Pub Date : 2023-12-19DOI: 10.1016/j.ajmo.2023.100063
Pieter Martens , Lauren Ives , Christopher Nguyen , Deborah Kwon , Mazen Hanna , W. H. Wilson Tang
Background
Reduced cardiac energy is a hallmark feature of heart failure and is common in cardiac amyloidosis (CA) and can be aggravated by the presence of iron deficiency.
Methods
Retrospective analysis of a single tertiary care center CA registry. Prevalence of iron deficiency was determined based on two definitions: (1) Classic definition, ferritin < 100 µg/L irrespective of transferin saturation (TSAT) or ferritin between 100 and 300 µg/L with a TSAT < 20%, and (2) TSAT-based definition, TSAT < 20%.
Results
Out of a total of 393 CA patients who had a full set of iron indices (44% light chain [AL]-CA, 50% transthyretin [ATTR]-CA, remainder other or unspecified CA subtype), 56% had iron deficiency according to the classic definition and 58% according to the TSAT definition, with similar prevalence in AL-CA vs ATTR-CA (p = .135). Per both definitions 58% had anemia. Only the TSAT-based definition was associated with worse functional status (p = .039) and worse cardiac function. CA patients with a TSAT < 20% illustrated features of more pronounced right ventricular (RV) failure including lower TAPSE on echocardiography, lower RV ejection fraction and RV stroke volume index on CMR, increased right-sided filling pressures, lower pulmonary artery pulsatility index, and higher RAP/PCWP ratio by right heart catheterization. Neither the classic nor the TSAT-based definition was associated with a higher risk of all-cause mortality after covariate adjustment.
Conclusion
Iron deficiency is common in cardiac amyloidosis and, when identified with a TSAT < 20%, is associated with worse functional status and more pronounced RV disease, but not with a higher risk of all-cause mortality.
{"title":"The Impact of Iron Deficiency on Disease Severity and Myocardial Function in Cardiac Amyloidosis","authors":"Pieter Martens , Lauren Ives , Christopher Nguyen , Deborah Kwon , Mazen Hanna , W. H. Wilson Tang","doi":"10.1016/j.ajmo.2023.100063","DOIUrl":"10.1016/j.ajmo.2023.100063","url":null,"abstract":"<div><h3>Background</h3><p>Reduced cardiac energy is a hallmark feature of heart failure and is common in cardiac amyloidosis (CA) and can be aggravated by the presence of iron deficiency.</p></div><div><h3>Methods</h3><p>Retrospective analysis of a single tertiary care center CA registry. Prevalence of iron deficiency was determined based on two definitions: (1) Classic definition, ferritin < 100 µg/L irrespective of transferin saturation (TSAT) or ferritin between 100 and 300 µg/L with a TSAT < 20%, and (2) TSAT-based definition, TSAT < 20%.</p></div><div><h3>Results</h3><p>Out of a total of 393 CA patients who had a full set of iron indices (44% light chain [AL]-CA, 50% transthyretin [ATTR]-CA, remainder other or unspecified CA subtype), 56% had iron deficiency according to the classic definition and 58% according to the TSAT definition, with similar prevalence in AL-CA vs ATTR-CA (<em>p</em> = .135). Per both definitions 58% had anemia. Only the TSAT-based definition was associated with worse functional status (<em>p</em> = .039) and worse cardiac function. CA patients with a TSAT < 20% illustrated features of more pronounced right ventricular (RV) failure including lower TAPSE on echocardiography, lower RV ejection fraction and RV stroke volume index on CMR, increased right-sided filling pressures, lower pulmonary artery pulsatility index, and higher RAP/PCWP ratio by right heart catheterization. Neither the classic nor the TSAT-based definition was associated with a higher risk of all-cause mortality after covariate adjustment.</p></div><div><h3>Conclusion</h3><p>Iron deficiency is common in cardiac amyloidosis and, when identified with a TSAT < 20%, is associated with worse functional status and more pronounced RV disease, but not with a higher risk of all-cause mortality.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266703642300033X/pdfft?md5=5cc8ad2356474dac465f9e1c27c75557&pid=1-s2.0-S266703642300033X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014690","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 : 2023-12-01Epub Date: 2023-06-05DOI: 10.1016/j.ajmo.2023.100044
Yousif M Hydoub, Andrew P Walker, Robert W Kirchoff, Hossam M Alzu'bi, Patricia Y Chipi, Danielle J Gerberi, M Caroline Burton, M Hassan Murad, Sagar B Dugani
Objective: To systematically review contemporary prediction models for hospital mortality developed or validated in general medical patients.
Methods: We screened articles in five databases, from January 1, 2010, through April 7, 2022, and the bibliography of articles selected for final inclusion. We assessed the quality for risk of bias and applicability using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and extracted data using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist. Two investigators independently screened each article, assessed quality, and extracted data.
Results: From 20,424 unique articles, we identified 15 models in 8 studies across 10 countries. The studies included 280,793 general medical patients and 19,923 hospital deaths. Models included 7 early warning scores, 2 comorbidities indices, and 6 combination models. Ten models were studied in all general medical patients (general models) and 7 in general medical patients with infection (infection models). Of the 15 models, 13 were developed using logistic or Poisson regression and 2 using machine learning methods. Also, 4 of 15 models reported on handling of missing values. None of the infection models had high discrimination, whereas 4 of 10 general models had high discrimination (area under curve >0.8). Only 1 model appropriately assessed calibration. All models had high risk of bias; 4 of 10 general models and 5 of 7 infection models had low concern for applicability for general medical patients.
Conclusion: Mortality prediction models for general medical patients were sparse and differed in quality, applicability, and discrimination. These models require hospital-level validation and/or recalibration in general medical patients to guide mortality reduction interventions.
{"title":"Risk Prediction Models for Hospital Mortality in General Medical Patients: A Systematic Review.","authors":"Yousif M Hydoub, Andrew P Walker, Robert W Kirchoff, Hossam M Alzu'bi, Patricia Y Chipi, Danielle J Gerberi, M Caroline Burton, M Hassan Murad, Sagar B Dugani","doi":"10.1016/j.ajmo.2023.100044","DOIUrl":"10.1016/j.ajmo.2023.100044","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review contemporary prediction models for hospital mortality developed or validated in general medical patients.</p><p><strong>Methods: </strong>We screened articles in five databases, from January 1, 2010, through April 7, 2022, and the bibliography of articles selected for final inclusion. We assessed the quality for risk of bias and applicability using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and extracted data using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist. Two investigators independently screened each article, assessed quality, and extracted data.</p><p><strong>Results: </strong>From 20,424 unique articles, we identified 15 models in 8 studies across 10 countries. The studies included 280,793 general medical patients and 19,923 hospital deaths. Models included 7 early warning scores, 2 comorbidities indices, and 6 combination models. Ten models were studied in all general medical patients (general models) and 7 in general medical patients with infection (infection models). Of the 15 models, 13 were developed using logistic or Poisson regression and 2 using machine learning methods. Also, 4 of 15 models reported on handling of missing values. None of the infection models had high discrimination, whereas 4 of 10 general models had high discrimination (area under curve >0.8). Only 1 model appropriately assessed calibration. All models had high risk of bias; 4 of 10 general models and 5 of 7 infection models had low concern for applicability for general medical patients.</p><p><strong>Conclusion: </strong>Mortality prediction models for general medical patients were sparse and differed in quality, applicability, and discrimination. These models require hospital-level validation and/or recalibration in general medical patients to guide mortality reduction interventions.</p>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43424414","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 : 2023-10-01DOI: 10.1016/j.ajmo.2023.100061
Daniel M. Gelfman
{"title":"The David Sign, Revisited","authors":"Daniel M. Gelfman","doi":"10.1016/j.ajmo.2023.100061","DOIUrl":"https://doi.org/10.1016/j.ajmo.2023.100061","url":null,"abstract":"","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-30DOI: 10.1016/j.ajmo.2023.100060
Alexandra B. Steverson MD, MPH , Paul J. Marano MD , Caren Chen MPH , Yifei Ma MS , Rachel J. Stern MD , Jean Feng MS, PhD , Efstathios D. Gennatas MBBS, PhD , James D. Marks MD, PhD , Matthew S. Durstenfeld MD, MAS , Jonathan D. Davis MD, MPHS , Priscilla Y. Hsue MD , Lucas S. Zier MD, MS
Introduction
Heart failure (HF) is a frequent cause of readmissions. Despite caring for underresourced patients and dependence on government funding, safety net hospitals frequently incur penalties for failing to meet pay-for-performance readmission metrics. Limited research exists on the causes of HF readmissions in safety net hospitals. Therefore, we sought to investigate predictors of 30-day all-cause readmission in HF patients in the safety net setting.
Methods
We performed a retrospective chart review of patients admitted for HF from October 2018 to April 2019. We extracted data on demographics and medical comorbidities and performed patient-specific review of social determinants and mental health in 4 domains: race/ethnicity, housing status, substance use, and mental illness. Multivariable Poisson regression modeling was employed to evaluate associations with 30-day all-cause readmission.
Results
The study population included 290 patients, among whom the mean age was 59 years and 71% (n = 207) were male; 42% (120) were Black/African American (AA), 22% (64) were Hispanic/Latino, and 96% (278) had public insurance; 28% (79) were not housed, 19% (56) had a diagnosis of mental illness, and active substance use was common. The 30-day readmission rate was 25.5% (n = 88). Factors that were associated with increased risk of readmission included self-identifying as Black/AA (relative risk 2.28, 95% confidence interval 1.00-5.20) or Hispanic/Latino (2.53, 1.07-6.00), experiencing homelessness (2.07, 1.21-3.56), living in a shelter (3.20, 1.27-8.02), or intravenous drug use (IVDU) (2.00, 1.08-3.70).
Conclusion
Race/ethnicity, housing status, and substance use were associated with increased risk of 30-day all-cause readmission in HF patients in a safety net hospital. In contrast to prior studies, medical comorbidities were not associated with increased risk of readmission.
{"title":"Predictors of All-Cause 30-Day Readmissions in Patients with Heart Failure at an Urban Safety Net Hospital: The Importance of Social Determinants of Health and Mental Health","authors":"Alexandra B. Steverson MD, MPH , Paul J. Marano MD , Caren Chen MPH , Yifei Ma MS , Rachel J. Stern MD , Jean Feng MS, PhD , Efstathios D. Gennatas MBBS, PhD , James D. Marks MD, PhD , Matthew S. Durstenfeld MD, MAS , Jonathan D. Davis MD, MPHS , Priscilla Y. Hsue MD , Lucas S. Zier MD, MS","doi":"10.1016/j.ajmo.2023.100060","DOIUrl":"https://doi.org/10.1016/j.ajmo.2023.100060","url":null,"abstract":"<div><h3>Introduction</h3><p>Heart failure (HF) is a frequent cause of readmissions. Despite caring for underresourced patients and dependence on government funding, safety net hospitals frequently incur penalties for failing to meet pay-for-performance readmission metrics. Limited research exists on the causes of HF readmissions in safety net hospitals. Therefore, we sought to investigate predictors of 30-day all-cause readmission in HF patients in the safety net setting.</p></div><div><h3>Methods</h3><p>We performed a retrospective chart review of patients admitted for HF from October 2018 to April 2019. We extracted data on demographics and medical comorbidities and performed patient-specific review of social determinants and mental health in 4 domains: race/ethnicity, housing status, substance use, and mental illness. Multivariable Poisson regression modeling was employed to evaluate associations with 30-day all-cause readmission.</p></div><div><h3>Results</h3><p>The study population included 290 patients, among whom the mean age was 59 years and 71% (<em>n</em> = 207) were male; 42% (120) were Black/African American (AA), 22% (64) were Hispanic/Latino, and 96% (278) had public insurance; 28% (79) were not housed, 19% (56) had a diagnosis of mental illness, and active substance use was common. The 30-day readmission rate was 25.5% (<em>n</em> = 88). Factors that were associated with increased risk of readmission included self-identifying as Black/AA (relative risk 2.28, 95% confidence interval 1.00-5.20) or Hispanic/Latino (2.53, 1.07-6.00), experiencing homelessness (2.07, 1.21-3.56), living in a shelter (3.20, 1.27-8.02), or intravenous drug use (IVDU) (2.00, 1.08-3.70).</p></div><div><h3>Conclusion</h3><p>Race/ethnicity, housing status, and substance use were associated with increased risk of 30-day all-cause readmission in HF patients in a safety net hospital. In contrast to prior studies, medical comorbidities were not associated with increased risk of readmission.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667036423000304/pdfft?md5=f7b8a5ceaa281d7df1e54dfd6497ec69&pid=1-s2.0-S2667036423000304-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92100996","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 : 2023-09-28DOI: 10.1016/j.ajmo.2023.100059
Alyssa C. Smith, Emily G. Holmes
Background
Catatonia is a complex psychomotor syndrome commonly associated with psychiatric disorders. However, hospitalists encounter this condition on medical floors, where it is typically due to an underlying medical, especially neurological, etiology. Delays in the diagnosis of catatonia are common and lead to worsened outcomes for patients, including a multitude of medical complications, such as venous thromboembolism and stasis ulcers. Catatonia due to a medical condition is less likely to respond to benzodiazepine therapy; identification and treatment of the underlying cause is crucial.
Methods
This article provides a practical review of the catatonia literature, with a focus on diagnosis, workup, and management of catatonia for patients admitted to medical hospitals.
Conclusions
With greater knowledge about catatonia, internists are uniquely positioned to recognize and initiate treatment.
{"title":"Catatonia: A Narrative Review for Hospitalists","authors":"Alyssa C. Smith, Emily G. Holmes","doi":"10.1016/j.ajmo.2023.100059","DOIUrl":"https://doi.org/10.1016/j.ajmo.2023.100059","url":null,"abstract":"<div><h3>Background</h3><p>Catatonia is a complex psychomotor syndrome commonly associated with psychiatric disorders. However, hospitalists encounter this condition on medical floors, where it is typically due to an underlying medical, especially neurological, etiology. Delays in the diagnosis of catatonia are common and lead to worsened outcomes for patients, including a multitude of medical complications, such as venous thromboembolism and stasis ulcers. Catatonia due to a medical condition is less likely to respond to benzodiazepine therapy; identification and treatment of the underlying cause is crucial.</p></div><div><h3>Methods</h3><p>This article provides a practical review of the catatonia literature, with a focus on diagnosis, workup, and management of catatonia for patients admitted to medical hospitals.</p></div><div><h3>Conclusions</h3><p>With greater knowledge about catatonia, internists are uniquely positioned to recognize and initiate treatment.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49715564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-24DOI: 10.1016/j.ajmo.2023.100058
Ahmad Alayyat , Munir Zaqqa , Ayman Hammoudeh , Daria Jaarah , Mohammad Bahhour , Mohammed Nawaiseh , Imad Alhaddad
Introduction
Direct oral anticoagulant agents (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Reduced doses of DOACs are indicated in patients who have renal impairment and according to age and weight criteria. The aim of this study was to investigate the frequency, clinical factors, and impact on 1-year prognosis of underdosing DOACs.
Methods
Data of patients enrolled in the Jordan AF (JoFib) study and who were followed for 1 year was used to compare patients prescribed standard dose with those who were underdosed.
Results
There were 672 patients (76.2%) who were prescribed standard dose and 210 patients (23.8%) who were underdosed. Baseline characteristics were similar between the 2 groups. Factors associated with underdosing were enrollment from an outpatient vs hospital site, moderate- or high-risk HAS-BLED score, an abnormal left ventricular ejection fraction (LVEF <50%), a history of heart failure, or current use of diuretics. At 1 year, the incidence of all-cause mortality was 12.2% in standard dose vs 13.3% in the underdose group (P = .82), stroke or systemic embolism was 3.6% in the standard dose vs 3.8% in the underdose group (P = .67), and major bleeding was 2.2% in the standard dose vs 3.3% in the underdose group (P = .35).
Conclusions
About (25%) of patients were underdosed. Factors associated with underdosing were outpatient (vs hospital) center enrollment, moderate- or high-risk HAS-BLED score, abnormal LVEF (<50%), history of heart failure, and current use of diuretics. There were no significant differences in the incidence of adverse events of mortality and major morbidity at 1-year follow-up between the standard dose and the underdose groups.
{"title":"Clinical Features and Impact on One Year Prognosis of Prescribing Low Doses of Direct Oral Anticoagulant Agents in a Middle Eastern Population with Atrial Fibrillation: Analysis from the Jordan Atrial Fibrillation Study","authors":"Ahmad Alayyat , Munir Zaqqa , Ayman Hammoudeh , Daria Jaarah , Mohammad Bahhour , Mohammed Nawaiseh , Imad Alhaddad","doi":"10.1016/j.ajmo.2023.100058","DOIUrl":"https://doi.org/10.1016/j.ajmo.2023.100058","url":null,"abstract":"<div><h3>Introduction</h3><p>Direct oral anticoagulant agents (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Reduced doses of DOACs are indicated in patients who have renal impairment and according to age and weight criteria. The aim of this study was to investigate the frequency, clinical factors, and impact on 1-year prognosis of underdosing DOACs.</p></div><div><h3>Methods</h3><p>Data of patients enrolled in the Jordan AF (JoFib) study and who were followed for 1 year was used to compare patients prescribed standard dose with those who were underdosed.</p></div><div><h3>Results</h3><p>There were 672 patients (76.2%) who were prescribed standard dose and 210 patients (23.8%) who were underdosed. Baseline characteristics were similar between the 2 groups. Factors associated with underdosing were enrollment from an outpatient vs hospital site, moderate- or high-risk HAS-BLED score, an abnormal left ventricular ejection fraction (LVEF <50%), a history of heart failure, or current use of diuretics. At 1 year, the incidence of all-cause mortality was 12.2% in standard dose vs 13.3% in the underdose group (<em>P</em> = .82), stroke or systemic embolism was 3.6% in the standard dose vs 3.8% in the underdose group (<em>P</em> = .67), and major bleeding was 2.2% in the standard dose vs 3.3% in the underdose group (<em>P</em> = .35).</p></div><div><h3>Conclusions</h3><p>About (25%) of patients were underdosed. Factors associated with underdosing were outpatient (vs hospital) center enrollment, moderate- or high-risk HAS-BLED score, abnormal LVEF (<50%), history of heart failure, and current use of diuretics. There were no significant differences in the incidence of adverse events of mortality and major morbidity at 1-year follow-up between the standard dose and the underdose groups.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49732134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-26eCollection Date: 2023-12-01DOI: 10.1016/j.ajmo.2023.100054
Zulvikar Syambani Ulhaq, Ferry Nur Nasyroh, Amalia Nur Aisa, Achmad Arief Hidayatullah, Lola Ayu Istifiani, Syafrizal Aji Pamungkas, Achmad Rilyadi Sholeh, Gita Vita Soraya
Objective: Online and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students' academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students.
Methods: A total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students' academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme.
Results: Both groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings.
Conclusion: Blended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.
目的：由于 COVID-19 的流行，在线和混合式学习方法在高等教育中得到了快速发展。我们的研究旨在比较医学本科生在线学习和混合式临床技能实验室（CSL）学习的学生学业成绩：印度尼西亚玛琅毛拉纳-马利克-易卜拉欣国立伊斯兰大学（Maulana Malik Ibrahim State Islamic University, Malang, Indonesia）共招收了101名医学本科生（2020学年50人[第一组：在线CSL]；2020学年51人[第二组：混合CSL]）。主要结果是从客观结构化临床考试（OSCE）成绩中收集的学生学习成绩。此外，学生还填写了一份评估问卷，以评估学习计划的质量：结果：两组学生都认为 CSL 是一门重要的学科，临床视频演示对他们的 OSCE 准备很有帮助。然而，与混合式 CSL 相比，接受在线学习的学生认为在线 CSL 效果不佳，在 OSCE 中得分较低。定性数据也支持这些发现：结论：就本科医学生的临床技能教学而言，混合式学习比在线学习更有价值。此外，在线 CSL 可能不足以让医学生获得关键技能。
{"title":"The Impact of Online vs Blended Clinical Skill Laboratory Learning on Student Academic Performance: A Case Study in Indonesia.","authors":"Zulvikar Syambani Ulhaq, Ferry Nur Nasyroh, Amalia Nur Aisa, Achmad Arief Hidayatullah, Lola Ayu Istifiani, Syafrizal Aji Pamungkas, Achmad Rilyadi Sholeh, Gita Vita Soraya","doi":"10.1016/j.ajmo.2023.100054","DOIUrl":"10.1016/j.ajmo.2023.100054","url":null,"abstract":"<p><strong>Objective: </strong>Online and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students' academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students.</p><p><strong>Methods: </strong>A total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students' academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme.</p><p><strong>Results: </strong>Both groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings.</p><p><strong>Conclusion: </strong>Blended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.</p>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11256266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44965500","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}
Online and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students’ academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students.
Methods
A total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students’ academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme.
Results
Both groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings.
Conclusion
Blended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.
由于新冠肺炎大流行，在线和混合学习方法在高等教育中经历了快速增长。我们的研究旨在比较医学本科生在线学习和混合临床技能实验室（CSL）学习的学生学习成绩。方法共有101名印度尼西亚马朗Maulana Malik Ibrahim国立伊斯兰大学的医学本科生入学（2020学年50名学生[第一组：在线CSL]；2020学年51名学生[第二组：混合CSL]）。主要结果是从目标结构化临床考试（OSCE）分数中收集的学生的学习成绩。此外，学生们还完成了一份评估问卷，以评估学习计划的质量。结果两组都认为CSL是一个重要的课题，临床视频演示对其欧安组织的准备工作很有用。然而，接受在线学习的学生认为在线CSL无效，与混合CSL相比，在欧安组织中得分更低。定性数据也支持这些发现。结论在医学本科生临床技能教学方面，混合学习比在线学习更有价值。此外，在线CSL可能不足以让医学生获得关键技能。
{"title":"The Impact of Online vs Blended Clinical Skill Laboratory Learning on Student Academic Performance: A Case Study in Indonesia","authors":"Zulvikar Syambani Ulhaq , Ferry Nur Nasyroh , Amalia Nur Aisa , Achmad Arief Hidayatullah , Lola Ayu Istifiani , Syafrizal Aji Pamungkas , Achmad Rilyadi Sholeh , Gita Vita Soraya","doi":"10.1016/j.ajmo.2023.100054","DOIUrl":"https://doi.org/10.1016/j.ajmo.2023.100054","url":null,"abstract":"<div><h3>Objective</h3><p>Online and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students’ academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students.</p></div><div><h3>Methods</h3><p>A total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students’ academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme.</p></div><div><h3>Results</h3><p>Both groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings.</p></div><div><h3>Conclusion</h3><p>Blended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49715315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-25DOI: 10.1016/j.ajmo.2023.100053
Ramy Sedhom , Rafail Beshai , Ahmed Elkaryoni , Michael Megaly , Ayman Elbadawi , Ahmed Athar , Wissam Jaber , Aditya S. Bharadwaj , Vinoy Prasad , Liset Stoletniy , Islam Y. Elgendy
Background
Data on outcomes of patients with high-risk acute pulmonary embolism (PE) transferred from other hospitals are scarce.
Methods
We queried the Nationwide Readmissions Database for admissions who were ≥18 years old, and with a primary discharge diagnosis of acute high-risk PE between the years 2016 and 2019. The main outcome of interest was the difference in all-cause in-hospital mortality between patients admitted directly to small/medium hospitals; patients admitted directly to large hospitals; and patients transferred to large hospitals.
Results
Among 11,341 weighted hospitalizations with high-risk PE, 631 (5.6%) patients were transferred to large hospitals. There was no significant change in the rates of transfer during the study period. Transferred patients were younger and had a higher prevalence of comorbidities. They were more likely to present with saddle PE and cor pulmonale and were more likely to receive advanced therapies. In-hospital mortality was not different between patients transferred to large hospitals and those admitted directly to large hospitals (adjusted odd ratio [OR] 1.11, 95% confidence interval [CI] 0.81, 1.54) as well as between patients transferred to large hospitals and those admitted directly to small/medium hospitals (aOR 1.28, 95% CI 0.92, 1.76). The rates of major bleeding and cardiac arrest were higher among transferred patients. Admissions for transferred patients were associated with higher cost and longer length of stay.
Conclusion
Transferred patients with high-risk PE were more likely to receive advanced therapies. There was no difference in-hospital mortality rates compared with patients admitted directly to the large or small/medium hospitals.
背景:从其他医院转来的高风险急性肺栓塞(PE)患者的预后数据很少。方法:我们在全国再入院数据库中查询了2016年至2019年期间入院的≥18岁且初步出院诊断为急性高危PE的患者。研究的主要结局是直接入住中小型医院的患者的全因住院死亡率的差异;直接入住大医院的患者;病人被转移到大医院。结果11341例高危PE加权住院患者中，631例(5.6%)转移至大医院。在研究期间，转移率没有显著变化。转院患者较年轻，合并症发生率较高。他们更有可能出现鞍型PE和肺心病，也更有可能接受先进的治疗。转到大医院的患者与直接入住大医院的患者住院死亡率无差异(调整奇数比[OR] 1.11, 95%可信区间[CI] 0.81, 1.54)，转到大医院的患者与直接入住中小型医院的患者住院死亡率无差异(aOR 1.28, 95% CI 0.92, 1.76)。转院患者大出血和心脏骤停的发生率较高。转院病人的入院费用较高，住院时间较长。结论高危PE转移患者接受先进治疗的可能性较大。与直接入住大医院或中小型医院的患者相比，住院死亡率没有差异。
{"title":"Trends and Outcomes of Interhospital Transfer for High-Risk Acute Pulmonary Embolism: A Nationwide Analysis","authors":"Ramy Sedhom , Rafail Beshai , Ahmed Elkaryoni , Michael Megaly , Ayman Elbadawi , Ahmed Athar , Wissam Jaber , Aditya S. Bharadwaj , Vinoy Prasad , Liset Stoletniy , Islam Y. Elgendy","doi":"10.1016/j.ajmo.2023.100053","DOIUrl":"10.1016/j.ajmo.2023.100053","url":null,"abstract":"<div><h3>Background</h3><p>Data on outcomes of patients with high-risk acute pulmonary embolism (PE) transferred from other hospitals are scarce.</p></div><div><h3>Methods</h3><p>We queried the Nationwide Readmissions Database for admissions who were ≥18 years old, and with a primary discharge diagnosis of acute high-risk PE between the years 2016 and 2019. The main outcome of interest was the difference in all-cause in-hospital mortality between patients admitted directly to small/medium hospitals; patients admitted directly to large hospitals; and patients transferred to large hospitals.</p></div><div><h3>Results</h3><p>Among 11,341 weighted hospitalizations with high-risk PE, 631 (5.6%) patients were transferred to large hospitals. There was no significant change in the rates of transfer during the study period. Transferred patients were younger and had a higher prevalence of comorbidities. They were more likely to present with saddle PE and cor pulmonale and were more likely to receive advanced therapies. In-hospital mortality was not different between patients transferred to large hospitals and those admitted directly to large hospitals (adjusted odd ratio [OR] 1.11, 95% confidence interval [CI] 0.81, 1.54) as well as between patients transferred to large hospitals and those admitted directly to small/medium hospitals (aOR 1.28, 95% CI 0.92, 1.76). The rates of major bleeding and cardiac arrest were higher among transferred patients. Admissions for transferred patients were associated with higher cost and longer length of stay.</p></div><div><h3>Conclusion</h3><p>Transferred patients with high-risk PE were more likely to receive advanced therapies. There was no difference in-hospital mortality rates compared with patients admitted directly to the large or small/medium hospitals.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48559756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-25DOI: 10.1016/j.ajmo.2023.100056
Ryan Abbott , Edward Kwok-Ho Hui , Lan Kao , Vincent Tse , Tristan Grogan , Betty L. Chang , Ka-Kit Hui
Background
The efficacy of providing self-acupressure educational materials in reducing stress and improving health-related quality of life (HRQOL) is uncertain. Evidence-based data to recommend for or against self-acupressure as an intervention for reducing stress and improving HRQOL is needed.
Objective
The Self-Acupressure for Stress (SAS) trial evaluates whether providing self-acupressure educational materials would reduce stress and improve HRQOL among health care providers (HCPs).
Design
Randomized behavioral clinical trial.
Setting
The entire study took place remotely.
Participants
One hundred fifty-nine adult HCPs with no prior experience or training in acupressure.
Intervention
The intervention group received self-acupressure educational materials.
Measurements
Primary outcomes were perception of stress measured by the Perceived Stress Scale (PSS), as well as scores on the physical and mental components of the 12-item Short Form Health Survey version 2 (SF-12v2).
Results
From the baseline to midpoint evaluations, the intervention group significantly reduced their PSS score (P ≤ .001) and increased their SF-12v2 Mental score (P = .002) but not their SF-12v2 Physical score (P = .55). These findings persisted at the final follow-up (both PSS and SF-12v2 Mental changes from baseline P < .001). However, the control group also significantly improved their SF-12v2 Mental from baseline to midpoint (P = .01) which was maintained at final follow-up (P = .02), whereas PSS and SF-12v2 Physical did not significantly change from baseline at either mid or final. Finally, the intervention group improved by significantly more than the control group from baseline to final follow-up for both PSS (P = .007) and SF-12v2 Mental (P = .02) HRQOL measures.
Limitation
The trial was not blinded.
Conclusion
Among HCPs during the coronavirus disease 2019 (COVID-19) pandemic, the provision of self-acupressure educational materials safely improved self-reported assessments of perception of stress and mental health. Self-acupressure represents a promising intervention for other populations. The study findings support the use of self-acupressure to reduce stress and improve HRQOL.
{"title":"Randomized Controlled Trial of Acupressure for Perception of Stress and Health-Related Quality of Life Among Health Care Providers During the COVID-19 Pandemic: The Self-Acupressure for Stress (SAS) Trial","authors":"Ryan Abbott , Edward Kwok-Ho Hui , Lan Kao , Vincent Tse , Tristan Grogan , Betty L. Chang , Ka-Kit Hui","doi":"10.1016/j.ajmo.2023.100056","DOIUrl":"10.1016/j.ajmo.2023.100056","url":null,"abstract":"<div><h3>Background</h3><p>The efficacy of providing self-acupressure educational materials in reducing stress and improving health-related quality of life (HRQOL) is uncertain. Evidence-based data to recommend for or against self-acupressure as an intervention for reducing stress and improving HRQOL is needed.</p></div><div><h3>Objective</h3><p>The Self-Acupressure for Stress (SAS) trial evaluates whether providing self-acupressure educational materials would reduce stress and improve HRQOL among health care providers (HCPs).</p></div><div><h3>Design</h3><p>Randomized behavioral clinical trial.</p></div><div><h3>Setting</h3><p>The entire study took place remotely.</p></div><div><h3>Participants</h3><p>One hundred fifty-nine adult HCPs with no prior experience or training in acupressure.</p></div><div><h3>Intervention</h3><p>The intervention group received self-acupressure educational materials.</p></div><div><h3>Measurements</h3><p>Primary outcomes were perception of stress measured by the Perceived Stress Scale (PSS), as well as scores on the physical and mental components of the 12-item Short Form Health Survey version 2 (SF-12v2).</p></div><div><h3>Results</h3><p>From the baseline to midpoint evaluations, the intervention group significantly reduced their PSS score (<em>P</em> ≤ .001) and increased their SF-12v2 Mental score (<em>P</em> = .002) but not their SF-12v2 Physical score (<em>P</em> = .55). These findings persisted at the final follow-up (both PSS and SF-12v2 Mental changes from baseline <em>P</em> < .001). However, the control group also significantly improved their SF-12v2 Mental from baseline to midpoint (<em>P</em> = .01) which was maintained at final follow-up (<em>P</em> = .02), whereas PSS and SF-12v2 Physical did not significantly change from baseline at either mid or final. Finally, the intervention group improved by significantly more than the control group from baseline to final follow-up for both PSS (<em>P</em> = .007) and SF-12v2 Mental (<em>P</em> = .02) HRQOL measures.</p></div><div><h3>Limitation</h3><p>The trial was not blinded.</p></div><div><h3>Conclusion</h3><p>Among HCPs during the coronavirus disease 2019 (COVID-19) pandemic, the provision of self-acupressure educational materials safely improved self-reported assessments of perception of stress and mental health. Self-acupressure represents a promising intervention for other populations. The study findings support the use of self-acupressure to reduce stress and improve HRQOL.</p></div><div><h3>Trial Registration</h3><p>ClinicalTrials.gov: NCT04472559.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45369970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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