Internal Medicine Wards Research Articles

Why Me? An Adult Chronic Patient’s Struggle between Illness and Self-Identity

<p>本文整理筆者在一般內科醫療病房，透過持續性的臨床會談，深入了解一位慢性病人的自我認同與疾病表徵變化等心理議題，同理共感於痛苦處境並得付出心理關懷之照顧歷程。本例病人為31歲男性，曾向主治醫師陳述家庭衝突造成其情緒低落及自殺意念，並經常未規律回診，常因症狀嚴重難耐才由急診轉住院治療。於心理會談中，病人自陳常因受困於醫院或聽到他人對自身處境的嫌棄貶損，陷入自我懷疑與批判，渴望能以死解脫。此病人在罹病後，會為疾病妥協生活，在抗拒與接受疾病間掙扎，致使全面影響其身心健康和病情控制。本文發現臨床工作者若可以透過反思與支持，以心理學的人文視角協助病人在自我認同與疾病表徵上的調適，有助於未來之疾病因應，本文的照護經驗可以作為其他醫療人員全人照護時的參考。</p> <p> </p><p>In the article, we summarized our endeavor in reaching an in-depth understanding of the struggle between illness and self-identity and other related mental health issues of an adult chronic patient in an internal medicine ward through clinical interviews, an endeavor prompting us to recognize the crucial importance of empathy in treating adult chronic patients struggling with changing perceptions of self-identify and illness representation. The patient in this case was a 31-year-old male who reported to his visiting staff that family conflicts had caused his depression and suicidal ideation. During the clinical interview, the patient expressed that he often fell victim to self-doubt because of being trapped in the hospital or hearing others criticize him, and he longed for death to find relief. Patients with chronic diseases often need to compromise their lives due to the illness and may struggle between resisting and accepting the illness, which can have adverse impacts on their mental health and disease control. The author suggests that medical practitioners should foster and use their empathy to help patients adjust their perceptions of self-identity and illness representation, encouraging patients to better cope with the impacts of their chronic diseases.</p> <p> </p>

Appropriateness and Cost of Prophylaxis Stress Ulcer for Inpatient in the Internal Medicine Department in a Government Hospital: A Cross-Sectional Study

Guidelines from the American Society of Health-System Pharmacists (ASHP) 1999 prohibit acid-suppressing therapy for stress ulcer prophylaxis (SUP) in patients who are not critically ill. Stress ulcer prophylaxis is not recommended in non-ICU patients with <2 risk factors. Inappropriate use of SUP can increase costs for patients. This study aims to evaluate the use and the cost of SUP. This research was a non-experimental observational study with a cross-sectional approach. Data was collected retrospectively using the consecutive sampling method with a random sampling technique on the medical records of inpatients in the internal medicine ward of Sleman Regional Public Hospital from January to December 2020, totaling 340 samples. The results showed that proton pump inhibitors were the most widely used acid-suppressing drugs, with 45.8%. Furthermore, the histamine-2 receptor antagonist was 42.6%, the sucralfate group was 7.4%, and the antacid group was 4.2%. Of 340 patients, 57 (16.8%) were in the proper indication based on the guidelines, and 283 (83.2%) were under the wrong indication for SUP. They were using SUP with the proper indication so that the therapy could save treatment costs by Rp. 19,933,582. There was a high prevalence of inappropriate SUP prescriptions among inpatients in the internal medicine department; if these drugs were given with the appropriate indications, they could save more on the prophylaxis cost. Clinician pharmacists should develop an effective intervention strategy to reduce inappropriate SUP drugs.

Validating the accuracy of the Hendrich II Fall Risk Model for hospitalized patients using the ROC curve analysis.

This retrospective study was conducted at a medical center in southern Taiwan to assess the accuracy of the Hendrich II Fall Risk Model (HIIFRM) in predicting falls. Sensitivity, specificity, accuracy, and optimal cutoff points were analyzed using receiver operating characteristic (ROC) curves. Data analysis was conducted using information from the electronic medical record and patient safety reporting systems, capturing 303 fall events and 47,146 non-fall events. Results revealed that at the standard threshold of HIIFRM score ≥5, the median score in the fall group was significantly higher than in the non-fall group. The top three units with HIIFRM scores exceeding 5 were the internal medicine (50.6%), surgical (26.5%), and oncology wards (14.1%), indicating a higher risk of falls in these areas. ROC analysis showed an HIIFRM sensitivity of 29.5% and specificity of 86.3%. The area under the curve (AUC) was 0.57, indicating limited discriminative ability in predicting falls. At a lower cutoff score (≥2), the AUC was 0.75 (95% confidence interval: 0.666-0.706; p < 0.0001), suggesting acceptable discriminative ability in predicting falls, with an additional identification of 101 fall events. This study emphasizes the importance of selecting an appropriate cutoff score when using the HIIFRM as a fall risk assessment tool. The findings have implications for fall prevention strategies and patient care in clinical settings, potentially leading to improved outcomes and patient safety.

Statins, ACE/ARBs drug use, and risk of pneumonia in hospitalized older patients: a retrospective cohort study.

The aims of this study is to evaluate the association between angiotensin-converting enzyme inhibitor (ACE-I), angiotensin II receptor blocker (ARBs) and/or statin use with the risk of pneumonia, as well as and with in-hospital and short-term outpatient mortality in hospitalized older patients with pneumonia. Patients aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro Politerapuie SIMI-Società Italiana di Medicina Interna) register from 2010 to 2019 were screened to assess the diagnosis of pneumonia and classified on whether or not they were prescribed with at least one drug among ACE-I, ARBs, and/or statins. Further study outcomes were mortality during hospital stay and at 3 months after hospital discharge. Among 5717 cases included (of whom 18.0% with pneumonia), 2915 (51.0%) were prescribed at least one drug among ACE-I, ARBs, and statins. An inverse association was found between treatment with ACE-I or ARBs and pneumonia (OR = 0.79, 95% CI 0.65-0.95). A higher effect was found among patients treated with ACE-I or ARBs in combination with statins (OR = 0.67, 95% CI 0.52-0.85). This study confirmed in the real-world setting that these largely used medications may reduce the risk of pneumonia in older people, who chronically take them for cardiovascular conditions.

Perceptions of Clinical Adverse Event Reporting by Nurses and Midwives.

The level of safety in healthcare units is mainly characterized by the occurrence of medical adverse events. The aim of the study was to present the experiences of reporting clinical adverse events and the perceptions of nurses working in internal medicine wards, surgical wards and midwives on these issues. The cross-sectional survey was conducted from October 2022 to April 2023. The study used the Author's Survey Questionnaire and sampling by assessment was applied. The study included nurses working in internal medicine wards and surgical wards as well as midwives at nine hospitals in a large provincial city in Poland, amounting to 745 participants. A one-way analysis of variance ANOVA and a post-hoc test (Fisher's NIR) were used. The significance level (p) did not exceed 0.05. Nurses working in surgical wards, internal medicine wards and midwives thought that clinical adverse events should be reported, and perceived this as an important and useful activity in ensuring patient safety. The most common adverse events reported by respondents were falls F(2.742) = 52.07; p = 0.001, bedsores F(2.742) = 19.62; p = 0.001, patient disappearances F(2.742) = 3.98; p = 0.019, and hospital-acquired infections F(2.742) = 3.88; p = 0.021. The most frequently selected factors influencing the abandonment of adverse event reporting were excessively complex paperwork, no or little harm to the patient or a fear of the negative consequences. The study suggests that an important way to overcome the barriers to nurses and midwives reporting adverse events would be to create a supportive atmosphere in which they could report errors and the reasons for them honestly and without fear, and to improve the way adverse events are reported at the personal and institutional levels.

Prevalence of Cardiovascular Disease During Seasonal Temperature Changes

Climate change poses a high risk to human health, both directly and indirectly, through various mechanisms.it is clear that climatic pressure is a hidden risk factor in sudden cardiovascular diseases. Our goal is to determine the prevalence of cardiovascular disease during seasonal temperature changes. We want to know the frequency of cardiovascular disease as the weather varies seasonally. This is a cross-sectional retrospective hospital-based study that This research lasted from 2023 to 2024.and was conducted at Nangarhar University Teaching Hospital in the internal medicine ward on patients who were admitted to the hospital. In this study, we reviewed 800 Patients files who were hospitalized with hypertension, cardiac ischemia, and heart failure. In this research, we only selected, conveniently, the patients from January and July as Sample months of the year. Because the coldest month of the year in Jalalabad is January, with a low temperature, and the hottest month is July, where the temperature is high. In this research, all the files of cardiovascular patients who were hospitalized in hot and cold seasons during one year have been processed. Gender, age, ischemic heart disease (IHD), heart failure (HF) and hypertension (HTN) are factors taken into account in this study. The analysis of this research was done by Excel and IBM-SPSS Version 26. Eight hundred patients with heart failure, hypertension, and myocardial ischemia were included in the study. There were 278 (34.75%) males and 522 (65.25%) females in this number. The patient's age statistics are as follows: mean age = 58.33±12.66, max age = 110 years, mod age = 60 years. 350 patients (43.75%) had ischemic heart disease (IHD), 250 patients (31.25%) had hypertension (HTN), and 200 patients (25%) had heart failure (HF). There were 130 patients in total in January (16.37%). The distribution of cardiovascular disease in January was IHD 50 (38%), HTN 44 (34%), and HF 36 (28%), in both sexes. 85 women (65%) and 45 men (35%).In January, the distribution of cardiovascular disease was as follows: 42.35% of females had IHD, 33.29% had HTN, and 22.35% had HF. 31.11% of men have IHD, 37.78% have HF, and 31.11% have HTN. In July, the number of female patients was 38(4.75%) and male was 27(3.37%), respectively. The mean age of patients in July in females was 56.93 and in males was 63.64 years. The prevalence of cardiovascular disease in female patients presented in July was as following: HTN=26.32%, IHD=23.68%, and HF=21.05%, and in male patients the prevalence of HF, HTN and IHD was13.16%, 10.53% and 5.25%, respectively. Given the global conversation around climate change, we aimed to assess the correlation between variations in temperatures and the prevalence of cardiovascular illnesses. Based to our research, the prevalence of cardiovascular disorders, such as ischemia, heart failure, and hypertension, is higher in the colder month of January and lower in the warmer month of July in Nangarhar. According to our research, patients should be kept warm and dressed in warm clothing all over the cold season in order to prevent cardiac diseases. Cold weather should also be taken care of in homes and hospital. It seems that cardiovascular diseases such as heart failure, hypertension, and cardiac ischemia are positively correlated with low temperatures. As there is no correlation between high body temperature and cardiovascular conditions such hypertension, myocardial ischemia, or cardiac insufficiency. Therefore, during the winter season, patients should be kept warm and dressed especially women warmly to prevent cardiac disorders. In addition, homes and hospitals should take precautions to keep their residents comfortable during the cold.

Seasonal Variation of Diabetic Ketoacidosis in Nangarhar University Teaching Hospital

Diabetic ketoacidosis is a life threating acute complication of diabetes mellitus aquiring special care. The aim of the study was to find out seasonal variation in the prevalence of diabetic ketoacidosis in diabetic patients. It was a cross sectional hospital based study conducted over both male and female diabetic patients admitter at the internal medicine ward of Nangarhar University Teaching Hospital during one year. Mean age across DKA was 53.9 ± 14 for DKA negative patients versus 51.3 ± 17.2 for DKA positive patients, P value = 0.26. Winter season was demonstrated with peak DKA positive cases 21 (43.7%) followed by fall 6 (22.2%), summer 11 (12.2%) and spring 10 (10.3%), respectively (P value = 0.01). Common associated factors included infection (72.2%), ischemia (8.2%), insulin withdrawal (7.7%), and others (6.9%) though not statistically different across seasons. There was significant seasonal variation in the prevalence of diabetic ketoacidosis denoting winter season with peak diabetic ketoacidosis. In fact, infection followed by ischemia and insulin withdrawal was the leading associated factor contributing to the prevalence of diabetic ketoacidosis. Season specific special attention should be paid the relevant symptoms of diabetic ketoacidosis for the early detection and treatment of the disease in order to avoid morbidity and mortality.

Relationship of self-care and degree of metabolic imbalance in patients with type II Diabetes Mellitus

The studies of recent decades prioritize diabetes as a highly significant disease. It is projected that by 2030, the number of people with diabetes will exceed 300 million, prompting systematic investigations on the topic. The objective of this study was to describe the relationship between self-care and the degree of metabolic imbalance in patients with Diabetes Mellitus admitted to the internal medicine ward of Gabriela Alvarado Hospital during the first half of 2023. The previously designed and validated EBADE questionnaire was used to assess self-care barriers in Type 2 Diabetes Mellitus patients. This instrument is considered reliable due to its numerous applications in the field of medical sciences. Following the questionnaire's administration, focusing on dietary control, medication, and medical supervision variables, it was observed that over 80% of respondents exhibit low self-monitoring during states of compensation. This lack of self-care contributes to disruptions in food consumption and medication adherence. It is essential to emphasize that self-care has visible implications in the disease's compensation state, making it an effective tool for disease management.

A case of patient with decompensated Budd-Chiari syndrome treated with T-TIPS: A case report

A 46-years old man with a recent onset of painful hepatomegaly and abdominal swelling was referred to the emergency department and hospitalized in the internal medicine ward for a diagnostic hepatological work-up. He had no clinically significant previous medical history, except for a mild long-standing polycitemia. When admitted to hospital, he was febrile but hemodynamically stable (blood pressure 100/60 mmHg, pulse rate 90/min) and had a satisfactory blood oxygen saturation levels in room air. At clinical examination, he was slightly sub-icteric; a palpable but tender hepatomegaly together with a significant abdominal effusion and a mild leg swelling were noticed. In order to evaluate different possible causes of liver disease, alcoholic, viral, autoimmune, metabolic and congenital etiologies were excluded, mainly by biochemical tests.

Deciphering cytopenias in internal medicine: a single-center observational study

Cytopenia is a common finding in patients admitted to internal medicine wards and the clinical workup may be long and time-consuming. In this single-center observational study, we analyzed a series of 151 inpatients who received hematologist referral due to cytopenia observed during hospital admission. Patients were mainly elderly (median 71 years, 15–96) and 87% had at least one comorbidity. Anemia was the most common cytopenia (91%), followed by thrombocytopenia (51%), and neutropenia (22%); 73 (48%) patients had a bicytopenia and 5 (3%) pancytopenia. Cytopenias were mainly severe, 66% of cases required RBC transfusions, and 21% platelet pools. During a median hospital stay of 15 days (1–166), 53 subjects (35%) received a hematologic discharge diagnosis, whilst the two-thirds had secondary cytopenia mainly due to associated comorbidities. Only about 34% of 2,728 diagnostic tests performed (including laboratory, imaging, and histology) clearly informed the discharge diagnosis in this heterogenous setting. Specifically, bone-marrow evaluation indicated in 46 (30%) patients, was diagnostic in 32 (69.6%). Eleven percent of patients died due to progression of the oncohematologic disease (29%), sepsis (24%), and solid tumor progression (24%). In conclusion, cytopenias in the internal medicine setting are mainly severe, more frequently secondary to associated comorbidities (2/3 of patients) and deserve proper workup before second/third-level tests (immune-hematological assays and CT scan or PET and bone-marrow evaluation, respectively).

Views of family members on using video calls during the hospital admission of a patient: A qualitative study.

Utilization of video calls on hospital wards to facilitate involvement of and communication with family members is still limited. A deeper understanding of the needs and expectations of family members regarding video calls on hospital wards is necessary, to identify potential barriers and facilitate video calls in practice. The aim of this study was to explore the views, expectations and needs of a patient's family members regarding the use of video calls between family members, patients and healthcare professionals, during the patient's hospital admission. A qualitative study was carried out. Semi-structured interviews with family members of patients admitted to two hospitals were conducted between February and May 2022. Family members of patients admitted to the surgical, internal medicine and gynaecological wards were recruited. Twelve family members of patients participated. Family members stated that they perceive video calls as a supplemental option and prefer live visits during hospital admission. They expected video calls to initiate additional moments of contact with healthcare professionals, e.g. to join in medical rounds. When deploying video calls, family members mentioned that adequate instruction and technical support by nurses should be available. Family members considered video calls valuable when visiting is not possible or to participate in medical rounds or other contacts with healthcare professionals outside of visiting hours. Family members need to be supported in options and use of video calls on hospital wards. Additional knowledge about actual participation in care through video calls is needed as well as the effect on patient, family and healthcare professional outcomes. Using video calls on hospital wards can provide family members with flexible alternatives for contact and promote family involvement. COREQ guidelines. Family members of patients admitted to hospital have contributed by sharing their perspectives in interviews. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Family members perceive additional value from the use of video calls on hospital wards. For family, use of video calls needs to be facilitated with clear instruction materials and support. Amsterdam UMC Medical Ethics Review Committee (ref number W21_508 # 21.560).

Characteristics of the clinical pharmacists' interventions at the main general tertiary care hospital in Qatar.

Medication-related problems (MRPs) are prevalent throughout healthcare systems, whereby pharmacy-based interventions are pivotal to reducing occurrence. In the Middle East, including Qatar, the professional roles of pharmacists have been expanding to improve patient safety. This study aimed to characterize and analyze pharmacist-led interventions among hospitalized patients in the leading general hospital in Qatar. A retrospective analysis of pharmacist interventions in the internal medicine ward, critical care unit, and emergency department (ED) was conducted. Data were extracted from three periods of 1 month (March 1-31, 2018, July 15-August 15, 2018, and January 1-31, 2019). A descriptive type of analysis was undertaken. A total of 340 patients with 858 interventions were analyzed. The average age of the study participants was 51 years (SD ± 17.7). The study population was predominantly male (65%). The prevailing pharmacist intervention was adding drug therapy (27%), followed by medication discontinuation (18%) and dosage adjustments (16%). This pattern was maintained across all subpopulations, e.g., gender, age, and ward, except for the ED, where cessation of medication was the most frequent intervention (4%). The two pharmacological classes associated with most interventions were anti-infective and cardiovascular agents. Pharmacist interventions effectively identify, prevent, and resolve MRPs in general inpatient settings in Qatar.

P-83 Primary thyroid lymphoma presented with hypercalcemia and rapidly growing neck mass

Abstract Introduction Primary thyroid lymphoma is an uncommon malignancy, accounting for 1% to 2% of extranodal lymphomas and 1% to 5% of thyroid malignancies. Large B-cell lymphoma is the most prevalent form of primary thyroid lymphoma. Here, we present a patient with hypercalcemia and a rapidly growing neck lesion who was diagnosed with diffuse large B-cell lymphoma of the thyroid gland. Clinical Case A 75-year-old patient presented to the emergency room with loss of appetite and decreased oral intake over the previous five days, as well as abdominal pain and inability to pass gas and feces. The nausea and vomiting symptoms began simultaneously with the abdominal discomfort. Inspection revealed a distinct, palpable, and erythematous mass in the patient's neck, which the patient reported developing within the previous three months. After noticing the growing mass and consulting her primary care physician, she was referred to an ENT specialist; a biopsy was conducted and the results were pending. Her preliminary laboratory results revealed hypercalcemia and renal failure with depressed parathyroid hormone levels. The following were the initial laboratory results: creatinine 2,14 mg/dL, Ca 13,5 mg/dL, Albumin: 4,2 g/dL, P 2,9 mg/dL, Mg:1 mg/dl, parathormone 11.6 ng/dL procalcitonin 0.04% ng/mL and hemoglobin 10.2% g/dl. Abdominal CT revealed a contracted gallbladder with stone formations in the lumen, but no other abnormalities. The patient was admitted to the internal medicine ward with an initial diagnosis of hypercalcemia and prerenal acute kidney failure as a result of decreased oral intake. The patient's hypercalcemia was determined to be PTH-independent, and malignancy was suspected due to a 4-month history of progressive neck lesion. The thyroid gland was 49×40×87mm in the right and 38×40×62mm in the left, and the isthmus was 50mm thick with lobulated outlines on contrast enhanced cervical MR. The signal intensity of parenchyma was heterogeneous. 18F-FDG PET/CT uncovered a bilateral, distinct increase in the size of the thyroid gland with protrusions to the hyoid bone in superior sequences. The solid mass was found to have diffusely increased FDG uptake and a hypermetabolic pattern, both of which are indicative of malignant characteristics. The lesions encompass the trachea and there are reports of invasion of the cricoid cartilage and thyroid cartilage. A second main malignant disease concern was raised when small intestine FDG uptake and wall thickening suggested malignancy. The patient was re-evaluated by the endocrinology clinic, and additional workup tests were ordered due to the suspicion of Riedel Struma, which was based on the control sedimentation rate of 93 mm/h and the firmness of the gland upon palpation. An open surgical biopsy was performed. The pathology report concluded that it is consistent with diffuse large B-cell lymphoma that is CD20-positive. The hematology department has scheduled chemotherapy treatment for the patient.

Application of the (fr)AGILE scale in the evaluation of multidimensional frailty in elderly inpatients from internal medicine wards: a cross-sectional observational study.

With the rapid growth of an aging global population and proportion, the prevalence of frailty is constantly increasing. Therefore, finding a frailty assessment tool suitable for clinical application by physicians has become the primary link in the comprehensive management of frailty in elderly patients. This study used the (fr)AGILE scale to investigate the frailty status of elderly patients from internal medicine wards and identified relevant factors that affect the severity of frailty. In this study, 408 elderly inpatients in internal medicine departments of Qilu Hospital of Shandong University from May 2021 to August 2022 were enrolled as research subjects, and a cross-sectional observational study was conducted. Researchers evaluated the frailty based on the (fr)AGILE scale score. The general condition, past medical history, physical examination, laboratory examination, nutrition control score, intervention and treatment measures and other elderly patient information was collected. Logistic regression analysis was used to analyze the relevant factors that affect the severity of frailty and hospitalization costs. According to the (fr)AGILE scale score, the elderly patients were divided into groups to determine whether they were frail and the severity of the frailty. Among them, 164 patients were in the prefrailty stage, which accounted for 40.2%. There were 188 cases of mild frailty that accounted for 46.1%, and 56 cases of moderate to severe frailty that accounted for 13.7%. Decreased grip strength, elevated white blood cell levels, and low sodium and potassium are independent risk factors affecting the severity of frailty. As the severity of frailty increases, the proportion of sodium, potassium, albumin supplementation as well as anti-infection gradually increases. Frailty is a common elderly syndrome with a high incidence among elderly patients in internal medicine departments. The main manifestations of frailty vary with different severity levels. Inflammation, anemia, and poor nutritional status can lead to an increase in the severity of frailty as well as blood hypercoagulability, myocardial damage, and additional supportive interventions. This ultimately leads to prolonged hospitalization and increased hospitalization costs.

The Impact of Admission Timing on ICU Outcomes for Patients Transferred from Internal Medicine Wards - A Single Center Study

The Impact of Admission Timing on ICU Outcomes for Patients Transferred from Internal Medicine Wards - A Single Center Study

The Use of Risk Scores for Thromboprophylaxis in Medically Ill Patients-Rationale and Design of the RICO trial.

Background Venous thromboembolism (VTE) in hospitalized medically ill patients is a significant cause of morbidity and mortality. Guidelines suggest that VTE and bleeding risk assessment models (RAMs) should be integrated into the clinical decision-making process on thromboprophylaxis. However, poor evidence is available comparing the use of a RAM versus clinical judgement in evaluating VTE and bleeding occurrence. Methods Reducing Important Clinical Outcomes in hospitalized medical ill patients (RICO) is a multicenter, cluster-randomized, controlled clinical trial (ClinicalTrials.gov Identifier: NCT04267718). Acutely ill patients hospitalized in Internal Medicine wards are randomized to the use of RAMs-namely the Padua Prediction Score and the International Medical Prevention Registry on Venous Thromboembolism Bleeding Score-or to clinical judgement. The primary study outcome is a composite of symptomatic objectively confirmed VTE and major bleeding at 90-day follow-up. Secondary endpoints include the evaluation of clinical outcomes at hospital discharge and the assessment of VTE prophylaxis prescription during the study period. In order to demonstrate a 50% reduction in the primary outcome in the experimental group and assuming an incidence of the primary outcome of 3.5% in the control group at 90-day; 2,844 patients across 32 centers will be included in the study. Discussion The RICO trial is a randomized study of clinical management assessing the role of RAMs in hospitalized medical ill patients with the aim of reducing VTE and bleeding occurrence. The study has the potential to improve clinical practice since VTE still represents an important cause of morbidity and mortality in this setting.

Prediction of COVID-19 in-hospital mortality in older patients using artificial intelligence: a multicenter study.

Once the pandemic ended, SARS-CoV-2 became endemic, with flare-up phases. COVID-19 disease can still have a significant clinical impact, especially in older patients with multimorbidity and frailty. This study aims at evaluating the main characteristics associated to in-hospital mortality among data routinely collected upon admission to identify older patients at higher risk of death. The present study used data from Gerocovid-acute wards, an observational multicenter retrospective-prospective study conducted in geriatric and internal medicine wards in subjects ≥60years old during the COVID-19 pandemic. Seventy-one routinely collected variables, including demographic data, living arrangements, smoking habits, pre-COVID-19 mobility, chronic diseases, and clinical and laboratory parameters were integrated into a web-based machine learning platform (Just Add Data Bio) to identify factors with the highest prognostic relevance. The use of artificial intelligence allowed us to avoid variable selection bias, to test a large number of models and to perform an internal validation. The dataset was split into training and test sets, based on a 70:30 ratio and matching on age, sex, and proportion of events; 3,520 models were set out to train. The three predictive algorithms (optimized for performance, interpretability, or aggressive feature selection) converged on the same model, including 12 variables: pre-COVID-19 mobility, World Health Organization disease severity, age, heart rate, arterial blood gases bicarbonate and oxygen saturation, serum potassium, systolic blood pressure, blood glucose, aspartate aminotransferase, PaO2/FiO2 ratio and derived neutrophil-to-lymphocyte ratio. Beyond variables reflecting the severity of COVID-19 disease failure, pre-morbid mobility level was the strongest factor associated with in-hospital mortality reflecting the importance of functional status as a synthetic measure of health in older adults, while the association between derived neutrophil-to-lymphocyte ratio and mortality, confirms the fundamental role played by neutrophils in SARS-CoV-2 disease.

Demographics, medication use, and admission characteristics of patients hospitalized with diabetes in Ontario, Canada: A retrospective cohort study.

In Canada, one in seven adults has diabetes (i.e., 2.3 million) and the lifetime risk of developing diabetes is approximately 30% by age 65. Although 30% of patients admitted to the hospital have diabetes, data from inpatient hospitalizations for patients with diabetes are lacking, both in Canada and globally. To validate International Classification of Diseases 10th edition Canadian version (ICD-10-CA) codes for the identification of patients with diabetes, to create a multicenter database of patients with diabetes hospitalized under internal medicine in Ontario, and to determine their baseline characteristics, medication use, and admission characteristics. We created a database of people who had diabetes and were hospitalized between 2010 and 2020 at 8 hospitals in Ontario that were part of the General Medicine Inpatient Initiative (GEMINI) hospital data-sharing network. Patients who had diabetes were identified using chart review, based upon either (i) a previous physician diagnosis of diabetes, (ii) a recorded hemoglobin A1c ≥ 6.5% or (iii) outpatient prescription of a diabetes medication preceding the hospitalization. The test characteristics of ICD-10-CA codes for diabetes were evaluated. We compared baseline demographics, medication use and hospitalization details among patients with and without diabetes. For hospitalization details, we collected information on the admission diagnosis, comorbidity index, length of stay, receipt of ICU-level care, and inpatient mortality. There were 384,588 admissions within the total study cohort, of which 118,987 (30.9%) had an ICD-10-CA diagnosis code of diabetes (E10.x, E11.x, E13.x, E14.x). The sensitivity and specificity of ICD-10-CA diagnostic codes was 95.9% and 98.8%, respectively. Most patients with an ICD-10-CA code for diabetes had a code for type 2 diabetes (93.9%) and a code for type 1 diabetes was rare (6.1%). The mean age was 66.4 years for patients without diabetes and 71.3 years for those with an ICD-10-CA diagnosis code for diabetes. Patients with diabetes had a higher prevalence of hypertension (64% vs. 37.9%), coronary artery disease (28.7% vs. 15.3%), heart failure (24.5% vs. 12.1%) and renal failure (33.8% vs. 17.3%) in comparison to those without diabetes. The most prevalent diabetes medications received in hospital were metformin (43%), DPP4 inhibitors (22.7%) and sulfonylureas (18.8%). The most common reason for admission among patients with diabetes was heart failure (9.0%), and among patients without diabetes was pneumonia (7.8%). Median length of stay was longer for patients with diabetes (5.5 vs. 4.5 days) and in-hospital mortality was similar between groups (6.8% with diabetes vs. 6.5% without diabetes). Diabetes is one of the most prevalent chronic medical conditions, affecting roughly one third of all patients hospitalized on an internal medicine ward and is associated with other comorbidities and longer hospital stays. ICD-10-CA codes were highly accurate in identifying patients with diabetes. The development of an inpatient cohort will allow for further study of in-hospital practices and outcomes among patients with diabetes.

Diabetic Ketoacidosis in Type 1 Diabetes Mellitus

Introduction: Diabetic ketoacidosis (DKA) is a state of metabolic decompensation/disorder characterized by the triad of hyperglycemia, acidosis and ketosis, caused by absolute or relative insulin deficiency and increased counter-regulatory hormones. Immediate therapy in DKA patients determines the patient's prognosis Case Report: A 19-year-old male treated in the internal medicine ward of Dr. M djamil Padang with diabetic ketoacidosis, type 1 DM, and Abscess capitis. The patient was treated with rehydration and intravenous insulin infusion can show clinical improvement. Conclusion: The diagnosis in patients is based on anamnesis, physical examination and supporting examinations. Immediate therapy is needed in the management of DKA in patients. After DKA is resolved, look for the causes of the risk of DKA. On the third day of treatment the patient's condition improved clinically and the laboratory.

Opinion of nurses of internal medicine wards regarding factors determining their work - observational and cross-sectional studies.

The aim of the study was to assess the factors determining the work of nurses in internal medicine departments. The study was multicentre, cross-sectional, and observational. The selection of the research group was intentional. The subject of the study were 209 nurses working in 11 internal medicine departments in 10 hospitals in the region of southern Poland. The number of patients cared for by one nurse, nurses' participation in the decision-making process, and nurses' age were shown to be direct predictors of emotional exhaustion. The number of patients cared for by a single nurse, nurses' participation in the decision-making process, and age were direct predictors of depersonalization. It was shown that significant (p < 0.05) independent (multivariate analysis) variables of the job satisfaction subscale were information on support for nurses at work by managerial staff and nurses' participation in the decision-making process. After analysing the impact of socio-demographic factors on the nurses' working environment, it was found that the participation of nurses in the decision-making process was significantly lower in the youngest group than in the other age groups (p = 0.006). Participation of nurses in the decision-making process is a direct determinant of occupational burnout. A higher number of patients under the care of a nurse, lack of participation in the decision-making process and a higher age of nurses are predictors of emotional exhaustion and depersonalization.