Patients In Department Of Internal Medicine Research Articles

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.

Screening for late-onset Pompe disease in Internal Medicine departments in Spain

BackgroundThe screening of high-risk populations using dried blood spots (DBS) has allowed the rapid identification of patients with Pompe disease, mostly in Neurology departments. The aim of the study was to determine the prevalence of late-onset Pompe disease (LOPD) among patients not previously diagnosed or tested for this entity despite presenting possible signs or symptoms of the disease in Internal Medicine departments in Spain.MethodsThis epidemiological, observational, cross-sectional, multicenter study included a single cohort of individuals with clinical suspicion of LOPD seen at Internal Medicine departments in Spain. The diagnosis of LOPD was initially established on the basis of the result of DBS. If decreased enzyme acid-alpha-1,4-glucosidase (GAA) activity was detected in DBS, additional confirmatory diagnostic measurements were conducted, including GAA activity in lymphocytes, fibroblasts, or muscle and/or genetic testing.ResultsThe diagnosis of LOPD was confirmed in 2 out of 322 patients (0.6%). Reasons for suspecting LOPD diagnosis were polymyositis or any type of myopathy of unknown etiology (in one patient), and asymptomatic or pauci-symptomatic hyperCKemia (in the other). The time between symptom onset and LOPD diagnosis was 2.0 and 0.0 years. Both patients were asymptomatic, with no muscle weakness. Additionally, 19.7% of the non-LOPD cases received an alternative diagnosis.ConclusionsOur study highlights the existence of a hidden population of LOPD patients in Internal Medicine departments who might benefit from early diagnosis and early initiation of potential treatments.

Causes of death in hospitalized patients in internal medicine departments with heart failure according to ejection fraction. RICA registry

IntroductionThere are few data in the Spanish population about the causes of death in patients admitted to Internal Medicine departments for heart failure (HF). Their study according to left ventricular ejection fraction (reduced: rEF, mid-range: mEF, and preserved: pEF) could improve the knowledge of patients and their prognosis. MethodsProspective multicentre cohort study of 4144 patients admitted with HF to Internal Medicine departments. Their clinical characteristics, mortality rate and causes were classified according to pEF (≥50%), mEF (40%–49%) and rEF (<40%). Patients were followed-up for a median of one year. ResultsThere were 1198 deaths (29%). The cause of death was cardiovascular (CV) in 833 patients (69.5%), mainly HF (50%) and sudden cardiac death (SCD, 7.5%). Non-cardiovascular (Non-CV) causes were responsible for 365 deaths (30.5%). The most common Non-CV causes were infections (13%). The most frequent and early cause in all groups was HF. Patients with pEF, compared to the other groups, had lower risk of SCD and higher risk of infections (P < .05). The causes of death in patients with mrEF were closer to those with pEF. ConclusionsThe causes of death in patients with HF were different depending on EF strata. Patients with mEF and pEF, due to their high comorbidity and higher frequency of NoCV death, would require comprehensive management by Internal Medicine.

Ankle Brachial Index Screening for Peripheral Arterial Disease in Asymptomatic Diabetic Patients

Background: Peripheral arterial disease (PAD) is a common macrovascular complication in diabetic patients related to atherosclerosis. Early diagnosis of PAD by ankle brachial index (ABI) is highly critical as this disease results in significant morbidity and mortality. Objectives: Toscreen for PAD in asymptomatic diabetic patients by using ABI, determining its prevalence and associated risk factors. Patients and Methods: This is a cross-sectional study conducted on 309 diabetic asymptomatic patients in Internal Medicine Department, Menoufia University Hospitals in the period between December 2018 and December 2020. Full history and biochemical profiles were obtained and ABI indices were measured to evaluate for PAD. Results: The prevalence of PAD in this study was 36.2%. Advancing age, sedentary life, long duration of diabetes, smoking, poor glycemic control and dyslipidemia were identified as risk factors for PAD (p value <0.001)while, hypertension and body mass index were not significant among studied patients (p value 0.594 and 0.733 respectively). Conclusion: PAD has a high prevalence in asymptomatic diabetic individuals. It is associated with multiple risk factors such as smoking, dyslipidemia, advancing age, atherosclerosis and prolonged uncontrolled hyperglycemia. Diabetic patients should be routinely examined by ABI to improve the outcome.

Dietary and herbal supplements use among patients hospitalized in internal medicine departments

ObjectivesTo assess consumption of dietary and herbal supplements (DHS) among patients in internal medicine departments and determine whether such use is documented in their medical files. Methods267 patients from three internal medicine departments of an academic medical center in Haifa, Israel were assessed prospectively with questionnaires about their DHS use in the month preceding hospitalization. DHS were categorized into vitamins & minerals, herbal supplements and others. Further data was then collected from patients' medical records on socio-demographic and medical characteristics, as well as documentation of DHS use. Results123 patients (50.6 %) used DHS on a daily basis. Most of them (53.7 %) were using more than one DHS. DHS use was more prevalent in older (OR = 1.02 [1.001–1.036], p = 0.034) and educated (OR = 0.482 [0.252-0.923], p = 0.028) patients. Vitamins & minerals were used mainly to enhance vitality and address laboratory abnormalities, whereas herbal supplements were used mainly for gastrointestinal problems (p < 0.001). DHS use was reported to the physicians by 42 % of the patients, mostly at the patients’ initiative [92 (82.1 %), p < 0.001)]. Vitamins and minerals were the most reported category of DHS (94 (57.3 %), p < 0.001). The use of DHS was reported to physicians for 112 DHS (41.8 %) but only 32 DHS (11.9 %) were documented in their medical files. The documentation of vitamins and minerals was significantly higher compared to herbal supplements documentation (29 (17.7 %) & 3 (2.9 %) respectively, P < 0.001). ConclusionsDHS are commonly used by patients hospitalized in the internal medicine departments. Many patients do not report such use to the physicians, and more strikingly, physicians do not document DHS use in patient medical files. This communication gap may have serious medico-legal ramifications due to DHS side effects and DHS interactions with other DHS and with conventional drugs.

Biermer Disease: Initial Presentation and Follow-Up of 66 Patients in Internal Medicine Department in Senegal

Pernicious anemia in black people, is little known. Through this study we assess its diagnostic and evolutive aspects, and compare vitamin therapy B12 intramuscular and oral. Sixty six Biermer disease patients followed (January 2000-June 2014) at Internal Medicine Department of Aristide Le Dantec University Teaching Hospital (Senegal) are included. They were 26 men and 46 women (gender ratio: 0.65), who had a mean age of 47.84 years ± 15.25 years. Patients consulted for anemia (65 cases), acquired melanodermia (36 cases), gastrointestinal symptoms (30 cases), peripheral neuropathy (27 cases), venous thrombosis (2 cases), acute depression (1 case). Macrocytosis was observed in 52 cases. The mean hemoglobin in the vitamin B12 intramuscular group (52 patients) or oral group (14 patients) was the inclusion: 6.55 g/dl ± 3.12 g/dl vs 6.52 g/dl ± 2.18 g/dl (p = 0.04); and at day 8 treatment: 8.69 g/dl ± 2.49 g/dl vs 8.85 g/dl ± 1.9 g/dl (p = 0.43). Neurological and vascular presentations are unusual in contrast to macrocytic anemia. Oral administration of vitamin B12, simple and effective should be recommended in country with limited resources.

Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients

Reduced food intake is a frequent problem at a hospital setting, being a cause and/or consequence of malnutrition. Food presentation can affect food intake and induce nutritional benefit. To investigate the effect of improved meal presentation supported by gastronomy expertise on the food intake in adults hospitalized in internal medicine departments. Controlled before and after study. Two hundred and six newly hospitalized patients in internal medicine departments were included and divided in two groups, a) control: receiving the standard lunch from the hospital and b) experimental: receiving a lunch improved in terms of presentation by the advices received by the Institut Paul Bocuse, Ecully, Lyon, France together with the hospital kitchen of the Beilinson Hospital, without change in the composition of the meal. The amount of food left at the participants' plates was estimated using the Digital Imaging Method, which consisted in photographing the plates immediately to previous tray collection by the researcher. In addition, the nutritionDay questionnaire was used to measure other variables concerned to their food intake during hospitalization. Charlson Comorbidity Index was calculated. There was no significant difference between the groups regarding demography or Charlson Comorbidity Index. Patients who received the meal with the improved presentation showed significantly higher food intake than those who received the standard meal, despite reported loss in appetite. Participants from the experimental group left on their plate less starch (0.19±0.30 vs. 0.52+0.41) (p<0.05) and less from the main course than the control group (0.18+0.31 vs. 0.46+0.41) (p<0.05). However, both of the groups left the same amount of vegetables (0.37+0.36 vs. 0.29+0.35) (p>0.05). Both of the groups were asked how hungry they were before the meal and no significance was shown. More participants from the experimental group reported their meal to be tasty in comparison to those in the control group (49.5% vs. 33.7% p<0.005). Length of stay was not different but readmission rate decreased significantly in the study group (p<0.02) from 31.2% to 13.5%. Improvement of meal presentation at a hospital setting can increase food intake, reduce waste food substantially and reduce readmission rate to hospital.

Avoidance of Blood Transfusion to Patients Suffering From Myocardial Injury and Severe Anemia Is Associated With Increased Long-Term Mortality: A Retrospective Cohort Analysis.

Myocardial injury and anemia are common among patients in internal medicine departments. Nevertheless, the level of anemia in which blood should be given to these patients is ill defined.We conducted a retrospective, cohort analysis.A total of 209 patients hospitalized to internal medicine, with myocardial injury (troponin I > 0.2 mcg/L, not diagnosed as ACS, acute coronary syndrome) and anemia (Hb < 10 g/dL, without overt bleeding) were included. The overall in-hospital mortality rate was 20.7%. A total of 37 patients (17.8%) had severe anemia (Hb < 8 g/dL). A total of 73 patients (34.9%) were transfused. Severe anemia was not associated with increased long-term mortality in the whole cohort while survival of patients with severe anemia that were not transfused was significantly reduced compared to transfused patients (44% vs 80%; P = 0.03). Mortality rates were similar for all patients with Hb ≥ 8 g/dL, regardless of transfusion (54% vs 49%; P = 0.60). Consistently, lack of blood transfusion in patients with severe anemia was independently associated with a 2.27 (1.08–4.81) greater adjusted risk of all-cause mortality (P-value for interaction = 0.04), whereas it did not significantly increase in patients with Hb ≥ 8 g/dL.Avoidance of blood transfusion is associated with unfavorable outcomes among patients with myocardial injury and severe anemia.

The effect of sleep intervention on life and sleep qualities of patients in internal medicine department

Objective To investigate the effect of sleep intervention on life and sleep qualities of patients in internal medicine department.Methods A total of 100 cases in internal medicine department were randomly divided into observation group and control group,the control group was given routine nursing,the observation group was given sleep intervention,nursing effects were compared between the two groups.Results Physical discomfort,ward noise and psychological factors were the main factors affecting patients'sleep.Sleep quality index before discharge and after 1 w intervention in observation group were significantly higher than those in control group (P ＜ 0.05).Life quality scores such as physiological function,body pain,emotional function before discharge in observation group were significantly lower than those in control group (P ＜ 0.05).Conclusions Sleep disorders are existed in internal medicine department patients,sleep intervention is beneficial to improve sleep and life qualities of the patients. Key words: Sleep intervention; Internal medicine department patient; Sleep quality; Life quality

Attitudes towards and practice of venous thromboembolism prevention in general internal medicine wards: A multinational survey from member countries of the European Federation of Internal Medicine

IntroductionHospitalised patients in Internal Medicine departments are at risk of venous thromboembolism (VTE). Adherence to risk stratification methods is poor. We conducted a survey among Internists from member countries of the European Federation of Internal Medicine (EFIM) to assess current knowledge and attitude towards VTE prevention. MethodsA multinational survey of Internists affiliated to EFIM. Results226 physicians from 30 countries were included. Seventy nine percent of the physicians were aware of clinical guidelines to prevent VTE. Most considered their knowledge of the guidelines to be moderate. Many had not updated their knowledge recently. The magnitude of the clinical problem was over- and underestimated by many (12.2% and 40.1%, respectively). Only 46.7% thought their patients were mostly receiving proper prophylaxis. Sixty four percent worked in departments without a formal VTE prophylaxis program. Risk of bleeding, lack of awareness and lack of decision support systems were the three most common reasons for deferring treatment (88.6%, 32.3% and 27.9%, respectively). Most of the participants stated that they strongly believe in VTE prophylaxis as an intervention that prevents morbidity and mortality. ConclusionsDespite general awareness of clinical guidelines, many medical wards do not have formal risk assessment methodologies incorporated into their operative workflow. This gap, as well as fear of complications, may be one of the reasons for the low rates of adherence reported by physicians. We speculate that perhaps current guidelines have not been accepted by Internists due to paucity of well defined and validated risk assessment tools.

The Risk Factors Of Non-Alcoholic Fatty Liver Disease Prevalence In Obesity With Or Without Diabetes Mellitus

Background. The main cause of non-alcoholic fatty liver disease (NAFLD) is insulin resistance and the one of the most common risk factors for insulin resistance is obesity. The abnormality of lipid metabolism can be seen in NAFLD such as: High level of free fatty acid (FFA) in plasma, formation of reactive oxygen species and high level of lipid peroxidation (malondialdehyde (MDA) and trans-4-hydroxy-2-nonenal).Objective. The aim of the study is to find the risk factors of NAFLD prevalence in obesity with or without diabetes mellitus.Methods. Case control study. The population was taken from general check up patients in Internal Medicine Department, Dr. Sardjito General Hospital Yogyakarta Indonesia, March 2007 until August 2008. The case group is obesity who suffered diabetes mellitus and the control group is obesity without diabetes mellitus. The Subjects who fulfilled inclusion and exclusion criteria are enrolled in this study. Diagnosis of NAFLD is defined by Liver Ultrasound (Bright Liver appearance). AST, ALT, GGT, cholesterol, triglyceride, fasting glucose, 2 hour post-prandial glucose, insulin, Apo-B, FFA, MDA and adiponectin were examined. Data analyzed by computer using t-test for different of mean, Anova and linear regression test for significant factors (CI 95% and p < 0.05), and odd ratio for risk factors. Results. The fourty six obese patients (case 23 pts, control 23 pts) are matched to age and sex. Significant difference are shown in triglyceride, FFA and adiponectin level (p: 0.013; p: <0.001; and p: 0,045). There are no significant difference in insulin resistance, cholesterol, MDA and Apo-B level. By linear regression test, triglyceride, FFA and adiponectin level are predicted as significant factor (p<0.05) with odd ratio 1.64, 12.4, and 0.9.Conclusion. Increasing of triglyceride, FFA and adiponectin level in obesity with diabetic have risk of NAFLD prevalence with odd ratio 1.64 time (triglyceride), 12.4 (FFA) and 0.9 (adiponectin).