General Medicine Units Research Articles

Prevalence, clinical characteristics, and health outcomes of dysmagnesemia measured by ionized and total body concentrations among medically hospitalized patients

Ionized Mg (iMg) may offer a more reliable indicator of Mg status during acute illness than total Mg (tMg) concentrations. This study aimed to determine the prevalence of dysmagnesemia and their relationship using iMg and tMg. The clinical and biochemical characteristics as well as health outcomes and their association with iMg and tMg were also assessed. A prospective study including all eligible adult patients (≥18 years) who were hospitalized in the General Internal Medicine unit at Sultan Qaboos University Hospital (SQUH) for 3.5 months in 2023. The iMg and tMg concentrations were collected on all at the admission. In total 500 patients were included (females 49.2%) with a median age of 64.5 years (IQR: 48-77). The prevalence of hypomagnesemia and hypermagnesemia by iMg concentrations was 3.4% and 26.6%, respectively, while by tMg concentrations 13.2% and 11.0%, respectively. The agreement between both measurements was strong (r=0.665, p<0.01). An increased tMg concentration was independently associated with high dependency units’ admission (adjusted odds ratio (aOR): 4.34, 95%CI: 1.24-15.06, p=0.02) and cardiac arrest (aOR: 14.64, 95%CI: 3.04-70.57, p<0.01), and 6-month all-cause mortality (aOR: 11.44, 95%CI: 2.46-53.17, p<0.01). During follow-up hypermagnesemia using tMg had a higher mortality compared to other groups (hazard ratio (HR): 1.82, 95%CI: 1.11-3.01, p=0.02) while no significant findings were demonstrated using iMg concentrations. iMg and tMg concentrations had a strong correlation that might be supporting the potential use of point-of-care devices. Multivariant regression analysis showed that hypermagnesemia by tMg was associated with adverse outcomes. However, the generalizability of the study findings should be taken with caution and the difference in the associations with outcomes highlight the importance of further research to examine the complex associations and impacts of dysmagnesemia in various clinical settings.

Frailty in general medicine patients receiving geriatric medicine liaison services is predictive of adverse outcomes.

Frailty is in an increasing focus for acute care systems due to its association with adverse health outcomes. The Clinical Frailty Scale (CFS) is a judgement-based frailty assessment tool, which classifies the frailty status of older adults, but more research involving general medicine inpatients is necessary. The objectives of this study were to describe the predictive ability of CFS, administered by geriatric medicine trained nurses, for adverse outcomes including the following: acute unit and total length of stay (LOS), new nursing home (NH) admission, 12-month mortality and readmission within 30-day. Design Retrospective study. Participants Patients admitted under general medicine unit and seen by the geriatric medicine liaison team in one general hospital. Main Measure CFS. Of 394 patients included, 60% were mild-moderately frail, and 21% severely frail. In a multivariable analysis, patients classified as severely frail (CFS 7-9) had significantly high odds of death during admission (OR = 13.64), new NH admission (OR = 34.97) and acute LOS (OR = 1.74), compared to non-frail patients (CFS1-4). Mild-moderately frail (CFS 5-6) patients had significantly higher odds for new NH admission (OR = 4.36), acute unit LOS (OR = 1.49) and total LOS (OR = 1.61) compared to non-frail patients. In a Cox regression multivariable survival analysis, the severely frail had a sixfold significantly higher likelihood (HR = 6.19) of 12-month mortality, and the mild-moderately frail had a doubled likelihood (HR = 2.13), compared to the non-frail. The CFS has clinical utility for identifying general medicine older inpatients at-risk of various adverse outcomes.

Impact of Constipation on Health Outcomes in Medically Hospitalized Patients: A Prospective Study on Laxative Use and Health Care Outcomes

Background and Objectives: Constipation affects health-related quality of life and increases hospital visits. We conducted this prospective cohort study to assess laxative use, health outcomes of constipation in medically hospitalized patients, and related health outcomes. Materials and Methods: A prospective single-center study included all adult patients admitted under the General Internal Medicine Unit from 1 February 2022, to 31 August 2022. Constipation was defined using the Constipation Assessment Scale (CAS). Patients were assessed for 28 days during their hospital stay and up to 90 days post-discharge. Result: Among the included patients, 62.45% experienced constipation, which was associated with poor health outcomes including delirium (p = 0.048), intensive care admission (p &lt; 0.01), cardiopulmonary arrest (p &lt; 0.01), inpatient mortality (p &lt; 0.01), longer hospital stay (p &lt; 0.01), 90-day mortality (p &lt; 0.01), and 90-day hospital readmission (p &lt; 0.01). Laxative treatment was administered to only 33.93% of patients with constipation and was more commonly used among older patients (p &lt; 0.01), those with high CAS scores (p &lt; 0.01), longer hospital stays (p &lt; 0.01), and critically ill patients (intensive care admission) (p = 0.01), as well as those who had cardiopulmonary arrest (p &lt; 0.01) and high inpatient mortality (p &lt; 0.01). Conclusions: This study identified several associations between constipation and poor health outcomes and highlighted the underutilization of laxatives in treating constipation. It is vital to interpret our results with caution. Therefore, we believe that a randomized controlled trial will help enhance our understanding of the interaction between constipation, laxative use, and poor health outcomes.

Clinical evaluation of a machine learning-based early warning system for patient deterioration.

The implementation and clinical impact of machine learning-based early warning systems for patient deterioration in hospitals have not been well described. We sought to describe the implementation and evaluation of a multifaceted, real-time, machine learning-based early warning system for patient deterioration used in the general internal medicine (GIM) unit of an academic medical centre. In this nonrandomized, controlled study, we evaluated the association between the implementation of a machine learning-based early warning system and clinical outcomes. We used propensity score-based overlap weighting to compare patients in the GIM unit during the intervention period (Nov. 1, 2020, to June 1, 2022) to those admitted during the pre-intervention period (Nov. 1, 2016, to June 1, 2020). In a difference-indifferences analysis, we compared patients in the GIM unit with those in the cardiology, respirology, and nephrology units who did not receive the intervention. We retrospectively calculated system predictions for each patient in the control cohorts, although alerts were sent to clinicians only during the intervention period for patients in GIM. The primary outcome was non-palliative in-hospital death. The study included 13 649 patient admissions in GIM and 8470 patient admissions in subspecialty units. Non-palliative deaths were significantly lower in the intervention period than the pre-intervention period among patients in GIM (1.6% v. 2.1%; adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.55-1.00) but not in the subspecialty cohorts (1.9% v. 2.1%; adjusted RR 0.89, 95% CI 0.63-1.28). Among high-risk patients in GIM for whom the system triggered at least 1 alert, the proportion of non-palliative deaths was 7.1% in the intervention period, compared with 10.3% in the pre-intervention period (adjusted RR 0.69, 95% CI 0.46-1.02), with no meaningful difference in subspecialty cohorts (10.4% v. 10.6%; adjusted RR 0.98, 95% CI 0.60-1.59). In the difference-indifferences analysis, the adjusted relative risk reduction for non-palliative death in GIM was 0.79 (95% CI 0.50-1.24). Implementing a machine learning-based early warning system in the GIM unit was associated with lower risk of non-palliative death than in the pre-intervention period. Machine learning-based early warning systems are promising technologies for improving clinical outcomes.

Diagnosis and management of COVID toes in outpatients: a case report

BackgroundSince the beginning of the coronavirus disease 2019 pandemic, the most common skin lesions observed due to infection with the severe acute respiratory syndrome coronavirus 2 are pseudochilblains (or coronavirus disease toes). However, this pathology remains infrequent and difficult to diagnose, as no specific test exists.Case presentationTwo Caucasian women, 30 and 22 years old, presented to our General Medicine Unit with perniosis lesions on the feet during the first two waves of the coronavirus disease 2019 pandemic. They did not have respiratory or general symptoms of severe acute respiratory syndrome coronavirus 2 infection, the reverse transcription polymerase chain reaction on nasopharyngeal swabs was negative, and the serology was positive only in the first case. The clinical presentation differed for the two cases, as the second patient suffered from swelling and burning after cold application. The diagnosis was based on clinical presentation, temporality, exclusion of other differential diagnoses, and blood test results (positive serology in the first case and high level of CXCL13 and VEGF in the second), supported by current literature. Lesions resolved spontaneously in the first patient. The second case was hospitalized for pain management and received corticosteroid therapy with resolution of the symptoms.ConclusionThese two cases with different clinical presentations illustrate the diagnostic approach to coronavirus disease 2019, a challenging disease with diverse manifestations, including, in some cases, coronavirus disease toes. We present a literature review that illustrates the progression of scientific research. Skin lesions associated with coronavirus disease 2019 infection could be the expression of an important interferon type 1 response and should be considered in the differential diagnosis in a primary care setting.

Enhancing inpatient glycemic education and management with a SMILE SBAR: A quantitative study

AimTo examine the effectiveness of a comprehensive diabetes education class on improving nurses' self-efficacy in glycemic management and physician communication, with a focus on using the SMILE (Sugar Trend, Medications, Intravenous fluid, Labs, and Eating) SBAR (Situation, Background, Assessment, Recommendation) as a communication tool. The secondary aim of this study was to investigate the translation of knowledge into practice, in this case, inpatient glycemic control. BackgroundInpatient glycemic management for patients living with diabetes can be challenging. Therefore, as patient advocates, nurses must be able to identify what clinical data warrants a call to the physician to facilitate timely decisions and interventions. MethodsData was collected from a purposive sample of 28 registered nurses from a single general medicine unit. A t-test was used to analyze nurses' pretest-posttest perceptions of self-efficacy in nine content areas. Kruskal-Wallis H analysis was also conducted on patients' median blood glucose values over four months (July–October 2023). ResultsThe results suggest the class was effective in improving nurses' perceived knowledge and self-efficacy in all nine content areas, with the highest mean difference increase of 1.46 for I have sufficient knowledge regarding the SMILE SBAR and [will] use it as a tool for communicating with the physician, p < 0.05. A comparison of 403 patients' median blood glucose values were also statistically significantly different across four months, χ2(3) = 21.088, p < 0.0001. ConclusionsContinued efforts to prevent and manage inpatient glycemic control should focus on enhancing nurse-physician communication and teamwork with simple yet effective tools such as the SMILE SBAR.

Comparing Outcomes of Community-Acquired Pneumonia Patients Discharged from General Medicine and Respiratory Units in Australia: A Propensity Score-Matched Analysis.

Background/Objectives: Community-acquired pneumonia (CAP) is a common emergency presentation in Australia, with the choice of admitting specialty unit often influenced by pneumonia severity and comorbidities. However, it remains unclear whether there are between-specialty differences in patient characteristics and outcomes. We sought to address this issue by investigating the characteristics and outcomes of CAP patients admitted to General Medicine (GM) versus Respiratory units. Methods: This retrospective observational study utilised data from the two largest metropolitan hospitals in South Australia, encompassing all non-COVID-19-related CAP admissions throughout 2021 to 2023. The hospital length of stay (LOS), in-patient and 30-day mortality, and 30-day readmission rates were assessed by propensity score matching (PSM) using 17 variables. Results: Of the 3004 cases of non-COVID-19 CAP admitted across the two hospitals during the study period, 2673 (71.8%) were admitted under GM units and 331 (9.1%) under Respiratory units. GM patients were, on average, a decade older, presented with a significantly higher burden of comorbidities, exhibited a greater prevalence of frailty, and had higher pneumonia severity compared to those admitted under a Respiratory unit (p < 0.05). Unadjusted analysis revealed a shorter median LOS among GM-admitted patients (5.9 vs. 4.1 days, p < 0.001). After PSM adjustment, patients admitted under the Respiratory units had an 8-fold higher odds of a longer LOS compared to GM (adjusted odds ratio [aOR] 8.53, 95% CI 1.96-37.25, p = 0.004). Other clinical outcomes were comparable between the two groups. Conclusions: Our findings indicate that GM units compared to Respiratory units provide efficient and safe care for patients requiring hospitalisation for CAP.

Clinical audit on management of suspected meningoencephalitis patients at lady reading Hospital, Peshawar

Objective: The purpose of this study was to observe management and empiric treatment of meningitis/encephalitis without doing initial investigation CSF-RE or delaying it, at Department of Emergency Medicine, General Medicine and Neurology wards. Method: It is an observational retrospective study this study was carried out at the General medicine, Neurology and Emergency units from July 2023 to Dec 2023.Total of 54 patients were included. Before conduction of study Ethical Review Committee permission was sought to access patient Data. We studied their hospital stored data on HMIS such as admission Date, start of empiric antibiotics, CT Scans, Blood Culture and CSF-REs. Results: 98% of patients were started on empiric Antibiotics without doing CSF-RE/LP on initial presentation at the hospital. In 64% patients CSF-RE was delayed and subsequently performed. In 34% CSF-RE was never carried out. Conclusion: We did presentations, Information campaigns, to follow standard Guidelines for Suspected meningitis /encephalitis to limit potential side effects, Development of Resistance to Antibiotics and to limit treatment costs.

Effect of Phenobarbital-Based Alcohol Withdrawal Protocol on Provider Practice and Patient Outcomes-A Quality Improvement Study.

Introduction: Alcohol is the most common substance use disorder in the United States. Despite this prevalence, there remains significant heterogeneity in medical management of alcohol withdrawal syndrome (AWS). While the 2020 American Society of Addition Medicine continues to recommend the use of benzodiazepines as first-line therapy for AWS, there is increasing use of phenobarbital in patients at high risk of severe AWS. Despite phenobarbital's favorable pharmacologic profile, historically, clinical utilization on general medicine services has been low and often restricted. In this project, we have examined practice patterns and associated clinical outcomes in adult patients experiencing AWS on the general medicine service pre and post implementation of a phenobarbital-based protocol for the treatment of severe AWS at our institution. Methods: This quality improvement study evaluated changes in management of AWS on general medicine units associated with implementation of a phenobarbital-based protocol and order set in the electronic medical record (EMR). Our primary outcome measures were receipt of a phenobarbital loading dose, concomitant benzodiazepine administration, and total benzodiazepine dose. Safety outcomes were also explored to assess clinical impacts of this protocol implementation. The project was determined "not research" by our Institutional Review Board. Results: Phenobarbital-protocol implementation was associated with increased frequency of receiving a phenobarbital loading dose (49.5% vs 9.4%; P < .001), decreased use of concomitant benzodiazepine/phenobarbital (4.3% vs 28.9%; P < .001), and decreased total benzodiazepine dose (7.8 vs 15.5 mg; P < .001). Regarding safety, there was no significant pre/post difference in the rate of ICU transfer, but among those transferred there was a trend toward decreased mechanical ventilation rate (100% vs 28.6%; P = .051), and a significantly reduced ICU length of stay (median 11 vs 3 days; P = .04). There were no pre/post differences in seizures, delirium or use of adjunct medications. Conclusions: This quality improvement study demonstrates a marked change in provider prescribing practices for treating AWS after implementation of an institutional phenobarbital-based protocol. We observed no difference in overall clinical outcomes after protocol implementation, although a larger follow-up study is needed to confirm this and to further explore the shorter ICU length of stay for patients with AWS postimplementation.

Correlation between elevated serum bilirubin levels and coronary artery disease risk - An institutional study

Background and objectives. Coronary artery disease (CAD) is a major public health problem resulting in profound morbidity and mortality. Recent research studies have suggested that bilirubin may play a role in preventing coronary artery disease. The purpose of this study was to determine the association between increased levels of bilirubin in the blood and risk for developing coronary artery disease (CAD). Material and methods. For the course of this study, an observational method was used where 30 participants were enrolled from our department’s general medicine unit. We collected demographic data and patient’s medical history. Moreover, we carried out complete blood count to measure serum levels of bilirubin such as total, direct and indirect, lipid profile, fasting blood glucose, C-reactive protein (CRP). Several statistical analyses were done to find out whether there is any relation between blood bilirubin levels and CAD related risk factors. Results. The current findings showed average serum concentration for bilirubin at 1.5 ± 0.5 mg/dL. In this regard, hypertension was prevalent among 40% of respondents while diabetes took up 20%. This present study indicates that there is strong negative relationship between cardiovascular risks indicator blood-bilirubins. Conclusion. Consequently, this study produces great proof that shows strong support for a negative relationship between the levels of bilirubin in the blood and the likelihood of getting affected by coronary arteries. This might be due to different roles played by bilirubin such as being an antioxidant and having anti-inflammatory properties. These findings suggest that there is a need for more investigations into bilirubin as its importance as a potential biomarker for assessing and mitigating cardiovascular risk has been highlighted.

Effectiveness of an Artificial Intelligence–Enabled Intervention for Detecting Clinical Deterioration

Inpatient clinical deterioration is associated with substantial morbidity and mortality but may be easily missed by clinicians. Early warning scores have been developed to alert clinicians to patients at high risk of clinical deterioration, but there is limited evidence for their effectiveness. To evaluate the effectiveness of an artificial intelligence deterioration model-enabled intervention to reduce the risk of escalations in care among hospitalized patients using a study design that facilitates stronger causal inference. This cohort study used a regression discontinuity design that controlled for confounding and was based on Epic Deterioration Index (EDI; Epic Systems Corporation) prediction model scores. Compared with other observational research, the regression discontinuity design facilitates causal analysis. Hospitalized adults were included from 4 general internal medicine units in 1 academic hospital from January 17, 2021, through November 16, 2022. An artificial intelligence deterioration model-enabled intervention, consisting of alerts based on an EDI score threshold with an associated collaborative workflow among nurses and physicians. The primary outcome was escalations in care, including rapid response team activation, transfer to the intensive care unit, or cardiopulmonary arrest during hospitalization. During the study, 9938 patients were admitted to 1 of the 4 units, with 963 patients (median [IQR] age, 76.1 [64.2-86.2] years; 498 males [52.3%]) included within the primary regression discontinuity analysis. The median (IQR) Elixhauser Comorbidity Index score in the primary analysis cohort was 10 (0-24). The intervention was associated with a -10.4-percentage point (95% CI, -20.1 to -0.8 percentage points; P = .03) absolute risk reduction in the primary outcome for patients at the EDI score threshold. There was no evidence of a discontinuity in measured confounders at the EDI score threshold. Using a regression discontinuity design, this cohort study found that the implementation of an artificial intelligence deterioration model-enabled intervention was associated with a significantly decreased risk of escalations in care among inpatients. These results provide evidence for the effectiveness of this intervention and support its further expansion and testing in other care settings.

Melatonin does not reduce delirium severity in hospitalized older adults: Results of a randomized placebo-controlled trial.

Delirium is common in older inpatients, causing distress, cognitive decline, and death. Current therapies are unsatisfactory, limited by lack of efficacy and adverse effects. There is an urgent need for effective delirium treatment. Sleep wake cycle is disturbed in delirium; endogenous Melatonin is perturbed, and exogenous Melatonin is a safe and effective medication for sleep disorders. This study aims to determine the effect of oral Melatonin 5 mg immediate release (IR) nightly for five nights on the severity of delirium in older (≥65 years) medical inpatients. This was a double-blinded, randomized controlled trial in general internal medicine units of a tertiary teaching hospital. Older inpatients with Confusion Assessment Method positive, hyperactive or mixed delirium within 48 h of admission or onset of in-hospital delirium were included. The primary outcome was change in delirium severity measured with the Memorial Delirium Assessment Scale (MDAS). A previous pilot trial showed 120 participants randomized 1:1 to Melatonin or Placebo would provide 90% power to demonstrate a 3-point reduction in the MDAS. One hundred and twenty participants were randomized, 61 to Melatonin 5 mg and 59 to Placebo. The medication was well tolerated. The mean MDAS improvement was 4.9 (SD 7.6) in the Melatonin group and 5.4 (SD 7.2) in the Placebo group, p-value 0.42, a non-significant difference. A post-hoc analysis showed length of stay (LOS) was shorter in the intervention group (median 9 days [Interquartile Range (IQR) 4, 12] vs. Placebo group 10 [IQR 6, 16] p-value = 0.033, Wilcoxon Rank Sum test). This trial does not support the hypothesis that Melatonin reduces the severity of delirium. This may be due to no effect of Melatonin, a smaller effect than anticipated, an effect not captured on a multidimensional delirium assessment scale, or a type II statistical error. Melatonin may improve LOS; this hypothesis should be studied.

Comparison of Characteristics and Outcomes in Patients With Acute Decompensated Heart Failure Admitted Under General Medicine and Cardiology Units

Acute decompensated heart failure (ADHF) is a leading cause of cardiovascular disease hospitalisations associated with significant morbidity and mortality. In hospitals, HF patients are typically managed by cardiology or physician teams, with differences in patient demographics and clinical outcomes. This study utilises contemporary HF registry data to compare patient characteristics and outcomes in those with ADHF admitted into General Medicine and Cardiology units. The Victorian Cardiac Outcomes Registry was utilised to identify patients hospitalised with ADHF 30-day period in each of four consecutive years. We compared patient characteristics, pharmacological management and outpatient follow-up of patients admitted to General Medicine and Cardiology units. Primary outcome measures included in-hospital mortality, 30-day readmission, and 30-day mortality. Between 2014 and 2017, a total of 1,253 patients with ADHF admissions were registered, with 53% admitted in General Medicine units and 47% in Cardiology units. General Medicine patients were more likely to be older (82 vs 71 years; p<0.001), female (51% vs 34%; p<0.001), and have higher prevalence of comorbidities and preserved left ventricular function (p<0.001). There were no differences in primary outcome measures between General Medicine and Cardiology in terms of: in-hospital mortality (5.0% vs 3.9%; p=0.35), 30-day readmission (23.4% vs 23.6%; p=0.93), and 30-day mortality (10.0% vs 8.0%; p=0.21). Hospitalised patients with HF continue to have high mortality and rehospitalisation rates. The choice of treatment by General Medicine or Cardiology units, based on the particular medical profile and individual needs of the patients, provides equivalent outcomes.

The medical emergency team pharmacist: describing an overnight service

AbstractBackgroundClinical practice after hours and attendance at medical emergency team (MET) calls are two novel and emerging areas of pharmacy practice. During the COVID‐19 pandemic, our institution's pharmacy services expanded from 8 am–5 pm to 24 h daily, including MET call attendance.AimThis study aimed to describe pharmacist roles, including medications charted by the general medicine and intensive care unit pharmacists during the period of extended‐hours pharmacy practice and the characteristics of MET calls attended.MethodThis descriptive, cross‐sectional study included patients admitted to the Alfred Hospital, Victoria, Australia between 3 April 2020–28 February 2021, when a MET was called between 5 pm–8 am, a pharmacist attended, and medication changes occurred. Data collected included whether the MET call was medication related and a description of medication changes. Ethics approval was granted by the Alfred Hospital Human Research Ethics Committee (Reference no: 297/21).ResultsOne thousand six hundred and forty‐four MET calls (average 5.4 calls per night) were attended by pharmacists during extended hours. Medication changes were made in response to clinical deterioration at 627 (38%) calls. The most frequent change was the initiation of cardiovascular medications (n = 206). Partnered pharmacist medication charting, including commencing, ceasing, or changing medications, occurred at 39% of MET calls with therapy changes.ConclusionPharmacists can play a key role in managing deteriorating patients as part of a MET team. Medications may be implicated in clinical deterioration of patients and are frequently administered at MET calls. The expansion of pharmacy services provided the opportunity for pharmacists to contribute to MET calls across the 24‐h period.

Incidence of Dysmagnesemia among Medically Hospitalized Patients and Associated Clinical Characteristics: A Prospective Cohort Study.

Magnesium (Mg) disorders are common among hospitalized patients and are linked to poor health outcomes. We aimed to determine the incidence of dysmagnesemia among medically hospitalized patients and to identify factors that are associated with dysmagnesemia. A prospective cohort study was conducted at Sultan Qaboos University Hospital (SQUH) from April 1st, 2022, to October 31st, 2022, and involved hospitalized adult patients (≥18 years) under the care of the general internal medicine unit. The patients' serum total magnesium (Mg) concentrations were categorized as hypomagnesemia (≤0.69 mmol/L), hypermagnesemia (≥1.01 mmol/L), or dysmagnesemia, which encompassed either hypomagnesemia or hypermagnesemia. Of the 304 patients evaluated, dysmagnesemia was observed in 22.0%, which comprised of 17.4% with hypomagnesemia and 4.6% with hypermagnesemia. Statistically significant associations were identified between hypermagnesemia and chronic kidney disease (CKD) (p = 0.05) and elevated creatinine levels (p < 0.01) and lower estimated glomerular filtration rate (eGFR) (p < 0.01). Hypomagnesemia was linked to lower ionized calcium (p = 0.03) and admission due to infectious diseases (p = 0.02). However, ordered regression analysis did not find any significant associations with the different magnesium groups. Dysmagnesemia was prevalent among hospitalized patients and was associated with different factors; however, ordered regression analysis did not find any association with the different magnesium group, probably due to the limited number of included individuals.

Implementation of a standardised accept note to improve communication during inter-hospital transfer: a prospective cohort study

ImportanceThe transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to communication errors and gaps in information exchange.ObjectiveTo design and implement a standardised accept note to improve communication during...

ANALYSIS OF HOSPITAL ANTIBIOTIC PRESCRIPTIONS AFTER THE IMPLEMENTATION OF STEWARDSHIP: A RETROSPECTIVE OBSERVATIONAL STUDY IN TWO HOSPITALS IN NORTH-EASTERN SICILY

Introduction: Antimicrobial resistance is a global problem caused by the inappropriate use of antibiotics. To combat this phenomenon, multidisciplinary antimicrobial stewardship programmes have been initiated, the primary objectives of which include improving both the level of appropriateness of prescription and clinicians’ awareness of the correct use of antibiotics. Objective/Purpose: The objective of the work was to conduct an analysis of antibiotic consumption at hospital level to assess the appropriateness of antibiotic prescription in a number of Operational Units. Method: From 01/01/2021 to 31/12/2022, data were extracted from the Pharmacy Operational Unit’s management software on the dispensing of antibiotics (injectable and oral use), the Defined Daily Doses, and the number of dosage units dispensed to the General Medicine, Intensive Care, General Surgery and Neurorehabilitation Operational Units of two hospitals. Results: Total antibiotic consumption was 7,845 dosage units in 2021 and 10,182 in 2022. The comparison of the defined daily dose values (4,565,485 in 2021 and 5,079,671 in 2022) is indicative of the use of antibiotics with different dosages, with a percentage increase of 11.3%. A comparison was also made between the Defined Daily Doses/100 bed-days delivered in 2021 and the regional and national figures, yielding a significantly lower figure than these latter figures. Conclusions: The loss of antibiotic efficacy threatens to throw healthcare systems into crisis, leading to in an increase in morbidity and mortality from infections. The implementation of antimicrobial stewardship programmes remains, at present, the best tool to harness in order to curb the phenomenon of antimicrobial resistance. There is therefore a need for increasingly specialised professionals in the field of infectious diseases. Nurses and pharmacists play a crucial role in antimicrobial stewardship programmes, as they collaborate not only in the implementation of antimicrobial guidelines, but also in the review of individual patient regimens in order to optimise treatment and in the training of healthcare personnel on the appropriate use of antimicrobials.

Prevalence, Recognition, and Risk Factors of Constipation among Medically Hospitalized Patients: A Cohort Prospective Study.

Background and Objective: Constipation is a prevalent gastrointestinal condition that has a substantial impact on individuals and healthcare systems. This condition adversely affects health-related quality of life and leads to escalated healthcare expenses due to an increase in office visits, referrals to specialists, and hospital admission. This study aimed to evaluate the prevalence, recognition, risk factors, and course of constipation among hospitalized patients in medical wards. Materials and Methods: A prospective study was conducted, including all adult patients admitted to the General Medicine Unit between 1 February 2022 and 31 August 2022. Constipation was identified using the Constipation Assessment Scale (CAS), and relevant factors were extracted from the patients' medical records. Results: Among the patients who met the inclusion criteria (n = 556), the prevalence of constipation was determined to be 55.6% (95% CI 52.8-58.4). Patients with constipation were found to be older (p < 0.01) and had higher frailty scores (p < 0.01). Logistic regression analysis revealed that heart failure (Odds ratio (OR) 2.1; 95% CI 1.2-3.7; p = 0.01), frailty score (OR 1.4; 95% CI 1.2-1.5; p < 0.01), and dihydropyridines calcium channel blockers (OR 1.8; 95% CI 1.2-2.8; p < 0.01) were independent risk factors for constipation. Furthermore, the medical team did not identify constipation in 217 patients (64.01%). Conclusions: Constipation is highly prevalent among medically hospitalized patients. To ensure timely recognition and treatment, it is essential to incorporate a daily constipation assessment scale into each patient's medical records.

Trends in oral anticoagulant use - A 10-year retrospective analysis from a general medicine department of a tertiary care hospital in south India.

The prescribing practice of newer oral anticoagulants (NOACs) has not been adequately studied in the Indian scenario. We aimed to describe the prescribing practices of oral anticoagulants, the patient profile and medical comorbidities among patients admitted in a general medicine unit. In this retrospective study of the 2742 patients prescribed vitamin- K antagonists (VKAs), during the study period, 150 cases were randomly taken for analysis to match the 105 NOACs cases. Their demographic details, clinical characteristics and treatment details were analyzed. More than 95% of anticoagulants prescribed were VKAs. The prescription of anticoagulants was more common in men (median age 63 years) for prescription of NOACs and 52 years for VKAs. Dabigatran (60.9%) and warfarin (81.3%) were the most prescribed drugs in their respective classes. The most common indication was for cardiovascular diseases with atrial fibrillation (32%). Diabetes and hypertension were the most common comorbidities in patients prescribed oral anticoagulants with a larger proportion of patients with heart failure being prescribed VKAs ( P < 0.01). Patients in the NOACs group had a higher HAS-BLED high-risk score (33.3% vs. 17.3%; P = 0.002). Logistic regression analysis revealed that patients with co-morbidities of congestive heart failure were more likely to be prescribed VKAs while diabetics were more likely to receive NOACs. VKAs were the most prescribed anticoagulants; congestive heart failure, diabetes, and hypertension were the commonest comorbidities; and atrial fibrillation was the commonest indication. Patients with a high HAS-BLED score were prescribed NOACs more often.

Effectiveness of a Multi-component Delirium Prevention Program Implemented on General Medicine Hospital Units: an Interrupted Time Series Analysis

BackgroundDelirium is among the most prevalent harmful events in hospitals that is associated with an elevated risk for severe outcomes such as functional decline, falls, longer length of stay, and increased mortality.ObjectiveTo evaluate the impact of the implementation of a multi-component delirium program on the prevalence of delirium and the incidence of falls among patients staying on general medicine inpatient hospital units.DesignA pre-post intervention study using retrospective chart abstraction and interrupted time series analysis.CohortPatients were selected from adult patients that stayed at least 1 day on one of the five general medicine units in a large community hospital in Ontario, Canada. A total of 16 random samples of 50 patients per month for 8 consecutive months pre-intervention (October 2017 to May 2018) and 8 months post intervention (January 2019 to August 2019) were selected for a total of 800 patients. There were no exclusion criteria.InterventionThe delirium program included multiple components: education of staff and hospital leadership, twice per day bed-side screen for delirium, non-pharmacological and pharmacological prevention, and intervention strategies and a delirium consultation team.MeasurementDelirium prevalence was assessed using the evidence-based delirium chart abstraction method, CHART-del. Demographic data as well as fall incidence were also collected.ResultOur evaluation showed that the implementation of a multicomponent delirium program led to a reduction in delirium prevalence and fall incidences. The reduction in both delirium and falls was the largest for patients in the ages between 72 and 83 years old and varied across inpatient units.ConclusionA multi-component delirium program to improve the prevention, recognition, and management of delirium reduces the prevalence of delirium and fall incidence among patients in general medicine units.