Health, University of Tel Aviv, Tel Aviv 6997801, Israel
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Watari T, Gupta A, Amano Y, Tokuda Y. Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey. Intern Med 2024; 63:221-229. [PMID: 37286507 PMCID: PMC10864084 DOI: 10.2169/internalmedicine.1494-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/23/2023] [Indexed: 06/09/2023] Open
Abstract
Objective The etiologies of diagnostic errors among internal medicine physicians are unclear. To understand the causes and characteristics of diagnostic errors through reflection by those involved in them. Methods We conducted a cross-sectional study using a web-based questionnaire in Japan in January 2019. Over a 10-day period, a total of 2,220 participants agreed to participate in the study, of whom 687 internists were included in the final analysis. Participants were asked about their most memorable diagnostic error cases, in which the time course, situational factors, and psychosocial context could be most vividly recalled and where the participant provided care. We categorized diagnostic errors and identified contributing factors (i.e., situational factors, data collection/interpretation factors, and cognitive biases). Results Two-thirds of the identified diagnostic errors occurred in the clinic or emergency department. Errors were most frequently categorized as wrong diagnoses, followed by delayed and missed diagnoses. Errors most often involved diagnoses related to malignancy, circulatory system disorders, or infectious diseases. Situational factors were the most cited error cause, followed by data collection factors and cognitive bias. Common situational factors included limited consultation during office hours and weekends and barriers that prevented consultation with a supervisor or another department. Conclusion Internists reported situational factors as a significant cause of diagnostic errors. Other factors, such as cognitive biases, were also evident, although the difference in clinical settings may have influenced the proportions of the etiologies of the errors that were observed. Furthermore, wrong, delayed, and missed diagnoses may have distinctive associated cognitive biases.
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Affiliation(s)
- Takashi Watari
- General Medicine Center, Shimane University Hospital, Japan
- Medicine Service, VA Ann Arbor Healthcare System, USA
- Department of Medicine, University of Michigan Medical School, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, USA
- Department of Medicine, University of Michigan Medical School, USA
| | - Yu Amano
- Faculty of Medicine, Shimane University, Japan
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Bellofatto IA, Schindler TH, Portincasa P, Carbone F, Canepa M, Liberale L, Montecucco F. Early diagnosis and management of cardiac amyloidosis: A clinical perspective. Eur J Clin Invest 2024:e14160. [PMID: 38217112 DOI: 10.1111/eci.14160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024]
Abstract
Cardiac amyloidosis multidisciplinary team (MDT). We propose the creation of a multidisciplinary team (MDT) for cardiac amyloidosis in which internal medicine physicians could take a lead role in coordinating other specialists involved in patient care. Created with BioRender.com.
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Affiliation(s)
- Ilaria Anna Bellofatto
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, Bari, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino-Italian Cardiovascular Network, Genoa, Italy
| | - Marco Canepa
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino-Italian Cardiovascular Network, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino-Italian Cardiovascular Network, Genoa, Italy
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Giangregorio F, Mosconi E, Debellis MG, Palermo E, Provini S, Mendozza M, Ricevuti L, Esposito C. Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients. Ultrasound Int Open 2024; 10:a21961599. [PMID: 38304447 PMCID: PMC10829908 DOI: 10.1055/a-2196-1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/22/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.
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Bolshakova M, González JL, Thompson T, Schneberk T, Sussman S, Unger JB, Bluthenthal RN. A qualitative analysis of internal medicine residents' experience with substance use disorder education and training: a pilot study. J Addict Dis 2024; 42:63-70. [PMID: 36330994 DOI: 10.1080/10550887.2022.2139580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD. OBJECTIVES This study explored resident physicians' experiences with SUD education throughout medical school and residency and qualitatively evaluated whether a SUD initiative improved resident's knowledge and efficacy of treating various SUDs. METHODS We implemented a brief (seven hours total) educational initiative focused on treating SUDs virtually over the course of an academic year for residents enrolled in the University of Southern California Internal Medicine Residency program. Semi-structured interviews were conducted with residents after completion of the initiative. A thematic analysis was conducted to identify common themes that emerged from the qualitative data. RESULTS Every resident noted receiving insufficient training for the treatment of SUDs prior to the initiative. The initiative was viewed favorably, and participants particularly appreciated having an introduction to prescribing medication for the treatment of SUD such as buprenorphine. Despite the perceived success of the initiative in increasing awareness of treatment modalities for SUD, residents expressed a lack of comfort in handling SUD cases and desired additional practical lectures and application of knowledge through increased experiential training. CONCLUSIONS SUD education and training appears to be a useful constituent of resident training and should be included in the standard curriculum and rotations. Residency programs should consider including formal education, hands-on practice, and providing adequate resources for residents to develop their capabilities to care for patients with SUD.
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Affiliation(s)
- Maria Bolshakova
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - José Luis González
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- LAC + USC Medical Center, Los Angeles, CA, USA
| | - Tiana Thompson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Heredia NI, John JC, Singh S, Hwang JP, Strong LL, Balakrishnan M, McNeill LH. Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study. Inquiry 2024; 61:469580241241272. [PMID: 38529894 DOI: 10.1177/00469580241241272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Primary care physicians (PCPs) are well suited to manage patients with non-alcoholic fatty liver disease (NAFLD), but the limited, existing research suggests inadequate knowledge about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to further understand the knowledge and practices for the diagnosis and management of NAFLD among PCPs. We conducted in-depth interviews with PCPs in the Greater Houston area, addressing current clinical practices used for diagnosing and managing NAFLD, as well as the perceptions of the PCPs regarding the burden of NAFLD on patients. We recorded interviews, transcribed them, coded transcripts, and identified patterns and themes. The interviewed PCPs (n = 16) were from internal or family medicine, with a range of experience (1.5-30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. Patients with abnormal liver imaging who had insurance or were within a safety-net healthcare system were referred by PCPs to specialists. Uninsured patients with persistently elevated liver enzymes received lifestyle recommendations from PCPs without confirmatory imaging or specialist referral. The role of PCPs in NAFLD management varied, with some helping patients set dietary and physical activity goals while others provided only general recommendations and/or referred patients to a dietitian. The diagnosis and management of NAFLD vary widely among PCPs and may be impacted by patients' insurance status and clinic-specific practices. The increasing burden of NAFLD in the U.S. medical system highlights the need for more PCPs involvement in managing NAFLD.
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Affiliation(s)
- Natalia I Heredia
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
- Center for Health Equity, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
| | - Jemima C John
- Center for Health Equity, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
- Department of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
| | - Sonia Singh
- The University of Texas Health Science Center at Houston, Houston TX, USA
| | - Jessica P Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larkin L Strong
- Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maya Balakrishnan
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Lorna H McNeill
- Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Jewiss J, Natkin LW, Clark/Keefe K, Crocker A, Welkowitz JA. Integrating behavioural health and primary care: qualitative findings on contextual factors that influence integration. Fam Pract 2023; 40:768-775. [PMID: 36943292 DOI: 10.1093/fampra/cmad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Integrating behavioural health care into primary care practices may increase patients' access to behavioural health services and improve health outcomes. However, few studies have explored factors that influence integration processes. OBJECTIVE We sought to better understand contextual factors that support or impede behavioural health integration in primary care practices. METHODS We conducted 71 semi-structured interviews with providers, staff, and leaders from eight primary care practices in the United States with integrated behavioural health services, which were participating in a randomized control, pragmatic trial: Integrating Behavioural Health and Primary Care. Practices were selected for diversity on geographic location, size, ownership, and experience with integration. We conducted a thematic analysis of the qualitative data derived from the interviews. RESULTS We identified four categories of contextual factors influencing behavioural health integration: leadership commitment to integration, financial considerations, workflow and communication systems, and providers' perspectives on integration and team-based healthcare. Supportive factors included leaders' commitment to integration, adequate staffing, customized communication and workflow systems, collaborative practice culture, and healthy working relationships amongst providers. Impediments included staffing issues and payment models that do not reimburse for activities required to support integrated care. CONCLUSION Interviewees described various benefits of integration, including providers feeling better equipped to address patients' needs due to collaboration between medical and behavioural providers and resulting interdisciplinary learning. Given concerns about provider burnout, this finding warrants further study.
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Affiliation(s)
- Jennifer Jewiss
- Department of Education, University of Vermont, Burlington, VT, United States
| | - Lisa W Natkin
- Department of Medicine, University of Vermont, Burlington, VT, United States
| | - Kelly Clark/Keefe
- Department of Education, University of Vermont, Burlington, VT, United States
| | - Abigail Crocker
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT, United States
| | - Julie A Welkowitz
- Department of Counseling, Human Development and Family Science, University of Vermont, Burlington, VT, United States
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Ben-Aharon I, Rotem R, Melzer-Cohen C, Twig G, Cercek A, Half E, Goshen-Lago T, Chodik G, Kelsen D. Pharmaceutical Agents as Potential Drivers in the Development of Early-Onset Colorectal Cancer: Case-Control Study. JMIR Public Health Surveill 2023; 9:e50110. [PMID: 37933755 PMCID: PMC10753427 DOI: 10.2196/50110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND The incidence of early-onset colorectal cancer (EOCRC) rose abruptly in the mid 1990s, is continuing to increase, and has now been noted in many countries. By 2030, 25% of American patients diagnosed with rectal cancer will be 49 years or younger. The large majority of EOCRC cases are not found in patients with germline cancer susceptibility mutations (eg, Lynch syndrome) or inflammatory bowel disease. Thus, environmental or lifestyle factors are suspected drivers. Obesity, sedentary lifestyle, diabetes mellitus, smoking, alcohol, or antibiotics affecting the gut microbiome have been proposed. However, these factors, which have been present since the 1950s, have not yet been conclusively linked to the abrupt increase in EOCRC. The sharp increase suggests the introduction of a new risk factor for young people. We hypothesized that the driver may be an off-target effect of a pharmaceutical agent (ie, one requiring regulatory approval before its use in the general population or an off-label use of a previously approved agent) in a genetically susceptible subgroup of young adults. If a pharmaceutical agent is an EOCRC driving factor, regulatory risk mitigation strategies could be used. OBJECTIVE We aimed to evaluate the possibility that pharmaceutical agents serve as risk factors for EOCRC. METHODS We conducted a case-control study. Data including demographics, comorbidities, and complete medication dispensing history were obtained from the electronic medical records database of Maccabi Healthcare Services, a state-mandated health provider covering 26% of the Israeli population. The participants included 941 patients with EOCRC (≤50 years of age) diagnosed during 2001-2019 who were density matched at a ratio of 1:10 with 9410 control patients. Patients with inflammatory bowel disease and those with a known inherited cancer susceptibility syndrome were excluded. An advanced machine learning algorithm based on gradient boosted decision trees coupled with Bayesian model optimization and repeated data sampling was used to sort through the very high-dimensional drug dispensing data to identify specific medication groups that were consistently linked with EOCRC while allowing for synergistic or antagonistic interactions between medications. Odds ratios for the identified medication classes were obtained from a conditional logistic regression model. RESULTS Out of more than 800 medication classes, we identified several classes that were consistently associated with EOCRC risk across independently trained models. Interactions between medication groups did not seem to substantially affect the risk. In our analysis, drug groups that were consistently positively associated with EOCRC included beta blockers and valerian (Valeriana officinalis). Antibiotics were not consistently associated with EOCRC risk. CONCLUSIONS Our analysis suggests that the development of EOCRC may be correlated with prior use of specific medications. Additional analyses should be used to validate the results. The mechanism of action inducing EOCRC by candidate pharmaceutical agents will then need to be determined.
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Affiliation(s)
- Irit Ben-Aharon
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Ran Rotem
- Harvard T Chan School of Public Health, Boston, MA, United States
| | - Cheli Melzer-Cohen
- KSM Research and Innovation Center, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Gilad Twig
- The Institute of Endocrinology Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Andrea Cercek
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth Half
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Tal Goshen-Lago
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Gabriel Chodik
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Kelsen
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Weill Cornell Medical College, New York, NY, United States
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Kanjee Z, Beltran CP, Smith CC, Tibbles CD, Lewis JJ, Sullivan AM. "Two Years Later I'm Still Just as Angry": A Focus Group Study of Emergency and Internal Medicine Physicians on Disrespectful Communication. Teach Learn Med 2023:1-11. [PMID: 38041804 DOI: 10.1080/10401334.2023.2288706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/07/2023] [Indexed: 12/04/2023]
Abstract
Phenomenon: Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. Approach: In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center. Findings: We organized focus group results into four overarching categories related to disrespectful communication: characteristics and context (including specific phrasing that members from each department interpreted as disrespectful, effects of listener engagement/disengagement, and the tendency for communication that is not in-person to result in misunderstanding and conflict); differences across training levels (with disrespectful communication more likely when participants were at different training levels); the individual correspondent's tendency toward perceived rudeness; and negative/long-term impacts of disrespectful communication on the individual and environment (including avoidance and effects on patient care). Insights: In the context of predominantly positive descriptions of interdepartmental communication, participants described episodes of perceived disrespectful behavior that often had long-lasting, negative impacts on the quality of the learning environment and clinical work. We created a conceptual model illustrating the process and outcomes of these interactions. We make several recommendations to reduce disrespectful communication that can be applied throughout the hospital to potentially improve patient care, interdepartmental collaboration, and trainee and faculty quality of life.
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Affiliation(s)
- Zahir Kanjee
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christine P Beltran
- Program for Medical Education Innovations and Research, New York University Grossman School of Medicine, New York, New York, USA
| | - C Christopher Smith
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Carrie D Tibbles
- Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jason J Lewis
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Amy M Sullivan
- Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Saunders Corea J, Schwartz KB, Fonarov I, Casadesus D. Acute Generalized Exanthematous Pustulosis in a Hemodialysis Patient. Cureus 2023; 15:e50354. [PMID: 38213362 PMCID: PMC10781596 DOI: 10.7759/cureus.50354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/13/2024] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is an uncommon skin condition that should be considered when evaluating patients with severe skin eruptions accompanied by systemic symptoms. We present a woman in her 70s with end-stage renal disease on hemodialysis who developed a generalized pruritic rash seven days after the administration of pre-procedure vancomycin and acetaminophen. Our patient underwent a biopsy with findings consistent with AGEP. This report highlights the need to consider AGEP in patients with severe cutaneous eruptions and systemic involvement. Prompt biopsy and blood cultures are essential to prevent misdiagnosis and treatment delays.
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Affiliation(s)
| | - Kaley B Schwartz
- Internal Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Ilya Fonarov
- Primary Care, Orlando College of Osteopathic Medicine, Orlando, USA
- Hospital Medicine, Jackson Memorial Hospital, Miami, USA
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Kerins J, Smith SE, Tallentire VR. "Ego massaging that helps": a framework analysis study of internal medicine trainees' interprofessional collaboration approaches. Med Educ Online 2023; 28:2243694. [PMID: 37535844 PMCID: PMC10402837 DOI: 10.1080/10872981.2023.2243694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Patient care depends on collaborative practice. Debate remains as to the best approach to providing education for collaboration, with educational interventions often far removed from the realities of the clinical workplace. Understanding the approaches used for collaboration in clinical practice could inform practical strategies for training. For internal medicine trainees, this involves collaboration with other professions but also with other specialties. This study aimed to explore the approaches that internal medicine trainees use for interprofessional collaboration and the ways that these approaches vary when internal medicine trainees interact with different healthcare provider groups. METHODS Following ethical approval and participant consent, interprofessional communication workshops between August 2020 and March 2021 were audio recorded and transcribed verbatim. Workshops involved groups of internal medicine trainees discussing collaboration challenges and the approaches they use in clinical practice. This framework analysis study used the interprofessional collaboration framework described by Bainbridge and Regehr (building social capital, perspective taking and negotiating priorities and resources), and cross-referenced the categorised data with the healthcare groups that trainees collaborate with, to look for patterns in the data. RESULTS Seventeen workshops, involving 100 trainees, were included. Trainees described relationship building, perspective taking and negotiating priorities and resources. Relationship building was a modification to the original framework domain of building social capital. Themes of power and civility transcended domains with evidence of using hierarchy as leverage when negotiating and employing civility as a tactical approach throughout. DISCUSSION This bi-dimensional analysis highlights patterns of perspective taking when collaborating with other specialties and professions, and the approaches to negotiation of courting favour and coercion when interacting with other specialties. This study provides evidence of the strategies currently utilised by internal medicine trainees, with different healthcare groups, and presents a modified framework which could inform the development of training for collaboration.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Acute medicine, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
- Medical Directorate, NHS Education for Scotland, Edinburgh, Scotland, UK
- College of Medicine and Vetinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK
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Fumagalli M, Landgraaf RG, Schiavi-Lods NN, Golcea SS, Büller HR, Nieuwdorp M. Novel insights into weight loss: acupuncture combined with a very low-carbohydrate diet-a Swiss experience. Acupunct Med 2023; 41:327-335. [PMID: 37789716 PMCID: PMC10656784 DOI: 10.1177/09645284231202811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE The objective of this study was to assess the effects of an acupuncture-diet program for treatment of overweight and obesity. METHODS The program consisted of weekly acupuncture sessions combined with a very low-carbohydrate diet in patients with a body mass index (BMI) of 25 kg/m2 or above. Data were collected retrospectively between 2002 and 2021 in seven clinics in Switzerland through automated data extraction of existing medical records. The treatments described are standard care at the facilities where they took place. RESULTS A total of 11,233 patients were included. In those with a BMI of 25 kg/m2 or above, a positive effect on body weight was noted with a peak average body weight loss of approximately 17.5 kg reached after 7 months. Long-term stabilization was at about 15.5 kg after 18 months. Significant male-female differences (p < 0.01) were observed with women losing less weight. Differences were also noted between overweight, obese and extremely obese patients suggesting a BMI-dependent effect. Maximum weight loss of patients with BMI of 35 kg/m2 or above was 29.8 ± 12 kg, while it was 18.8 ± 8 kg for obese patients (BMI = 30-34.9 kg/m2) and 12 ± 7 kg for overweight patients (BMI = 25-29.9 kg/m2), reflecting a significant overall difference between groups (p < 0.01). Compliance to the protocol by patients and physicians seemed to be another differentiating factor; more adherent patients appeared to lose more weight and preserve body weight loss better over time. CONCLUSION Although this study lacked a control group and was retrospective and observational in nature, a program of acupuncture combined with a very low-carbohydrate diet appeared to be effective at inducing weight loss among obese patients. The observed weight reduction in this retrospective chart review represents a good starting point for further investigation of this approach via a comparative evaluation.
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Affiliation(s)
| | - Raymond G Landgraaf
- Sinomedica, Lugano, Switzerland
- Department of Internal and Vascular Medicine, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Harry R Büller
- Department of Internal and Vascular Medicine, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
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Al-Zaman N, Alem A, Alharbi OA, Ahmed Abdullah E, Azouni DW, Hammad RK, Alhejaily RM, Albadrani M. Physicians' Knowledge, Attitudes and Barriers Regarding Chronic Kidney Disease Diagnosis and Management in Saudi Arabia. Cureus 2023; 15:e50247. [PMID: 38196437 PMCID: PMC10774705 DOI: 10.7759/cureus.50247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is defined as abnormalities of kidney structure and/or function persisting for a minimum of three months. METHODS An online cross-sectional study was conducted in the Kingdom of Saudi Arabia (KSA) between June and August 2022 to assess the knowledge, attitudes, practices, and barriers among family, internal medicine, and general physicians related to CKD screening, diagnosis, and management. RESULTS A total of 427 physicians were included in the study. The majority exhibited a strong grasp of the accurate definition of CKD (83%) and recognized common risk factors, such as diabetes (99%), drugs (95%), and hypertension (98%). Two-thirds of physicians were aware of the five stages of CKD and identified estimated glomerular filtration rate (eGFR) and creatinine clearance as the most suitable markers for kidney function. Physicians also displayed knowledge of CKD-related complications. However, a noticeable gap between knowledge and practice was evident. Only one-third of participants reported screening their patients every year, primarily using serum creatinine (92.5%) and eGFR (97%) for diagnosis, while only 16% recognized that stage 4 CKD is the appropriate time to refer patients to nephrologists. In terms of barriers, the majority of physicians reported encountering low barriers to CKD management, but general practitioners working in primary healthcare centers experienced significantly higher levels of barriers. CONCLUSION Most participants in our study possess a good level of knowledge and positive attitudes towards CKD diagnosis and management. Nevertheless, a discrepancy between knowledge and practical application, particularly in terms of over-screening and early referral, highlights the need for educational efforts to improve physician practice in KSA. These findings underscore the importance of addressing this gap to promote effective CKD management.
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Affiliation(s)
- Naweed Al-Zaman
- Internal Medicine, College of Medicine, Taibah University, Medina, SAU
| | - Alaa Alem
- Internal Medicine, College of Medicine, Taibah University, Medina, SAU
| | - Ohood A Alharbi
- Medicine, College of Medicine, Taibah University, Medina, SAU
| | | | - Duha W Azouni
- Medicine, College of Medicine, Taibah University, Medina, SAU
| | - Raghad K Hammad
- Medicine, College of Medicine, Taibah University, Medina, SAU
| | | | - Muayad Albadrani
- Family and Community Medicine, College of Medicine, Taibah University, Medina, SAU
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Gardner TA, Breitbach EK, Limes JE, Connors GR, Berry AR, Longino AA, Shah S, Fainstad B, Miller TM, Ortiz-Lopez C, Fleshner M. A Quality Improvement Approach to Modification of a Point-of-Care Ultrasound Curriculum. ATS Sch 2023; 4:538-545. [PMID: 38196688 PMCID: PMC10773275 DOI: 10.34197/ats-scholar.2023-0018in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/29/2023] [Indexed: 01/11/2024] Open
Abstract
Background There is increasing emphasis on resident involvement in quality improvement (QI) efforts, yet resident engagement in QI has remained low for many reasons. Although QI methods are classically applied to clinical processes, there are many opportunities to incorporate QI principles into curricular design and implementation. Objective Demonstrate the utility of QI methods when applied to curricular design and the implementation of a novel point-of-care ultrasound portfolio development and quality assurance program at a large internal medicine residency program. Methods We applied foundational QI methods, including process mapping, plan-do-study-act (PDSA) cycles, time-trap identification, run-chart analysis, and qualitative interviews throughout the curricular design and implementation phases to rapidly identify areas for improvement and perform timely tests of change. Results Fifty-one interns participated in the curriculum, submitting 731 images in the first trimester. Process mapping and submission review revealed that 29% of images were saved to the incorrect digital archive. Resident-reviewer interpretation concordance was present in 80.7% of submissions. In 95.2% of completed quality assurance cards, the same information was provided in the commentary feedback and the evaluator's checklists, representing a time trap. Interventions included restricting access to image archives and removing redundant fields from quality assurance cards. The time to feedback fell from 69.5 to 6.5 days, demonstrating nonrandom variation via run-chart analysis. Conclusion This pilot study demonstrates the successful application of QI methods to a novel point-of-care ultrasound curriculum. The systematic use of these methodologies in curricular design and implementation allows expeditious curricular improvement. Emphasizing the relevance of QI methods to subject matter beyond clinical processes may increase resident engagement in QI efforts.
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Affiliation(s)
| | | | | | | | - Andrew R. Berry
- Division of Hospital Medicine, Rocky Mountain VA Medical Center
| | | | - Sneha Shah
- Division of Hospital Medicine, Rocky Mountain VA Medical Center
| | - Brandon Fainstad
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tyler M. Miller
- Division of Hospital Medicine, Rocky Mountain VA Medical Center
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Ryden AG, Fuller TC, Rose RS, Lappe KL, Raaum S, Johnson SA. Comparison of internal medicine applicant and resident characteristics with performance on ACGME milestones. Med Educ Online 2023; 28:2211359. [PMID: 37166474 PMCID: PMC10177668 DOI: 10.1080/10872981.2023.2211359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Internal medicine (IM) residency programs select applicants based on several metrics. Factors predicting success during residency are unclear across studies. To identify whether specific applicant or resident factors are associated with IM resident performance using ACGME milestones. We tested for associations between applicant factors available prior to the start of IM residency and resident factors measured during IM residency training, and resident performance on ACGME milestones across three consecutive years of IM training between 2015-2020. Univariable and multivariable linear regression modeling was used to test associations. Eighty-nine categorical IM residents that completed 3 consecutive years of training were included. Median age was 28 years (IQR 27-29) and 59.6% were male. Mean ACGME milestone scores increased with each post-graduate year (PGY) from 3.36 (SD 0.19) for PGY-1, to 3.80 (SD 0.15) for PGY-2, to 4.14 (SD 0.15) for PGY-3. Univariable modeling suggested referral to the clinical competency committee (CCC) for professionalism concerns was negatively associated with resident performance during each PGY. No applicant or resident factors included in the final multivariable regression models (age at starting residency, USMLE Step scores, interview score, rank list position, ITE scores) were associated with ACGME milestone scores for PGY-1 and PGY-2. Referral to the CCC for professionalism was negatively associated with resident performance during PGY-3. Residency selection factors did not predict resident milestone evaluation scores. Referral to the CCC was associated with significantly worse resident evaluation scores, suggesting professionalism may correlate with clinical performance.
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Affiliation(s)
- Alex G Ryden
- Internal Medicine Residency Program, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Trent C Fuller
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Richard S Rose
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of General Internal Medicine, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Katie L Lappe
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sonja Raaum
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stacy A Johnson
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Zhang F, Zhang X, Peng Q, Tang L. Electroacupuncture of the cymba concha alleviates p-chlorophenylalanine-induced insomnia in mice. Acupunct Med 2023; 41:345-353. [PMID: 37081732 DOI: 10.1177/09645284231160193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Insomnia is the most common sleep disorder and is often comorbid with mental and physical diseases. The present study was designed to investigate the hypnotic effect of electroacupuncture (EA) of the cymba concha to stimulate the auricular branch of the vagus nerve (ABVN). METHODS Mice were intraperitoneally injected with p-chlorophenylalanine (PCPA, 300 mg/kg·d) for 2 days to induce insomnia and subsequently received EA or manual acupuncture (MA) of the cymba concha for 30 min once daily for 5 consecutive days, or no treatment. The phenobarbital-induced sleep test was used to analyze the hypnotic effects and the open field test was used to analyze the locomotor activities and anxiolytic effects of EA/MA of the cymba concha. In addition, the levels of gamma-aminobutyric acid (GABA) and glutamate (Glu) in the hypothalamus and peripheral blood were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS PCPA injection significantly decreased sleep duration, increased sleep latency and induced anxiety-like behaviors in mice. In PCPA-insulted mice, EA of the cymba concha improved the sleep disturbance by significantly prolonging sleep duration, while no change in sleep latency was observed. Moreover, EA of the cymba concha improved PCPA-induced anxiety-like behaviors without decreasing locomotor activities in the open field test. EA of the cymba concha increased the level of GABA in the hypothalamus and peripheral blood, while Glu concentrations remained unchanged. CONCLUSION These findings indicate that EA of the region innervated by the ABVN upregulates GABA levels in the hypothalamus and ameliorates the symptoms of insomnia and anxiety, suggesting that EA of the cymba concha might have potential value as an intervention for insomnia.
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Affiliation(s)
- Fenyan Zhang
- Department of Neurology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoming Zhang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Sub-Health Institute, Hubei University of Chinese Medicine, Wuhan, China
| | - Qi Peng
- University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Tang
- Department of Neurology, University-Town Hospital of Chongqing Medical University, Chongqing, China
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Camargo CHF, Coutinho L, Neto YC, Engelhardt E, Filho PM, Walusinski O, Teive HAG. Jean-Martin Charcot: the polymath. Arq Neuropsiquiatr 2023; 81:1098-1111. [PMID: 37899048 PMCID: PMC10756797 DOI: 10.1055/s-0043-1775984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/29/2023] [Indexed: 10/31/2023]
Abstract
Jean-Martin Charcot, widely regarded as a leading founder of modern neurology, made substantial contributions to the understanding and characterization of numerous medical conditions. His initial focus was on internal medicine, later expanding to include neuropathology, general neurology, and eventually emerging fields such as neuropsychology and neuropsychiatry. Furthermore, Charcot's intellectual pursuits extended beyond medicine, encompassing research in art history, medical iconography, sociology, religious studies, and the arts, solidifying his status as a polymath.
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Affiliation(s)
- Carlos Henrique Ferreira Camargo
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna, Disciplina de Doenças Neurodegenerativas, Curitiba PR, Brazil.
| | - Léo Coutinho
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna, Disciplina de Doenças Neurodegenerativas, Curitiba PR, Brazil.
| | - Ylmar Correa Neto
- Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Serviço de Neurologia, Florianópolis SC, Brazil.
| | - Eliasz Engelhardt
- Universidade Federal do Rio de Janeiro, Instituto de Neurologia Deolindo Couto e Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.
| | - Pericles Maranhão Filho
- Universidade Federal do Rio de Janeiro, Departamento de Clínica Médica, Serviço de Neurologia, Rio de Janeiro RJ, Brazil.
| | | | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna, Disciplina de Doenças Neurodegenerativas, Curitiba PR, Brazil.
- Universidade Federal do Paraná, Departamento de Clínica Médica, Serviço de Neurologia, Curitiba PR, Brazil.
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Yortanlı BC, Ecirli S, Soykan Sert Z. Prevalence of Iron Deficiency and Iron Deficiency Anemia Among Nursing Students Working in the Internal Medicine Clinic. Cureus 2023; 15:e51212. [PMID: 38283473 PMCID: PMC10819089 DOI: 10.7759/cureus.51212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Objective The objective of this study is to evaluate the frequency of iron deficiency (ID) and iron deficiency anemia (IDA) among nursing students working in the internal medicine clinic of our hospital. Methods The study was designed as a prospective cohort study. The study population comprised nursing students working in the internal medicine clinic of our hospital from January 1, 2016, through June 1, 2016. Data concerning the participants' anamnesis, physical examination findings, and sociodemographic characteristics were recorded. Blood samples were taken. The participants' blood parameters were evaluated for anemia. Results A total of 99 nursing students, 43 (43.4%) male and 56 (56.6%) female, were included in the study. The mean age was 17.4 ± 0.58 years for the male student group and 17.64 ± 0.73 years for the female student group. We detected ID in 22.2% of the nursing students, anemia in 8%, and IDA in 4%. ID was present in 22 (39.3%) of the female students. There was a significant difference between the male and female student groups in terms of the prevalence of ID (p < 0.001). The mean hemoglobin levels of the male and female student groups were 15.85 ± 1.10 g/dL and 12.90 ± 1.05 g/dL, respectively. Conclusion We determined that the number of students with ID was higher than the number of students with IDA. Once ID is diagnosed, it may be necessary to take precautions and treat it according to the severity of the deficiency. It is extremely important to educate nursing students and raise their awareness about ID and IDA.
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Affiliation(s)
| | - Samil Ecirli
- Department of Internal Medicine, Private Academy Meram Hospital, Konya, TUR
| | - Zekiye Soykan Sert
- Department of Gynecology and Obstetrics, Aksaray University School of Medicine, Aksaray, TUR
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Williams KH, Jagadish A, Shah R. A Case of Pasteurella Bacteremia in a Patient With Hepatocellular Carcinoma. Cureus 2023; 15:e50161. [PMID: 38186515 PMCID: PMC10771712 DOI: 10.7759/cureus.50161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Pasteurella multocida is a Gram-negative coccobacillus commonly associated with soft tissue and skin infections. On rare occasions, it may result in systemic bacteremia and sepsis. Our case describes a 59-year-old male who presented to the emergency department with septic shock. Physical examination was remarkable for bilateral lower extremity wounds which were in recent contact with feline oral secretions. Blood cultures were obtained and resulted in the growth of P. multocida after 48 hours. His treatment involved intravenous antibiotics and supportive care. After finishing his two-week course of antibiotics, he was placed on inpatient hospice care due to his clinical course involving other comorbidities and expired shortly after. This case highlights the importance of early recognition and treatment of P. multocida infection in patients with comorbid conditions such as hepatocellular carcinoma.
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Affiliation(s)
- Kendrick H Williams
- Internal Medicine, East Tennessee State University, James H. Quillen College of Medicine, Johnson City, USA
| | - Ashwin Jagadish
- Internal Medicine, East Tennessee State University, James H. Quillen College of Medicine, Johnson City, USA
| | - Rupal Shah
- Internal Medicine, East Tennessee State University, James H. Quillen College of Medicine, Johnson City, USA
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Hald JD, Keerie C, Weir CJ, Javaid MK, Lam W, Osborne P, Walsh J, Langdahl BL, Ralston SH. Protocol of a randomised trial of teriparatide followed by zoledronic acid to reduce fracture risk in adults with osteogenesis imperfecta. BMJ Open 2023; 13:e078164. [PMID: 37993151 PMCID: PMC10668140 DOI: 10.1136/bmjopen-2023-078164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Osteogenesis imperfecta (OI) is a rare genetic disease associated with multiple fractures throughout life. It is often treated with osteoporosis medications but their effectiveness at preventing fractures is unknown. The Treatment of Osteogenesis Imperfecta with Parathyroid Hormone and Zoledronic Acid trial will determine if therapy with teriparatide (TPTD) followed by zoledronic acid (ZA) can reduce the risk of clinical fractures in OI. METHODS AND ANALYSIS Individuals aged ≥18 years with a clinical diagnosis of OI are eligible to take part. At baseline, participants will undergo a spine X-ray, and have bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) at the spine and hip. Information on previous fractures and previous bone targeted treatments will be collected. Questionnaires will be completed to assess pain and other aspects of health-related quality of life (HRQoL). Participants will be randomised to receive a 2-year course of TPTD injections 20 µg daily followed by a single intravenous infusion of 5 mg ZA, or to receive standard care, which will exclude the use of bone anabolic drugs. Participants will be followed up annually, have a repeat DXA at 2 years and at the end of study. Spine X-rays will be repeated at the end of study. The duration of follow-up will range between 2 and 8 years. The primary endpoint will be new clinical fractures confirmed by X-ray or other imaging. Secondary endpoints will include participant reported fractures, BMD and changes in pain and HRQoL. ETHICS AND DISSEMINATION The study received ethical approval in December 2016. Following completion of the trial, a manuscript will be submitted to a peer-reviewed journal. The results will inform clinical practice by determining if TPTD/ZA can reduce the risk of fractures in OI compared with standard care. TRIAL REGISTRATION NUMBER ISRCTN15313991.
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Affiliation(s)
- Jannie D Hald
- Department of Endocrinology and Internal Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Muhammad K Javaid
- Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Wayne Lam
- Centre for Genomic and Experimental Medicine, University of Edinburgh Western General Hospital, Edinburgh, UK
| | | | - Jennifer Walsh
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Bente L Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, University of Edinburgh Western General Hospital, Edinburgh, UK
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50
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Pilosof NP, Barrett M, Oborn E, Barkai G, Zimlichman E, Segal G. Designing for flexibility in hybrid care services: lessons learned from a pilot in an internal medicine unit. Front Med Technol 2023; 5:1223002. [PMID: 38053662 PMCID: PMC10694442 DOI: 10.3389/fmedt.2023.1223002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Digital transformation in healthcare during the COVID-19 pandemic led to the development of new hybrid models integrating physical and virtual care. The ability to provide remote care by telemedicine technologies and the need to better manage and control hospitals' occupancy accelerated growth in hospital-at-home programs. The Sheba Medical Center restructured to create Sheba Beyond as the first virtual hospital in Israel. These transformations enabled them to deliver hybrid services in their internal medicine unit by managing inpatient hospital-care with remote home-care based on the patients' medical condition. The hybrid services evolved to integrate care pathways multiplied by the mode of delivery-physical (in person) or virtual (technology enabled)-and the location of care-at the hospital or the patient home. The study examines this home hospitalization program pilot for internal medicine at Sheba Medical Center (MC). The research is based on qualitative semi-structured interviews with Sheba Beyond management, medical staff from the hospital and the Health Maintenance Organization (HMO), Architects, Information Technology (IT), Telemedicine and Medtech organizations. We investigated the implications of the development of hybrid services for the future design of the physical built-environment and the virtual technological platform. Our findings highlight the importance of designing for flexibility in the development of hybrid care services, while leveraging synergies across the built environment and digital platforms to support future models of care. In addition to exploring the potential for scalability in accelerating the flexibility of the healthcare system, we also highlight current barriers in professional, management, logistic and economic healthcare models.
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Affiliation(s)
- Nirit Putievsky Pilosof
- Cambridge Digital Innovation—CJBS & Hughes Hall, University of Cambridge, Cambridge, United Kingdom
- Cambridge Judge Business School (CJBS), University of Cambridge, Cambridge, United Kingdom
| | - Michael Barrett
- Cambridge Digital Innovation—CJBS & Hughes Hall, University of Cambridge, Cambridge, United Kingdom
- Cambridge Judge Business School (CJBS), University of Cambridge, Cambridge, United Kingdom
| | - Eivor Oborn
- Warwick Business School, The University of Warwick, Coventry, United Kingdom
| | - Galia Barkai
- Sheba Beyond Virtual Hospital, Sheba Medical Center, Israel Ministry of Health, Ramat Gan, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sheba Medical Center, Israel Ministry of Health, Ramat Gan, Israel
- Sheba’s Talpiot Medical Leadership Program, Ramat Gan,Israel
| | - Gad Segal
- Sheba Beyond Virtual Hospital, Sheba Medical Center, Israel Ministry of Health, Ramat Gan, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sheba Medical Center, Israel Ministry of Health, Ramat Gan, Israel
- Education Authority, Sheba Medical Center, Ramat Gan,Israel
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