General Medicine Wards Research Articles

Role of Eosinophil Count and Percentage in Chronic Obstructive Pulmonary Disease Exacerbation: A Retrospective Observational Study

Aim: To reveal the role of eosinophil count and percentage evaluated at the time of presentation in
 patients hospitalized with the exacerbation of chronic obstructive pulmonary disease (COPD).
 Material and Methods: In this study, the data of patients with a diagnosis of the exacerbation of COPD,
 who presented to the emergency department, and admitted to the general internal medicine ward, were
 retrospectively analyzed. The relationship of eosinophil count and ratios with the length of hospital
 stay and intensive care requirement was investigated.The Spearman correlation analysis was used for
 investigating correlation between parameters and outcome.
 Results: Of the study population, 39.7% were female and 60.3% were male. The ages of the participants
 ranged from 25 to 94 years, with a median value of 76 years. There was no significant correlation
 between the length of stay in ward and eosinophil count and percentage (rho=-0.148, p=0.066 and
 p=0.074, rho=-0.143, respectively) (Spearman correlation test). The group admitted to the intensive
 care unit had a significantly higher eosinophil count and percentage of eosinophils than the group that
 did not require intensive care (0.81(Inter Quarter Range (IQR):0.41-1.31) versus 1.32 (IQR:0.83-1.43)
 p=0.042 and 1.0 (IQR:0.81-1.21) versus 1.42 (IQR:1.02-1.64), p=0.018, respectively) (Mann Whitney
 U test).
 Conclusion: There was no correlation between a high eosinophil count and percentage and the length
 of hospital stay. However, the number and percentage of eosinophils were significantly higher among
 the patients requiring intensive care.

A Case Report of Nephrotic Syndrome with Anasarca

Nephrotic syndrome is a condition characterized by Proteinuria, Hypoalbuminemia, Edema, Hyperlipidemia. Nephrotic syndrome is caused by damaged to the clusters of small blood vessels in the kidney that filter waste products and the excessive water from the blood. A 35-year-old male patient admitted in the general medicine ward with chief complaints of swelling over the face,hand and then whole body from 5 years. While there are several more common causes of nephrotic syndrome in adults.if patient can take proper medication they can decrease the edema and improve their condition.

Analysis of burden and outcomes of anti-tuberculosis therapy-induced adverse drug effects at a tertiary care center

Background: Tuberculosis (TB), one of the most ancient diseases known to mankind, is one of the ten major causes of mortality worldwide. Combinations of antibiotics, called anti-TB therapy (ATT), are given for a period of six months or more as treatment. Aims and Objectives: The aim of this study was to assess the incidence of adverse drug reactions (ADRs), clinical profile, severity and causality among the admitted patients taking ATT in a tertiary care hospital. Materials and Methods: This was a hospital-based, prospective, observational and non-interventional cohort study undertaken in the General Medicine wards of the hospital. This study was conducted from June 2017 to December 2018. The Patients’ data was recorded using a structured ADR reporting form. The baseline parameters, medical history and details of underlying diseases, clinical data, characteristics of ADRs and details of medication responsible for ADRs as well as medication for treatment of ADRs were recorded. The data was analyzed using descriptive statistics with the Statistical Packages for the Social Sciences (SPSS) version 26.0 software. Results: Out of the 164 patients admitted due to ADRs within the study period, 45 (27.4%) developed ADRs due to anti-TB treatment. Most ATT-related ADRs involved the liver (n=39). The severity of ADR was found to be mild in two patients (4.4%), moderate in 28 patients (62.5%) and severe in 15 patients (33.3%). 16 patients (35.6%) completely recovered, 23 patients (51.1%) were still recovering (at the time of the analysis of the data), one patient (2.2%) did not recover and five patients (11.1%) had a fatal outcome. The presence of systemic comorbidities and polypharmacy was found to be a significant risk factor associated with ATT associated ADRs. Conclusion: ATT is not without its side effects. About 27.4% of the patients on ATT in our study developed ADRs, a few resulting in fatality. Educating the patients about possible ADRs associated with ATT at the time of prescription can improve patient compliance and strengthen the doctor-patient relationship. Early diagnosis and treatment of ADRs associated with ATT is paramount. This requires a better surveillance system, which India is in a dire need for.

Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario.

To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04). Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies.

Invasive Fungal Sinusitis in Post-COVID-19 Patients with Diabetes Mellitus.

Invasive fungal sinusitis is an invasive disease associated with high mortality of up to 60%. There is a well-documented increase in rhino-orbital-cerebral fungal co-infection in COVID-19 patients. Our study aimed to determine the factors that lead to the development, the natural history of progression and the therapeutic interventions done for this grave complication. Patients admitted in general medicine ward in King Edward Memorial (KEM) Hospital, Mumbai were included. Patient's history and examination findings were noted. Advised Investigations- imaging studies like CT scan, MRI done were noted down. Operative procedures like functional endoscopic sinus surgery (FESS), abscess drainage, dental extraction, were performed at the hospital and details were taken. Fungal cultures, sugar monitoring, liver function test, renal function test, complete blood counts, ECGs, chest X-rays, and amphotericin charting were also done.. On retrospective analysis of the presenting patient's records, we found that all patients had received steroids for COVID-19 treatment and had co-morbidities, especially diabetes mellitus. Prolonged hospitalization further exposes the patient to various multi-resistant bacteria making them prone to various secondary infections. It is of paramount importance that physicians know the associated risk factors, mentioned in our study, that may lead to invasive fungal co-infection in COVID-19 patients, and to regularly examine the patient for any developing signs so appropriate diagnosis and treatment can be initiated as early as possible. It is an unrelenting disease process that requires the utmost care, and our case series provides an in depth look of four such cases for future reference.

A STUDY ON POLYPHARMACY AMONG ELDERLY PATIENTS IN MEDICINE WARD OF A TERTIARY CARE TEACHING HOSPITAL OF EASTERN INDIA

Background: In the modern era, with the increase in the lifespan of individuals with increasing access to health-care facilities, the population of elderly is also increasing with an equal pace. However, on the other hand, with the increasing population of the elderly another important issue of polypharmacy has also emerged. Elderly people usually have more disease conditions for which more of medications are prescribed in older individuals as compared to younger population. Hence, optimizing drug therapy in this aging population is a challenging task for physician. Polypharmacy can also lead to increase in drug interactions, adverse drug reactions, and medication errors. It was an observational, cross-sectional, prospective study. The Materials and Methods: study was conducted in patients admitted in general medicine wards at College of Medicine& JNM Hospital, Kalyani, West Bengal. The study involved 320 elderly patients (above 65 years of age) of either sex for 3 months from January to March 2020. The information recorded included the demographic details of the patients, diagnosis, comorbid illnesses, details about medications being, the total number of drugs being used, and the factors associated with polypharmacy. A total of 320 geriatric patients were included in the study. Pol Results: ypharmacy was found (>5 medications/day) in 79.71% of geriatrics. Pantoprazole , antimnicrobials and NSAIDS were most commonly prescribed drugs. To counteract the problems Conclusion: associated with polypharmacy, regular follow- ups and proper monitoring of drug regimens of older individuals are the need of the hour.

Review of the utility of routine mortality reviews among deaths on General Internal Medicine wards in a Canadian tertiary care hospital

BackgroundHospital morbidity and mortality reviews are common quality assurance activities, intended to uncover latent or unrecognised systemic issues that contribute to preventable adverse events and patient harm. Mortality reviews may...

Hospital hand hygiene after COVID-19: has the pandemic heightened healthcare workers’ awareness?

Abstract Background Hand hygiene (HH) is the leading measure for preventing the transmission of healthcare-associated infections (HAI), and a cornerstone to prevent COVID-19 spread. Aim of the research was the assessment of HCWs’ adherence to the application of WHO optimal practices, with the goal to promote a culture of safety and quality infection prevention and control (IPC) activities. Methods Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, implemented a HH monitoring plan in which HCWs’ adherence to HH procedures is evaluated using WHO guidelines, technical manual and observation form. Direct field observations took place in March and April 2022 by trained personnel. Process index was HH adherence, stratified by profession, opportunity and unit, which has been visited at least twice. Results Overall, 302 HCWs were observed from 18 hospital units (105 physicians, 108 nurses, 84 healthcare assistants and 5 students). Out of 1382 opportunities, global adherence was 52% with 190 handwashing and 598 hand rubbing. The indication with the highest adherence was “after body fluid exposure risk” (76%), whereas the lowest were “after touching the patient's setting” (40%) and “before touching a patient” (43%). Adherence was higher in specialistic surgeries and haematology units, while the worst performances were reported in general medicine ward (29%). Physicians’ and nurses’ adherence was respectively 45% and 61%. Audits occasionally revealed non-conformities in glove use (i.e., unnecessary use, not changed between patients, hand rubbing on gloves). Conclusions These preliminary findings could be directly linked to habits acquired during the pandemic, when HW tended to consider COVID-19 patients as a unique block to shield themselves from infections, rather than safeguarding individual patient units. HH awareness could have changed in the wake of COVID-19 pandemic and our study described how HCWs’ adherence to optimal practices needs specific initiatives to promote correct HH. Key messages • The COVID-19 pandemic reinforced the importance of handwashing and IPC, showing the key role of the HCWs’ adherence to hand hygiene (HH) procedures. • HH audits play a leading part in clinical governance and IPC, aiming at enhancing the quality of care and patient safety, particularly to strengthen health system resilience in post-COVID era.

STUDY OF RISK FACTORS ASSOCIATED WITH MUCORMYCOSIS IN COVID-19 PANDEMIC AT TERTIARY CARE HOSPITAL IN INDIA

Background: The second wave of SARS-COV2 pandemic in India has witnessed a massive increase in the number of mucormycosis cases. The present study is aimed at evaluating the risk factors associated with the development of mucormycosis. The case-control study involved Methods: patients admitted to the general medicine and ENT wards of a tertiary care government hospital in India between 1st June and 31st July 2021. During the study period, 70 cases of mucormycosis were compared with 140 biologically-matched controls. Univariate and multivariate logistic regression analyses were carried out to evaluate the association of the following parameters with the development of mucormycosis: demographic factors, severe acute respiratory illness (SARI)/COVID-19, RT-PCR swab status, comorbidities, CT severity grading, and use of steroids, antibiotics, antivirals, anticoagulants, immunomodulators, and oxygen therapy. The st Results: udy involved a total of 210 subjects (70 cases and 140 controls). The ndings of univariate analysis demonstrated that SARI, high-dose steroid use (cumulative dose of dexamethasone ≥40 mg for 5 days), diabetes mellitus, usage of remdesivir, CT severity grade more than moderate were associated with statistically signicant odds for developing mucormycosis. Multivariate analysis showed individual association of SARI, diabetes mellitus and high-dose steroid with the development of mucormycosis. SARI, diabetes mellitus, and high-dose corticosteroids Conclusion: are found to be risk factors in developing mucormycosis, which requires immediate medical attention in this current pandemic.

Urinary albumin-to-creatinine ratio and serum albumin are predictors of acute kidney injury in non-ventilated COVID-19 patients: a single-center prospective cohort study

PurposeAcute kidney injury (AKI) is a frequent complication among COVID-19 patients in the intensive care unit, but it is less frequently investigated in general internal medicine wards. We aimed to examine the incidence, the predictors of AKI, and AKI-associated mortality in a prospective cohort of non-ventilated COVID-19 patients. We aimed to describe the natural history of AKI by describing trajectories of urinary markers of hemodynamic, glomerular, and tubular injury.Methods141 COVID-19 patients were enrolled to the study. AKI was defined according to KDIGO guidelines. Urine and renal function parameters were followed twice a week. Multivariate logistic regression was used to determine the predictors of AKI and mortality. Trajectories of urinary markers were described by unadjusted linear mixed models.Results19.7% patients developed AKI. According to multiple logistic regression, higher urinary albumin-to-creatinine ratio (OR 1.48, 95% CI 1.04–2.12/1 mg/mmol) and lower serum albumin (OR 0.86, 95% CI 0.77–0.94/1 g/L) were independent predictors of AKI. Mortality was 42.8% in the AKI and 8.8% in the group free from AKI (p < 0.0001). According to multiple logistic regression, older age, lower albumin, and AKI (OR 3.9, 95% CI 1.24–12.21) remained independent predictors of mortality. Urinary protein-to-creatinine trajectories were diverging with decreasing values in those without incident AKI.ConclusionWe found high incidence of AKI and mortality among moderately severe, non-ventilated COVID-19 patients. Its development is predicted by higher albuminuria suggesting that the originally damaged renal structure may be more susceptible for virus-associated effects. No clear relationship was found with a prerenal mechanism, and the higher proteinuria during follow-up may point toward tubular damage.

Impact of pulmonary rehabilitation training on Chronic Obstructive Pulmonary Disease (COPD) and asthma patients

The objective of this study is to assess the impact of pulmonary rehabilitation training in the management of asthma and chronic obstructive pulmonary disease patients. A 6-month prospective interventional study was conducted in a tertiary care hospital that included participants above 18 to less than 70 years of age admitted to the general medicine ward with the diagnosis of mild-moderate chronic obstructive pulmonary disease and asthma without any other comorbidity or concurrent illness. The rehabilitation procedure consisted of breathing exercises and endurance training. Parameters like FEV1, FVC, modified medical research council scale, modified BORG grade, 6-minute walk test, and questionnaire like SF-36 were measured and compared with post-training results. A total of 80 patients were enrolled in the study. The pre and post-rehabilitation comparison in both COPD and asthma patients showed significant results in terms of improved dyspnea (FEV1, FVC, FEV1/FVC ratio; p=0.001) evident with modified Medical Research Council scores and modified BORG grades followed by significant differences in distance covered during 6-minute walk test (p=0.001) and health-related quality of life (SF-36 scores; p=0.001). Conclusion: Pulmonary rehabilitation significantly improved exercise tolerance, perception of dyspnea, health-related quality of life, and psychosocial behavior. Inclusion of pulmonary rehabilitation in COPD and asthma patients is essential to palliate the disease burden, reduce the rate of hospitalizations and improves the quality of life of a patients.

Nasogastric tube care and flushing in a Portuguese general medicine ward: a best practice implementation project.

To implement evidence-based practice related to care and flushing of nasogastric tubes inserted for feeding, in a general medicine ward. Nasogastric tube feeding is a widely used nutritional support form. Although performed by qualified professionals, it is not a harm-free intervention. Progression to the trachea during initial insertion, aspiration of gastric contents, improper position for patient feeding, and/or a blocked tube are examples of problems that can occur. The project used JBI's methodological approach of the Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit focused on nursing procedures related to the maintenance of nasogastric tube feeding, based on 14 criteria informed by the JBI evidence summaries, was performed for a month. Education sessions and other engagement strategies and resources were used to increase nasogastric tube maintenance. This best-practice implementation was conducted in Portugal, between January 2020 and April 2021, in a 33-bed general medicine ward with a staff of 30 registered nurses. Different samples, for each audited procedure, were obtained from a universe of 25 nurses and 14 episodes of patients with nasogastric tube in baseline and 10 in follow-up audit. At baseline, compliance with the criteria ranged from 0 to 88%. Ten of the 14 criteria were below 50%. The follow-up audit showed significant improvement in all compliance criteria (ranging from 44.4 to 100%). Criteria 1 and 2, which were aimed at preventing adverse consequences related to wrong placement or displacement of the nasogastric tube, showed a high postimplementation compliance level (89.3 and 90%). With an integrated plan incorporating interventions, strategies, and resources, tailored for this context, we improved nurses' knowledge of nasogastric tube maintenance and achieved significantly increased compliance with nasogastric tube care best-practice. We suggest maintaining current strategies, and reinforcing clinical supervision and regular assessment.

Patterns of use and outcomes of peripherally inserted central catheters in hospitalized patients with solid tumors: A multicenter study.

The risk of peripherally inserted central catheter (PICC)-related complications in patients hospitalized with solid tumors remains unclear. Existing studies are limited by single-center, outpatient designs and include heterogenous patients. A retrospective cohort study was designed and included adult patients with solid organ cancers who were admitted to a general medicine ward or intensive care unit and received a PICC. Data were collected from November 2013 to December 2019 at 50 Michigan hospitals. Major complications were defined as central line-associated bloodstream infection, deep vein thrombosis, pulmonary embolism, and catheter occlusion. Hospital variation in PICC use and outcomes was examined. Data included 3235 hospitalized patients with solid tumors who had PICCs placed for 51,047 catheter days. Most catheters were double-lumen devices (57.0%). Notably, 17.5% of patients had another central venous catheter at the time of PICC insertion. The most common indications for PICC use were antibiotics (34.5%) and difficult access or blood draws (21.6%); chemotherapy was the primary indication in only 15.7% of patients. A major PICC-related complication occurred in 491 patients (15.2%); catheter occlusion was the most prevalent complication (n=322; 10.0%) followed by deep vein thrombosis (n=116; 3.6%), central line-associated bloodstream infection (n=82; 2.5%), and pulmonary embolism (n=20; 0.6%). Significant variation in indications for PICC use, device characteristics, and frequency of major complications across hospitals was observed (p < .001). PICCs were associated with significant complications in hospitalized patients who had solid malignancies and were often used for reasons other than chemotherapy. Policies and guidance for the appropriate use of PICCs in oncologic patients appear necessary. Peripherally inserted central catheters (PICCs) are devices placed in peripheral veins to deliver medication to large veins near the heart. PICCs are used frequently in oncology. The objective of this report was to describe PICC-associated complications in hospitalized patients with solid tumors. This study was performed across 50 Michigan hospitals and included 3235 patients with solid tumor cancers and who had a PICC. Overall, 15.2% of patients experienced a complication, including central line-associated bloodstream infections, deep vein thrombosis, pulmonary embolism, or catheter occlusion. Complication rates varied across hospitals. PICCs are associated with substantial complications in hospitalized patients with solid tumors.

Bottle Gourd (Lagenaria siceraria) Toxicity Diagnosed in the Emergency Department

BackgroundBottle gourd (Lagenaria siceraria) is sometimes used in complementary medicine practice for the treatment of chronic ailments. However, there have been reports of toxicity due to consumption of bottle gourd juice, leading to severe abdominal upset and upper gastrointestinal bleeding. Case ReportWe present a case of a 41-year-old gentleman who presented to the Emergency Department with multiple episodes of vomiting, hematemesis, and diarrhea after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors, and antiemetics. He was subsequently admitted to the General Medicine ward for further management. He continued to receive symptomatic treatment in the ward and underwent esophagogastroduodenoscopy during his hospitalization stay. His symptoms improved and he was discharged stable 5 days later.Why Should an Emergency Physician Be Aware of This? Early recognition of this rare presentation of bottle gourd toxicity is important in our local context, especially where traditional medicine is widely prevalent nowadays. Treatment is supportive. Public awareness of dangerous effects from the consumption of bitter bottle gourd juice and complementary medicine without proper consultation with a practitioner plays a crucial role to prevent further cases. Physicians need to advise patients on the use of traditional medicine and their potential side effects.

Nonmedical Discharge Barriers in Prolonged Stays on a General Medicine Ward: A Retrospective Review

Background: Prolonged stays negatively impact patient outcomes and are costly for the healthcare system. Nonmedical barriers to discharge, such as lack of insurance or post-acute care facility acceptances, are increasingly recognized as causes of prolonged stays beyond medical necessity. Methods: A retrospective chart review of patients admitted over a two-year period with stays beyond 30 days on a general medicine floor of an urban academic hospital was conducted. Demographic, clinical and administrative data were recorded. Barriers to discharge were characterized at days 30, 60, and 90 of admission. Nonmedical barriers were recorded for patients who stayed beyond medical readiness for discharge. Results: Out of 2866 admissions, 101 hospitalizations (3.5%) of 97 patients were prolonged, accounting for a total of 6518 (27.2%) of 23,934 inpatient days. Of the prolonged stays, 37 stays lasted longer than 60 days and 17 lasted longer than 90 days. At lengths of stay day 30, 60, and 90, the proportion of admissions that were prolonged beyond medical necessity by nonmedical factors were 36.6%, 59.5%, and 52.9% respectively. The most common nonmedical barrier to discharge at all three timepoints was barriers to facility placement. Conclusions: A small proportion of prolonged stay patients make up a disproportionately high number of inpatient days, with nonmedical factors contributing to more than half of cases beyond 60 days. The rising prevalence of nonmedical barriers, particularly the lack of facility acceptances, highlights the need to examine delays at the systems-level.

Patterns of antimicrobial prescribing, utilization, and cost of in patients attending a tertiary care hospital's general medicine ward

BACKGROUND: Antibiotic overuse is of great public health concern.Multiple studies performed globally have demonstrated a strong association between antibiotic use and antibiotic resistance (AMR), at both individual and community levels and they also shown that Antimicrobials are most commonly prescribed medications in acute care settings with 80% of its usedeemed inappropriate. OBJECTIVES: The primary aim of this study was to determine the possible impact of appropriate prescribing of antibiotics in General medicine ward of tertiary health centre on treatment outcomes and costs related to treatment. METHODOLOGY: This retrospective study looked at antimicrobial prescribing data in patients admitted to general medicine.Patients data was retrieved from Medical record section and the records of discharged patients were reviewed. The demographic data, disease related data and utilization of antibiotics were noted in specially designed proforma and analyzed. The documented data evaluated for use, safety outcomes and cost for the treatment associated with the use of antibiotics. RESULTS: Female patients 60.2 %(n=759)aremore hospitalized when compared to males, Average length of stay in hospital was 8 days. Majority of hospitalized patients had HTN &amp; DM as primary comorbidities. The widely prescribed antibiotics among all classes as prophylaxis were third generationcephalosporins in parenteral form.

Patterns of antimicrobial prescribing, utilization, and cost of in patients attending a tertiary care hospital's general medicine ward

Background: Antibiotic overuse is of great public health concern.Multiple studies performed globally have demonstrated a strong association between antibiotic use and antibiotic resistance (AMR), at both individual and community levels and they also shown that Antimicrobials are most commonly prescribed medications in acute care settings with 80% of its usedeemed inappropriate. Objectives: The primary aim of this study was to determine the possible impact of appropriate prescribing of antibiotics in General medicine ward of tertiary health centre on treatment outcomes and costs related to treatment. Methodology: This retrospective study looked at antimicrobial prescribing data in patients admitted to general medicine.Patients data was retrieved from Medical record section and the records of discharged patients were reviewed. The demographic data, disease related data and utilization of antibiotics were noted in specially designed proforma and analyzed. The documented data evaluated for use, safety outcomes and cost for the treatment associated with the use of antibiotics. Results: Female patients 60.2 % (n=759)aremore hospitalized when compared to males, Average length of stay in hospital was 8 days. Majority of hospitalized patients had HTN &amp; DM as primary comorbidities. The widely prescribed antibiotics among all classes as prophylaxis were third generationcephalosporins in parenteral form.

Impact of SARS-CoV-2 transmission-based precautions on inpatient management of general medical patients.

This audit reviewed the impact on access to routine medical care and adverse outcomes in patients with suspected SARS‐CoV‐2 infection managed on a ‘COVID‐19’ (CV) ward compared with a general medicine ward at Box Hill Hospital, Victoria. Data were collected at two time points to capture changes associated with onsite testing. We found no healthcare delays from admission to CV wards and observed faster exits from CV wards with improved testing efficiency. This critical finding is relevant as Victoria manages a third wave of infections.

Effect of goal-directed mobilisation intervention compared with standard care on physical activity among medical inpatients: protocol for the GoMob-in randomised controlled trial

IntroductionDespite the fact that immobilisation is a major contributor to morbidity and mortality, patients hospitalised in general internal medicine (GIM) wards spend up to 50% of time in bed. Previous...

NutriSup-PPN: A pilot randomized control trial of oral nutritional supplementation (ONS) and peripheral parenteral nutrition (PPN) in canadian, malnourished, hospitalized patients

Hospitalized malnourished patients experience poor outcomes. Our study determined the feasibility of a novel nutritional care pathway which both rapidly identifies and treats malnourished medical inpatients accounting for the obstacles in nutritional optimization. In our interventional arm, we utilize peripheral parental nutrition (PPN) followed by oral nutritional supplementation (ONS) on a composite outcome of 30 day readmission, mortality and continued admission, as well other important clinical and nutritional outcomes. The study was registered under ClinicalTrials.gov Identifier no. NCT02632630. NutriSUP-PPN was a 2×2 factorial pilot randomized trial. In two large Canadian hospitals, we recruited 100 adult patients >18 years, < 48h from admission to a general medicine ward who were moderately or severely malnourished. Patients received: 1. PPN for 5 days and then enhanced ONS until 30 days post randomization; 2. PPN for 5 days and then standard ONS until 30 days; 3. Standard care for intravenous (IV) fluid administration for 5 days and then enhanced ONS until 30 days; 4. Standard care for IV fluid administration for 5 days and standard ONS until 30 days. Our primary outcome was a composite of 30 day readmission, continued admission and mortality. There was no significant differences in the composite outcome of 30 day readmission, continued admission or mortality between any interventional group and control. We did however note a trend in the PPN+ONS arm where only 4/22 patients versus 10/24 patients (p=0.16) in the control (no PPN, no enhanced ONS) experienced an adverse outcome which was largely driven by a reduction of readmission in the ONS+PPN arm We demonstrated feasibility in recruitment, adherence to protocol, and safety. The incidence of sepsis was greater in the PPN arm compared to control (15.5% versus 4.2%) but was not statistically significant. Improvement in nutritional status for interventional arms were not significant compared to control. However, there was a trend of improvement in preventing decline of nutritional status in both the enhanced ONS arm and PPN+enhanced ONS arm. There are signals in our data, which suggest that the combination of PPN with ONS may improve both clinical and nutritional outcomes compared to PPN or ONS alone. We posit that a large, multi-center, definitive randomized control trial is now justified to determine if PPN for up to 5 days along with 30 days of ONS, versus standard of care, will improve a composite outcome of death, continued admission, and readmission at 30 days. However, because PPN was associated with a non-statistically significant increase in episodes of sepsis, future studies should ensure that sepsis episodes are well documented and monitored closely by the data safety monitoring board.