Internal Medical Department Research Articles

Analysis of Stenotrophomonas maltophilia infections in lower respiratory tract samples at a university hospital: 5 year data

Objectives Patients with reported Stenotrophomonas maltophilia (S. maltophilia) growth in lower respiratory tract samples were investigated. The results of these patients were assessed by clinicians as either infection or colonization. The data of patients considered to have S. maltophilia infection were compared to those considered to have colonization to explore factors associated with infection. Methods Parameters including as age, length of hospital stay, duration of S. maltophilia growth after hospital admission, sex, unit, department, specimen type, mechanical ventilation treatment status, antimicrobial susceptibility results, comorbidities, survival, and antimicrobials used during the period from hospital admission to S. maltophilia growth were investigated. Additionally, some biochemical parameters that were examined include the day of hospital admission, the day of sample collection when the bacterium was isolated (±1 day), and the day of discharge/died. Results The infection group had a significantly higher rate of admissions to internal medical departments and more cases of discharge/died. The infection group showed a lower amount of aminoglycoside antibiotic usage and significantly higher levels of BUN, creatinine, neutrophils, and neutrophil-to-lymphocyte ratio on their day of discharge/died. Conclusion Being admitted to internal medical departments and receiving aminoglycoside treatment were identified to be factors associated with S. maltophilia infection. These patients should be monitored for infection markers such as CRP and neutrophil count, as well as renal function tests. It should be noted that being infected with S. maltophilia is an independent risk factor for mortality. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1095-1103

Impact of In- Service Training Program on Nurses' Performance for Minimizing Chemotherapy Extravasation.

The objective of this study was to evaluate the impact of an in-service training program on nurses' performance in minimizing chemotherapy extravasation. Quasi-experimental (Pre /Posttest) research design was utilized to conduct this study. The study was conducted at the internal medical oncology departments at South Egypt Cancer Institute. A convenience sample was used to select all available nurses working in medical oncology departments (40) nurses. Data was collected by using a pre/post questionnaire sheet for nurses' knowledge, Pre/post observation checklist for nurses' practice, and an in-service nursing training program on nurses' knowledge and practice for minimizing chemotherapy extravasation. The majority of nurses have attained any training program related to chemotherapy extravasation in their last 10 years of educational and professional training, There was a Positive correlation between nurses' knowledge scores pre and post-implementation of in-service training program with ±SD mean 23.77±.97 and with P. value <0.001** There were highly statistical significant differences between total score checklist nurses' practice pre/ post implementation of in-service training program on nurses to minimize chemotherapy extravasation through mean 234.97± .15 and Value < 0.001**. The In-service training program had statistically significant improvement on totally nurses' knowledge and practice on minimizing chemotherapy extravasation.

Malnutrition Prevalence Measurement and Nutritional Interventions in Internal Medical Departments of Turkish Hospitals: Results of the LPZ Study

Objective: The Landelijke Prevalentiemeting Zorgkwaliteit (LPZ), or National Care Indicators Prevalence, study is an annual international multicenter cross-sectional prevalence measurement of care problems on the institution, department, and patient level across Europe. The aim of this study was to measure the prevalence of malnutrition (MN) and examine nutritional interventions in internal medical departments of Turkish hospitals. Methods: A multicenter, cross-sectional study was performed using a standardized and tested questionnaire. Data were collected from adult patients (18 years and over) who were hospitalized in internal medical departments of the hospitals. The cross-sectional study was done in 12 different centers from six big cities in the country in every November of three consecutive years (2017–2019). Results: A total of 1,764 patients (60.9% men, 39.1% women; mean age, 62.6±0.4 years; range, 18–99 years) from 12 centers were enrolled in the study. The main diagnoses were cardiovascular disease (35.8%), diabetes (29.3%), cancer (20.2%), respiratory diseases (20.0%), infectious diseases (18.7%), gastrointestinal diseases (18.5%), endocrine diseases (17.3%), neurological diseases (15%; dementia, 6%), and hematological diseases (9.3%). Mean weight and body mass index of the patients were 71.9±16.5 kg (range, 30–153 kg) and 27.0±5.1 kg/m2 (range, 10.6–51.3 kg/m2). MN risk prevalence was 44.2%, according to the malnutrition universal screening test (MUST), and 46.5% in elderly patients. Of the patients, 43.4% indicated unintentional weight loss in the last 6 months. Nutritional interventions to treat MN were referral to a dietitian (57.2%), oral nutrition supplements (40.7%), energy/protein–enriched diet (38%), energy/protein–enriched snacks (18.1%), parenteral nutrition (16.7%), support at mealtimes (15.8%), and tube enteral feeding (10.4%). No interventions were given to 5.4% of patients. Regular audits were made to ensure compliance with the protocol/guidelines in 88.5% of patients, and 68.5% of patients were discussed with multidisciplinary teams at the hospitals. Conclusion: MN is highly prevalent the in internal medical departments of our hospitals. Although MN awareness is increasing, different interventions are in use according to national and international protocols/guidelines, and the number of active multidisciplinary teams is increasing. MN is still a big problem that needs further national plans.

Effectiveness of in-patient internal-psychosomatic hospital treatment: Evaluation of a treatment-concept in Lower Austria

Effectiveness of in-patient internal-psychosomatic hospital treatment: Evaluation of a treatment-concept in Lower Austria Background: Medical care for psychosomatic patients in Austria differs from Germany. Besides treatment in psychiatric wards, there are also inpatient programs for psychosomatic patients integrated in internal medical departments. Such an integrated ward in Lower Austria operates for more than 35 years and treats internal-psychosomatic and gastroenterological patients. However, its effectiveness was not yet evaluated. Objective: The aim of the current study was to evaluate the effectiveness of an inpatient program for psychosomatic patients. Method: In total, 184 patients participated in the naturalistic study and filled in questionnaires at admission and discharge from inpatient treatment. Primary endpoint was the difference in global symptom burden, as well as symptom burden in the areas of somatization, anxiety, and depression as measured with the Brief Symptom Inventory (BSI) between admission and discharge. Secondary endpoints were body image (FKB-20) and subjective therapeutic success (BVB-2000). The predictive power of the Structure of Personality (OPD-SF) and adverse childhood experiences (ACE-D) was also investigated. A smaller sample of 59 patients also participated in a four-month follow up assessment. Results: The inpatient treatment was associated with improvement in the primary endpoints that can be interpreted as large effects. The effects were also small to large for the secondary endpoints, however, the improvement was smaller at the follow up time point. Patients with deficits in the dimensions regulation of relationships and internal emotional communication showed less improvement. Discussion: Symptoms improve over the course of the evaluated inpatient treatment program. Specific dimension of the structure of personality predict treatment response and should be considered in treatment planning. Conclusion: This study provides initial evidence for the presented internal-psychosomatic inpatient program. The program might act as model for psychosomatic medical care in Austrian hospitals.

Effect of Nursing Education on Knowledge and Self Care for Patient's with Systemic Lupus Erythematosus

Abstract Patients with systemic lupus erythematosus are suffering from a lot of problems that can be overcomed by nursing education that focused on the improvement of patients' knowledge level, self-care. This study aimed to evaluate the effect of nursing education on knowledge level and self-care for patient's with systemic lupus erythematosus. Research design: This study was pre-post test research design was be utilized in this study. Sample: This study carried out on (200) patients with SLE, adult patients from both sex, their ages are ranged from (20-65) years old and are willing to participate in the study. Setting: The study was conducted in internal medical department (Rheumatology unit) at Assiut University Hospital. Tools: Two tools were used: patient assessment sheet, pre-post knowledge level and Self-Care questionnaire. Results: There were a statistical significant difference between total scores of knowledge level, self-care pre and post-test (after one month, after three month) after implementing nursing education (P=0.001). Conclusion: designed nursing education protocol were effective in improving knowledge level and self-care for patient with systemic lupus erythmatosus. Recommendation: Conducting additional studies on larger samples from a wider range of participants.

Nursing Management for Terminal Cancer Patients Undergoing Parenteral Fluids

Abstract Background: Parenteral hydration improves symptoms associated with dehydration and has an effect on quality of life and survival among the patients with advanced cancer. Aim; to evaluate the effect of nursing management on manifestations of patients with terminal cancer undergoing parenteral fluid. Research design: This study was a quazi experimental research design. Sample: sixty convenience adult patients with terminal cancer undergoing parenteral fluid, their age ranged between (20- 65) from both sexes. Setting: The study was conducted in Internal Medical Oncology Department at South Egypt Cancer Institute Tools: Two tools were used: Tool (I): Structured an interview questionnaire for patients: included demographic and medical data. Tool (II): Patient's manifestation assessment included (physical and psychological assessment) Results: Revealed that the highest percentage for both groups their age ranged from (>50 to 65) years old. All of them were married, and half of them (50%) were illiterate, there was a statistical significant difference between both groups regarding physical and psychological manifestations for patients. Conclusion: Nursing management was effective in fewer physical and psychological manifestations of patients with terminal cancer undergoing parenteral fluid. Recommendation: Studying the factors that affect palliative management of patients with terminal cancer undergoing parenteral fluid

Relating Medical Errors to Medical Specialties: A Mixed Analysis Based on Litigation Documents and Qualitative Data.

BackgroundWe know a great deal about types, causes, and prevention of medical errors, as well as the risks of each medical specialties. Although we know something about medical errors, much remains to be done in this area particularly around effective prevention. However, little is known about whether medical errors are related to medical specialties. Our objective was to categorize and map the distribution of medical errors and analyze their relationships with medical specialties.MethodsFirst, public cases of medical disputes were searched on “China Judgment Online” according to the key words including medical errors. Second, we set up a database with 5237 medical litigations. After removing unrelated judgment documents, we used systematic random sampling to extract half of these. Then, we hired two frontline physicians with M.D. to review the litigation documents and independently determine the medical errors and the departments in which they took place. A third physician further reviewed the divergent results. After the descriptive statistical analysis and mind map analysis, semi-structured interviews were further conducted with 63 doctors to reveal the relationships mentioned above.ResultsMore than 97.8% of medical errors occurred in clinical departments. The insufficient implementation of informed consent obligations is the top medical error in all medical departments [internal medical departments (12.86%, N=36), surgical departments (14.57%, N=106), specialist departments (13.16%, N=86)]. The types of medical errors in diverse medical departments might be associated with therapeutic means used by physicians. Errors related to surgical operations were common in surgical departments, errors related to diagnoses were common in internal medicine departments, and errors related to therapy were common in specialist departments. A lack of clinical experience and undesirable work system design have contributed to the occurrence of medical errors. Inadequate human resources and unreasonable shift systems have increased the workload of staff members and this has in turn increased the incidence rate of medical errors.ConclusionMedical departments are facing medical errors both in humanity and technology. Medical institutions should be alert to the harm caused by medical humanity (mainly including insufficient communication between physicians and patients, insufficient implementation of infringement of informed consent, infringement of patient’s privacy and overtreatment). Improving the clinical skill and vigilance of medical staff is a top priority. Medical institutions should also improve undesirable system designs.

Effect of lifestyle Promotion Booklet on the Outcomes of Patients with Insulin Dependent Diabetes Mellitus (IDDM)

Background: Type 1 diabetes is an autoimmune disease with a strong genetic component. It can occur at any age Aim: To evaluate the effect of lifestyle promotion on outcomes of patients with insulin dependent diabetes mellitus. Research design: Pre/posttest research design was utilized. Setting: The study was conducted in the internal medical department & outpatient clinic at Assuit University Hospital. Samples included 50 adult patients selected according to the following criteria: Conscious patient, age range between 18-65 years, from both sexes and insulin dependent diabetes mellitus. Tools: Patient interview questionnaire. It includes: demographic data and health promotion lifestyle. Based on the analysis of the assessment tools health promotion lifestyle booklet was developed. Results: More than have of the studied sample were female and there mean age were 49.220±14.226. Patients' level of knowledge was increased after the implementation of the booklet; particularly in the areas of the health responsibility, physical activity, interpersonal relations, and nutrition. Conclusion: There are statistical significance differences for studied samples as regard to life style subscale. Recommendation: It is important to educate patients about how to modify life style to healthy life, prevent and manage diabetic complications

Prevalence and overlap of sarcopenia, frailty, cachexia and malnutrition in older medical inpatients

BackgroundSarcopenia, frailty, cachexia and malnutrition are widespread syndromes in older people, characterized by loss of body tissue and related to poor outcome. The aim of the present cross-sectional study was to assess the prevalence of these syndromes and their overlap in older medical inpatients.MethodsPatients aged 70 years or older who had been admitted to the internal medical department of a German university hospital were recruited. Sarcopenia, frailty, cachexia and malnutrition were assessed in a standardized manner according to current consensus definitions. Prevalence rates of these syndromes and their constituents and the concurrent occurrence of the syndromes (overlap) were calculated.ResultsOne hundred patients (48 female) aged 76.5 ± 4.7 years with a BMI of 27.6 ± 5.5 kg/m2 were included. The main diagnoses were gastroenterological (33%) and oncological diseases (31%). Sarcopenia was present in 42%, frailty in 33%, cachexia in 32% and malnutrition in 15% of the patients. 63% had at least one syndrome: 32% one, 11% two, 12% three and 8% all four. All four syndromes are characterized by significant weight loss during the last 12 months, which was most pronounced in malnourished patients and least pronounced in frail patients, and by significantly reduced physical performance. All syndromes were significantly pairwise related, except malnutrition and frailty. In 19% of patients sarcopenia and frailty occurred concurrently, in 20% frailty and cachexia and in 22% sarcopenia and cachexia with or without additional other syndromes. All malnourished patients except one were also cachectic (93%) and 80% of malnourished patients were also sarcopenic. 53% of malnourished patients were in addition frail, and these patients were affected by all four syndromes.ConclusionsNearly two thirds of older medical inpatients had at least one of the tissue loss syndromes sarcopenia, frailty, cachexia and malnutrition. The syndromes overlapped partly and were interrelated. Future studies with larger patient groups and longitudinal design are required to clarify the significance of single and concurrent occurrence of these syndromes for clinical outcome and successful therapy.

The Chinese version of attitudes towards guidelines scale: validity and reliability assessment

BackgroundThe use of guidelines has shown to improve clinical practice process and structure of health care, but health care providers don’t always use and keep up-to-date with the new clinical practice guidelines. Nurses’ attitudes towards guidelines have shown to be the most frequently identified factor affecting their actual use of clinical practice guidelines, but no instruments for measuring it are available in China. There are scales validated in the western countries, but there is no information about their validity in Chinese health care. The purpose of this study is to test the validity and reliability of Chinese Attitudes towards guidelines - scale for nurses.MethodsThe study was conducted from April to July 2017. The Attitudes towards guidelines scale was translated into Chinese with forward-backward translation method and a questionnaire survey was conducted. Eight hundred randomly selected nurses (final N = 768) from Geriatrics, Internal medical and Rehabilitation departments of 16 hospitals were drawn in Sichuan province, China. Construct validity was evaluated by exploratory and confirmatory factor analysis, and reliability was assessed by test-retest reliability (represented by intra class correlation) and internal consistency (expressed by Cronbach’s coefficients). The test-retest reliability was examined with a sample of 32 clinical nurses who filled out the questionnaire 14 days after the first survey.ResultsExploratory factor analysis supported a four-factor model for the Chinese version of the scale. Confirmatory factor analysis indicated that the hypothetical four-factor model fitted the data relatively well. The intra class correlation coefficient was 0.85 (95%CI, 0.68–0.93) and the Cronbach’s alpha values for the four subscales ranged from 0.645 to 0.912.ConclusionsThe results support the acceptable level of validity and reliability of the Chinese version of Attitudes towards guidelines scale, which can be used to assess nurses’ attitudes towards guidelines in China. Future testing for the Chinese version of Attitudes towards guidelines scale needs to be carried out to see whether these results are generalizable to other professionals and occupational groups and to be used to revise attitudes towards specific guidelines in China.

Effect of Designing Nursing Teaching Protocol on Patients Undergoing Chemotherapy to Minimize Complications of Neutropenia

Background Patients undergoing chemotherapy are at risk of developing neutropenia that may cause life-threatening infections and death. Aim: Evaluate effect of designing nursing teaching protocol on patients undergoing chemotherapy to minimize complications of neutropenia. Design: A Pre and Post test research design was utilized. Sample: sixty adult patients undergoing chemotherapy both males and females. Setting: The study was carried out in the internal medical oncology departments and intensive care unit at South Egypt Cancer Institute. Tools: An interview questionnaire sheet for the patient, A designed nursing teaching protocol for patients undergoing chemotherapy to minimize complications of neutropenia and patient`s assessment sheet for complications of neutropenia. Results: There were highly statistically significant differences between pre and post application of the designed nursing teaching protocol in both all knowledge items and complications of neutropenia P<0.001. Conclusion: there were highly statistically significant differences between studied patients pre and post application of the designed nursing teaching protocol regarding total knowledge and complications of neutropenia. Recommendation: Tangible tools and education of patients, families and healthcare workers are keys to speedy recognition of potentially life-threatening symptoms associated with neutropenia.

Effect of designed nursing instructions on knowledge and self-care behavior among patients with chemotherapy induced neutropenia

Background:Chemotherapy-induced neutropenia (CIN) is the main dose limiting toxicity of systemic chemotherapy and it is associated with significant morbidity, mortality and treatment cost.Aim:Of the study was to evaluate effect of designed nursing instructions on knowledge and self-care behavior among patients with chemotherapy-induced neutropenia.Research design: Pre-post research design was utilized.Setting: The study was conducted at internal Medical Oncology Department at South Egypt Cancer Institute.Sample: Sixty adult patients with chemotherapy induced neutropenia. Tools of data collection: Tool (I): Patient assessment sheet, Tool (II): Self-care behavior assessment.Results: There was a highly statistically significant difference between pre and post applying of designed nursing instructions as regard patients' level of knowledge and self- care behavior of the studied patients (p&lt;0.01).Conclusion: The designed nursing instructions improved knowledge and self-care behavior among patients with chemotherapy-induced neutropenia.Recommendation: Each neutropenic patient should be given a booklet including knowledge about neutropenia, importance, and how to practice standards self-care behavior. Education of patients and families are keys to prompt recognition about potentially life-threatening symptoms associated with neutropenia. Â

Splenomegaly - Diagnostic validity, work-up, and underlying causes.

PurposeOur aim was to assess the validity of the ICD-10 code for splenomegaly in the Danish National Registry of Patients (DNRP), as well as to investigate which underlying diseases explained the observed splenomegaly.BackgroundSplenomegaly is a common finding in patients referred to an internal medical department and can be caused by a large spectrum of diseases, including haematological diseases and liver cirrhosis. However, some patients remain without a causal diagnosis, despite extensive medical work-up.Patients and methodsWe identified 129 patients through the DNRP, that had been given the ICD-10 splenomegaly diagnosis code in 1994–2013 at Odense University Hospital, Denmark, excluding patients with prior splenomegaly, malignant haematological neoplasia or liver cirrhosis. Medical records were reviewed for validity of the splenomegaly diagnosis, diagnostic work-up, and the underlying disease was determined. The positive predictive value (PPV) with 95% confidence interval (CI) was calculated for the splenomegaly diagnosis code. Patients with idiopathic splenomegaly in on-going follow-up were also invited to be investigated for Gaucher disease.ResultsThe overall PPV was 92% (95% CI: 85, 96). Haematological diseases were the underlying causal diagnosis in 39%; hepatic diseases in 18%, infectious disease in 10% and other diseases in 8%. 25% of patients with splenomegaly remained without a causal diagnosis. Lymphoma was the most common haematological causal diagnosis and liver cirrhosis the most common hepatic causal diagnosis. None of the investigated patients with idiopathic splenomegaly had Gaucher disease.ConclusionOur findings show that the splenomegaly diagnosis in the DNRP is valid and can be used in registry-based studies. However, because of suspected significant under-coding, it should be considered if supplementary data sources should be used in addition, in order to attain a more representative population. Haematological diseases were the most common cause, however in a large fraction of patients no causal diagnosis was found.

The survival prognosis of elderly undernourished inpatients admitted to the internal medical department of an emergency hospital as assessed using the nutritional screening, tool CONUT (for CONtrolling NUTritional status).

CONUT, a tool for "CONtrolling NUTritional status" assesses the nutritional status of a subject by taking into account their serum albumin level, total cholesterol level and total lymphocyte count. Elderly undernourished inpatients admitted to the internal medical department were divided into two groups, those who left the hospital and those who died in the hospital. The goal of this study was to analyze whether or not the CONUT score, serum albumin level, total cholesterol level and total lymphocyte count could predict the survival prognosis of elderly undernourished inpatients and to show the ratio of patients discharged with artificial hydration and nutrition (AHN). We divided elderly undernourished inpatients into two groups, those who left the hospital (229 patients) and those who died in the hospital (363 patients), and examined the serum albumin level, total cholesterol level and total lymphocyte count within 10 days before discharge or death. Based on the degree of undernutrition as determined by CONUT, we further classified the patients 4-into four levels of nutrition status, normal, light undernutrition, moderate undernutrition and severe undernutrition. In addition, based on the serum albumin level, total cholesterol level and total lymphocyte count, the patients were also classified 4-into four levels of nutrition status, and we calculated the ratio of AHN patients in the discharged group. On comparing the discharge and death groups according to the degree of undernutrition, serum albumin level, total cholesterol level and total lymphocyte count, significant differences were found between the groups of all nutrition statuses except moderate undernutrition. Furthermore, the patients with moderate undernutrition status demonstrated no statistically significant difference in both groups, except the serum albumin level. Among the discharged patients, the ratio of AHN was 37.0% in those with a normal nutrition status and more than 50% in the patients with light to severe undernutrition. We calculated and scored the serum albumin level, total cholesterol level, total lymphocyte count and the degree of undernutrition according to CONUT in elderly undernourished inpatients admitted to the internal medical department of an emergency hospital.We then divided the patients into groups, based on death or discharge from the hospital as well as nutrition status, normal, light undernutrition, moderate undernutrition and severe undernutrition. Therefore, comparing the groups based on their death or discharge, their nutrition status was found to be helpful for predicting the prognosis.

How obesity impacts outcomes of infectious diseases.

Obesity is associated with co-morbidities and increased risk of acquiring infections with worse outcomes. Paradoxically, a few studies indicate that obesity may have a decreased mortality in hospitalized patients with pneumonia. The objective of this study was to determine the impact of body mass index (BMI) on short-term all-cause mortality and clinical outcomes among hospitalized adults with pneumonia, urinary tract infections, skin and soft tissue infections, and bacteremia. The study cohort included 1437 consecutive patients who were admitted with infectious disease including pneumonia (717), urinary tract infection (506), bacteremia (69), and skin and soft tissue infections (145), and hospitalized in internal medical departments, during 2013-2015. BMI was categorized as underweight (≤20kg/m2), normal (20-25kg/m2), overweight (25.1-29.9kg/m2), and obese (≥30kg/m2). Clinical outcomes of 30- and 90-day all-cause mortality rates, length of hospital stay, and transfer to the intensive care unit (ICU) were compared among groups, sorted according to BMI and different infectious diseases. Obesity was associated with decreased 30-day mortality in patients with pneumonia [odds ratio (OR) = 0.26, 95 % confidence interval (CI) 0.06-1.01; p = 0.052]. On the contrary, increased 30-day mortality was observed in the underweight patients (OR = 2.89, 95 % CI 1.1-7.6; p = 0.03). Similar impacts were not found for urinary tract infections, skin and soft tissue infections, or bloodstream infections. Furthermore, obesity had no effect on 90-day mortality, length of hospital stay, or transfer to the ICU in all kinds of infectious diseases. Obesity is associated with reduced short-term mortality among hospitalized patients with pneumonia. Whether gut microbiota in obese individuals plays a role in this protective effect remains to be investigated by further studies.

High prevalence of diabetes mellitus and impaired glucose tolerance in liver cancer patients: A hospital based study of 4610 patients with benign tumors or specific cancers

Objective: The prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were hypothesised to be different among different tumor patients. This study aimed to study the association between the prevalence of DM, IGT and IFG and liver cancer, colorectal cancer, breast cancer, cervical cancer, nasopharyngeal cancer and benign tumor. Methods: A hospital based retrospective study was conducted on 4610 patients admitted to the Internal Medical Department of the Affiliated Tumor Hospital of Guangxi Medical University, China. Logistic regression was used to examine the association between gender, age group, ethnicity , cancer types or benign tumors and prevalence of DM, IFG, IGT. Results: Among 4610 patients, there were 1000 liver cancer patients, 373 breast cancer patients, 415 nasopharyngeal cancer patients, 230 cervical cancer patients, 405 colorectal cancer patients, and 2187 benign tumor patients. The prevalence of DM and IGT in liver cancer patients was 14.7% and 22.1%, respectively. The prevalence of DM and IGT was 13.8% and 20%, respectively, in colorectal cancer patients, significantly higher than that of benign cancers. After adjusting for gender, age group, and ethnicity, the prevalence of DM and IGT in liver cancers patients was 1.29 times (CI :1.12-1.66) and 1.49 times (CI :1.20-1.86) higher than that of benign tumors, respectively. Conclusion: There was a high prevalence of DM and IGT in liver cancer patients.

High prevalence of diabetes mellitus and impaired glucose tolerance in liver cancer patients: A hospital based study of 4610 patients with benign tumors or specific cancers.

The prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were hypothesised to be different among different tumor patients. This study aimed to study the association between the prevalence of DM, IGT and IFG and liver cancer, colorectal cancer, breast cancer, cervical cancer, nasopharyngeal cancer and benign tumor. A hospital based retrospective study was conducted on 4610 patients admitted to the Internal Medical Department of the Affiliated Tumor Hospital of Guangxi Medical University, China. Logistic regression was used to examine the association between gender, age group, ethnicity , cancer types or benign tumors and prevalence of DM, IFG, IGT. Among 4610 patients, there were 1000 liver cancer patients, 373 breast cancer patients, 415 nasopharyngeal cancer patients, 230 cervical cancer patients, 405 colorectal cancer patients, and 2187 benign tumor patients. The prevalence of DM and IGT in liver cancer patients was 14.7% and 22.1%, respectively. The prevalence of DM and IGT was 13.8% and 20%, respectively, in colorectal cancer patients, significantly higher than that of benign cancers. After adjusting for gender, age group, and ethnicity, the prevalence of DM and IGT in liver cancers patients was 1.29 times (CI:1.12-1.66) and 1.49 times (CI:1.20-1.86) higher than that of benign tumors, respectively. There was a high prevalence of DM and IGT in liver cancer patients.

Knowledge, attitude and opinion of patients regarding the new German legislation on advance care planning : Results of a survey in a department of general internal medicine

In September 2009 a new legislation for advance care planning was introduced in Germany with the important characteristics of bindingness and unlimited validity for individual directives. Knowledge regarding this act and the attitude towards its characteristics among patients is unclear. Analysis of knowledge, attitude and opinion of patients in a general internal medical department regarding advance care planning in general and the recent German legislation. A total of 200 consecutive patients in an internal medicine ward were interviewed with the help of a questionnaire regarding their attitude to and knowledge on advance care planning in general and the current legislation. Approximately 40 % of the patients had issued some form of directive (either advance care directive or health care proxy) and only 7.5 % were advised by their physicians to make an advance directive. Patients with no directive were not willing to deal with dying and death, were not well-informed about directives or assumed that relatives or physicians would make an appropriate decision. Characteristics of the new legislation were controversially assessed; only 21 % of the patients wished to have a literal implementation of their directive. Regarding the content of an advance directive, more than 80 % of the patients voted for pain control in the palliative setting. The proportion of patients with a directive regarding advance care planning is only slowly increasing. Many patients are not well-informed, do not want to deal with dying or would like to delegate decisions to relatives and physicians. The present characteristics of the German legislation are controversially assessed and often do not represent the wishes of the patients.

The nutritional intake of elderly patients with dysphagia admitted to the internal medical department of the emergency hospital was analyzed. The Fujishima dysphagia scale after care and treatment by the Nutrition Support Team was assessed.

The Nutrition Support Team (NST) assessed the severity of dysphagia in elderly patients admitted to the internal medical department, and the appropriate nutritional treatment was determined. Patients were treated with either oral nutrition (enteral nutrition, EN) or artificial alimentation (parenteral nutrition, PN). The goal of this study was to analyze whether or not the route of nutrition affected the patient discharge rates. We divided 290 elderly inpatients with dysphagia into 2 groups, the pneumonia group (200 patients) and the non-pneumonia group (90 patients). The NST estimated the swallowing function using the Fujishima dysphagia scale. Monitoring was continued until the NST care and treatment had been finalized. We further divided the pneumonia patients into two subgroups: those with a Fujishima dysphagia scale score ≤3 or ≥4 at the beginning of NST intervention. The changes in the swallowing function were analyzed.The swallowing function in the patients with a score ≥4 was significantly improved compared with that in the patients with a score ≤3. This difference, however, was not observed in the non-pneumonia group. In both the pneumonia and non-pneumonia groups, the ratio of patients discharged on oral nutrition was one-third, and the ratio of death in hospital was one-quarter, the remaining patients required artificial alimentation. Among elderly patients admitted to the internal medical department of the emergency hospital with dysphagia, one-third left the hospital with oral nutritional intake, one-quarter died in hospital, and the remaining required artificial alimentation.

Evaluation of Patient Compliance, Knowledge, and Health Services among Diabetic Patients Admitted in the Internal Department of Kamal Odwan Hospital

Diabetes mellitus is a chronic disorder characterized by hyperglycemia andthe late development of vascular and neuropathic complications. Diabetes is best managed by multidisciplinary care team and overlapping skills: physician, specialist diabetes nurse, dietitian, and chiropodist. The aim of this study is to evaluate patient knowledge and compliance with treatment of diabetes. The study conducted in Kamal Odwan Hospital in Gaza between designed prospective studies in which all patients that are admitted to the internal medical department and diagnosed with diabetes alone or associated with other diseases were included in this study. The patients were filled questionnaire regarding their age, history of the disease and other variables. the data analyzed manually and the results is shown below.The results that patient education and knowledge is very poor and the patients visit the physicians only to take their medications without any follow up as measurement of blood glucose level or other investigations. Only 20% of patient knows about the disease and only 20% were educated by specialist I primary health care or physician. So we recommend increase the role of health education in primary health care and other centers to reduce the complications of diabetes.