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":"10 ","pages":"Article 100059"},"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":"10 ","pages":"Article 100058"},"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":" ","pages":"100054"},"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":"10 ","pages":"Article 100054"},"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":"10 ","pages":"Article 100053"},"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":"10 ","pages":"Article 100056"},"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}
Pub Date : 2023-08-24DOI: 10.1016/j.ajmo.2023.100057
John King Khoo MBBS, FRACP , Benjamin Peter Trewin MBBS, FRACP , Audrey Adji MB, MBiomedE, PhD , Yee Weng Wong MBBS, MHS, FRACP, FCSANZ , Sara Hungerford MBBS, FRACP, FCSANZ, PhD
Background
Cardiogenic shock complicating acute myocardial infarction is associated with reduced survival despite advancements in the treatment of acute coronary syndromes. Characterizing predictors of morbidity and mortality in this setting is crucial to improving risk stratification and management. Notwithstanding, the interplay of factors determining survival in this condition remains poorly studied.
Methods
Embase, MEDLINE, and CINAHL databases were searched for original studies evaluating predictors of short-term (30-day or in-hospital) survival in ST elevation myocardial infarction with cardiogenic shock (STEMI-CS). Included studies were analyzed by way of vote counting, identifying variables that predicted mortality or survival.
Results
Twenty-four studies, consisting of 14,735 patients (5649 nonsurvivors and 9086 survivors) were included. All studies were observational by design (17 retrospective and 7 prospective) with clinical and statistical heterogeneity. Unsuccessful revascularization, reduced left ventricular ejection fraction, renal impairment, and other variables were identified as key independent predictors of mortality.
Conclusion
Several key variables have been shown to independently increase mortality in STEMI-CS populations. Future prospective studies examining the prognostic role of multivariate scoring systems incorporating these domains are required.
{"title":"ST Elevation Myocardial Infarction Complicated by Cardiogenic Shock: Systematic Review of Survival Predictors","authors":"John King Khoo MBBS, FRACP , Benjamin Peter Trewin MBBS, FRACP , Audrey Adji MB, MBiomedE, PhD , Yee Weng Wong MBBS, MHS, FRACP, FCSANZ , Sara Hungerford MBBS, FRACP, FCSANZ, PhD","doi":"10.1016/j.ajmo.2023.100057","DOIUrl":"10.1016/j.ajmo.2023.100057","url":null,"abstract":"<div><h3>Background</h3><p>Cardiogenic shock complicating acute myocardial infarction is associated with reduced survival despite advancements in the treatment of acute coronary syndromes. Characterizing predictors of morbidity and mortality in this setting is crucial to improving risk stratification and management. Notwithstanding, the interplay of factors determining survival in this condition remains poorly studied.</p></div><div><h3>Methods</h3><p>Embase, MEDLINE, and CINAHL databases were searched for original studies evaluating predictors of short-term (30-day or in-hospital) survival in ST elevation myocardial infarction with cardiogenic shock (STEMI-CS). Included studies were analyzed by way of vote counting, identifying variables that predicted mortality or survival.</p></div><div><h3>Results</h3><p>Twenty-four studies, consisting of 14,735 patients (5649 nonsurvivors and 9086 survivors) were included. All studies were observational by design (17 retrospective and 7 prospective) with clinical and statistical heterogeneity. Unsuccessful revascularization, reduced left ventricular ejection fraction, renal impairment, and other variables were identified as key independent predictors of mortality.</p></div><div><h3>Conclusion</h3><p>Several key variables have been shown to independently increase mortality in STEMI-CS populations. Future prospective studies examining the prognostic role of multivariate scoring systems incorporating these domains are required.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"10 ","pages":"Article 100057"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42067215","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 : 2023-08-23DOI: 10.1016/j.ajmo.2023.100055
Stephanie André , Anne-Violette Bruyneel , Audrey Chirumberro , Alain Roman , Marc Claus , Stephane Alard , Nathalie De Vos , Marie Bruyneel
Background
In COVID-19 intensive care unit (ICU)–admitted patients, multiorgan acute complications lead to long-lasting sequelae. The aim of this study was to assess (1) changes in chest CT, pulmonary function test (PFT), functional capacity (6-minute walking distance test (6MWT)), and health-related quality of life (HR-QoL) among ICU COVID-19 survivors at 3, 6, and 12 months after ICU discharge and (2) predictors of persistent impairment/improvement in 6MWT and HR-QoL.
Methods
ICU COVID-19 survivors were prospectively included. Outcomes at 3, 6, and 12 months included PFT, 6MWT, respiratory muscle strength (RMS), HR-QoL (SF-36), Medical Research Council dyspnea scale (mMRC), and post-COVID Functional Status scale.
Results
Eighty-seven survivors were included, from June 3, 2020, to September 2, 2021. At 12 months, 50% of PFT were normal, 46% were restrictive, and 22% showed reduced diffusing capacity for carbon monoxide (DLCO). Impaired DLCO was associated with ICU length of stay and age. In mixed linear model analysis, improvements in RMS and mMRC persisted over time regardless of the adjustments applied (P ≤ .050). SF-36 improved in parallel with FEV1 and 6MWT between 3 and 12 months (P ≤ .044), while increment in DLCO correlated with changes in FEV1 and total lung capacity (TLC) (p ≤ 0.026).
Conclusions
This longitudinal study demonstrated that improvements in SF-36 occur in parallel with improvements in FEV1 and 6MWT between 3 and 12 months post-ICU discharge in a sample of critically ill COVID-19 patients. However, PFT remained, however, abnormal in 50% of patients. Based on continued improvements observed from 3 to 12 months, it is anticipated that COVID-19 ICU patients will continue to recover similarly to ARDS patients.
{"title":"Health-Related Quality of Life Improves in Parallel with FEV1 and 6-Minute Walking Distance Test at Between 3 and 12 Months in Critical COVID-19 Survivors","authors":"Stephanie André , Anne-Violette Bruyneel , Audrey Chirumberro , Alain Roman , Marc Claus , Stephane Alard , Nathalie De Vos , Marie Bruyneel","doi":"10.1016/j.ajmo.2023.100055","DOIUrl":"10.1016/j.ajmo.2023.100055","url":null,"abstract":"<div><h3>Background</h3><p>In COVID-19 intensive care unit (ICU)–admitted patients, multiorgan acute complications lead to long-lasting sequelae. The aim of this study was to assess (1) changes in chest CT, pulmonary function test (PFT), functional capacity (6-minute walking distance test (6MWT)), and health-related quality of life (HR-QoL) among ICU COVID-19 survivors at 3, 6, and 12 months after ICU discharge and (2) predictors of persistent impairment/improvement in 6MWT and HR-QoL.</p></div><div><h3>Methods</h3><p>ICU COVID-19 survivors were prospectively included. Outcomes at 3, 6, and 12 months included PFT, 6MWT, respiratory muscle strength (RMS), HR-QoL (SF-36), Medical Research Council dyspnea scale (mMRC), and post-COVID Functional Status scale.</p></div><div><h3>Results</h3><p>Eighty-seven survivors were included, from June 3, 2020, to September 2, 2021. At 12 months, 50% of PFT were normal, 46% were restrictive, and 22% showed reduced diffusing capacity for carbon monoxide (DLCO). Impaired DLCO was associated with ICU length of stay and age. In mixed linear model analysis, improvements in RMS and mMRC persisted over time regardless of the adjustments applied (<em>P</em> ≤ .050). SF-36 improved in parallel with FEV1 and 6MWT between 3 and 12 months (<em>P</em> ≤ .044), while increment in DLCO correlated with changes in FEV1 and total lung capacity (TLC) (<em>p</em> ≤ 0.026).</p></div><div><h3>Conclusions</h3><p>This longitudinal study demonstrated that improvements in SF-36 occur in parallel with improvements in FEV1 and 6MWT between 3 and 12 months post-ICU discharge in a sample of critically ill COVID-19 patients. However, PFT remained, however, abnormal in 50% of patients. Based on continued improvements observed from 3 to 12 months, it is anticipated that COVID-19 ICU patients will continue to recover similarly to ARDS patients.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"10 ","pages":"Article 100055"},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48544920","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 : 2023-08-02DOI: 10.1016/j.ajmo.2023.100052
Nandakumar Mohan , Samir Shah , Atif Nehvi , Edward Bley , Kevin Bryan Lo , Sarah Perloff
Introduction
Cirrhosis-associated immune dysfunction (CAID) is a chronic vasodilatory state with hyperdynamic circulation and alterations in thermoregulation that may make patients more susceptible to and mask underlying infection. This study aims to determine whether SIRS criteria are an accurate tool for predicting bloodstream infection (BSI) in cirrhosis.
Methods
In our retrospective chart review, study population included patients with cirrhosis that were 18 years or older. For all study patients, model for end-stage liver disease (MELD) scores and values for each SIRS variable at the time of admission and blood culture data were recorded. Univariable and multivariable logistic regression analysis was performed to identify any associations between dichotomized SIRS variables that fulfill SIRS positivity and BSI.
Results
Significantly more patients without BSI met positivity criteria for WBC counts (30% vs 13% p < .001). In the analysis of the SIRS variables as continuous variables in prediction of BSI, the AUC curves generated were all unsatisfactory with the temperature (36-38°C) and WBC count (4 × 103 to 12 × 103 mcL) at the time of admission having the highest areas under the ROC curve (0.52 and 0.55, respectively). Looking at the SIRS variables dichotomized (according to whether fulfilling SIRS criteria or not) in univariable logistic regression, only WBC counts meeting SIRS criteria were significantly associated with BSI OR 0.37 (0.18-0.77); p = .008, but this was an inverse association. This association was true even in the multivariable model OR 0.38 (0.18-0.80); p = .01.
Conclusion
Our study shows that SIRS criteria are a poor predictor of BSI among patients with cirrhosis.
肝硬化相关免疫功能障碍(CAID)是一种慢性血管舒张状态，伴有高动力循环和体温调节的改变，这可能使患者更容易感染并掩盖潜在的感染。本研究旨在确定SIRS标准是否是预测肝硬化血流感染(BSI)的准确工具。方法在我们的回顾性图表回顾中，研究人群包括18岁及以上的肝硬化患者。对于所有研究患者，记录入院时终末期肝病模型(MELD)评分和每个SIRS变量的值以及血培养数据。采用单变量和多变量logistic回归分析来确定SIRS阳性的二分类SIRS变量与BSI之间的关联。结果:无BSI患者WBC计数符合阳性标准的患者明显增多(30% vs 13% p <措施)。在将SIRS变量作为预测BSI的连续变量进行分析时，所生成的AUC曲线均不理想，入院时的温度(36 ~ 38℃)和白细胞计数(4 × 103 ~ 12 × 103 mcL)的ROC曲线下面积最大(分别为0.52和0.55)。单变量logistic回归中SIRS变量二分类(根据是否满足SIRS标准)，只有符合SIRS标准的WBC计数与BSI显著相关or为0.37 (0.18-0.77);P = 0.008，但这是负相关。即使在多变量模型中，这种关联也是成立的OR为0.38 (0.18-0.80);p = 0.01。结论我们的研究表明SIRS标准不能很好地预测肝硬化患者的BSI。
{"title":"Is the SIRS Criteria a Good Predictor of Blood stream Infection in Cirrhosis? A Single-Center Retrospective Analysis","authors":"Nandakumar Mohan , Samir Shah , Atif Nehvi , Edward Bley , Kevin Bryan Lo , Sarah Perloff","doi":"10.1016/j.ajmo.2023.100052","DOIUrl":"10.1016/j.ajmo.2023.100052","url":null,"abstract":"<div><h3>Introduction</h3><p>Cirrhosis-associated immune dysfunction (CAID) is a chronic vasodilatory state with hyperdynamic circulation and alterations in thermoregulation that may make patients more susceptible to and mask underlying infection. This study aims to determine whether SIRS criteria are an accurate tool for predicting bloodstream infection (BSI) in cirrhosis.</p></div><div><h3>Methods</h3><p>In our retrospective chart review, study population included patients with cirrhosis that were 18 years or older. For all study patients, model for end-stage liver disease (MELD) scores and values for each SIRS variable at the time of admission and blood culture data were recorded. Univariable and multivariable logistic regression analysis was performed to identify any associations between dichotomized SIRS variables that fulfill SIRS positivity and BSI.</p></div><div><h3>Results</h3><p>Significantly more patients without BSI met positivity criteria for WBC counts (30% vs 13% <em>p</em> < .001). In the analysis of the SIRS variables as continuous variables in prediction of BSI, the AUC curves generated were all unsatisfactory with the temperature (36-38°C) and WBC count (4 × 10<sup>3</sup> to 12 × 10<sup>3</sup> mcL) at the time of admission having the highest areas under the ROC curve (0.52 and 0.55, respectively). Looking at the SIRS variables dichotomized (according to whether fulfilling SIRS criteria or not) in univariable logistic regression, only WBC counts meeting SIRS criteria were significantly associated with BSI OR 0.37 (0.18-0.77); <em>p</em> = .008, but this was an inverse association. This association was true even in the multivariable model OR 0.38 (0.18-0.80); <em>p</em> = .01.</p></div><div><h3>Conclusion</h3><p>Our study shows that SIRS criteria are a poor predictor of BSI among patients with cirrhosis.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"10 ","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43022180","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 : 2023-07-20DOI: 10.1016/j.ajmo.2023.100051
Abhilash Koratala , Hari R. Paudel , Kevin R. Regner
Background
Point-of-care ultrasonography (POCUS) is being increasingly recognized as an adjunct to physical examination. However, limited availability of trained faculty in specialties other than emergency medicine and lack of universal training standards remain key barriers to its widespread integration into undergraduate and graduate medical curricula. In this study, we sought to explore the effectiveness of a short simulation-based workshop for medical students teaching basic cardiac ultrasound led by a nephrologist.
Methods
Workshops were conducted for 2 different groups of 4th-year medical students with a total of 25 attendees. The workshop consisted of a 1-hour lecture followed by 15 minutes of cardiac anatomy simulation and a 2- to 2.5-hour hands-on session in the simulation laboratory. An anonymous precourse questionnaire comprising 10 questions assessing the interpretation of common grayscale ultrasound findings encountered in patients with undifferentiated hypotension was performed. After the workshop, a postcourse exam and survey were conducted, retesting the same concepts and seeking the students’ feedback on the course.
Results
In total, 23 and 20 students answered the pre- and postcourse surveys, respectively. The mean total score on the pretest was 63.8% ± 13.6%, which significantly increased to 91.5% ± 10.5% on the posttest (P < .001). About 90% of the respondents strongly agreed that the cardiac anatomy simulation improved their understanding of the cardiac sonographic anatomy; 75% strongly agreed that the hands-on simulation enhanced their confidence in image acquisition and interpretation; and 70% said they would choose nephrology elective if POCUS training was integrated with it.
Conclusions
A nephrologist-led diagnostic POCUS workshop using simulation techniques is effective in improving the learners’ knowledge, understanding of the sonographic cardiac anatomy, and confidence in image acquisition. Integration of POCUS training may increase medical student interest in nephrology elective rotations.
{"title":"Nephrologist-Led Simulation-Based Focused Cardiac Ultrasound Workshop for Medical Students: Insights and Implications","authors":"Abhilash Koratala , Hari R. Paudel , Kevin R. Regner","doi":"10.1016/j.ajmo.2023.100051","DOIUrl":"10.1016/j.ajmo.2023.100051","url":null,"abstract":"<div><h3>Background</h3><p>Point-of-care ultrasonography (POCUS) is being increasingly recognized as an adjunct to physical examination. However, limited availability of trained faculty in specialties other than emergency medicine and lack of universal training standards remain key barriers to its widespread integration into undergraduate and graduate medical curricula. In this study, we sought to explore the effectiveness of a short simulation-based workshop for medical students teaching basic cardiac ultrasound led by a nephrologist.</p></div><div><h3>Methods</h3><p>Workshops were conducted for 2 different groups of 4th-year medical students with a total of 25 attendees. The workshop consisted of a 1-hour lecture followed by 15 minutes of cardiac anatomy simulation and a 2- to 2.5-hour hands-on session in the simulation laboratory. An anonymous precourse questionnaire comprising 10 questions assessing the interpretation of common grayscale ultrasound findings encountered in patients with undifferentiated hypotension was performed. After the workshop, a postcourse exam and survey were conducted, retesting the same concepts and seeking the students’ feedback on the course.</p></div><div><h3>Results</h3><p>In total, 23 and 20 students answered the pre- and postcourse surveys, respectively. The mean total score on the pretest was 63.8% ± 13.6%, which significantly increased to 91.5% ± 10.5% on the posttest (<em>P</em> < .001). About 90% of the respondents strongly agreed that the cardiac anatomy simulation improved their understanding of the cardiac sonographic anatomy; 75% strongly agreed that the hands-on simulation enhanced their confidence in image acquisition and interpretation; and 70% said they would choose nephrology elective if POCUS training was integrated with it.</p></div><div><h3>Conclusions</h3><p>A nephrologist-led diagnostic POCUS workshop using simulation techniques is effective in improving the learners’ knowledge, understanding of the sonographic cardiac anatomy, and confidence in image acquisition. Integration of POCUS training may increase medical student interest in nephrology elective rotations.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"10 ","pages":"Article 100051"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45006862","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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