Internal Medicine Patients Research Articles

Acute kidney injury in hospitalized patients with nonmalignant pleural effusions: a retrospective cohort study

BackgroundNonmalignant pleural effusion (NMPE) is common and remains a definite health care problem. Pleural effusion was supposed to be a risk factor for acute kidney injury (AKI). Incidence of AKI in NMPE patients and whether there is correlation between the size of effusions and AKI is unknown.ObjectiveTo assess the incidence of AKI in NMPE inpatients and its association with effusion size. Study design and methodWe conducted a retrospective cohort study of inpatients admitted to the Chinese PLA General Hospital with pleural effusion from 2018-2021. All patients with pleural effusions confirmed by chest radiography (CT or X-ray) were included, excluding patients with diagnosis of malignancy, chronic dialysis, end-stage renal disease (ESRD), community-acquired AKI, hospital-acquired AKI before chest radiography, and fewer than two serum creatinine tests during hospitalization. Multivariate logistic regression and LASSO logistic regression models were used to identify risk factors associated with AKI. Subgroup analyses and interaction tests for effusion volume were performed adjusted for the variables selected by LASSO. Causal mediation analysis was used to estimate the mediating effect of heart failure, pneumonia, and eGFR < 60 ml/min/1.73m2 on AKI through effusion volume. ResultsNMPE was present in 7.8% of internal medicine inpatients. Of the 3047 patients included, 360 (11.8%) developed AKI during hospitalization. After adjustment by covariates selected by LASSO, moderate and large effusions increased the risk of AKI compared with small effusions (moderate: OR 1.47, 95%CI 1.11-1.94 p = 0.006; large: OR 1.86, 95%CI 1.05-3.20 p = 0.028). No significant modification effect was observed among age, gender, diabetes, bilateral effusions, and eGFR. Volume of effusions mediated 6.8% (p = 0.005), 4.0% (p = 0.046) and 4.6% (p < 0.001) of the effect of heart failure, pneumonia and low eGFR on the development of AKI respectively. ConclusionThe incidence of AKI is high among NMPE patients. Moderate and large effusion volume is independently associated with AKI compared to small size. The effusion size acts as a mediator in heart failure, pneumonia, and eGFR.

Analysis of Clinical Care of Respiratory Medicine Patients

The rapid development of industrialization has brought serious pollution to the living environment of human beings, and the res- piratory system of human beings is vulnerable to the invasion of foreign germs, which poses a great threat to human health. The chances of respiratory disease patients to feel heavy after treatment are very high, therefore, it is necessary to provide effective nursing care forrespira- tory internal medicine patients to realize the harmony between doctors and patients and to cure the disease together. The authors of this paper analyze the clinical care of respiratory medicine patients.

Quality of Life Assessment in Internal Medicine Patients

The relationship between quality of life and chronic illness is clearly established, the evaluation of the latter is necessary for overall care of these patients, the SF36 is a good tool dedicated to this purpose. Our study, although limited by its single-center nature, sheds light on the impact of pathologies encountered in internal medicine hospitalization on quality of life. Our series includes 41 patients with a slight female predominance: 22 women and 19 men. The average age is 48 years old. Thus, it appears that, just like cancer, diabetes and connective tissue disease significantly reduce the quality of life of patients.

Internal Medicine Residents' Perceptions of Their Continuity Clinic Training.

Internal Medicine (IM) residents have reported dissatisfaction with continuity clinic (CC) training, which may contribute to the increasing shortage of primary care physicians. Studies show balancing inpatient and outpatient duties as a driver of dissatisfaction, but few studies have compared CC with inpatient (IP) training, following transition to an X + Y model, or assessed the impact of show rates, continuity, and telemedicine use on resident perceptions. The aim of this study was to adapt a validated survey to compare residents' perceptions of their CC with their inpatient medicine training and examine the impact of objective clinic measures on training. This quantitative cross-sectional study included a survey that was sent to 152 residents at an academic IM program in May-June 2021. Clinic measures such as show versus no-show rates, continuity with the residents' own patients, and visit modality were obtained through the electronic health records at Veterans Affairs and non-Veterans Affairs CCs. The survey response rate was 78% (118/152). Residents were more satisfied with inpatient general medicine rotations than their CC experience (4.5 vs 3.3 on a 5-point scale, P < 0.001). Residents were more likely to pursue a profession in inpatient IM than in primary care (3.7 vs 2.3, P < 0.001). No correlation was found between higher show rates, continuity with patients, or proportion of visits conducted through telemedicine and resident satisfaction with CC. This study aligns with previous findings of IM resident dissatisfaction with CC training while adding a side-by-side comparison to inpatient training and including objective CC data. We identified new areas for improvement of CC training, including residents' medical knowledge through review of quality metrics, making CC representative of real-world practice, and mentorship from faculty.

Effect of ordering thyroid-stimulating hormone levels on subsequent clinical management of internal medicine in-patients admitted with delirium

Effect of ordering thyroid-stimulating hormone levels on subsequent clinical management of internal medicine in-patients admitted with delirium

The association of degree of polypharmacy before and after among hospitalised internal medicine patients and clinical outcomes: a retrospective, population-based cohort study

ObjectivesTo determine the prevalence and incidence of polypharmacy/hyperpolypharmacy and which medications are most prescribed to patients with varying burden of polypharmacy.DesignRetrospective, population-based cohort study.SettingIceland.ParticipantsIncluding patients (≥18 years) admitted to internal...

The development of an islamic nursing care model to improve patient satisfaction

Introduction: This study aimed to the development of an Islamic nursing care model to improve patient satisfaction. Methods: Cross-sectional design random sampling technique on 134 respondents, consisting of patients and nurses in the surgical inpatient room, internal medicine inpatient room, and postpartum and gynecology inpatient rooms, using simple random techniques. The variables of this study were the nursing factors, Islamic nursing care, and patient satisfaction and were collected using questionnaire. The data were collected using questionnaire in December 2021 at Islamic Hospital, Indonesia, and processed using a Smart Partial Least Squares (SmartPLS) analysis and Sommers' correlation test. Results: The Sommers' test results show significant relationship between nursing factor (nurse knowledge, nurse’s attitude, nurse competence, nurse personality) and patient satisfaction; nurse knowledge (p=0.000); nurse attitude (p=0.000); nurse competence (p=0.000); nurse personality (p=0.000; α&lt;0.05). SmartPLS test results show the nurse factor with Islamic nursing care has a strong significant influence (p value 0.000; β value 0.539; t value&gt; 1.96). Then for Islamic nursing care with patient satisfaction, it has a very strong significant effect (p value 0.000; β value 0.753; t value&gt; 1.96). Conclusions: Islamic nursing care as a mediator of nurse factors with patient satisfaction can be described in this study model because Islamic nursing care is a real form of care by nurses that is felt by the patient and the application of Islamic values so that the form of nursing care makes patients feel satisfied.

A Prospective Quasi-Experimental Study of Multifaceted Interventions Including Computerized Drug Utilization Evaluation to Improve an Antibiotic Stewardship Program.

This study aimed to determine and evaluate interventions that improve an antibiotic stewardship program (ASP) in reduction of the amount of antibiotic use and errors in drug utilization evaluation (DUE) form completion. A prospective quasi-experimental study was conducted to evaluate the effectiveness of the multifaceted interventions (preauthorization with computerized DUE, self-supervised checklists, and short active reminders of the antibiotic guidelines recommendations) incorporating an ASP among hospitalized internal medicine patients in a Thai tertiary care center. The preintervention period was from January to December 2018, and the postintervention period was from February 2019 to January 2020. A total of 9188 and 9787 patient data were analyzed during the preintervention and postintervention periods, respectively. The overall median antibiotic use (defined daily dose/1000 bed-days) was significantly decreased in the postintervention period compared with the preintervention period (867.68 versus 732.33; P < 0.001). The reduction in antibiotic use was predominantly observed among broad-spectrum antibiotics, including cefoperazone/sulbactam (15.35 versus 9.75; P = 0.04), cefepime (13.09 versus 6.37; P = 0.003), ciprofloxacin (32.99 versus 17.83; P < 0.001), piperacillin/tazobactam (99.23 versus 91.93; P = 0.03), meropenem (2.01 versus 0.99; P < 0.001), imipenem/cilastatin (9.53 versus 4.59; P = 0.04), and colistin (74.70 versus 22.34; P < 0.0001). The overall rate of errors in DUE form completion was significantly decreased after the intervention (40% versus 28%; P < 0.001). The incidence of carbapenem-resistant Enterobacteriaceae infections/colonization was significantly lower in the postintervention period (0.27 versus 0.12/1000 bed-days; P = 0.02). The study multifaceted interventions incorporating ASP were associated with significant reduction in the amount of broad-spectrum antibiotic use, DUE form completion errors, and incidence of carbapenem-resistant Enterobacteriaceae infection/colonization.

Designing a Virtual Hospital-at-Home Intervention for Patients with Infectious Diseases: A Data-Driven Approach.

Virtual hospital-at-home care might be an alternative to standard hospital care for patients with infectious diseases. In this study, we explore the potential for virtual hospital-at-home care and a potential design for this population. This was a retrospective cohort study of internal medicine patients suspected of infectious diseases, admitted between 1 January and 31 December 2019. We collected information on delivered care during emergency department visits, the first 24 h, between 24 and 72 h, and after 72 h of admission. Care components that could be delivered at home were combined into care packages, and the potential number of eligible patients per package was described. The most feasible package was described in detail. 763 patients were included, mostly referred for general internal medicine (35%), and the most common diagnosis was lower respiratory tract infection (27%). The most frequently administered care components were laboratory tests, non-oral medication, and intercollegiate consultation. With a combination of telemonitoring, video consultation, non-oral medication administration, laboratory tests, oxygen therapy, and radiological diagnostics, 48% of patients were eligible for hospital-at-home care, with 35% already eligible directly after emergency department visits. While the potential for virtual hospital-at-home care is high, it depends greatly on which care can be arranged.

Characteristics of liver cirrhosis patients: A literature review

Introduction: Based on data from the World Health Organization (WHO), there is an increase in the number of deaths due to liver cirrhosis from year to year, with the death rate reaching 905,418 in 2000 and soaring to 1,161,914 in 2015. According to a 2016 government public hospital report in Indonesia, The prevalence of liver cirrhosis is estimated at 3.5% of total internal medicine patients, or an average of around 47.4% of all patients treated for cirrhosis. This research using the literature review method aims to describe the characteristics of liver cirrhosis sufferers (gender, etiology of liver cirrhosis, age, child-turcotte-pugh) in Indonesia. Methods: The type of study in this research is a literature review using secondary data in the form of literature that meets the inclusion and exclusion criteria. The inclusion criteria for this research are literature that has been published in the last 10 years, can be accessed in its entirety, literature set in Indonesia, and meets the search keywords. The exclusion criteria in this study were literature with the type of study in the form of a review. Results: A literature search conducted on Google Scholar and Pubmed found eight pieces of literature that met the inclusion and exclusion criteria. Eight pieces of literature are descriptive observational studies. The total samples obtained from the eight pieces of literature were 1010 samples. The time span of the literature obtained was 2015-2023. Before data extraction, each piece of literature was assessed for risk of bias using JBI (Joanna Briggs Institute) critical appraisal. Conclusions: Based on literature review research, cirrhosis sufferers are more likely to suffer from men (685 samples), the elderly age group (&gt;45 years) with hepatitis B etiology (477 samples), and Child-Turcotte-Pugh score category C (397 samples).

Motives of patients presenting independently at the emergency department-aprospective monocentric observational study

In the ongoing professional, societal, and political discussion, the hypothesis is repeatedly put forward that alarge portion of patients who independently visit the emergency department could also be treated in other care settings such as by ageneral practitioner, the statutory medical on-call service, or in emergency clinics. Various reasons are cited for why these alternative care settings are not utilized in these cases. This study investigates the motives of patients who presented independently at the emergency department, as well as the socio-demographic parameters of this study cohort. The survey was carried out as part of aprospective monocentric observational study of internal medicine patients at auniversity emergency department. Atotal of 1086 patients were included in the study. In total, 33% of the study participants visited the emergency department based on aphysician's recommendation or referral instead of opting for an alternative care option. The main reason for visiting the emergency department was the subjectively assessed urgency of their symptoms. Among the patients who presented independently at the emergency department, 28% required further inpatient care during the course of treatment. Awareness of alternative care pathways, such as utilizing emergency medical services, seeking care from the statutory medical on-call service, or visiting an emergency clinic, was low. Emergency departments remain an important point of contact for patients who present there independently, without being brought by emergency medical services. The motives behind why patients choose avisit to the emergency department over treatment in an alternative care setting vary. If alternatives are to be used instead of emergency departments, structures first need to be established or expanded.

Reduction of hospital length of stay through the implementation of SAFER patient flow bundle and Red2Green days tool: a pre–post study

BackgroundIn 2018, the National Health System released the ‘Guide to reducing long hospital stays’ to stimulate improvement and decrease length of stay (LOS) in England hospitals. The SAFER patient flow...

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties—A multicenter cross-sectional study

ObjectiveTo adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. ResultsThe scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. DiscussionCuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed “ill will” to fill out the scale. Psychiatric patients’ scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. ConclusionThe Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients’ perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

Cost Analysis of Thromboprophylaxis in Patients at High Thromboembolic Risk with Enoxaparin, Dalteparin and Nadroparin in Colombia: A Systematic Literature Review-Based Study.

To analyze the costs of high thromboembolic risk patients who require low molecular weight heparins (LMWHs) as a thromboprophylaxis strategy. Cost analysis was conducted to assess LMWHs (enoxaparin versus comparators: nadroparin and dalteparin) as thromboprophylaxis for hospitalized patients with high thromboembolic risk in Oncology, General or Orthopedic Surgery, and Internal Medicine services from the healthcare provider's perspective in Colombia. A decision tree was developed, and the health outcomes considered in the analysis were deep vein thrombosis, major bleeding, pulmonary thromboembolism, and chronic pulmonary hypertension. Clinical inputs were obtained from a systematic review of the literature and the economic parameters from micro-costing. Inputs were validated by three clinical experts. Costs were expressed in 2020 US dollars (USD). In a hypothetical cohort of 10,000 patients with a thromboprophylaxis use rate of 40%, the use of enoxaparin was less costly than that of dalteparin in Oncology (difference of USD 624,669), Orthopedic Surgery (difference of USD 275,829), and Internal Medicine (difference of USD 109,119) patients. For these services, using enoxaparin was more efficient than using nadroparin (cost differences of USD 654,069, USD 416,927, and USD 92,070, respectively). Sensitivity analysis showed an important influence of the number of patients undergoing thromboprophylaxis, as well as the unit cost, and the risk of events (DVT, PTE, and CTEPH). Enoxaparin is the least expensive health technology for thromboprophylaxis in most of the medical contexts analyzed in Colombia due to its efficacy and the lower risk of complications than dalteparin and nadroparin.

PELAKSANAAN BIMBINGAN ROHANI ISLAM DALAM MENGELOLA EMOSIONAL PASIEN DI RUMAH SAKIT ISLAM METRO

Islamic spiritual guidance services in fostering the emotional state of internal medicine patients at the Metro Islamic Hospital are motivated by the many problems in the emotional condition of internal medicine patients such as boredom, sadness, disappointment, stress and lack of confidence. The problem in this study is that patients at the Metro Islam Hospital who are given spiritual guidance by counselors experience emotional instability due to their physical condition. The purpose of this study is to explain the implementation of Islamic spiritual guidance services in fostering emotional internal medicine patients at Metro Islam Hospital. This type of research is, field research (Field Research). While the nature of the research is descriptive. The location of this research is Metro Islam Hospital. Data collection techniques used are interviews, observation, and documentation. This study uses the Miles and Huberman model to analyze the research data.&#x0D; The results showed that in the implementation of Islamic spiritual guidance for internal medicine patients at the Metro Islam Hospital there is a service schedule that is carried out every Monday to Friday. The methods used in Islamic spiritual guidance are the direct guidance method and the indirect guidance method. The forms of Islamic Spiritual Guidance Services that are carried out are a) guidance services consisting of tadzkirah guidance, worship guidance, dhikr and prayer guidance, guidance for patients with special needs, and funeral relocations; b) Spiritual consultation services, this service is more focused on patients who experience spiritual problems that can interfere with their psychology; c) Spiritual development services. There are three stages in carrying it out, namely the pre-service stage, the process stage and the post-service stage.

The incidence and prevalence of proton pump inhibitor usage among internal medicine patients after hospital admission: A retrospective cohort study.

The use of proton pump inhibitors (PPIs) has increased over the past decades. One potential gateway into new PPI use is following a hospital admission. The study aimed to examine the incidence of new PPI usage following admission to internal medicine services and the ratio of new persistent users. A retrospective descriptive study was conducted among all adults who had been admitted to internal medicine wards at the National University Hospital of Iceland from 2010-2020. Data was obtained from the Icelandic Internal Medicine Database. The proportion of patients who started treatment with PPI within 3months of discharge (new users) and the proportion of patients who continued to use it after 3months (persistent users) were examined. Among 85.942 admissions during the study period, 7238 (15.6%) became new users, and of those 4942 (68%) were new persistent users. The incidence of new PPI use was highest for patients discharged from gastroenterology (32.2%), hematology (31.8%), and oncology (29.2%). Patients with new PPI use more commonly had a history of malignancy (19.5%) and liver disease (22.7%) and more commonly were admitted to the ICU during their hospitalization. The highest ratio of persistent usage was among patients discharged from geriatric medicine (84%). One in every six patients admitted to internal medicine wards filled out a prescription for PPI within 3months from discharge, and a large proportion of them became persistent users. The high rate of new PPI users from oncology and hematology is noteworthy and requires further research.

The dose–response effect of time between emergency admission and inpatient care on mortality

To analyse mortality associated to emergency admissions on weekends, differentiating whether the patients were admitted to the Internal Medicine department or to the hospital as a whole. Retrospective follow-up study of patients discharged between 2015 and 2019 in: (a) the Internal Medicine department (n = 7656) and (b) the hospital as a whole (n = 83,146). Logistic regression models were fitted to analyse the risk of death, adjusting for age, sex, severity, Charlson index, sepsis, pneumonia, heart failure and day of admission. Cox models were also adjusted for the time from admission until normal inpatient care. There was a significant increase in mortality for patients admitted in weekends with short stays in Internal Medicine (48, 72 and 96 h: OR = 2.50, 1.89 and 1.62, respectively), and hospital-wide (OR = 2.02, 1.41 and 1.13, respectively). The highest risk in weekends occurred on Fridays (stays ≤ 48 h: OR = 3.92 [95% CI 2.06–7.48]), being no significative on Sundays. The risk increased with the time elapsed from admission until the inpatient department took over care (OR = 5.51 [95% CI 1.42–21.40] when this time reached 4 days). In Cox models patients reached HR = 2.74 (1.00–7.54) when the delay was 4 days. Whether it was Internal Medicine or hospital-wide patients, the risk of death associated with emergency admission in WE increased with the time between admission and transfer of care to the inpatient department; consequently, Friday was the day with the highest risk while Sunday lacked a weekend effect. Healthcare systems should correct this serious problem.

Estimated Costs of Drug-Related Problems Prevented by Pharmacist Prescription Reviews Among Hospitalized Internal Medicine Patients.

Data are lacking on the estimated costs of pharmacist prescription reviews (PPRs) for hospitalized internal medicine patients. This study investigates the estimated costs of drug-related problems (DRPs) prevented by PPRs among hospitalized internal medicine patients. We reviewed all medication orders for patients at an academic teaching hospital in China for 2 years. DRPs were categorized using the Pharmaceutical Care Network Europe classification. The severity of the potential harm of DRPs was assessed by the Harm Associated with Medication Error Classification (HAMEC) tool. The estimated cost of PPRs was calculated. A total of 162426 medication orders for 4314 patients were reviewed, and 1338 DRPs were identified by pharmacists who spent 2230 hours performing PPRs. Among the 1080 DRPs that were prospectively intervened upon, 703 were resolved. The HAMEC tool showed that 47.1% of DRPs were assessed as level 2, 30.4% as level 3, 20.6% as level 1, and 0.6% carried a life-threatening risk. Pharmacist interventions contributed to the prevention of DRP errors and a reduction of $339 139.44. This resulted in a mean cost saving of $482.42 per patient at an input cost of $21 495.06 over the 2 years. The benefit-cost ratio was 15.8. PPRs are beneficial for detecting potential DRPs and creating potential cost savings among hospitalized internal medicine patients.

Abstract 13123: Sex-Based Disparity in Referral for Catheter Ablation for Atrial Fibrillation at a Single Integrated Health System

Introduction: Catheter ablation for atrial fibrillation (AFCA) is indicated for patients with symptomatic AF and has proven to reduce AF burden and improve quality of life. Older studies have shown that women are less likely to undergo ablation compared to men despite having more AF-related symptoms. We investigated whether an association exists between referral patterns and this sex-based disparity in the modern era of AFCA. Methods and Results: A retrospective cohort study was conducted of outpatients with newly diagnosed AF between 2011 and 2020 using an EMR database at Northwestern Medicine. Of 5,445 patients analyzed, 2,108 were women (mean [standard deviation, SD] age 70 [13], 19.2% non-Hispanic Black) and 3,337 were men (mean [SD] age 66 [13], 11.7% non-Hispanic Black). Other characteristics including insurance status, comorbidities, and prior treatment of AF were also compared by sex. Logistic regression models adjusted for these factors were constructed to determine associations between sex and a set of binary dependent variables including referrals to and visits with general cardiology and electrophysiology (EP) as well as performance of AFCA. In adjusted models, among internal medicine and primary care patients, there were no significant differences in odds of referral to or visits with general cardiology or EP between men and women. Additionally, there was no significant difference in odds to undergo AFCA between men and women once seen by EP (Figure). Conclusions: Our study demonstrates no significant difference with respect to sex in referral patterns or performance of AFCA. Further work must be done to investigate whether these results are generalizable to other health systems regarding performance of AFCA as addressing these differences, when present, could prove essential in dismantling sex-based disparities in AF treatment.

Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty

AimThis work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. MethodsThis cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. ResultsA total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12–1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. ConclusionsPatients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.