Pub Date : 2025-02-01DOI: 10.1016/j.ajmo.2025.100090
Rawan El Kurdi , Krish H. Nayar , Michael B. Gotway , Janis Blair , Sandhya Nagarakanti
Cavitary pneumonia, characterized by gas-filled spaces within lung tissue, is commonly associated with bacterial pathogens, such as Staphylococcus aureus, Streptococcus, Pseudomonas, and Klebsiella species. This study aimed to investigate the most common causes of cavitary pneumonia in southern Arizona, where coccidioidomycosis is endemic. Fungal infections were the predominant cause of cavitary pneumonia (69%), either alone or in association with bacterial infections. Seven percent of patients had concurrent fungal and bacterial infections. Overall, coccidioidomycosis was the most common cause of cavitary pneumonia, accounting for 39% of all cases and 82% of fungal cases. Among these, 24% had proven coccidioidomycosis, 51% had probable infections, and 25% had possible infections. Bacterial infections accounted for 30% of cavitary pneumonia cases, with Staphylococcus aureus (12%), Streptococcus species (12%), and Pseudomonas species (11%) being the most prevalent organisms. Overall mortality was 25%, with 34% of deaths directly attributed to cavitary pneumonia.
{"title":"Cavitary Pneumonia Causes in the Arid Landscapes of Southern Arizona","authors":"Rawan El Kurdi , Krish H. Nayar , Michael B. Gotway , Janis Blair , Sandhya Nagarakanti","doi":"10.1016/j.ajmo.2025.100090","DOIUrl":"10.1016/j.ajmo.2025.100090","url":null,"abstract":"<div><div>Cavitary pneumonia, characterized by gas-filled spaces within lung tissue, is commonly associated with bacterial pathogens, such as <em>Staphylococcus aureus, Streptococcus, Pseudomonas</em>, and <em>Klebsiella</em> species. This study aimed to investigate the most common causes of cavitary pneumonia in southern Arizona, where coccidioidomycosis is endemic. Fungal infections were the predominant cause of cavitary pneumonia (69%), either alone or in association with bacterial infections. Seven percent of patients had concurrent fungal and bacterial infections. Overall, coccidioidomycosis was the most common cause of cavitary pneumonia, accounting for 39% of all cases and 82% of fungal cases. Among these, 24% had proven coccidioidomycosis, 51% had probable infections, and 25% had possible infections. Bacterial infections accounted for 30% of cavitary pneumonia cases, with <em>Staphylococcus aureus</em> (12%), <em>Streptococcus</em> species (12%), and <em>Pseudomonas</em> species (11%) being the most prevalent organisms. Overall mortality was 25%, with 34% of deaths directly attributed to cavitary pneumonia.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1016/j.ajmo.2025.100089
Aamir Javaid , Essa Hariri , Bige Ozkan , Katherine Lang , Sadiya S. Khan , Janani Rangaswami , Neil J. Stone , Roger S. Blumenthal , Chiadi E. Ndumele
These 4 hypothetical cases highlight new features of the American Heart Association cardiovascular-kidney-metabolic (CKM) health construct. The cases incorporate the CKM staging system, estimates from the PREVENT risk calculator, and clinical approaches related to CKM stages and individual risk profiles. Topics include management considerations for (1) a patient with stage 1 obesity and impaired glucose tolerance, (2) a patient with metabolic risk factors and moderate-risk chronic kidney disease (CKD), (3) a patient with subclinical atherosclerotic cardiovascular disease and multiple comorbid conditions, and (4) a patient with metabolic risk factors, prior myocardial infarction, new-onset heart failure, atrial fibrillation, and CKD.
{"title":"Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Case-Based Narrative Review","authors":"Aamir Javaid , Essa Hariri , Bige Ozkan , Katherine Lang , Sadiya S. Khan , Janani Rangaswami , Neil J. Stone , Roger S. Blumenthal , Chiadi E. Ndumele","doi":"10.1016/j.ajmo.2025.100089","DOIUrl":"10.1016/j.ajmo.2025.100089","url":null,"abstract":"<div><div>These 4 hypothetical cases highlight new features of the American Heart Association cardiovascular-kidney-metabolic (CKM) health construct. The cases incorporate the CKM staging system, estimates from the PREVENT risk calculator, and clinical approaches related to CKM stages and individual risk profiles. Topics include management considerations for (1) a patient with stage 1 obesity and impaired glucose tolerance, (2) a patient with metabolic risk factors and moderate-risk chronic kidney disease (CKD), (3) a patient with subclinical atherosclerotic cardiovascular disease and multiple comorbid conditions, and (4) a patient with metabolic risk factors, prior myocardial infarction, new-onset heart failure, atrial fibrillation, and CKD.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.ajmo.2025.100087
Ian Beeton , Jay Acharya , Bengisu Kesin Meric , James Hobden , Tahir Ali , Thang S. Han
Background
There is a paucity of data on direct comparison of clinical measures in patients with abdominal aortic aneurysm (AAA) and those with peripheral arterial disease (PAD). Here, we examine the risk factors and outcomes between these 2 conditions.
Methods
Group differences were examined by Fisher's exact tests with Bonferroni correction, postoperative complications (including delirium and pneumonia) and LOS by logistic regression, and mortality by Cox regression, adjusted for age, sex, smoking, co-morbidities and medications.
Results
In total, 160 men and 33 women aged 74.5years (SD = 9.4) were referred for preoperative cardiac assessment for AAA (n = 70) and PAD (n = 123). Vascular surgery was performed in 148 patients (70% of AAA; 80.5% of PAD). Myocardial infarct was more prevalent in AAA, and diabetes more in PAD, whilst atrial fibrillation, stroke, congestive heart failure and hypertension did not differ between groups. Compared to patients with PAD, there were higher proportions of patients with AAA prescribed with cardiovascular medications, and developed post-operative complications in hospital: odds ratio = 7.34 (95% CI, 2.26-23.84, P < .001), and stayed in hospital >1week: odds ratio = 2.60 (95% CI, 1.15-5.85, P = .021). Compared to those with AAA, patients with PAD were at greater risk of death in the entire sample: hazard ratio = 3.34 (95% CI, 1.64-6.79), and in those who underwent vascular surgery: hazard ratio = 4.90 (95% CI, 1.88-12.79). Left ventricular function did not relate to outcomes.
Conclusions
Differences between AAA and PAD in risk profile and management which may have a bearing on higher risk of death associated with PAD. More intensive cardiovascular management may help improve their outcomes.
{"title":"Comparisons of risk factors and outcomes between abdominal aortic aneurysm and peripheral arterial disease: a case-control study","authors":"Ian Beeton , Jay Acharya , Bengisu Kesin Meric , James Hobden , Tahir Ali , Thang S. Han","doi":"10.1016/j.ajmo.2025.100087","DOIUrl":"10.1016/j.ajmo.2025.100087","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of data on direct comparison of clinical measures in patients with abdominal aortic aneurysm (AAA) and those with peripheral arterial disease (PAD). Here, we examine the risk factors and outcomes between these 2 conditions.</div></div><div><h3>Methods</h3><div>Group differences were examined by Fisher's exact tests with Bonferroni correction, postoperative complications (including delirium and pneumonia) and LOS by logistic regression, and mortality by Cox regression, adjusted for age, sex, smoking, co-morbidities and medications.</div></div><div><h3>Results</h3><div>In total, 160 men and 33 women aged 74.5years (SD = 9.4) were referred for preoperative cardiac assessment for AAA (<em>n</em> = 70) and PAD (<em>n</em> = 123). Vascular surgery was performed in 148 patients (70% of AAA; 80.5% of PAD). Myocardial infarct was more prevalent in AAA, and diabetes more in PAD, whilst atrial fibrillation, stroke, congestive heart failure and hypertension did not differ between groups. Compared to patients with PAD, there were higher proportions of patients with AAA prescribed with cardiovascular medications, and developed post-operative complications in hospital: odds ratio = 7.34 (95% CI, 2.26-23.84, <em>P</em> < .001), and stayed in hospital >1week: odds ratio = 2.60 (95% CI, 1.15-5.85, <em>P</em> = .021). Compared to those with AAA, patients with PAD were at greater risk of death in the entire sample: hazard ratio = 3.34 (95% CI, 1.64-6.79), and in those who underwent vascular surgery: hazard ratio = 4.90 (95% CI, 1.88-12.79). Left ventricular function did not relate to outcomes.</div></div><div><h3>Conclusions</h3><div>Differences between AAA and PAD in risk profile and management which may have a bearing on higher risk of death associated with PAD. More intensive cardiovascular management may help improve their outcomes.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malnutrition is related to increased mortality and poor outcome. Therefore, early diagnosis and intervention of malnutrition are recommended. However, the optimal nutrition screening tool for diagnosing malnutrition remains undetermined. This study aimed to verify the discrimination and difficulty of nutrition screening items through item response theory (IRT) analysis and develop a simpler malnutrition screening tool.
Methods
This study enrolled 10,375 patients aged ≥18 years who were admitted at Tokushima University Hospital. Patients who were pregnant had short-term hospitalization (≤3 days), were hospitalized only in the weekend, could not hear clearly, and were hospitalized merely for examination were excluded. A skilled dietitian performed the Subjective Global Assessment, rating a good nutritional status as A, moderate malnutrition as B, and severe malnutrition as C.
Results
According to Subjective Global Assessment, we classified 7119 patients as A, 2892 as B, and 364 as C. Between these classes, the total number of application items was significantly lower in class A but significantly higher in class C. In the discrimination of each item calculated by IRT analysis, the highest discrimination item was “Has your food intake been less than usual?”, followed by “Have you had anorexia?”, “Have you had vomiting?”, “Have you had nausea?”, “Have you had dehydration?”, and “Have you lost weight?”.
Conclusions
Human Key Tool of Nutrition, which is based on the IRT analysis results, is a new simple nutrition screening tool developed by us. Human Key Tool of Nutrition can contribute to the widespread use of nutrition screening.
{"title":"Development of a New Malnutrition Screening Tool for Patients: Human Key Tool of Nutrition","authors":"Kotono Oishi MSc, Arisa Inoue-Hamano PhD, Yasuhiro Hamada MD,PhD","doi":"10.1016/j.ajmo.2024.100086","DOIUrl":"10.1016/j.ajmo.2024.100086","url":null,"abstract":"<div><h3>Background and aims</h3><div>Malnutrition is related to increased mortality and poor outcome. Therefore, early diagnosis and intervention of malnutrition are recommended. However, the optimal nutrition screening tool for diagnosing malnutrition remains undetermined. This study aimed to verify the discrimination and difficulty of nutrition screening items through item response theory (IRT) analysis and develop a simpler malnutrition screening tool.</div></div><div><h3>Methods</h3><div>This study enrolled 10,375 patients aged ≥18 years who were admitted at Tokushima University Hospital. Patients who were pregnant had short-term hospitalization (≤3 days), were hospitalized only in the weekend, could not hear clearly, and were hospitalized merely for examination were excluded. A skilled dietitian performed the Subjective Global Assessment, rating a good nutritional status as A, moderate malnutrition as B, and severe malnutrition as C.</div></div><div><h3>Results</h3><div>According to Subjective Global Assessment, we classified 7119 patients as A, 2892 as B, and 364 as C. Between these classes, the total number of application items was significantly lower in class A but significantly higher in class C. In the discrimination of each item calculated by IRT analysis, the highest discrimination item was “Has your food intake been less than usual?”, followed by “Have you had anorexia?”, “Have you had vomiting?”, “Have you had nausea?”, “Have you had dehydration?”, and “Have you lost weight?”.</div></div><div><h3>Conclusions</h3><div>Human Key Tool of Nutrition, which is based on the IRT analysis results, is a new simple nutrition screening tool developed by us. Human Key Tool of Nutrition can contribute to the widespread use of nutrition screening.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-17DOI: 10.1016/j.ajmo.2024.100084
Andrew W. Gardner , Polly S. Montgomery , Ming Wang , Menglu Liang , Shangming Zhang , William A. Pomilla , Neyha Cherin
Purpose
We compared the prevalence of older cardiovascular patients with and without metabolic syndrome (MetS) who met the recommendations of walking more than 7000 and 10,000 steps/d, and we determined whether MetS status was significantly associated with meeting the daily step count recommendations before and after adjusting for demographic variables, comorbid conditions, and cardiovascular risk factors.
Methods
Older cardiovascular participants with MetS (n = 489) and without MetS (n = 154) were assessed on their walking for seven consecutive days with a StepWatch activity monitor.
Results
The MetS group took significantly fewer steps/d than the non-MetS control group (7307 ± 3625 vs. 8933 ± 4487 steps/d; P < .001). Only 47 % and 21 % of the MetS group walked ≥7000 and 10,000 steps/d, respectively, whereas 68 % and 34 % of the control group met these recommendations (P < .001 and p = .002, respectively). The odds of walking 7000 steps/d were 52 % lower in the MetS group (OR = 0.48, 95 %CI = 0.29-0.77, P = .003), and the odds of walking 10,000 steps/d were a 37 % lower trend (OR = 0.63, 95 %CI = 0.39-1.04, P = .069). Additionally, the odds of walking 7000 and 10,000 steps/d were lower in participants with reduced HDL-cholesterol (OR = 0.35, 95 %CI = 0.21-0.60, P < .001 and OR = 0.45, 95 %CI = 0.25-0.80, P = .007, respectively) and abdominal obesity (OR = 0.52, 95 %CI = 0.37-0.74, P < .001 and OR = 0.45, 95 %CI = 0.30-0.68, P < .001, respectively).
Conclusions
Older cardiovascular participants with MetS had an 18 % lower daily step count compared to those without MetS and were less likely to meet the 7000 and 10,000 steps/d recommendations. Additionally, older cardiovascular participants who were least likely to meet the daily step count recommendations included those who had reduced HDL-cholesterol and abdominal obesity.
{"title":"Prevalence of Meeting Daily Step Count Recommendations in Cardiovascular Patients With and Without Metabolic Syndrome","authors":"Andrew W. Gardner , Polly S. Montgomery , Ming Wang , Menglu Liang , Shangming Zhang , William A. Pomilla , Neyha Cherin","doi":"10.1016/j.ajmo.2024.100084","DOIUrl":"10.1016/j.ajmo.2024.100084","url":null,"abstract":"<div><h3>Purpose</h3><div>We compared the prevalence of older cardiovascular patients with and without metabolic syndrome (MetS) who met the recommendations of walking more than 7000 and 10,000 steps/d, and we determined whether MetS status was significantly associated with meeting the daily step count recommendations before and after adjusting for demographic variables, comorbid conditions, and cardiovascular risk factors.</div></div><div><h3>Methods</h3><div>Older cardiovascular participants with MetS (<em>n</em> = 489) and without MetS (<em>n</em> = 154) were assessed on their walking for seven consecutive days with a StepWatch activity monitor.</div></div><div><h3>Results</h3><div>The MetS group took significantly fewer steps/d than the non-MetS control group (7307 ± 3625 vs. 8933 ± 4487 steps/d; <em>P</em> < .001). Only 47 % and 21 % of the MetS group walked ≥7000 and 10,000 steps/d, respectively, whereas 68 % and 34 % of the control group met these recommendations (<em>P</em> < .001 and <em>p</em> = .002, respectively). The odds of walking 7000 steps/d were 52 % lower in the MetS group (OR = 0.48, 95 %CI = 0.29-0.77, <em>P =</em> .003), and the odds of walking 10,000 steps/d were a 37 % lower trend (OR = 0.63, 95 %CI = 0.39-1.04, <em>P</em> = .069). Additionally, the odds of walking 7000 and 10,000 steps/d were lower in participants with reduced HDL-cholesterol (OR = 0.35, 95 %CI = 0.21-0.60, <em>P</em> < .001 and OR = 0.45, 95 %CI = 0.25-0.80, <em>P</em> = .007, respectively) and abdominal obesity (OR = 0.52, 95 %CI = 0.37-0.74, <em>P</em> < .001 and OR = 0.45, 95 %CI = 0.30-0.68, <em>P</em> < .001, respectively).</div></div><div><h3>Conclusions</h3><div>Older cardiovascular participants with MetS had an 18 % lower daily step count compared to those without MetS and were less likely to meet the 7000 and 10,000 steps/d recommendations. Additionally, older cardiovascular participants who were least likely to meet the daily step count recommendations included those who had reduced HDL-cholesterol and abdominal obesity.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-07DOI: 10.1016/j.ajmo.2024.100081
Leonardo Pozo Garcia , Livia Frost , Bryan M. Tucker
Pseudohyponatremia is frequently misunderstood and often mistaken for other types of hyponatremia. In this study, we present a case of pseudohyponatremia resulting from hypertriglyceridemia. We provide an in-depth analysis of the pathophysiological mechanisms involved, comparing them with those of other hyponatremic disorders, and outline the diagnostic approach used to identify this atypical form of hyponatremia. Recognizing and accurately diagnosing non–hypo-osmolar hyponatremia is paramount, as these conditions are treated differently than other forms of hyponatremia.
{"title":"Hyponatremia with an Osmolar Gap, Pseudohyponatremia or Hyper-Osmolar Hyponatremia?","authors":"Leonardo Pozo Garcia , Livia Frost , Bryan M. Tucker","doi":"10.1016/j.ajmo.2024.100081","DOIUrl":"10.1016/j.ajmo.2024.100081","url":null,"abstract":"<div><div>Pseudohyponatremia is frequently misunderstood and often mistaken for other types of hyponatremia. In this study, we present a case of pseudohyponatremia resulting from hypertriglyceridemia. We provide an in-depth analysis of the pathophysiological mechanisms involved, comparing them with those of other hyponatremic disorders, and outline the diagnostic approach used to identify this atypical form of hyponatremia. Recognizing and accurately diagnosing non–hypo-osmolar hyponatremia is paramount, as these conditions are treated differently than other forms of hyponatremia.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ajmo.2022.100021
Stuart R. Chipkin MD
{"title":"Gun-related mortality in children- seeing past geography","authors":"Stuart R. Chipkin MD","doi":"10.1016/j.ajmo.2022.100021","DOIUrl":"10.1016/j.ajmo.2022.100021","url":null,"abstract":"","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48633831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ajmo.2023.100061
Daniel M. Gelfman MD
This commentary discusses a new, previously unrecognized, undocumented, anatomic finding concerning the jugular venous distention present on one of the world’s most famous statues, Michelangelo’s David. This finding is provocative as it involves of one of Michelangelo’s “messages” being demonstrated in The David, has clinical relevance, and, appears to reveal something about Michelangelo, himself.
{"title":"The David Sign, Revisited","authors":"Daniel M. Gelfman MD","doi":"10.1016/j.ajmo.2023.100061","DOIUrl":"10.1016/j.ajmo.2023.100061","url":null,"abstract":"<div><div>This commentary discusses a new, previously unrecognized, undocumented, anatomic finding concerning the jugular venous distention present on one of the world’s most famous statues, Michelangelo’s David. This finding is provocative as it involves of one of Michelangelo’s “messages” being demonstrated in The David, has clinical relevance, and, appears to reveal something about Michelangelo, himself.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136152418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.ajmo.2024.100080
Julia Heizmann , Christopher Gross , Chelsea Yap , Mary Anne Walling , Moya Reid , Albert Hsu , Marie Crandall , Jin Ra
Background
The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.
Objective
Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.
Methods
We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities. Bivariate statistics and multivariate regression analyses were used to investigate the correlation between time of EN initiation and mortality rates, as well as the relationship of mNUTRIC scores with EN commencement with early EN initiation being ≤48 hours and malnutrition risk mNUTRIC ≥5.
Results
Among 931 patients reviewed, bivariate analysis showed higher mNUTRIC scores correlated with older, sicker patients and higher mortality. However, multivariate analysis revealed no significant association between higher mNUTRIC scores and increased mortality (OR 1.2, 95% CI 0.7-2.1, p=0.52). Although most patients received EN within 48 hours, there was no association between mNUTRIC score and timing of EN initiation after adjusting for demographic variables and illness severity.
Conclusions
Our findings indicate that while the mNUTRIC score can effectively identify malnutrition risk, it does not meaningfully inform early EN initiation timing nor predict mortality in mechanically ventilated trauma patients.
背景：危重症患者改良营养风险（mNUTRIC）评分已被提出作为一种工具来识别有营养不良风险的住院患者，这些患者可能受益于早期肠内营养（EN）治疗。目的：我们的目的是确定在重症监护病房入院时，mNUTRIC评分是否可以预测机械通气创伤患者是否有营养不良的风险，并可能从早期EN中获益，这表明死亡率降低。方法：回顾性分析2012年1月21日至2016年12月31日期间所有需要机械通气至少48小时的成人创伤患者，回顾住院病历、人口统计资料、疾病标志物、损伤严重程度和合并症。采用双变量统计和多变量回归分析，探讨EN起始时间与死亡率的相关性，以及EN起始时间≤48小时、营养不良风险mNUTRIC≥5分与EN起始时间的关系。结果：在931例患者中，双变量分析显示，较高的mNUTRIC评分与年龄较大、病情较重的患者和较高的死亡率相关。然而，多变量分析显示较高的mNUTRIC评分与死亡率增加之间没有显著关联（OR 1.2, 95% CI 0.7-2.1, p=0.52）。虽然大多数患者在48小时内接受了EN，但在调整人口统计学变量和疾病严重程度后，mNUTRIC评分与EN开始时间之间没有关联。结论：我们的研究结果表明，尽管mNUTRIC评分可以有效地识别营养不良风险，但它并不能为机械通气创伤患者的早期EN起始时间提供有意义的信息，也不能预测死亡率。
{"title":"Use of a Nutritional Risk Assessment Tool to Guide Early Enteral Nutrition among Mechanically Ventilated Trauma Patients","authors":"Julia Heizmann , Christopher Gross , Chelsea Yap , Mary Anne Walling , Moya Reid , Albert Hsu , Marie Crandall , Jin Ra","doi":"10.1016/j.ajmo.2024.100080","DOIUrl":"10.1016/j.ajmo.2024.100080","url":null,"abstract":"<div><h3>Background</h3><div>The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.</div></div><div><h3>Objective</h3><div>Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities. Bivariate statistics and multivariate regression analyses were used to investigate the correlation between time of EN initiation and mortality rates, as well as the relationship of mNUTRIC scores with EN commencement with early EN initiation being ≤48 hours and malnutrition risk mNUTRIC ≥5.</div></div><div><h3>Results</h3><div>Among 931 patients reviewed, bivariate analysis showed higher mNUTRIC scores correlated with older, sicker patients and higher mortality. However, multivariate analysis revealed no significant association between higher mNUTRIC scores and increased mortality (OR 1.2, 95% CI 0.7-2.1, p=0.52). Although most patients received EN within 48 hours, there was no association between mNUTRIC score and timing of EN initiation after adjusting for demographic variables and illness severity.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that while the mNUTRIC score can effectively identify malnutrition risk, it does not meaningfully inform early EN initiation timing nor predict mortality in mechanically ventilated trauma patients.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1016/j.ajmo.2024.100079
Alexander Y. Pan , Pedram J. Khorsandi , Jeanne M. Farnan , Margarita N. German , Pranab M. Barman , Madeline A. Berschback , Michael Kriss , Ross McMillan , Omar Mousa , Frederick B. Peng , Tejinder Randhawa , Kamilah Scales , Adam E. Mikolajczyk
The burden of cirrhosis and chronic liver disease is growing, yet there is a projected worsening deficit in hepatology providers. As such, cirrhosis and liver disease have been important inclusions within the core curricula of Internal Medicine. Formal assessments of provider preparedness resulting from the curriculum are lacking though. Prior studies have demonstrated that exposure to cirrhosis in undergraduate medical education is insufficient, as are learner comfort and self-reported knowledge levels. These findings are further corroborated by a multicenter survey of incoming Internal Medicine interns showing that subjective comfort with and objective knowledge of various liver disease topics are lacking compared to other common Internal Medicine topics. This paper also demonstrates how similar surveys may be used to identify additional topics that may require adjustments for curricular improvement.
{"title":"Lessons Learned From the Liver About the Undergraduate to Graduate Medical Education Transition","authors":"Alexander Y. Pan , Pedram J. Khorsandi , Jeanne M. Farnan , Margarita N. German , Pranab M. Barman , Madeline A. Berschback , Michael Kriss , Ross McMillan , Omar Mousa , Frederick B. Peng , Tejinder Randhawa , Kamilah Scales , Adam E. Mikolajczyk","doi":"10.1016/j.ajmo.2024.100079","DOIUrl":"10.1016/j.ajmo.2024.100079","url":null,"abstract":"<div><div>The burden of cirrhosis and chronic liver disease is growing, yet there is a projected worsening deficit in hepatology providers. As such, cirrhosis and liver disease have been important inclusions within the core curricula of Internal Medicine. Formal assessments of provider preparedness resulting from the curriculum are lacking though. Prior studies have demonstrated that exposure to cirrhosis in undergraduate medical education is insufficient, as are learner comfort and self-reported knowledge levels. These findings are further corroborated by a multicenter survey of incoming Internal Medicine interns showing that subjective comfort with and objective knowledge of various liver disease topics are lacking compared to other common Internal Medicine topics. This paper also demonstrates how similar surveys may be used to identify additional topics that may require adjustments for curricular improvement.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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