COPD influences survival in patients affected by COVID‐19, comparison between subjects admitted to an internal medicine unit, and subjects admitted to an intensive care unit: An Italian experience

In large acute medical wards treating heterogenous and complex patients, intensity of patient care should be graduated according to clinical severity. We conducted a retrospective observational study on all unselected admissions (8838) to the internal medicine ward of the Santa Chiara Hospital of Trento from 2012 to 2017. During 2012 and 2013, a standard organizational model (SMC) was in place, while an organizational model for intensity of medical care (IMC) was introduced in 2014. In SMC, patient admission was performed according to bed availability only. In IMC, patients were allocated to three different ward settings (high, medium and post-acute care) based on the stratification of clinical instability. The National Early Warning Score (NEWS) was used for the stratification, together with the clinical judgment. The implementation of the IMC model led to a decrease of mortality and urgent transfers for clinical deterioration to Intensive Care Unit and to an increase of admissions from Intensive Care Unit and from regional spoke hospitals. Redesigning delivery processes based on IMC can play a pivotal role in improving patient outcomes and bed management.

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Smart Phone/Device Application to Improve Delivery of Enteral Nutrition in Adult Patients Admitted to the Medical Intensive Care Unit

Nutrition and Metabolic Insights ◽

10.1177/1178638818820299 ◽

2019 ◽

Vol 12 ◽

pp. 117863881882029

Author(s):

Sultan Mahmood ◽

Leah Hoffman ◽

Ijlal Akbar Ali ◽

Yan D Zhao ◽

Allshine Chen ◽

...

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Enteral Nutrition ◽

Clinical Guidelines ◽

Academic Medical Center ◽

Smart Phone ◽

Device Application ◽

Resident Physicians ◽

The Impact

Background: Resident physicians are frequently uncomfortable ordering enteral nutrition (EN) and are unaware of the variety of formulas and supplements available for different disease processes. Many depend on a clinical dietician to assist with recommending EN formulas and patient energy requirements that may not be readily available on patient admission. This creates a barrier to early initiation of EN and non-compliance with Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition clinical guidelines. Objective: Internal medicine resident physicians were provided an iPod with a smart phone/device application (EN application) to assist them in choosing EN formulas for patients during their intensive care unit (ICU) rotation. The primary outcome was improved initiation of EN within 24 hours of admission. Secondary outcomes included the following: time to initiate EN, goal calories reached, infections rates, length of stay, mortality, and concordance with clinical guidelines. Design: The study is a quasi-experimental design to improve delivery of EN at an academic medical center in the medical ICU. Data were collected from a retrospective chart review to evaluate the impact of an EN application to assist resident physicians when ordering EN. Results: Use of the EN application reduced the percent of patients with delayed initiation of EN from 61.2% prior to 37.5% ( P < .01). The mean time to initiate EN also improved 44.5 vs 31.9 hours ( P < .01). Patients were also more likely to achieve their daily caloric goal ( P < .01). Conclusion: The use of an EN application to assist internal medicine residents when ordering EN reduced delays in initiation of EN and improved overall delivery of EN to medical ICU patients.

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Impact of COVID-19 on liver function: results from an internal medicine unit in Northern Italy

Internal and Emergency Medicine ◽

10.1007/s11739-020-02425-w ◽

2020 ◽

Vol 15 (8) ◽

pp. 1399-1407 ◽

Cited By ~ 3

Author(s):

Marco Vincenzo Lenti ◽

◽

Federica Borrelli de Andreis ◽

Ivan Pellegrino ◽

Catherine Klersy ◽

...

Keyword(s):

Internal Medicine ◽

Intensive Care ◽

Liver Function ◽

Laboratory Data ◽

Liver Function Tests ◽

Gamma Glutamyl Transpeptidase ◽

Function Tests ◽

Altered Liver ◽

The Impact ◽

Internal Medicine Unit

Abstract Little is known regarding coronavirus disease 2019 (COVID-19) clinical spectrum in non-Asian populations. We herein describe the impact of COVID-19 on liver function in 100 COVID-19 consecutive patients (median age 70 years, range 25–97; 79 males) who were admitted to our internal medicine unit in March 2020. We retrospectively assessed liver function tests, taking into account demographic characteristics and clinical outcome. A patient was considered as having liver injury when alanine aminotransferase (ALT) was > 50 mU/ml, gamma-glutamyl transpeptidase (GGT) > 50 mU/ml, or total bilirubin > 1.1 mg/dl. Spearman correlation coefficient for laboratory data and bivariable analysis for mortality and/or need for intensive care were assessed. A minority of patients (18.6%) were obese, and most patients were non- or moderate-drinkers (88.5%). Liver function tests were altered in 62.4% of patients, and improved during follow-up. None of the seven patients with known chronic liver disease had liver decompensation. Only one patient developed acute liver failure. In patients with altered liver function tests, PaO2/FiO2 < 200 was associated with greater mortality and need for intensive care (HR 2.34, 95% CI 1.07–5.11, p = 0.033). To conclude, a high prevalence of altered liver function tests was noticed in Italian patients with COVID-19, and this was associated with worse outcomes when developing severe acute respiratory distress syndrome.

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Quality of penicillin allergy management in the intensive care unit and internal medicine ward

Allergy Asthma & Clinical Immunology ◽

10.1186/1710-1492-6-s2-p1 ◽

2010 ◽

Vol 6 (S2) ◽

Author(s):

Philippe Bégin ◽

Matthieu Picard ◽

Hugues Bouchard ◽

Jonathan Cloutier ◽

Émilie Daoust ◽

...

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Penicillin Allergy ◽

Internal Medicine Ward ◽

Allergy Management

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COMEPA (COVID-19 Medicina Policlinico Palermo): a study in hospitalized patients

Geriatric Care ◽

10.4081/gc.2021.9895 ◽

2021 ◽

Vol 7 (3) ◽

Author(s):

The COMEPA group

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Factors ◽

Clinical Practice ◽

Medical Records ◽

University Hospital ◽

Efficacy And Safety ◽

The Past ◽

The University

Coronavirus disease 2019 (COVID-19) has dramatically changed our lives. In the past months, hospitals were saturated of patients; therefore, it is still important to have simple and standardized prognostic factors and to evaluate the efficacy and safety of medications commonly used for COVID-19. We aimed to collect data of the patients hospitalized in Internal Medicine and Geriatrics Wards at the University Hospital (Policlinico) ‘P. Giaccone’ in Palermo, Italy (COMEPA, COVID-19 Medicina Policlinico Palermo), with the main purpose of finding prognostic tools that can be easily used in clinical practice in order to identify patients hospitalized for/with COVID-19 at higher risk of negative outcomes, such as mortality, transfer to Intensive Care Unit (ICU) and institutionalization, as well as evaluating the efficacy/safety of medications commonly used for COVID-19. For reaching these aims, the medical records of approximately 600 patients will be recorded, having data on several parameters and including as outcomes mortality, ICU placement, institutionalization. With the COMEPA study, we therefore plan to update current literature, giving new data on prognostic factors and on the efficacy/safety of some medications used for COVID-19.

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