Division Of Internal Medicine Research Articles

Understanding Physician Characteristics of Cervical Cancer Screening Rates at TUKHS Division of General Internal Medicine

Understanding Physician Characteristics of Cervical Cancer Screening Rates at TUKHS Division of General Internal Medicine

Understanding Cervical Screening Rates at TUKHS Division of General Internal Medicine

Understanding Cervical Screening Rates at TUKHS Division of General Internal Medicine

CLUSTER ANALYSIS OF PULSE WAVE VELOCITY LONGITUDINAL TRENDS IN HYPERTENSIVE PATIENTS

Objective: Arterial stiffness (AS) is an important predictor of cardiovascular disease and mortality. Its trend over time, assessed through multiple measurements, is still largely unexplored. The aim of this study was to assess the determinants of trajectories of carotid-femoral pulse wave velocity (PWV) in a cohort of Italian hypertensive adults. Design and method: From a population of 2581 hypertensive patients referred to Hypertension Unit of Internal Medicine Division at University Hospital Città della Salute e della Scienza of Turin (Italy) from 2005 to 2023, those who had at least 3 PWV recordings over time were included in this study. Those with rare vascular diseases were excluded. Cluster analysis of PWV trajectories was performed using K-means method. Results: A total of 271 patients were included. Median follow-up time was 4.5 [0.6-8.4] years). Three clusters of PWV trends were identified: low-stable (A, n=126), high-increasing (B, n=107), and high-stable (C, n= 38) clusters. Patients in the clusters B and C were progressively older than those in cluster A (60.4±8.9 and 65.8±10.3 vs. 51.9±13.3 years, respectively). Mean BP (MBP) and PWV at baseline were progressively higher in the high-increasing and high-stable clusters compared to the low-stable one (MBP was 103±15 and 111±22 mmHg in clusters B, and C vs. 97±11mmHg in cluster A; PWV was 10.1±0.7 and 13.6±1.4 m/s in clusters B, and C vs. 7.8±0.9 m/s in cluster A; all p<0.001). There were no significant differences in sex distribution or anti-hypertensive treatment among the clusters. On multinomial regression analysis, older age and higher MBP at baseline were independently associated to increased probability of belonging to either B or C clusters when compared to the low-stable one. Conclusions: Through multiple PWV assessment in hypertensive patients during a large time span, this study shows that patients with less favorable arterial stiffness behavior present higher PWV values at baseline. Older age and higher MBP at baseline are associated with worse evolution of PWV over time.

Core stories of physicians on a Swiss internal medicine ward during the first COVID-19 wave: a qualitative exploration.

The first COVID-19 wave (2020), W1, will remain extraordinary due to its novelty and the uncertainty on how to handle the pandemic. To understand what physicians went through, we collected narratives of frontline physicians working in a Swiss university hospital during W1. Physicians in the Division of Internal Medicine of Lausanne University Hospital (CHUV) were invited to send anonymous narratives to an online platform, between 28 April and 30 June 2020. The analysed material consisted of 13 written texts and one audio record. They were examined by means of a narrative analysis based on a holistic content approach, attempting to identify narrative highlights, referred to asfoci, in the texts. Five main foci were identified: danger and threats, acquisition of knowledge and practices, adaptation to a changing context, commitment to the profession, and sense of belonging to the medical staff. In physicians' narratives,dangerdesignated a variety of rather negative feelings and emotions, whereasthreatswere experienced as being dangerous for others, but also for oneself. Theacquisition of knowledge and practicesfocus referred to the different types of acquisition that took place during W1. The narratives that focused onadaptationreflected how physicians coped with W1 and private or professional upheavals. COVID-19 W1 contributed to revealing a naturalcommitment(or not) of physicians towards the profession and patients, accompanied by the concern of offering the best possible care to all. Lastly,sense of belongingreferred to the team and its reconfiguration during W1. Our study deepens the understanding of how physicians experienced the pandemic both in their professional and personal settings. It offers insights into how they prepared and reacted to a pandemic. The foci reflect topics that are inherent to a physician's profession, whatever the context. During a pandemic, these foundational elements are particularly challenged. Strikingly, these topics are not studied in medical school, thus raising the general question of how students are prepared for the medical profession.

Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized with COPD in a Department of General Internal Medicine: A Cross-Sectional Study.

The suboptimal use of inhalers in the treatment of patients with chronic obstructive pulmonary disease (COPD) is probably a major but poorly documented problem in hospitalized patients. We aimed to describe the prevalence of misused inhalers among patients hospitalized with COPD in a department of general internal medicine. We conducted a monocentric cross-sectional study in consecutive patients with a diagnosis of COPD and hospitalized between August 2022 and April 2023 in the internal medicine division of Fribourg Hospital, Switzerland. Patients underwent an assessment of their inhaler technique and peak inspiratory flow (PIF) using the In-Check Dial G16®. The primary outcome was the prevalence of misused inhalers, defined as an inhaler used with a critical error and/or insufficient PIF. Secondary outcomes included the prevalence of inhalers unsuitable to patients' characteristics and of patients using at least one misused inhaler. The study included 96 patients and 160 inhalers were assessed at admission. Among these inhalers, 111 (69.4%; 95% confidence interval [CI] 61.6-76.4) were misused; 105 (65.6%; 95% CI 57.7-72.9) due to the presence of a critical error in the inhalation technique and 22 (13.8%; 95% CI 8.8-20.1) due to insufficient PIF. Concerning the secondary outcome, 27 inhalers (16.9%) were unsuitable, and 79 patients (82.3%) used at least one misused inhaler. Among patients hospitalized with a diagnosis of COPD, two-thirds of inhalers were misused. Suboptimal use was mainly due to the presence of critical errors, but also to the presence of an insufficient PIF and unsuitable inhalers.

Performance of serum soluble interleukin-2 receptor as a diagnostic marker for lymphoma in patients with fever

There have been few reports on the diagnostic performance of soluble interleukin-2 receptor (sIL-2R) for lymphoma. A cross-sectional study was conducted at a university hospital; all patients who were admitted to the Division of General Internal Medicine and underwent serum sIL-2R testing were included. Patients were divided into two groups based on the presence of fever (≥ 38.0 °C). Among 602 patients, 421 had fever and 76 were diagnosed with lymphoma (48 of the 76 were in the febrile group). In all patients, the area under the receiver operating characteristic curve (AUROC) of sIL-2R for the diagnosis of lymphoma was 0.81 [95% confidence interval (CI), 0.75–0.87]. The AUROC was significantly higher in the febrile group (0.88; 95% CI, 0.81–0.94) than in the afebrile group (0.75; 95% CI, 0.65–0.85). In the febrile group, the sensitivity and specificity were 81.2% and 82.3%, respectively, with an optimal cutoff value of 3,250 U/mL. In the afebrile group, they were 89.3% and 54.9%, respectively, with a cutoff value of 868 U/mL. Serum sIL-2R showed high performance as an adjunctive diagnostic marker for lymphoma, particularly among febrile patients. Different cutoff values should be used for patients with and without fever to maximize diagnostic performance.

Defining Usual Oral Temperature Ranges in Outpatients Using an Unsupervised Learning Algorithm

Although oral temperature is commonly assessed in medical examinations, the range of usual or "normal" temperature is poorly defined. To determine normal oral temperature ranges by age, sex, height, weight, and time of day. This cross-sectional study used clinical visit information from the divisions of Internal Medicine and Family Medicine in a single large medical care system. All adult outpatient encounters that included temperature measurements from April 28, 2008, through June 4, 2017, were eligible for inclusion. The LIMIT (Laboratory Information Mining for Individualized Thresholds) filtering algorithm was applied to iteratively remove encounters with primary diagnoses overrepresented in the tails of the temperature distribution, leaving only those diagnoses unrelated to temperature. Mixed-effects modeling was applied to the remaining temperature measurements to identify independent factors associated with normal oral temperature and to generate individualized normal temperature ranges. Data were analyzed from July 5, 2017, to June 23, 2023. Primary diagnoses and medications, age, sex, height, weight, time of day, and month, abstracted from each outpatient encounter. Normal temperature ranges by age, sex, height, weight, and time of day. Of 618 306 patient encounters, 35.92% were removed by LIMIT because they included diagnoses or medications that fell disproportionately in the tails of the temperature distribution. The encounters removed due to overrepresentation in the upper tail were primarily linked to infectious diseases (76.81% of all removed encounters); type 2 diabetes was the only diagnosis removed for overrepresentation in the lower tail (15.71% of all removed encounters). The 396 195 encounters included in the analysis set consisted of 126 705 patients (57.35% women; mean [SD] age, 52.7 [15.9] years). Prior to running LIMIT, the mean (SD) overall oral temperature was 36.71 °C (0.43 °C); following LIMIT, the mean (SD) temperature was 36.64 °C (0.35 °C). Using mixed-effects modeling, age, sex, height, weight, and time of day accounted for 6.86% (overall) and up to 25.52% (per patient) of the observed variability in temperature. Mean normal oral temperature did not reach 37 °C for any subgroup; the upper 99th percentile ranged from 36.81 °C (a tall man with underweight aged 80 years at 8:00 am) to 37.88 °C (a short woman with obesity aged 20 years at 2:00 pm). The findings of this cross-sectional study suggest that normal oral temperature varies in an expected manner based on sex, age, height, weight, and time of day, allowing individualized normal temperature ranges to be established. The clinical significance of a value outside of the usual range is an area for future study.

Adverse drug reactions in the ambulatory internal patients at the emergency department: Focus on causality assessment and drug-drug interactions.

A non-interventional retrospective study in ambulatory patients was conducted at the emergency department of the Division of internal medicine. In 2 months, 266 suspected adverse drug reactions (ADRs) were identified in 224/3453 patients (6.5 %). In 158/3453 patients (4.6 %), an ADR was the reason for emergency department visit and in 49 patients (1.4 %), ADRs led to hospitalisation. A causality assessment algorithm was developed, which included Naranjo algorithm and levels of ADR recognition by the treating physician and the investigators. Using this algorithm, 63/266 ADRs (23.7 %) were classified as "certain", whereas using solely the Naranjo score calculation, only 19/266 ADRs (7.1 %) were assessed as "probable" or "certain", and the rest of ADRs (namely, 247/266 = 92.9 %) were assessed as "possible". There were 116/266 (43.6 %) ADRs related to potential drug-drug interactions (DDIs), stated in at least one of the literature sources used. Based on the causality relationship, the rate of the clinically expressed DDIs was 19.0 %, or 12/63 "certain" ADR cases. Of these, 10 cases presented serious DDI-related ADRs. In summary, ADR causality assessment based exclusively on Naranjo algorithm demonstrated low sensitivity at an ambulatory emergency setting. Additional clinical judgment, including the opinion of the treating physician, proved necessary to avoid under-rating of the causality relationship, and enabled the determination of clinically expressed DDIs.

Controlling nutritional status score predicts 2-year outcomes in elderly patients admitted for acute heart failure

BackgroundHeart failure (HF) is a major cause of death among the elderly. Its prevalence increases dramatically with age. The prevalence of malnourished subjects is high in hospitalized elderly patients. We aimed to investigate the prognostic role of malnutrition, assessed by controlling nutritional status (CONUT) score, on adverse clinical outcomes in the elderly admitted for acute HF.MethodsWe enrolled 293 patients (mean age 84 years; 48% men) consecutively admitted for acute HF to the Internal Medicine or Geriatrics Divisions at the ‘IRCCS Sacro Cuore-Don Calabria’ Hospital of Negrar (Verona, Italy) from 2013 to 2015. We predicted the risk of all-cause death, re-hospitalizations for HF and non-HF causes, and the composite of all-cause death or hospitalizations over 2-year follow-up. Patients were divided into four groups according to CONUT score: normal-CONUT (0–1; n = 30); mild-CONUT (2–3; n = 56); moderate-CONUT (4–7; n = 171); and severe-CONUT (≥ 8; n = 36).ResultsHigher CONUT scores were associated with older age and lower entry blood pressures. No difference in hemodynamics was noted at the discharge. Kaplan–Meier curves showed a significant association between worsening CONUT scores and risk of all-cause death (p < 0.01), re-hospitalizations (p < 0.01), or both (p < 0.001). Cox regression analysis revealed these significant associations persisted after adjustment for age, sex, pre-existing cardiovascular disease, diabetes, chronic kidney disease, heart rate, systolic blood pressure, and plasma brain natriuretic peptide levels at discharge (all-cause mortality HR = 1.29 (1.00–1.66), p = 0.049; hospitalization for HF HR = 1.36 (1.03–1.81), p = 0.033; hospitalization for non-HF HR = 1.38 (1.03–1.86), p = 0.034; composite outcome HR = 1.33 (1.07–1.64), p = 0.01).ConclusionsMalnutrition, assessed by the CONUT score, is common among elderly patients admitted for acute HF and is strongly related to increased long-term risk of all-cause death and re-hospitalizations.

Against medical advice: A structured approach to narrative medicine as a balm to the madness.

Journal of the American Geriatrics SocietyEarly View ARS LONGA: HUMANITIES AND AGING Against medical advice: A structured approach to narrative medicine as a balm to the madness Michelle Izmaylov MD, Corresponding Author Michelle Izmaylov MD [email protected] Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA Correspondence Michelle Izmaylov, Vanderbilt University Medical Center, Nashville, TN, USA. Email: [email protected]Search for more papers by this authorTom Elasy MD, Tom Elasy MD Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USASearch for more papers by this author Michelle Izmaylov MD, Corresponding Author Michelle Izmaylov MD [email protected] Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA Correspondence Michelle Izmaylov, Vanderbilt University Medical Center, Nashville, TN, USA. Email: [email protected]Search for more papers by this authorTom Elasy MD, Tom Elasy MD Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USASearch for more papers by this author First published: 06 March 2023 https://doi.org/10.1111/jgs.18299Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Birthdays.

Journal of Palliative MedicineVol. 26, No. 3 Personal ReflectionBirthdaysW. David ClarkW. David ClarkAddress correspondence to: W. David Clark, MD, Internal Medicine-Palliative Care, Division of General Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA E-mail Address: w-david-clark@uiowa.eduInternal Medicine-Palliative Care, Division of General Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA.Search for more papers by this authorPublished Online:1 Mar 2023https://doi.org/10.1089/jpm.2022.0466AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Birthdays." Journal of Palliative Medicine, 26(3), p. 443FiguresReferencesRelatedDetails Volume 26Issue 3Mar 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:W. David Clark.Birthdays.Journal of Palliative Medicine.Mar 2023.443-443.http://doi.org/10.1089/jpm.2022.0466Published in Volume: 26 Issue 3: March 1, 2023PDF download

Prospective study on the prevalence of HCV infection in consecutive adult inpatients in a hospital division of Internal Medicine in Tuscany

Prospective study on the prevalence of HCV infection in consecutive adult inpatients in a hospital division of Internal Medicine in Tuscany

Be kind. Use systems. Improve care.

Health Services ResearchVolume 58, Issue 2 p. 247-249 COMMENTARY Be kind. Use systems. Improve care Taressa K. Fraze PhD, Corresponding Author Taressa K. Fraze PhD [email protected] orcid.org/0000-0002-8346-6425 Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USA Correspondence Taressa K. Fraze, Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, CA, USA. Email: [email protected]Search for more papers by this authorSunita Mutha MD, Sunita Mutha MD orcid.org/0000-0001-6618-7240 Division of General Internal Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USASearch for more papers by this author Taressa K. Fraze PhD, Corresponding Author Taressa K. Fraze PhD [email protected] orcid.org/0000-0002-8346-6425 Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USA Correspondence Taressa K. Fraze, Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, CA, USA. Email: [email protected]Search for more papers by this authorSunita Mutha MD, Sunita Mutha MD orcid.org/0000-0001-6618-7240 Division of General Internal Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USASearch for more papers by this author First published: 26 January 2023 https://doi.org/10.1111/1475-6773.14135 Commentary on ‘A systematic review of research on empathy in health care’ by Nembhard et al., https://doi.org/10.1111/1475-6773.14016. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume58, Issue2April 2023Pages 247-249 RelatedInformation

Cardiometabolic HFpEF: NASH of the Heart.

HomeCirculationVol. 147, No. 6Cardiometabolic HFpEF: NASH of the Heart No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextCardiometabolic HFpEF: NASH of the Heart Federico Capone, MD, Roberto Vettor, MD and Gabriele G. Schiattarella, MD, PhD Federico CaponeFederico Capone Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (F.C., G.G.S.). Division of Internal Medicine, Department of Medicine, University of Padua, Italy (F.C., R.V.). Search for more papers by this author , Roberto VettorRoberto Vettor Division of Internal Medicine, Department of Medicine, University of Padua, Italy (F.C., R.V.). Search for more papers by this author and Gabriele G. SchiattarellaGabriele G. Schiattarella Correspondence to: Gabriele G. Schiattarella, MD, PhD, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité - Universitätsmedizin Berlin, Berlin, Germany. Email E-mail Address: [email protected] https://orcid.org/0000-0002-7582-7171 Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (F.C., G.G.S.). Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité - Universitätsmedizin Berlin, Germany (G.G.S.). German Center for Cardiovascular Research, Partner Site Berlin, Germany (G.G.S.). Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.S.). Search for more papers by this author Originally published6 Feb 2023https://doi.org/10.1161/CIRCULATIONAHA.122.062874Circulation. 2023;147:451–453FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 453.Circulation is available at www.ahajournals.org/journal/circCorrespondence to: Gabriele G. Schiattarella, MD, PhD, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité - Universitätsmedizin Berlin, Berlin, Germany. Email gabriele.[email protected]de

Knowledge and Attitudes of Turkish Physicians towards Human Monkeypox Disease and Related Vaccination: A Cross-Sectional Study.

Background: In May 2022, the monkeypox virus outbreak in multiple countries on various continents marked a potential resurgence of the disease as a global health issue. Considering the crucial role of physicians in mitigating the monkeypox outbreak, we sought to evaluate physicians’ knowledge, attitude, concerns, and vaccine acceptance for monkeypox, in the shadow of the COVID-19 pandemic. Methods: A large-scale, cross-sectional survey was conducted among 283 physicians between 20 August−2 September 2022, in Turkey. The participants’ sociodemographic characteristics, knowledge, attitudes, concerns, and vaccine acceptance toward monkeypox infection were collected via a questionnaire. Results: Our study revealed that 32.5% of physicians achieved a good level of knowledge; similarly, 31.4% of the physicians planned to have the monkeypox vaccine. Multivariate binary logistic regression analysis showed that female physicians (p = 0.031) and older people (≥30 vs. <30) were more likely to be knowledgeable about monkeypox (p = 0.007). We found that participants from divisions of internal medicine (p = 0.033) who knew about the monkeypox disease during medical school or residency (p = 0.005) and were previously exposed to COVID-19 disease (p = 0.005) were more likely to have a good knowledge score of monkeypox. We also found that physicians with a good knowledge score were more worried about monkeypox compared to COVID-19 (AOR: 2.22; 95% CI:1.13−4.33; p = 0.019). Additionally, those who had information on monkeypox during medical education (AOR = 2.16, 95% CI = 1.10−4.21; p = 0.024) were more likely to receive the smallpox vaccine to prevent monkeypox viral infection when available. Conclusions: The present study pointed out that physicians in Turkey have unsatisfactory levels of knowledge about the emerging monkeypox. This study results can impede attempts to detect and manage cases of monkeypox and should be addressed through appropriate and timely awareness and educational programs, alerts, and seminars. These might serve as the basis for policymakers’ decisions about promoting national monkeypox vaccination strategies and addressing potential vaccine hesitancy and misinformation when needed.

Four-dimensional Flow in Pulmonary Artery Aneurysm with Localized Dissection.

HomeRadiology: Cardiothoracic ImagingVol. 4, No. 6 Previous Images in Cardiothoracic ImagingPulmonary ImagingFour-dimensional Flow in Pulmonary Artery Aneurysm with Localized DissectionRachel Orbuch , Koushik Kondapi, Jacob E. Ref, Ryan J. AveryRachel Orbuch , Koushik Kondapi, Jacob E. Ref, Ryan J. AveryAuthor AffiliationsFrom the Division of Internal Medicine, McGaw Medical Center of Northwestern University, 420 E Superior St, Chicago, IL 60611 (R.O.); Division of Radiology (R.J.A.), Northwestern University Feinberg School of Medicine, Chicago, Ill (K.K.); and University of Arizona College of Medicine, Tucson, Ariz (J.E.R.).Address correspondence to R.O. (email: [email protected]).Rachel Orbuch Koushik KondapiJacob E. RefRyan J. AveryPublished Online:Dec 8 2022https://doi.org/10.1148/ryct.220052MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryReceived: Mar 31 2022Revision requested: June 19 2022Revision received: Nov 1 2022Accepted: Nov 8 2022Published online: Dec 08 2022 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 4, No. 6 Metrics Altmetric Score PDF download

Running against the clock: a qualitative study of internal medicine residents' work experience.

While hospitals are adopting strategies designed to increase the overall efficiency of the healthcare system, physicians are facing expanding requirements. Such changes in work environment add new psychosocial and physical stressors. Building on a previous quantitative time-motion study, we conducted a qualitative study to better understand the work experience of internal medicine residents. The study used a qualitative description approach, and was based on focus group discussions with residents. Data were analysed using reflexive thematic analysis. The study was conducted among all residents of the Internal Medicine division of a tertiary university hospital in Switzerland. Time emerged as the major determinant of residents' daily experience, which residents want to waste on no account. Shifts are perceived as a constraining succession of distinct periods, with little room for adjustments. Moreover, residents feel held back and distracted in their progression toward the end of the shift. Under time pressure, some essential professional activities, such as caring for patients and families, dealing with medical complications and talking with consultants, may be experienced as unexpected undesirable bumps on the road. Residents describe "running through" a structured day, scattered with obstacles, and resorting to "tricks of the trade" in an attempt to influence the course of the shift. Time constraints are not new to medicine. However, our findings outline how time has become a constant preoccupation for internal medicine residents, permeating their daily work experience. This changing relationship with time carries the risk of undermining the foundations of clinical medicine and challenges the ability of hospitals to preserve the "sense of the profession". Introduction.

Early reduction of estimated Glomerular Filtration Rate (eGFR) predicts poor outcome in acutely ill hospitalized COVID-19 patients firstly admitted to medical regular wards (eGFR-COV19 study)

BackgroundAnalysis of autopsy tissues obtained from patients who died from COVID-19 showed kidney tropism for SARS-COV-2, with COVID-19-related renal dysfunction representing an overlooked problem even in patients lacking previous history of chronic kidney disease. This study aimed to corroborate in a substantial sample of consecutive acutely ill COVID-19 hospitalized patients the efficacy of estimated GFR (eGFR), assessed at hospital admission, to identify acute renal function derangement and the predictive role of its association with in-hospital death and need for mechanical ventilation and admission to intensive care unit (ICU). MethodsWe retrospectively analyzed charts of 764 patients firstly admitted to regular medical wards (Division of Internal Medicine) for symptomatic COVID-19 between March 6th and May 30th, 2020 and between October 1st, 2020 and March 15th, 2021. eGFR values were calculated with the 2021 CKD-EPI formula and assessed at hospital admission and discharge. Baseline creatinine and GFR values were assessed by chart review of patients’ medical records from hospital admittance data in the previous year. The primary outcome was in-hospital mortality, while ARDS development and need for non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) were the secondary outcomes. ResultsSARS-COV-2 infection was diagnosed in 764 patients admitted with COVID-19 symptoms. A total of 682 patients (age range 23–100 years) were considered for statistical analysis, 310 needed mechanical ventilation and 137 died. An eGFR value <60 mL/min/1.73 m2 was found in 208 patients, 181 met KDIGO AKI criteria; eGFR values at hospital admission were significantly lower with respect to both hospital discharge and baseline values (p < 0.001). In multivariate analysis, an eGFR value <60 mL/min/1.73 m2 was significantly associated with in-hospital mortality (OR 2.6, 1.7–4.8, p = 0.003); no association was found with both ARDS and need for mechanical ventilation. eGFR was non-inferior to both IL-6 serum levels and CALL Score in predicting in-hospital death (AUC 0.71, 0.68–0.74, p = 0.55). ConclusionseGFR calculated at hospital admission correlated well with COVID-19-related kidney injury and eGFR values < 60 mL/min/1,73 m2 were independently associated with in-hospital mortality, but not with both ARDS or need for mechanical ventilation.

Implementing a Multifaceted Intervention among Internal Medicine Residents with Audit and Educative Data Feedback Significantly Reduces Low-Value Care in Hospitalized Patients.

Background: The dissemination of recommendations on low-value care alone may not lead to physicians’ behavioral changes. The aim of this study was to evaluate whether a multifaceted behavioral intervention among internal medicine residents could reduce low-value care in hospitalized patients. Methods: A pre–post quality improvement intervention was conducted at the Internal Medicine Division of La Tour hospital (Geneva, Switzerland) from May 2020 to October 2021. The intervention period (3 months) consisted of a multifaceted informational intervention with audits and educative feedback about low-value care. The pre- and post-intervention periods including the same six calendar months were compared in terms of number of blood samples per patient day, prescription rates of benzodiazepines (BZDs) and proton pump inhibitors (PPIs), as well as safety indicators including potentially avoidable readmissions, premature deaths and complications. results: A total of 3400 patients were included in this study; 1095 (32.2%) and 1155 (34.0%) were, respectively, hospitalized during the pre- and post-intervention periods. Patient characteristics were comparable between the two periods. Only the number of blood tests per patient day and the BZD prescription rate at discharge were significantly reduced in the post-intervention phase (pre: 0.54 ± 0.43 vs. post: 0.49 ± 0.60, p ≤ 0.001; pre: 4.2% vs. post: 1.7%, p = 0.003, respectively). PPI prescription rates remained comparable. Safety indicators analyses revealed no significant differences between the two periods of interest. Conclusions: Our results demonstrate a modest but statistically significant effect of a multifaceted educative intervention in reducing the number of blood tests and the BZD prescription rate at discharge in hospitalized patients. Limiting low-value services is very challenging and additional long-term interventions are necessary for wider implementation.

The Prevalence of COVID-19 Among Health Care Personnel in a University Hospital by the End of 2020, and Ambient Air CO2 in Hospital Rooms Ventilated by Window-Opening in 2021/22

In autumn and winter 2020/21 and again in 2021/22 Slovenia has ranked among countries with the highest incidence of COVID-19 per million inhabitants and high excess mortality over the average of previous years. Many patients on non-COVID-19 hospital wards were in fact infected by SARS-CoV-2. Health care personnel at the University Medical Centre Ljubljana (UMCL) were falling ill by Covid-19 in large numbers despite wearing surgical masks and eye protection when dealing with patients. We compared the prevalence of COVID-19 among health care personnel of the Division of Internal Medicine, UMCL by the end of December 2020 with the national average of Slovenia. After instructions had been issued to increase room ventilation by opening windows every hour for at least 10 minutes, ambient air CO2 was measured in an intensive care room and in an outpatient clinic room during a 10-month period, from April 2021 to February 2022. The prevalence of COVID-19 by the end of December 2020 was 42 % among nurses, 21 % among registered nurses and 17 % among medical doctors, whereas the national of average of the population was significantly lower at 5.5 %. Between April 2021 and February 2022, the average CO2 (ppm) in the intensive care was 633 (standard deviation 198, range 376 – 1540), while in the outpatient clinic the average was 552 (standard deviation 199, range 380 - 1910). During 2020, before the instructions for the use of personal protective equipment were up-graded and before regular window-opening was advised, the prevalence of Covid-19 among health care personnel at the Division of Internal medicine, UMCL exceeded the national average by 3- to 8-fold. After regular window-opening was advised, the peak CO2 levels still often exceeded the recommended “safe” level of 750 ppm.