Hospital practice (1995)最新文献

Objective: Low in-hospital mobility is highly prevalent and can cause hospital-associated-disability. In both research and clinical care, valid and reliable outcome measures of in-hospital mobility are necessary. The Acute Care Mobility Assessment (ACMA) provides a single measure of hospital out-of-bed mobility and may be a promising tool. The purpose of this study was to perform a cross-cultural validation to facilitate international uptake.

Methods: We performed a linguistic validation (translation, cognitive interviewing, cultural adaptation) of the ACMA in Denmark and investigated the convergent-validity of the Danish version (ACMA-DK) in older hospitalized (+65) Danish adults by evaluating the correlation between the ACMA-DK and 24-hour mobility assessed as number of steps, time spent walking, and upright time by SENS motion® activity monitors.

Results: The linguistic validation showed ACMA-DK to be well understood and accepted by the respondents. We found a moderate positive correlation between the ACMA-DK and both steps and time spent walking (r > 0.5). Linear regression analyses suggested that for every 1-point increase in the ACMA-DK, steps increased by 363 and time spent walking by 0.14 hours.

Conclusion: The ACMA-DK was cross-culturally adapted and was positively associated with out-of-bed mobility (steps taken and time spent walking). The ACMA is a potential tool for evaluating day-to-day out-of-bed mobility in clinical settings.

Background: Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. The infection is associated with a high mortality rate and risk of recurrence. We assessed risk factors for death or recurrent CDI (CDI) in patients with diabetes mellitus (DM).

Methods: This retrospective cohort study was conducted at a single institution from 2019 to 2020. CDI was defined as a positive toxin assay for C. difficile. CDI was defined as a repeat positive toxin assay within ≤ 60 days of stopping CDI treatment. Logistic regression models were used to identify risk factors for CDI-related mortality, recurrence, and the combined outcome of mortality and recurrence.

Results: Of the 252 enrolled patients with CDI, 19% had DM. Only 49% of patients with DM fully recovered after the first CDI occurrence, whereas 69% of patients without diabetes fully recovered (p = 0.021); 23% of patients with DM vs. 17% of patients without DM had recurrences (p = 0.200); and 23% of patients with DM vs. 15% of patients without DM died (p = 0.169). DM was associated with mortality (OR 2.75, 95% CI 0.94-8.06) and the combined outcome (OR 2.10, 95% CI 1.05-4.18). Nosocomial transmission, immunosuppression, CKD, and age were associated with mortality.

Conclusions: Diabetes is associated with a worse prognosis in patients with CDI. Prevention efforts should be optimized in patients with diabetes by reducing CDI transmission and avoiding nonessential medications, such as PPIs or antibiotics when they are not necessary. [Figure: see text].

Background: Preoperative anxiety is linked to various adverse effects on anesthesia, intraoperative vital signs, and postoperative outcomes. Despite its widespread impact, managing preoperative anxiety is not consistently implemented, partly due to concerns over the efficacy and side effects of anxiolytic drugs. Previous clinical trials on the anxiolytic effect of melatonin showed conflicting results regarding its effect. Furthermore, they involved placing the patients in settings that deviate of real-world clinical practice.

Objective: We sought to assess the efficacy of melatonin as a preoperative anxiolytic in real-world settings.

Methods: This is a triple-blinded, randomized, controlled clinical trial that enrolled 87 patients aged 18 to 65 planned for elective surgery under general anesthesia. They were divided into three groups to receive melatonin, diazepam, or a placebo and were placed in the same waiting rooms as other non-enrolled patients. Preoperative anxiety was assessed at baseline and one-hour post-treatment using the Visual Analog Scale (VAS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS). Secondary outcomes included changes in orientation and sedation levels.

Results: Of the 87 enrolled participants, 76 completed the second assessment. The median age of the participants was 38 years (IQR = 18.5), and 50.6% were females. Our study showed no significant effect of melatonin on preoperative anxiety, sedation, or orientation compared to diazepam or placebo.

Conclusion: Our study highlights the need for incorporating other factors in future clinical trials on preoperative anxiety to better translate the results into a real-world setting.

Clinical trial registration number: NCT06103188.

Introduction: The Wells score, which is a 9-item clinical rule, is used to assess the diagnostic probability of deep vein thrombosis (DVT) in suspected patients. However, the accuracy of the Wells rule has not been investigated in Ghanaians.

Methods: In a cross-sectional design, 138 suspected DVT patients underwent pretest probability of DVT using the Wells rule. Thereafter, a compressive duplex ultrasound study (CDUS) was performed on both legs to confirm the presence of DVT. Using the CDUS as the gold standard, the accuracy and reliability of the Wells rule were assessed as sensitivity, specificity, predictive values and accuracy diagnostic odds. Youden's index was used to determine the optimal cutoff of Wells score to predict DVT.

Results: The prevalence of DVT was 38.8% and it was associated with localized tenderness [OR (95% CI) = 3.4 (1.49 - 7.76), p = 0.003], calf swelling [3.72 (1.7 - 8.12), p = 0.001] and previous DVT [4.69 (1.74 - 12.61), p = 0.001]. The sensitivity, specificity, and accuracy diagnostic odds ratio for the 2-level Wells score were 38.3%, 93.3%, 73.9% and 8.44 respectively. From the receiver operator characteristic analysis, the area under curve for the 2-level Wells score was 0.76 and the optimal Wells score cut-point for diagnosing DVT based on Youden's index was >1, with sensitivity, specificity, positive and negative predictive values of 69.4%, 72.1%, 58.6% and 80.5% respectively.

Conclusion: The prevalence of DVT in suspected patients in our study population was 38.8% and associated with localized tenderness, calf swelling and previous DVT. Reducing the cut-point of the Wells score to 1 increased the sensitivity and accuracy of the Wells rule in our study population.

It is well known that rheumatic diseases are characterized by an increased infection risk, due to several factors, such as an intrinsically dysfunctional immune system, disease activity, and the use of immunosuppressive drugs. Glucocorticoids are widely used therapeutic agents for treating several chronic inflammatory and immune diseases, due to their anti-inflammatory and immunosuppressive effects. Their use is burdened by well-known side effects in dose- and duration of use-dependent manner. Physicians need to be aware of the mechanism of action of glucocorticoids, their side effects, particularly infectious side effects, and the significance of cumulative dose and duration of glucocorticoid treatment. Additionally, physicians shoultdleveld have knowledge of each patient and their comorbidities. They could use appropriate tools for assessing glucocorticoid-related toxicity and morbidity, particularly in the context of chronic glucocorticoid administration. This comprehensive understanding is crucial for ensuring the proper and safe use of these drugs, particularly in terms of minimizing infectious risks. The aim of this review is to focus on available data concerning the infectious risk associated to glucocorticoid treatment in rheumatic diseases, highlighting the role of the correct drug management in clinical practice and the role of the disease itself in the occurrence of this worthy side effect. We conducted a review of randomized controlled trials and observational studies about glucocorticoid use in autoimmune/rheumatic diseases, analyzing the infectious risk during glucocorticoid therapy, and its relationship with the used dose and duration of treatment.

Objectives: Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper's objective was to understand hospitalists' comfort with LGBTQ health.

Methods: A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients.

Results: Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (p < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients.

Conclusions: Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists' ability to more confidently and competently serve LGBTQ patients.

Metabolic-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatohepatitis (MASH) in lean individuals represents a distinctive subset of MASH. Current pharmacotherapies, for MASH as demonstrated in clinical trials, predominantly target obese patients with limited consideration for lean MASH. We aimed to systematically review the literature on the pharmacotherapy of lean MASH. We searched standard medical databases, such as PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov to identify eligible studies published in English up to 31 December 2023 regarding the effect of pharmacological interventions in individuals with lean MASH. We have summarized the role of various drug classes including peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, vitamin E, farnesoid X receptor agonists, selective thyroid hormone receptor-β agonists, and selective cholesterol absorption inhibitors. Consequently, lifestyle interventions, encompassing dietary modifications, exercise, and weight loss particularly directed at visceral obesity or achieving a reduction in body weight are recommended for all non-obese individuals with MASH. A highlight on the only available treatment recommendation for lean MASH is also presented. The available evidence regarding the efficacy of various drugs for the treatment of lean MASH is limited. Conclusive evidence is warranted from clinical trials exclusively involving lean individuals with MASH.

The multifaceted crises that Lebanon is facing have led to a shortage of medications in the country's community pharmacies. This shortage has triggered a cascade of adverse effects, rippling throughout the nation's healthcare system. In this report, we examine the causes, which range from economic turmoil to inadequate resource distribution, along with the profound impacts on public health, such as increased length of hospital stays and compromised patient care. The paper also proposes a suite of solutions aimed at mitigating the immediate challenges and paving the way for a more resilient healthcare framework.

Background: The current discourse within the thoracic surgical and pulmonological communities pertains to a contentious debate over the optimal selection criteria for thoracostomy tube diameters utilized in the management of pleural effusions. A comprehensive examination of the variables that inform the clinical decision-making paradigm for the determination of appropriate chest tube calibers is imperative to enhance patient management and elevate the prognostic results.

Objectives: The objective of this inquiry is to elucidate the determinants that influence thoracic surgeons and pulmonologists in their selection of chest tube size for the management of pleural effusions.

Methods: This cross-sectional study was based on an electronic questionnaire that was sent to the targeted populations through e-mail or a professional WhatsApp. The survey assessed the considerations of chest tube size selection as well as the respective advantages, disadvantages, and potential complications related to each size.

Results: The conducted study encompassed participants, with a nearly even distribution between thoracic surgeons (49.1%) and pulmonologists (50.9%). Most of these practitioners are within tertiary-level medical institutions (82.1%). A preference for small-bore chest tubes (SBCT), defined as < 14 French (Fr), was indicated by 54.8% of participants. The drawbacks associated with SBCT, such as kinking (60%) and blockage (70%), influenced the decision-making process negatively, while pain was a significant factor in the selection against LBCT (64%). Ultrasound guidance was a positive influence for the selection of SBCT (55%). Complications associated with LBCT included visceral and vascular injuries (55.7%), wound infection (45.3%), re-expansion pulmonary edema (43.3%), and subcutaneous emphysema (57.5%). In contrast, malposition was a complication more commonly associated with SBCT (49.1%).

Conclusion: The decision regarding chest tube size was influenced by several critical factors which included the nature of pleural effusion, the volume of pleural fluid, and potential complications specific to the size of the chest tube used.

Objectives: The aim of this study was to compare outcomes of using intravenous insulin infusion (IVII) therapy for managing hyperglycemia in a non-intensive care unit (ICU) versus an ICU setting.

Methods: We conducted a retrospective analysis on patients who received IVII for hyperglycemia. The analysis compared variables associated with hypoglycemic events while on IVII, and point-of-care blood glucose control and insulin regimens at discharge. Insulin administration errors occurring on IVII were determined.

Results: Between November 2020 and August 2022, 881 patients received 1,106 IVIIs (780 in ICU and 326 non-ICU). A cumulative 468 days were spent on IVII in the non-ICU setting and 1564 in the ICU (total 2,032 days). The frequency of hypoglycemia on IVII was higher when provided in the non-ICU vs ICU (1.4% vs 0.7%), p < 0.01). Non-ICU patients had significantly higher average blood glucose during the last 24 h of the hospital stay (185 mg/dL vs 160 mg/dL, non-ICU vs. ICU, Pp < 0.01) and were more likely discharged with basal-bolus insulin therapy (p < 0.01). After adjusting for other variables, the probability of having hypoglycemia (OR 2.35; 95% CI 1.62-3.42; p < 0.001) was higher for the non-ICU cohort. In addition, patients who received IVII in the non-ICU settings had mean glucose levels nearly 26 mg/dL higher (95% CI 19.40-32.9, p < 0.001) at discharge vs. ICU. Seven cases of insulin errors were reported while on IVII in the non-ICU settings, compared to one in the ICU.

Conclusions: A large number (468) of ICU days were avoided by providing IVII in the non-ICU setting. Of the more than 400 days of IVII therapy provided in the non-ICU, only 7 medication errors occurred. Further studies are needed to optimize IVII strategy for non-ICU patients.