Medical Conditions Of Patients Research Articles

B-131 The Prevalence and Clinical Relevance of the DFS Immunofluorescent Staining Pattern in a Large ANA-positive Cohort

Abstract Background The dense fine-speckled (DFS) nuclear pattern is one of the most common indirect immunofluorescence (IIF) patterns detected during routine antinuclear antibody (ANA) screening. Although various researchers have studied the DFS pattern in recent years, it presents a clinical puzzle since its significance remains elusive. Anti-DFS-70 antibodies occur in healthy individuals with different medical conditions. Unlike the other ANA patterns, they are not associated with systemic autoimmune disease. The present study examined the association of a DFS ANA pattern with the medical conditions of patients who presented to a tertiary care medical center. Methods Retrospective chart review of all laboratory values (January 2020 through June 2022) with ANA- and DFS-positive patterns in patients with ANA tests ordered by various clinicians and compared to the patient diagnosis reported. UMass Human IRB approves this study. Results Of 8885 ANA samples analyzed, 67.8% (6022) were reported negative. Of total positive ANA (2863) samples, 78.6% (2257) had nuclear patterns, 9.1% (260) had mitotic patterns, and 12.1% (346) had cytoplasmic patterns. Of the positive ANA samples, 14.6% (417) had DFS patterns. For samples with DFS pattern, titers ranged from 1:40 to 1:1280; 62.5% were between1:40, and 1:80. Of samples positive for ANA DFS patterns, 76% (317) were from female patients, and 90% (375) were from patients >21 years of age. Among patients with DFS patterns, the most commonly reported diseases were neurological, followed by respiratory, digestive, circulatory, and musculoskeletal (Table 1). Conclusion Clinicians should use a positive ANA with a DFS pattern to indicate pathological phenomena other than autoimmune diseases. Only 3.1% of the patients with DFS patterns have a systemic rheumatic disorder. Clinicians should pay close attention to ANA Patterns, especially DFS staining when using ANA testing.

Child and adolescent psychiatric emergency admissions before, during and after the Covid-19 pandemic: An Interrupted time series analysis from Turkey.

Acute psychiatric care of youth is paramount as prompt evaluation is known to mitigate potentially catastrophic outcomes in the future. The aim of this study was to analyze changes in child and adolescent psychiatric (CAP) emergency admissions within a 4-year period, including the pandemic course. Electronic patient health records of children and adolescents aged 0-18 years, admitted to the pediatric emergency department (ED) for psychiatric complaints between January 2018-December 2021, were retrospectively reviewed (n=2014). Data including the age, sex, presenting complaint and preliminary diagnosis, length of stay in the ED, and history of previous psychiatric outpatient/emergency admissions were recorded. Interrupted Time series analysis was conducted to detect changes. During the first month of the COVID-19 pandemic period (March 2020); low-risk suicide attempts (60.6%;IRR=0.394;CI=0.216-0.718), high-risk suicide attempts (82.2%;IRR=0.178;CI=0.070-0.457), manic symptoms (87.9%;IRR=0.121;CI=0.016-0.896), and total CAP emergency admissions were found to have decreased (30.7%;IRR=0.693;CI=0.543-0.885). CAP consultations due to general medical conditions were found to have increased by 7.3% (IRR=1.073;CI=1.019-1.130), and total CAP emergency admissions showed a mild increase of 1.8% (IRR=1.018;CI=1.001-1.036) through April 2020 to December 2021. While suicide attempts, manic symptoms, and total CAP emergency admissions decreased during the first month of the pandemic, there was an increase in total CAP emergency admissions, especially in general medical conditions presenting with psychiatric symptoms during the following pandemic period. This study highlights the importance of accounting for underlying medical conditions in patients presenting with psychiatric complaints to the ED in the normalization phase. The datasets generated and/or analyzed during the present study are available from the corresponding author on reasonable request.

Contribution of Comorbid Conditions to the Diagnosis of Insomnia: A Database Study in a Commercially Insured Population.

Insomnia is a common sleep disorder characterized as dissatisfaction with sleep quantity or quality resulting in distress or impairment of social, occupational, or other daily functioning. It is unknown if there are medical conditions that have strong associations with insomnia but are unrecognized in previous literature. In this cross-sectional study based on IBM Marketscan Research Databases, we measured insomnia and 78 medical conditions in patients with 2-year continuous enrollment during 2018-2019. We selected important comorbidities associated with insomnia for eight age-sex groups and built logistic regression models to measure the associations. The prevalence of diagnosed insomnia increased with age, from <0.4% in the age group 0-17 to 4%-5% in the age group ≥65. Females had a higher prevalence of insomnia than males. Anxiety and depression were two important comorbidities across all age-sex subgroups. Most odds ratios of comorbidities remained significant after adjusting for other comorbidities in regression models. We did not find any new medical conditions that had strong associations with insomnia but were unrecognized in previous literature. The findings can help physicians use comorbidities to identify patients with high risk of insomnia.

The analysis of organic diseases in elderly patients diagnosed with bipolar disorders- A retrospective study

IntroductionBoth organic and psychiatric comorbidities are frequently detected in bipolar disorders (BD) and this phenomenon has a significant impact on case management in these patients. The most reported general medical conditions in patients with BD are migraine, thyroid illness, obesity, diabetes mellitus, and cardiovascular disease. The screening for comorbidities detection in BD patients is important from multiple perspectives, including the need to construct an adequate therapeutic plan, the need to increase treatment adherence, and to improve these patients’ quality of life.ObjectivesTo assess the prevalence of comorbid organic diseases in a clinical sample of BD patients.MethodsA chart- and register-based analysis of BD patients (i.e., type I and II BD) evaluated in our department during a period of three years (January 2019- January 2022) was conducted in order to detect the prevalence rate of organic diseases. All patients aged over 65 years were evaluated either for acute mood episodes or presented to their treating psychiatrists for follow-up visits.ResultsA number of 87 patients were included in this analysis, 45 male and 42 female, with a mean age of 70.5 years. The most frequently detected organic comorbidities were metabolic disorders (obesity, dyslipidemia, diabetes mellitus- 36.8%), cardiovascular (arterial hypertension, arrhythmias, myocardial ischemia, deep/superficial venous thrombosis- 26.4%), digestive system-related (hepatic, gastric, intestinal diseases- 21.8%), neurologic (i.e., stroke, migraine, Parkinson’s disease) (18.3%), endocrine (mainly thyroid diseases) (17.2%), and other (19.5%). A relatively high rate of organic diseases (38%) were newly diagnosed (in the last 3 months), suggesting there is a certain need to screen for organic pathology in this population, but most of the BD patients presented a long history of investigated and treated comorbid conditions.ConclusionsOrganic diseases are very common in elderly BD patients. Even where no history of somatic conditions exists, comprehensive investigations are granted in order to detect such health problems with important prognostic impact.Disclosure of InterestNone Declared

Prevalence of Anxiety amongst Interns while Performing Treatments in Dental Colleges of Navi Mumbai: A Cross-sectional Survey

Introduction: Anxiety is one of the most commonly experienced disorders across gender and all ages. Dental anxiety seen in patients prior to or during treatment is a well-researched topic. However, anxiety experienced by interns while treating patients in the dental college is a lesser explored side of the same coin. Aim: To evaluate and understand the prevalence of anxiety experienced by dental interns while performing treatments in a college clinical set-up and studies the various factors precipitating anxiety. Materials and Methods: This cross-sectional survey was conducted using Google forms, amongst interns of five dental colleges in Navi Mumbai region from July 2021 to October 2021. A sample size of 350 was derived by convenient sampling method. The parameters assessed via questionnaire through a Likert-type response scale included various factors precipitating anxiety amongst interns such as performing invasive dental treatments, lack of in-depth knowledge of procedures, age, attitude and medical conditions of patients, encountering complications while treating patients, presence of supervision and working with anxious peers. Chi-square test was performed to analyse collected data, extract results and draw a conclusion. Results: Out of 350 participants, 332 showed symptoms of anxiety while treating patients in clinics. No significant gender predilection was noted for anxiety (p=0.544). Factors precipitating anxiety included performing invasive dental treatments (p=0.0004), lack of in-depth knowledge of certain procedures (p=0.020), patient’s attitude (p=0.017), treating patients with certain medical conditions (p=0.035) as well as encountering complications while treating patients (p=0.022). A significant number of participants thought that anxiety leads to more procedural errors (p=0.010). The need to incorporate anxiety management in the dental curriculum was observed (p=0.023). Conclusion: The results of this study showed prevalence of anxiety amongst dental students and highlighted the need to incorporate anxiety management programs in the curriculum. Preparing interns to cope with anxiety resulting from treating patients seems to be of importance for their future clinical practice.

Acute physiology and chronic health evaluation score and mortality of patients admitted to intermediate care units of a hospital in a low- and middle-income country: A cross-sectional study from Pakistan.

Intermediate care units (IMCUs) serve as a bridge between general wards and intensive care units by providing close monitoring and rapid response to medical emergencies. We aim to identify the common acute medical conditions in patients admitted to IMCU and compare the predicted mortality of these conditions by acute physiology and chronic health evaluation-II (APACHE-II) score with actual mortality. A cross-sectional study was conducted at a tertiary care hospital from 2017 to 2019. All adult internal medicine patients admitted to IMCUs were included. Acute conditions were defined as those of short duration (<3 weeks) that require hospitalization. The APACHE-II score was used to determine the severity of these patients' illnesses. Mean (standard deviation [SD]) age was 62 (16.5) years, and 493 (49.2%) patients were male. The top three acute medical conditions were acute and chronic kidney disease in 399 (39.8%), pneumonia in 303 (30.2%), and urinary tract infections (UTIs) in 211 (21.1%). The mean (SD) APACHE-II score of these patients was 12.5 (5.4). The highest mean APACHE-II (SD) score was for acute kidney injury (14.7 ± 4.8), followed by sepsis/septic shock (13.6 ± 5.1) and UTI (13.4 ± 5.1). Sepsis/septic shock was associated with the greatest mortality (odds ratio [OR]: 6.9 [95% CI (confidence interval): 4.5-10.6]), followed by stroke (OR: 3.9 [95% CI: 1.9-8.3]) and pneumonia (OR: 3.0 [95% CI: 2.0-4.5]). Sepsis/septic shock, stroke, and pneumonia are the leading causes of death in our IMCUs. The APACHE-II score predicted mortality for most acute medical conditions but underestimated the risk for sepsis and stroke.

Altered Mental Status and Its Causes: Commonest Dilemma of Residents and Emergency Physicians

Objective: To assess the frequency of the various medical conditions in patients presenting with altered mental status (AMS) in the Emergency Department of Pakistan Naval Ship (PNS) Shifa Hospital.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Emergency Department, Pak Naval Ship Shifa Hospital, Karachi Pakistan from Feb-Jul 2021.&#x0D; Methodology: Adult patients who have presented with altered mental status (Glasgow coma scale score less than 15) or who have the diagnosis "AMS" written in their notes were included in the study. Patients were observed in the wards until a definitive diagnosis could be made.&#x0D; Results: Sixty patients presented with AMS at the Emergency Department of PNS Shifa, during the study period. The causes of AMS were sepsis (20, 33.33%), CVA (12, 20%), metabolic (hepatic/uremic) encephalopathy (8, 13.33%), diabetic complications (7, 11.66%), seizures (5, 8.33%), drug intoxication (4, 6.66%) and respiratory failure due to lung pathology (4,6.66%). The overall mortality rate was 20%.&#x0D; Conclusion: Sepsis is the most frequently encountered cause of altered mental state in emergency department patients,followed by CVA, metabolic encephalopathy, and diabetic complications.

Evolving Fuzzy logic Systems for creative personalized Socially Assistive Robots

Socially Assistive Robots (SARs) are increasingly used in dementia and elderly care. In order to provide effective assistance, SARs need to be personalized to individual patients and account for stimulating their divergent thinking in creative ways. Rule-based fuzzy logic systems provide effective methods for automated decision-making of SARs. However, expanding and modifying the rules of fuzzy logic systems to account for the evolving needs, preferences, and medical conditions of patients can be tedious and costly. In this paper, we introduce EFS4SAR, a novel Evolving Fuzzy logic System for Socially Assistive Robots that supports autonomous evolution of the fuzzy rules that steer the behavior of the SAR. EFS4SAR combines traditional rule-based fuzzy logic systems with evolutionary algorithms, which model the process of evolution in nature and have shown to result in creative behaviors. We evaluate EFS4SAR via computer simulations on both synthetic and real-world data. The results show that the fuzzy rules evolved over time are not only personalized with respect to the personal preferences and therapeutic needs of the patients, but they also meet the following criteria for creativity of SARs: originality and effectiveness of the therapeutic tasks proposed to the patients. Compared to existing evolving fuzzy systems, EFS4SAR achieves similar effectiveness with higher degree of originality.

Psychometric properties of The COVID-19 Fears Questionnaire for Chronic Medical Conditions in patients with pre-existing medical conditions.

Fear of COVID-19 can have adverse mental health consequences in vulnerable patients with pre-existing conditions. We aimed to validate The COVID-19 Fears Questionnaire for Chronic Medical Conditions in Lithuania and to evaluate fears of COVID-19 in patients with pre-existing conditions. Between October and December, 2020, 371 respondents with pre-existing conditions completed an online survey including the 10-item COVID-19 Fears Questionnaire for Chronic Medical Conditions (COVID-19 fears), Patient Health Questionnaire-8 (PHQ-8; depressive symptoms), Generalised Anxiety Disorders-7 (GAD-7; anxiety symptoms) and Impact of Events Scale Revised (IES-R; posttraumatic stress symptoms). The majority of participants were women (84%) and from 41 to 60years old (46%). The most common pre-existing conditions were respiratory diseases (33%) and diabetes (22%). Mean total score on the COVID-19 Fears Questionnaire was 24.89±8.79. Exploratory factor analysis yielded one-factor solution with the Cronbach's coefficient alpha of 0.913. The highest rated COVID-19 fears were infection of close people, inability to receive treatment for COVID-19 and pre-existing condition and fear of severe complications because of the pre-existing condition. There was moderate to strong correlation of the 10-item COVID-19 Fears Questionnaire for Chronic Medical Conditions score with scores on the PHQ-8 (r=0.371), GAD-7 (r=0.358) and IES-R (r=0.553; all p<0.001). Test-retest reliability was adequate. The 10-item COVID-19 Fears Questionnaire for Chronic Medical Conditions has good psychometric properties in patients with pre-existing conditions and greater fear is associated with worse mental health. Consideration of COVID-19 fears is important for optimised care of patients with pre-existing during the pandemic.

Impact of COVID-19 on Taste and Smell Sensation among Population in Western Region of Saudi Arabia

Background: COVID-19 is pandemic disease caused by (SARS-CoV-2) first discovered in China in December 2019. It affects smell and taste sensation among large proportion of patients with COVID-19.&#x0D; The aims of this study is to asses impact of COVID-19 on smell and taste sensation among COVID-19 patients in western region of Saudi Arabia.&#x0D; Methods: The study design was descriptive cross sectional and our sample was be is 500 patients with COVID-19. The data was collected by using structured questionnaire which was distributed electronically and contain (sociodemographic data, diagnosed with COVID-19, status of smell and taste sensation…). The data was analyzed using SPSS program version 22.&#x0D; Results: We were able to collect 404 responses to our questionnaire with response rate of 80.8 %. The mean age of total sample was 32.1 years with standard deviation of 14.34 years and 56.1 % of participants were females. Prevalence of weak or loss of smell or taste after infection with the emerging corona virus was 74.4%. Moreover, we found that patients who had weak or loss of smell or taste because of COVID-19 were older than those whose sense did not be affected. Moreover, non- Saudi Arabian were more affected by losing of smell and taste with significant difference (P=0.026). Considering medical conditions of patients, we found that patients with any medical conditions were associated with significantly higher incidence of losing smell and taste.&#x0D; Conclusion: The prevalence of losing smell and taste among patients with COVID-19 in our sample were high and was higher in older patients, male, Saudi arabian and those with other medical conditions. More investigations should be conducted to assess the same variables using retrospective study design.

A Survey on Data Mining Techniques for COVID Prediction

Corona Virus Disease of 2019 (COVID-19) has emerged as a serious health emergency worldwide. The symptoms of COVID-19 are un-detectable at early stage in most of the patients. It spreads from person to person very rapidly and causes severe sickness and loss of life in a number of cases if not treated early. Data mining techniques are very commonly being used in medical sector for detection and prediction of a variety of diseases and medical conditions of patients. A number of researchers are also working towards prediction of possibility of infection of COVID-19 among humans using machine learning techniques, specifically by applying data mining methods. In this paper, an extensive survey of available literature in the domain of prediction of COVID-19 infection and other diseases has been presented. This also includes survey on data mining techniques, models and various datasets.

Impact of the COVID-19 Pandemic on Patients Affected by Non-Communicable Diseases in Europe and in the USA

An international online patient community, Carenity, conducted a patient study in two independent waves among adults affected by non-communicable diseases (NCDs) in Europe and in the United States of America (USA). The study aimed to assess the real time impact of the coronavirus disease 2019 (COVID-19) on the medical conditions of patients with NCDs, their access to health care, and their adaptation to daily life as well as to describe their sources of information on COVID-19 and their needs for specific information and support. During the pandemic, 50% of the patients reported a worsening of their medical condition, and 17% developed a new disease. Additionally, 26% of the respondents reported an impact of the pandemic on regular/long-term treatment intake. 54% of the patients felt very or completely socially isolated and reported a strong impact of the COVID-19 pandemic on their stress level and state of mind, with higher levels observed in the USA compared to Europe. 59% of the respondents wished to have received additional information regarding the risks associated to their medical condition during the pandemic. Television was the most used source of information, whereas physicians were the most trusted one. This study describes the substantial impact of the COVID-19 pandemic on NCD patients.

Medical comorbidities of patients presenting to an adult neurodevelopmental new case clinic in Singapore

AimsTo describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.BackgroundMedical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.MethodA retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.Result319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.ConclusionPatients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.

Bidirectional associations between treatment-resistant depression and general medical conditions

Depression is associated with general medical conditions (GMCs), but it is not known if treatment-resistant depression (TRD) affects GMC risk and vice versa. We estimated bidirectional associations between TRD and GMCs (prior and subsequent). All individuals aged 18–69 years, born and living in Denmark, with a first-time prescription for an antidepressant between 2005 and 2012 were identified in the Danish Prescription Registry (N = 154,513). TRD was defined as at least two shifts in treatment regimes. For prior GMCs, we estimated odds ratios (ORs) using conditional logistic regression comparing TRD patients with matched non-TRD controls adjusted for other GMCs and number of other GMCs. For subsequent GMCs, we used Cox regression to calculate hazard ratios (HRs) in TRD vs. non-TRD patients adjusted for age at first prescription, calendar time, other GMCs and number of other GMCs. Patients with TRD had higher prevalence of prior GMCs related to the immune or neurological systems; musculoskeletal disorders (women aOR: 1.35, 95% CI: 1.26–1.46, men aOR: 1.30, 95% CI: 1.19–1.42) and migraine (women aOR: 1.22, 95% CI: 1.09–1.36, men aOR: 1.25, 95% CI: 1.00–1.56). Subsequent GMCs were related to a broader spectrum; cardiovascular (women aHR: 1.43, 95% CI: 1.32–1.54, men aHR: 1.31, 95% CI: 1.19–1.43), endocrine (women aHR: 1.52, 95% CI: 1.37–1.67, men aHR: 1.24, 95% CI: 1.07–1.44), and neurological disorders (women aHR: 1.24, 95% CI: 1.13–1.35, men aHR: 1.19, 95% CI: 1.07–1.34).Our study presents a broad overview of comorbid medical conditions in patients with TRD and further studies are needed to explore the associations in detail.

The evaluation of medical conditions in patients admitted to the oral diagnosis clinic

Background/Aim: The aim of this study is to set forth the current systemic diseases of the patients admitted to the oral diagnosis clinic of the Faculty of Dentistry Sütçü İmam University, and the prevalence of these diseases. Material and Methods: This study will be conducted by retrospective evaluation of anamneses in the tooth information management system of patients admitted to the oral diagnosis clinic of the Faculty of Dentistry, Sütçü İmam University for dental treatment. The anamneses taken from the patients before their treatments will be obtained from digital medium. Results: Out of 4077 patients included in the study, 2554 were female, and 1523 were male. Of them, 25.6% had systemic diseases. The mean age of the patients was 35.24%+12.3. It was found that cardiovascular diseases were more common than the other systemic diseases. The most common cardiovascular disease was found to be hypertension (7.5%), while the most common endocrine system disease was diabetes mellitus (7.5%). Conclusions: Dental practitioners must keep themselves up-to-date as they encounter patients with systemic diseases. They must pay attention while taking anamneses from patients. Therefore, they may apply medical consultation to prevent probable complications when necessary.

Improving agreement of ASA physical status class between pre-anesthesia screening and day of surgery by adding institutional-specific and ASA-approved examples: a quality improvement project

BackgroundA successful anesthesia pre-assessment clinic needs to identify patients who need further testing, evaluation, and optimization prior to the day of surgery to avoid delays and cancelations. Although the ASA Physical Status Classification system (ASA PS) has been used widely for over 50 years, it has poor interrater agreement when only using the definitions. In 2014, ASA-approved examples for each ASA physical status class (ASA PS). In this quality improvement study, we developed and evaluated the effectiveness of institutional-specific examples on interrater reliability between anesthesia pre-anesthesia clinic (APAC) and the day of surgery evaluation (DOS).MethodsA multi-step, multi-year quality improvement project was performed. Step 1, pre-intervention, was a retrospective review to determine the percentage agreement of ASA PS assignment between APAC and DOS for adult and pediatric patients. Step 2 was a retrospective review of the step 1 cases where the ASA PS assignment differed to determine which medical conditions were valued differently and then develop institutional-specific examples for medical conditions not addressed by ASA-approved examples. Step 3 was to educate clinicians about the newly implemented examples and how they should be used as a guide. Step 4, post-intervention, was a retrospective review to determine if the examples improved agreement between APAC and DOS ASA PS assignments. Weighted Kappa coefficient was used to measure of interrater agreement excluding chance agreement.ResultsHaving only ASA PS definitions available, APAC and DOS agreement was only 74% for adults (n = 737) and 63% for pediatric patients (n = 216). For adults, 20 medical co-morbidity categories and, for pediatric patients, 9 medical co-morbidity categories accounted for > 90% the differences in ASA PS. After development and implementation of institutional-specific examples with ASA-approved examples, the percentage agreement increased for adult patients (n = 795) to 91% and for pediatric patients (n = 239) to 84%. Weighted Kappa coefficients increased significantly for all patients (from 0.62 to 0.85, p < .0001), adult patients (from 0.62 to 0.86, p < .0001), and pediatric patients (from 0.48 to 0.78, p < .0001).ConclusionsASA-approved examples do not address all medical conditions that account for differences in the assignment of ASA PS between pre-anesthesia screening and day of anesthesia evaluation at our institution. The process of developing institutional-specific examples addressed the medical conditions that caused differences in assignment at one institution. The implementation of ASA PS examples improved consistency of assignment, and therefore communication of medical conditions of patients presenting for anesthesia care.

Complicaciones de la cirrosis hepática

Hepatic cirrhosis is a disease with high morbidity and mortality. In its decompensated phase, cirrhosis can present numerous complications resulting from advanced hepatic impairment and the development of portal hypertension. Ascites is the most common complication and is found in 80% of cases of decompensated cirrhosis. In this update, however, we will cover the other 3 most common complications: gastrointestinal haemorrhage secondary to portal hypertension, spontaneous bacterial peritonitis and hepatic encephalopathy. These 3 complications are emergency medical conditions in patients with cirrhosis and can be life-threatening. Managing these complications consists of specific treatment and prevention of new episodes and directly related complications, while always considering the possible indication for liver transplantation for these patients.

Immunization Status against Measles of Health-Care Workers Operating at Three Sicilian University Hospitals: An Observational Study.

Measles is a highly contagious vaccine-preventable disease (VPD) that also commonly affects health-care workers (HCWs). Measles immunization of HCWs was strongly recommended by international health authorities, in order to limit the spreading of the illness to susceptible patients and colleagues. An observational study, evaluating the immunization and vaccination status against measles of HCWs working at three Sicilian university hospitals, was conducted. All subjects not completely immune (vaccinated with only one dose in their lifetime), not immune (not vaccinated or not naturally immunized), and with an unknown immunization status were considered not immunized. Among HCWs operating in the three Sicilian university hospitals, 54.6% were not immune against measles. The average age of not immune HCWs was 51.3 (SD ± 9.8), ranging between 25 and 71 years old. In particular, 46.9% of HCWs not immunized worked in “at-risk” hospital units, based on medical conditions of patients which increases the probability of contracting an infection. Vaccination coverage rates observed against measles are considerably lower than other European countries and inadequate. It is therefore crucial to tackle vaccine hesitancy among HCWs, promoting strategies targeted to evaluate immunization status against VPDs and to significantly increase vaccine coverages, such as tailored training and vaccination offer or compulsory vaccination programs.

Ventilator-associated pneumonia and bloodstream infections in intensive care unit cancer patients: a retrospective 12-year study on 3388 prospectively monitored patients.

PurposeSome publications suggest high rates of healthcare-associated infections (HAIs) and of nosocomial pneumonia portending a poor prognosis in ICU cancer patients. A better understanding of the epidemiology of HAIs in these patients is needed.MethodsA retrospective analysis of all the patients hospitalized for ≥ 48 h during a 12-year period in the 12-bed ICU of the Gustave Roussy hospital, monitored prospectively for ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) and for use of medical devices.ResultsDuring 3388 first stays in the ICU, 198 cases of VAP and 103 primary, 213 secondary, and 77 catheter-related BSIs were recorded. The VAP rate was 24.5/1000 ventilator days (95% confidence interval [CI] 21.2–28.0); the catheter-related BSI rate was 2.3/1000 catheter days (95% CI 1.8–2.8). The cumulative incidence during the first 25 days of exposure was 58.8% (95% CI 49.1–66.6%) for VAP, 8.9% (95% CI, 6.2–11.5%) for primary, 15.1% (95% CI 11.6–18.5%) for secondary and 5.0% (95% CI 3.2–6.8%) for catheter-related BSIs. VAP or BSIs were not associated with a higher risk of ICU mortality.ConclusionsThis is the first study to report HAI rates in a large cohort of critically ill cancer patients. Although both the incidence of VAP and the rate of BSI are higher than in general ICU populations, this does not impact patient outcomes. The occurrence of device-associated infections is essentially due to severe medical conditions in patients and to the characteristics of malignancy.Electronic supplementary materialThe online version of this article (10.1007/s00520-019-04800-6) contains supplementary material, which is available to authorized users.

Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review.

BackgroundEngaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication.ObjectiveThe aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research.MethodsA systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed).ResultsThe systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes.ConclusionsWhile the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.