Inpatient Clinic Research Articles

Predictors of In-Hospital Mortality Among Patients with COVID-19 Related Stroke

Introduction. COVID-19-related stroke is associated with a significantly higher mortality than COVID-19 or stroke alone. Mechanisms underlying the increased mortality of patients with stroke and COVID-19 should be thoroughly studied.
 Objective: to analyze predictors of hospital mortality associated with COVID-19-related stroke.
 Materials and methods. We retrospectively analyzed 1,386 cases of COVID-19-related stroke reported by an infectious diseases inpatient clinic in 2020. We studied clinical, laboratory, and instrumental parameters in patients with different outcomes. Logistic regression was used to identify independent predictors of mortality.
 Results. 539 (38.9%) patients died during their hospital stay, with 437 (38.0%) deaths from ischemic stroke and 102 (42.7%) deaths from hemorrhagic stroke (p = 0.0001). Independent predictors of mortality associated with COVID-19-related stroke included age, neurological deficit severity measured by NIHSS, COVID-19 severity, and laboratory parameters including white blood cell count, creatinine, glucose, and D-dimer blood levels.
 Discussion. The results of logistic regression analysis were able to explain only 41% of the variability in hospital deaths among patients with stroke associated with COVID-19.
 Conclusion. Hospital mortality in patients with COVID-19-related stroke is associated with severity of inflammatory response, impaired coagulation, age, neurological deficit severity, and somatic comorbidities.

A survey exploring the practices of smoking cessation support among hospital-based healthcare providers

BackgroundHospital visits constitute a ‘window of opportunity’ for initiating smoking cessation attempts, and healthcare providers (HCPs) play an important role in supporting patients to stop smoking. Yet, the current practices of supporting smoking cessation in the hospital setting are largely unexplored. The aim of this study was to explore practices of smoking cessation support among hospital-based HCPs.MethodsHCPs working in a large hospital in the secondary care sector completed an online, cross-sectional survey, including sociodemographic and work-related factors as well as 21 questions assessing practices of smoking cessation support based on the “five As” framework. Descriptive statistics were computed, and predictors of HCPs giving patients advice to stop smoking were explored using logistic regression analysis.ResultsAll employees (N = 3998) in the hospital received a survey link; 1645 (41.1%) HCPs with daily patient contact completed the survey. Smoking cessation support in the hospital setting was limited with regard to assessment of smoking; providing information and advice; planning and referral for further support; and follow-up on smoking cessation attempts. Almost half (44.8%) of participating HCPs with daily patient contact never or rarely advise their patients to stop smoking. Physicians were more likely than nurses to advice patients to stop smoking, and HCPs in outpatient clinics were more likely to give advice than inpatient clinic HCPs.ConclusionSmoking cessation support is very limited in the hospital-based healthcare setting. This is problematic, as hospital visits can be windows of opportunity to help patients change their health behaviour. An intensified focus on the implementation of hospital-based smoking cessation support is needed.

The 2022 NCI Community Oncology Research Program (NCORP) Landscape Committee Assessment: Methods and participating practice group characteristics.

e13517 Background: The National Cancer Institute Community Oncology Research Program (NCORP) Landscape Assessment (funding support from 2UG1CA189824) provides important information about available services and capacity to engage in research among the 46 NCORP sites (encompassing ~1000 discrete clinics). We describe the methods for conducting the Landscape Assessment and present practice group characteristics. Methods: The Landscape Committee included representation from all NCORP research bases and community NCORP site members. The 2022 assessment was updated from the 2017 assessment after a network-wide request for questions. All items were reviewed for relevance, question quality, applicability to community sites, and data collection burden. The 2022 assessment update included an expanded range of topics (e.g., social determinants of health screening, pediatric and AYA services, fertility preservation services). After an initial pilot phase, the final assessment was distributed to NCORP affiliate/sub-affiliates via representatives designated by the participating sites. Data were collected April-June, 2022. Results: 271 NCORP practice groups rostered and provided demographics for 517 individual sites (98% response from NCORP sites; 52% of discrete clinics). 70 practice groups (26%) represented multiple NCORP clinics, with a median of 4 clinics (IQR: 2-7 sites). Practice groups were located in the Midwest (42%), South (30%), West (18%) and Northeast (10%). Treatment was provided to adults only at 83% of groups, 12% treated adults and children, and 5% provided only pediatric care. 28% were independently owned and 64% were owned by large regional health systems; 28% participated in the Center for Medicare and Medicaid Services Oncology Care Model. Cancer treatment services were provided in the hospital setting for 73%, freestanding practices in 49%, and 64% at inpatient clinics. The median number of annual cancer cases was 875 (IQR: 453-2,004). Practice groups reported on average most new patients were White (79%), followed by Black (13%), Asian (2.5%), and Native Hawaiian/Pacific Islander (0.64%). 10% were identified as Hispanic ethnicity. Provider availability to recruit patients for research varied by provider type (95% medical oncology; 73% radiation oncology; 47% general surgery/surgical oncology; 38% gynecology oncology; 21% uro-oncology; 19% neuro-oncology; 15% pediatric oncology; & 7% orthopedic surgical oncology). Conclusions: The Landscape assessment was successfully updated and administered in 2022 with a high response rate. Results provide updated information about community site infrastructure and capacity to conduct research among NCORP clinics. Detailed results are available to investigators by request for concept development and to help identify affiliate/sub-affiliate sites to participate in studies.

Evaluation of Efficacy and Side Effects of Impairement Liver Function in Psoriasis Vulgaris Patients Treated with Methotrexate in Dr. Soetomo General Academic Hospital Surabaya: A Retrospective Study

Background: Psoriasis is a chronic inflammatory skin disease that involves several factors, genetic, immunity defects, hormones, and environmental factors. Psoriasis vulgaris is often characterized by a thick, erythematous, well-defined, rough, layered, silvery white plaque. Methotrexate is a first-line systemic therapy in the management of psoriasis vulgaris. This drug effective to reduce the severity of the disease by at least 50% in more than 75% of patients. Unfortunately, methotrexate also has the potential to cause adverse effects, this drug is considered one of the main causes of increased liver enzymes in psoriasis patients for several years so special consideration is needed when prescribing methotrexate to patients. Therefore, periodic evaluation during the use of this drug is needed to find out the side effects that can be caused. Purpose: The aim was to to evaluate PASI, SGOT and SGPT score of psoriasis vulgaris patients who received methotrexate therapy at Dermatology and Venerology Outpatient and Inpatient Clinic Dr. Soetomo General Academic Hospital Surabaya. Methods: This was a observational analytical study with retrospective data through one shot case study pre-experimental study approach, but was conducted pre and post treatment that aimed to evaluate PASI, SGOT and SGPT score of psoriasis vulgaris patients who received methotrexate therapy at Dermatology and Venerology Outpatient and Inpatient Clinic Dr. Soetomo General Academic Hospital Surabaya for the period January 2018-December 2020. Results: The results of this study were 51 psoriasis patients who received methotrexate that include in inclusion criteria. The number of male patients was more than women, 30(58,8%) for men and 21(41.2%) for women. There was a statistically significant difference in the reduction in PASI score of psoriasis vulgaris patients before and after methotrexate therapy (p = 0.001). However, the results of statistical analysis SGOT score of psoriasis vulgaris patients before methotrexate therapy were no different than after receiving methotrexate therapy (p = 0.286). In contrast, the results of statistical analysis SGPT score of psoriasis vulgaris patients after receiving methotrexate therapy increased significantly compared to before receiving methotrexate therapy (p = 0.001). Conclusion: there was significant decrease in PASI scores and significant increase in SGPT scores before and after receiving methorexate therapy. However, for SGOT scores statistically there was no significant difference before and after receiving methorexate therapy.

Decreased plasma neuropeptides in first-episode schizophrenia, bipolar disorder, major depressive disorder: associations with clinical symptoms and cognitive function.

There is an urgent need to identify differentiating and disease-monitoring biomarkers of schizophrenia, bipolar disorders (BD), and major depressive disorders (MDD) to improve treatment and management. We recruited 54 first-episode schizophrenia (FES) patients, 52 BD patients, 35 MDD patients, and 54 healthy controls from inpatient and outpatient clinics. α-Melanocyte Stimulating Hormone (α-MSH), β-endorphin, neurotensin, orexin-A, oxytocin, and substance P were investigated using quantitative multiplex assay method. Psychotic symptoms were measured using the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS), manic symptoms using the Young Mania Rating Scale (YMRS), and depressive symptoms using 17 item-Hamilton Depression Rating Scale (HAMD). We additionally measured cognitive function by using a battery of tests given to all participants. α-MSH, neurotensin, orexin-A, oxytocin, and substance P were decreased in the three patient groups compared with controls. Neurotensin outperformed all biomarkers in differentiating patient groups from controls. There were no significant differences for 6 neuropeptides in their ability to differentiate between the three patient groups. Higher neurotensin was associated with better executive function across the entire sample. Lower oxytocin and higher substance p were associated with more psychotic symptoms in FES and BD groups. β-endorphin was associated with early morning wakening symptom in all three patient groups. Our research shows decreased circulating neuropeptides have the potential to differentiate severe mental illnesses from controls. These neuropeptides are promising treatment targets for improving clinical symptoms and cognitive function in FES, BD, and MDD.

Facing Pandemic: Burnout in Nurses in Turkey.

Burnout syndrome is a disorder that characterized by emotional exhaustion, depersonalization, and personal lack of accomplishment perception and it is common in nurses. During the coronavirus disease 2019 pandemic, nurses tried to take care of their patients and protect themselves and their families from disease and death. This study examines the factors affecting nurses' burnout in Turkey during the coronavirus disease 2019 pandemic. Data were collected from 3523 nurses in 69 cities across Turkey by sociodemographic questions and Maslach Burnout Scale with the electronic questionnaire created in the "SurveyMonkey" application between June 9, 2020 and June 21, 2020. To assess the impact of the pandemic on nurses' burnout, nurses were categorized as those working in pandemic units and others. The response rate was 68%, and 3523 nurses from 69 cities across Turkey participated in the survey. Analyses were conducted with 2386 nurses that answered all questions. 76.45% of the nurses were from tertiary hospitals, and 54.9% (n = 1309) worked in pandemic units. Of 2386 participants, 86.13% (n = 2055) were female, the mean age was 33.9 (±8.43), and 58.76% (n = 1402) were married. Of 2386 participants, 54.9% (n = 1309) worked in pandemic units (outpatient clinics, inpatient clinics, and intensive care units). In multivariate linear regression analyses, the emotional exhaustion score was higher in nurses working in pandemic units (P < .05). The factors that have been shown to cause burnout in previous studies were similar. However, in this study, it was also seen that the pandemic is a fundamental cause of burnout.

Quality of Life of Caregivers of Women Receiving Cancer Treatment in Turkey.

The study aims to explore the predictors of the quality of life of caregivers of women receiving cancer treatment in Turkey. This study was conducted in a Medical-Oncology inpatient clinic of a University Hospital in Istanbul, Turkey, between February and June 2020. Descriptive data were collected from 128 family caregivers using caregiver and patient identification forms and the quality of life scale- family version. Bivariate analyses and multiple regression were used to analyze the data. The mean score of the quality of life was 4.41 (standard deviation=0.63). A backward multiple regression revealed that being female caregivers, increased time spent for care per day, and caring for women with metastatic cancer were factors associated with poor quality of life. Although caregiving responsibilities bring challenges to every caregiver, those who are at high risk for impaired quality of life during caregiving need further support in their caregiving to maintain quality of life. Further research should focus on finding solutions to better support caregivers who are experiencing impairment in their quality of life.

A Versatile Prison Psychiatric Pharmacy Program

BackgroundBefore the coronavirus disease 2019 (COVID-19) pandemic, 20% of the adult population in the United States experienced mental illness annually. Since the COVID-19 pandemic, 93% of countries have reported disruptions to mental health services. The demand for services is high whereas infrastructure and qualified professionals are appallingly low. Health care in the correctional setting is unique, where mental illness prevalence is double than that in the community. The intersection of policies and procedures and the beneficence plus nonmaleficence responsibility of health care professionals is exceptionally complex. Studies have shown the potential benefits of pharmacists following patients in chronic care psychiatry visits. ObjectivesAn inpatient psychiatric pharmacy clinic was launched to fill gaps to provide safe and up-to-date patient-centric services for more than 240 extremely psychiatrically ill inmate patients at the Federal Correctional Center Butner (FCC Butner), a Federal Bureau of Prisons medical center. MethodsThe inpatient psychiatric pharmacist practiced independently under a collaborative practice agreement and completed mental health clinical visits for a revolving portion of 240 inpatient mental health inmate patients at FCC Butner. The pharmacist provided ancillary services including completing movement disorder testing, monitoring narrow therapeutic index medication laboratory test results, and executing an antipsychotic psychoeducation meeting with other health care departments and inmate patients. ResultsNotably, 74% of patients monitored in the specialty program experienced stable or improved symptoms of depression, schizophrenia, and bipolar disorder. Adverse effects, particularly psychiatric-related movement disorders, were also more closely managed. Finally, 43% of the total inmate patient population who previously declined psychiatric medication treatment consented to begin treatment after participation in a pilot antipsychotic psychoeducation meeting. ConclusionThe inpatient psychiatric pharmacy program at FCC Butner is a dynamic program that has bolstered the facility’s health care mission. The services detailed in this article can be applied to other correctional environments that have a medical outpatient or inpatient presence.

A clinical pharmacist's intervention on interaction between meropenem and valproic acid in paediatric inpatient clinic: A case report

A clinical pharmacist's intervention on interaction between meropenem and valproic acid in paediatric inpatient clinic: A case report

Mental health related stigma, service provision and utilization in Northern India: situational analysis

Stigma, discrimination, poor help seeking, dearth of mental health professionals, inadequate services and facilities all adversely impact the mental health treatment gap. Service utilization by the community is influenced by cultural beliefs and literacy levels. We conducted a situational analysis in light of the little information available on mental health related stigma, service provision and utilization in Haryana, a state in Northern India. This involved: (a) qualitative key informant interviews; (b) health facility records review; and (c) policy document review to understand the local context of Faridabad district in Northern India. Ethical approvals for the study were taken before the study commenced. Phone call in-depth interviews were carried out with a purposive sample of 13 participants (Mean = 38.07 years) during the COVID-19 pandemic, which included 4 community health workers, 4 people with mental illness, 5 service providers (primary health care doctors and mental health specialists). Data for health facility review was collected from local primary health and specialist facilities while key policy documents were critically analysed for service provision and stigma alleviation activities. Thematic analysis was used to analyse patterns within the interview data. We found poor awareness and knowledge about mental illnesses, belief in faith and traditional healers, scarcity of resources (medicines, trained professionals and mental health inpatient and outpatient clinics), poor access to appropriate mental health facilities, and high costs for seeking mental health care. There is a critical gap between mental health related provisions in policy documents and its implementation at primary and district level.

Outpatient Fully Endoscopic Cervical Unilateral Laminotomy for Bilateral Decompression with Virtual Postoperative Monitoring

Objective: Cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) is a promising novel surgical approach. However, to date, there is a paucity of data regarding safety, efficacy, and functional outcomes following CE-ULBD.Methods: The aim of this study was to investigate the outcomes of outpatient CE-ULBD combined with postoperative smartphone-based continuous physiological monitoring and virtual follow-up. Results: We included a total of 23 patients in our study group. The mean age was 69.1±2.5 years. A significant postoperative reduction of the visual analogue scale for neck pain (4.1±0.6 pre- vs. 2.3±0.5 post-surgery; P&lt;0.0001) and upper extremity pain (2.6±0.6 vs. 1.1±0.3; P=0.0012) was reported alongside a significant improvement in the Neck Disability Index (18.6±2.5 vs. 9.1±2.5; p=0.032). Eleven patients were monitored with continuous physiological monitoring via a smartphone app (SPINEHealthie ). Those patients were more likely to be outpatients (p=0.0002) and less likely to have postoperative inpatient clinic utilization (p&lt;0.0001). Continuous physiological monitoring suggested a trend towards higher levels of function in patients following CE-ULBD. Conclusion: : Our early results suggest that outpatient CE-ULBD followed by virtual postoperative monitoring is a safe and efficient therapeutic intervention for symptomatic cervical spinal stenosis.

SARS-CoV-2-Related Adaptation Mechanisms of Rehabilitation Clinics Affecting Patient-Centered Care: Qualitative Study of Online Patient Reports.

The SARS-CoV-2 pandemic impacted access to inpatient rehabilitation services. At the current state of research, it is unclear to what extent the adaptation of rehabilitation services to infection-protective standards affected patient-centered care in Germany. The aim of this study was to determine the most relevant aspects of patient-centered care for patients in inpatient rehabilitation clinics under early phase pandemic conditions. A deductive-inductive framework analysis of online patient reports posted on a leading German hospital rating website, Klinikbewertungen (Clinic Reviews), was performed. This website is a third-party, patient-centered commercial platform that operates independently of governmental entities. Following a theoretical sampling approach, online reports of rehabilitation stays in two federal states of Germany (Brandenburg and Saarland) uploaded between March 2020 and September 2021 were included. Independent of medical specialty groups, all reports were included. Keywords addressing framework domains were analyzed descriptively. In total, 649 online reports reflecting inpatient rehabilitation services of 31 clinics (Brandenburg, n=23; Saarland, n=8) were analyzed. Keywords addressing the care environment were most frequently reported (59.9%), followed by staff prerequisites (33.0%), patient-centered processes (4.5%), and expected outcomes (2.6%). Qualitative in-depth analysis revealed SARS-CoV-2-related reports to be associated with domains of patient-centered processes and staff prerequisites. Discontinuous communication of infection protection standards was perceived to threaten patient autonomy. This was amplified by a tangible gratification crisis of medical staff. Established and emotional supportive relationships to clinicians and peer groups offered the potential to mitigate the adverse effects of infection protection standards. Patients predominantly reported feedback associated with the care environment. SARS-CoV-2-related reports were strongly affected by increased staff workloads as well as patient-centered processes addressing discontinuous communication and organizationally demanding implementation of infection protection standards, which were perceived to threaten patient autonomy. Peer relationships formed during inpatient rehabilitation had the potential to mitigate these mechanisms.

Typical disease courses of patients with unipolar depressive disorder after in-patient treatments-results of a cluster analysis of the INDDEP project.

Previously established categories for the classification of disease courses of unipolar depressive disorder (relapse, remission, recovery, recurrence) are helpful, but insufficient in describing the naturalistic disease courses over time. The intention of the present study was to identify frequent disease courses of depression by means of a cluster analysis. For the longitudinal cluster analysis, 555 datasets of patients who participated in the INDDEP (INpatient and Day clinic treatment of DEPression) study, were used. The present study uses data of patients with at least moderate depressive symptoms (major depression) over a follow-up period of 1 year after their in-patient or day-care treatments using the LIFE (Longitudinal Interval Follow-Up Evaluation)-interview. Eight German psychosomatic hospitals participated in this naturalistic observational study. Considering only the Calinski-Harabatz index, a 2-cluster solution gives the best statistical results. In combination with other indices and clinical interpretations, the 5-cluster solution seems to be the most interesting. The cluster sizes are large enough and numerically balanced. The KML-cluster analyses revealed five well interpretable disease course clusters over the follow-up period: "sustained treatment response" (N = 202, 36.4% of the patients), "recurrence" (N = 80, 14.4%), "persisting relapse" (N = 115, 20.7%), "temporary relapse" (N = 95, 17.1%), and remission (N = 63, 11.4%). The disease courses of many patients diagnosed with a unipolar depression do not match with the historically developed categories such as relapse, remission, and recovery. Given this context, the introduction of disease course trajectories seems helpful. These findings may promote the implementation of new therapy options, adapted to the disease courses.

Cancer-Associated Thrombosis: Risk Assessment, Prevention, and Treatment.

The risk of developing venous thromboembolism (VTE) is four to seven times higher in patients with cancer than in those without. At JADPRO Live 2022, presenters discussed risk factors and assessing patients for VTE, as well as how to protect patients against VTE in both the inpatient and outpatient clinic settings. They reviewed selecting an appropriate anticoagulation treatment, including the choice of agent and duration of treatment for the patient with cancer, and finally the steps needed to assess and treat patients experiencing therapeutic anticoagulation failure.

Potential Risk Factors for, and Clinical Implications of, Delirium During Inpatient Rehabilitation: A Matched Case-Control Study.

To investigate the association between a wide set of baseline characteristics (age, sex, rehabilitation discipline), functional scores [Functional Independence Measure (FIM), cumulative Illness Rating Scale (CIRS)], diseases, and administered drugs and incident delirium in rehabilitation inpatients and, furthermore, to assess clinical implications of developing delirium during rehabilitation. Matched case-control study based on electronic health record data. We studied rehabilitation stays of inpatients admitted between January 1, 2015, and December 31, 2018, to ZURZACH Care, Rehaklinik Bad Zurzach, an inpatient rehabilitation clinic in Switzerland. We conducted unconditional logistic regression analyses to estimate adjusted odds ratios (AORs) with 95% CIs of exposures that were recorded in ≥5 cases and controls. Among a total of 10,503 rehabilitation stays, we identified 125 validated cases. Older age, undergoing neurologic rehabilitation, a low FIM, and a high CIRS were associated with an increased risk of incident delirium. Being diagnosed with a bacterial infection (AOR 2.62, 95% CI 1.06-6.49), a disorder of fluid, electrolyte, or acid-base balance (AOR 2.76, 95% CI 1.19-6.38), Parkinson's disease (AOR 5.68, 95% CI 2.54-12.68), and administration of antipsychotic drugs (AOR 8.06, 95% CI 4.26-15.22), antiparkinson drugs (AOR 2.86, 95% CI 1.42-5.77), drugs for constipation (AOR 2.11, 95% CI 1.25-3.58), heparins (AOR 2.04, 95% CI 1.29-3.24), or antidepressant drugs (AOR 1.88, 95% CI 1.14-3.1) during rehabilitation, or an increased anticholinergic burden (ACB ≥ 3) (AOR 2.59, 95% CI 1.41-4.73) were also associated with an increased risk of incident delirium. We identified a set of factors associated with an increased risk of incident delirium during inpatient rehabilitation. Our findings contribute to detect patients at risk of delirium during inpatient rehabilitation.

155 An Assessment of Gender-Affirming Language within Patient Encounter Notes

OBJECTIVES/GOALS: Transgender, non-binary, and gender expansive (TGE) patients experience significant barriers to high-quality care including limited provider expertise and pathologization within health documentation. This study aimed to evaluate the use of gender-affirming language within free text medical notes of TGE patients. METHODS/STUDY POPULATION: We conducted a qualitative analysis of free text medical notes in adult (&gt; age 18 years) TGE patients seen in inpatient and outpatient medicine and general surgery clinics between January 2019 and January 2022 at three independent health systems in San Francisco. TGE patients were identified based on self-identified gender identity, sex assignment at birth, and legal sex. We conducted a thematic analysis to assess use of gender-affirming language, including self-identified pronouns, chosen names, gendered and gender-neutral descriptors, sex-related traits, and pathologizing language. RESULTS/ANTICIPATED RESULTS: Within pilot data, we found inconsistent use of gender-affirming language within notes, with pronounced variability within the history of present illness, the clinical one liner, and the problem list. Within one liners, many did not include patient-identified pronouns (81%), omitted chosen names (53%), and utilized gendered language that was misaligned with patient self-identified gender identity (27%) - frequently including the use of outdated terms i.e. female-to-male and transsexual. Many problem lists included gender-related care, with some describing hormonal and surgical interventions and others utilizing language to pathologize trangender status. DISCUSSION/SIGNIFICANCE: Our study identifies gaps in the use of gender-affirming language in medical notes. Of particular significance in the era of open notes wherein patients can view their medical records, our study offers a framework for assessing and increasing gender-affirming language use within free text medical notes that can be applied across health systems.

Is the prognostic nutritional index a predictor of Covid-19 related hospitalizations and mortality?

Prognostic nutritional index (PNI) is a novel inflammation marker that useful in predicting prognosis of certain conditions. We aimed to study PNI of the outpatient and inpatient subjects with established Covid-19 and also aimed to compare PNI of deceased and survived Covid-19 patients. The patients with Covid-19 whom presented to outpatient or inpatient clinics of Abant Izzet Baysal University Hospital were enrolled to the study. PNI levels of the inpatients and outpatients, deceased and survived were compared. PNI values of deceased and survived in inpatients were also compared. Study population was consisted of 4419 subjects (2907 outpatients and 1512 inpatients). PNI of the inpatient (41.55 (36.42-47.1)) group was significantly lower than the PNI of the outpatient (51.95 (47.95-55.75)) subjects (p<0.001). The sensitivity and specificity of PNI (≤46.2 level) in determination of requirement inpatient treatment were 71.2% and 83.5%, respectively. PNI of the deceased patients (37(33.39-40.86)) was lower than the PNI of the survivors (50.45(45.6-54.65)), (p<0.001). The sensitivity and specificity of PNI at ≤44.55 level in determining mortality were 89.22% and 78.87%, respectively. We suggest that PNI could serve as a reliable prognostic index in covid-19 patients. Reduced level of PNI should alert physicians since it is associated with need for hospitalization and mortality in this population.

Knowledge, attitude and practice behavior regarding blood pressure among physical therapists of twin cities

Background: Blood pressure (BP) monitoring has a very crucial role in physical therapy for accurate evaluation and re-evaluation of the patient, otherwise it can lead to inaccurate clinical decision making and the patient may be falsely diagnosed. It is an important cardinal sign that cannot be neglected in making clinical decision, may put the individual to a greater risk of cardiovascular and other health problems. Objective: to explore the knowledge, attitude, and practice behavior regarding BP among physical therapists (PT) of twin cities. Methods: A cross sectional study was conducted in 6 months, from January 2019 to June 2019 in different hospitals of Islamabad and Rawalpindi. The data was collected from n=296 PT of twin cities after obtaining the written consent. The data of knowledge, attitude and practice behaviors towards BP was collected by semi structured questionnaire. The results were presented in table and graph while description was given as Mean ± SD and f (%). Results: The mean age of study participants was 28.4±3.71 years. The overall mean score of knowledge (4.27±3.05) showed that n=159(53.72%) participants in the study have poor knowledge about the information related to BP. While attitude score (19.74±.2.29) showed that majority of the sample n=179(60.47%) have positive attitude towards the importance of BP evaluation during assessment, management and educating the patient. While observing the behaviour, mean score (14.55±4.78) showed that physical therapist has acceptable behaviour towards the BP measurement. But frequency distribution showed that n=160(54.05%) physical therapist has poor behaviour towards BP measurement during their practice. Conclusion: The knowledge and practice behavior regarding the BP assessment and evaluation among the physical therapist is very poor, while their attitude is positive towards the importance of BP evaluation during assessment, management and educating the patients. Keywords: Blood pressure, inpatient clinic, outpatient clinic, physical therapy.

Daily serum phosphate increase as early and reliable indicator of kidney injury in children with leukemia and lymphoma developing tumor lysis syndrome.

Tumor lysis syndrome (TLS) and its most serious complication, acute kidney injury (AKI) are one of the emergency conditions in onco-hematology. It is difficult to predict the degree of kidney involvement. Therefore, we studied children with leukemia and lymphoma treated in four Hungarian tertiary centers (inpatient university clinics) retrospectively (2006-2016) from a nephrological aspect. Data of 31 pediatric patients were obtained from electronic- and paper-based medical records. Physical status, laboratory test results, treatments, and outcomes were assessed. Patients were analyzed according to both "traditional" TLS groupings, as laboratory TLS or clinical TLS, and nephrological aspect based on pRIFLE classification, as mild or severe AKI. Significant differences were found between the changes in parameters of phosphate homeostasis and urea levels in both classifications. Compared to age-specific normal phosphate ranges, before the development of TLS, hypophosphatemia was common (19/31 cases), while in the post-TLS period, hyperphosphatemia was observed (26/31 cases) most frequently. The rate of daily change in serum phosphate level was significant in the nephrological subgroups, but peaks of serum phosphate level show only a moderate increase. The calculated cut-off value of daily serum phosphate level increased before AKI was 0.32mmol/L per ROC analysis for severe TLS-AKI. The 24-h urinalysis data of eight patients revealed transiently increased phosphate excretion only in those patients with TLS in whom serum phosphate was elevated in parallel. Daily serum phosphate level increase can serve as a prognostic factor for the severity of pediatric TLS, as well as predict the severity of kidney involvement. A higher resolution version of the Graphical abstract is available as Supplementary information.

Clozapine in first episode psychosis – the experience of a Portuguese center

IntroductionAntipsychotics are the standard in the treatment of first psychotic episodes. Although the majority of patients respond to the established treatment, it is currently known that there is a subgroup of patients whose response is not satisfactory. In this group, the subsequent response to a new antipsychotic is generally poor. Clozapine is an antipsychotic with a unique profile, with demonstrated efficacy and approval in the treatment of treatment-resistant schizophrenia. Its role in the first psychotic episodes remains unclear and its use is, to say the least, controversial.ObjectivesThis work aims to analyze and evaluate the use of clozapine in patients with a first psychotic episode, taking into account the experience of a Portuguese Hospital Center.MethodsWe carried out a retrospective study, including all patients admitted to the inpatient clinic of adults with a first psychotic episode, in the Department of Psychiatry of Centro Hospitalar Universitário of São João, in Oporto, between 2007 and 2020. Clinical and socio-demographic data were collected.We performed a retrospective analysis of patients who, at discharge, were medicated with clozapine, proceeding to a descriptive analysis.ResultsIn this case series, we intended to describe the cases of patients in whom the use of clozapine in the first psychotic episode was initiated. All patients were discharged with the diagnosis of Schizophrenia. Prior to the introduction of clozapine, patients were treated with other antipsychotics, normally two. Patients taking clozapine were younger and had a longer duration of untreated psychosis. They had also longer length of hospital stay. The pattern of prescribing antipsychotics in the first and subsequent episodes has generally been extensively studied. However, the use of clozapine in the first episodes remains unclear.In the literature, and despite clozapine being considered one of the most effective antipsychotics, there is a high prevalence of polypharmacy and a significant delay in its use in the first episodes.Notwithstanding the unfavorable metabolic and hematological profile of clozapine, compared to other antipsychotics, in terms of hospitalization, mortality and discontinuation rates for all causes, it demonstrates a pattern of superiority.ConclusionsThe superiority in effectiveness of clozapine is well established, despite its underutilization and frequent delay in its introduction.The clinicians attitude remains a significant barrier to the commencement of clozapine, although it is important to define and characterize better potential groups of eligible patients. Education resources for clinicians as well as services specifically dedicated to early identification and management of eligible patients would be beneficial.Disclosure of InterestNone Declared