Prevalence of anemia in hospitalized internal medicine patients: Correlations with comorbidities and length of hospital stay

2018 ◽  
Vol 51 ◽  
pp. 11-17 ◽  
Author(s):  
Carlo Zaninetti ◽  
Catherine Klersy ◽  
Concetta Scavariello ◽  
Raffaella Bastia ◽  
Carlo L. Balduini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Prevalence Of Anemia

scholarly journals Antibiotic use in Departments of Internal Medicine of Lazio

2017 ◽  
Vol 11 (4) ◽  
pp. 364 ◽  
Author(s):  
Dario Martolini ◽  
Maurizia Galiè ◽  
Anna Maria Santoro ◽  
Danilo Monno ◽  
Claudio Santini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Antimicrobial Treatment ◽  
Duration Of Treatment ◽  
Lazio Region ◽  
Multicenter Observational Study ◽  
Healthcare Associated ◽  
Hospital Acquired

Antimicrobial therapy is inappropriate in 9 to 64% of the patients hospitalized. We evaluated the antibiotic use in Internal Medicine wards of an Italian region (Lazio) by a prospective multicenter, observational study. One thousand and nine patients were evaluated. Patients under antimicrobial treatment (PUAT) were 588 (58.2%), patients without treatment (PWT) 421 (41.8%). Infections were classified as community acquired (47.8%), hospital acquired (10.3%) or healthcare-associated (11.4%); the remaining 30.5% of infections did not receive any epidemiological classification. Samples for microbiological examination were collected in 41.6% of PUAT. The antibiotic choice was empiric in 94.8% of the cases and protected penicillins were selected in 48% of the cases. The mean duration of treatment was 9.5±6 standard deviation (SD) days. Only 6% of the patients switched from intravenous to oral therapy. Age, length of hospital stay and mortality were higher for PUAT than for PWT (mean age: 75.9±15 SD vs 74.2±15 SD years, P<0.02; length of hospital stay: 13.7±10.4 SD vs 10±8.4 SD days, P<0.01; mortality: 15.9% vs 3.1%). Antibiotic stewardship needs to be implemented all over the hospitals of Lazio region.

scholarly journals The Appropriateness of Heparin Antibody Testing. A Single Institution Retrospective Analysis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3277-3277 ◽  
Author(s):  
Danny A. Landau ◽  
Nadezhda Kholodnaya ◽  
Ana CuestaFernandez ◽  
Ariel PerezPerez
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Scoring System ◽  
High Probability ◽  
Conflicts Of Interest ◽  
Length Of Hospital Stay ◽  
Low Risk ◽  
Antibody Testing ◽  
Drug Induced ◽  
Heparin Induced Thrombocytopenia

Abstract Background: Heparin-induced thrombocytopenia (HIT) is a drug-induced, immune-mediated prothrombotic disorder associated with thrombocytopenia and venous and/or arterial thrombosis.Up to 5% of patients exposed to heparin for at least one week develop HIT, and approximately 50% of them will have thrombosis. Diagnosis of HIT is suspected from the clinical picture based on the ''4 T's'' (Thrombocytopenia, Timing, Thrombosis, no other cause of platelet fall) or the HIT Expert Probability (HEP) scoring system. However, often these "4 T's" are ignored and testing is inappropriately ordered in low risk patients. This could lead to possible morbidity and increase length of hospital stay. We opted to look back at the appropriateness of testing done within our academic center. Methods/ Design: All hospitalized patients with thrombocytopenia who underwent HIT antibody testing (HIT ELISA) during February 2013 were screened using our internal electronic medical record. Patients were subdivided to low, intermediate or high pretest probability group according to the 4Ts scoring system. Appropriateness of testing was determined according ASH 2013 Clinical Practice Guideline on the Evaluation and Management of Adults with Suspected Heparin-Induced Thrombocytopenia (HIT). HIT Ab test is recommended to be tested when there is intermittent to high probability of HIT (4T's score above or equal to 4). The percentage of appropriate/inappropriate testing was calculated. The results were then subdivided by ordering physician group. Results: 120 HIT ab tests were performed during February 2013 in our institution. Only 13 patients tested had a positive HIT Ab. Internal medicine ordered the majority of these tests. Of the 120 patients tested, 7 patients had high risk and another 50 had intermediate risk as per 4T's scoring. 61 patients were low risk and should not have been tested. (Table 1) Table 1. HIT antibody test ordered per Service and probability of HIT. Service ordering test Low probability of HIT Intermediate/high probability of HIT TOTAL Internal Medicine 28 28 56 Cardiothoracic Surgery 13 11 24 Hematology Oncology 7 5 12 Cardiology 3 1 4 Surgery 1 4 5 Emergency medicine 0 1 1 Infectious disease 4 0 4 Pulmonary 0 1 1 Critical care 1 6 7 Nephrology 1 2 3 Ob Gyn 1 0 1 Family Medicine 2 0 2 TOTAL 61 59 120 Conclusions: HIT testing has been overused within our institution. Low platelets, without other signs or symptoms of typical HIT were used as a trigger for testing the antibody. This has potential to cause harm due to increased bleeding risk, increased length of hospital stay, and the potential to utilize extended anticoagulation when not necessary. Better education on the appropriateness of the test can limit the potential harm of its use. Disclosures No relevant conflicts of interest to declare.

scholarly journals Pain Prevalence and Management in an Internal Medicine Setting in Italy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Fabio Fabbian ◽  
Alfredo De Giorgi ◽  
Marco Pala ◽  
Alessandra Mallozzi Menegatti ◽  
Massimo Gallerani ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Rating Scale ◽  
Length Of Hospital Stay ◽  
Numeric Rating Scale ◽  
Biliary Disease ◽  
Pain Evaluation ◽  
Significant Pain ◽  
Final Sample ◽  
Pain Prevalence

Background. Since data on pain evaluation and management in patients admitted to internal medicine wards (IMWs) are limited, we aimed to evaluate these aspects in a cohort of internistic patients. Methods. We considered all patients consecutively admitted from June to December 2011 to our unit. Age, gender, and length-of-hospital-stay (LOS) were recorded. Comorbidities were arbitrarily defined, and pain severity was evaluated by Numeric Rating Scale (NRS) on admission and discharge. Results. The final sample consisted of 526 patients (mean age 74±14 years; 308 women). Significant pain (NRS ≥ 3) was detected in 63% of cases, and severe (NRS ≥ 7) in 7.6%. Pain was successfully treated, and NRS decreased from 4.65 ± 2.05 to 0.89 ± 1.3 (P<0.001). Compared with subjects with NRS < 3, those with significant pain were older (75.5 ± 13.9 versus 72.9 ± 14.5 years, P=0.038), and had a higher LOS (7.9 ± 6.1 versus 7.3 ± 6.8, P=0.048). Significant pain was independently associated with age (OR 0.984, P=0.018), cancer (OR 3.347, P<0.001), musculoskeletal disease (OR 3.054, P<0.0001), biliary disease (OR 3.100, P<0.01), and bowel disease (OR 3.100, P<0.003). Conclusion. In an internal medicine setting, multiple diseases represent significant cause of pain. Prompt pain evaluation and management should be performed as soon as possible, in order to avoid patients’ suffering and reduce the need of hospital stay.

scholarly journals Length of Stay and Costs for Hospitalized Hemodialysis Patients

2000 ◽  
Vol 11 (8) ◽  
pp. 1526-1533
Author(s):  
ABHIJIT V. KSHIRSAGAR ◽  
SUSAN L. HOGAN ◽  
LARRY MANDELKEHR ◽  
RONALD J. FALK
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hemodialysis Patients ◽  
Major Health ◽  
Care Issue ◽  
Medicine Service

Abstract. The high cost of hospitalization for hemodialysis patients has become a major health care issue. To address this issue, length of hospital stay and costs for these patients were compared with services covered by nephrologists and services covered by internists. Hemodialysis patients (n = 161) were prospectively admitted 219 times on alternate days to services covered by nephrologists or by internists from July 1995 to March 1996. Admissions to nonmedical services and admissions for overnight observation were excluded. Length of stay, costs, and risk-adjusted predicted length of stay and costs, as well as the number of consultations were compared between services, using Wilcoxon rank sum tests. Readmissions and deaths were compared using χ2 tests. Mean length of stay for admissions to the nephrology service (n = 114) was 6.3 days compared with 8.1 days for admissions to internal medicine services (n = 105) (P = 0.017). The predicted length of stay was similar. Mean overall cost for admissions under the care of nephrologists was $7,925 versus $10,773 under the care of internists (P = 0.101). The internal medicine service averaged 1.5 consultations versus 0.5 consultations for the nephrology service (P = 0.001). The risk of readmission was 24% for nephrologists and 30% for internists (P = 0.328). Death within 90 days of discharge was 12% for the nephrology group and 22% for the internal medicine group (P = 0.07). The length of stay was significantly shorter for hemodialysis patients under the care of nephrologists compared with internists. The average total costs and risk of readmissions tended to be lower for nephrologists. If these results are corroborated, the care of hemodialysis patients by the nephrologist could diminish the overall expense of the ESRD program.

scholarly journals Resident-driven Quality Improvement Pre-post Intervention Targeting Reduction of Emergency Department Decision to Admit Time

1970 ◽  
Vol 11 (2) ◽  
Author(s):  
Rahim Kachra MD ◽  
Alison Walzak MD ◽  
Stacey Hall MD ◽  
William JA Connors MD ◽  
Katherine A Eso MS ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
Quality Improvement ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Healthcare Systems ◽  
Teaching Hospitals ◽  
Wait Times ◽  
Post Intervention

Long Emergency Department (ED) wait times represent a key point for quality improvement in many healthcare systems. A delayed ED disposition decision may lead to increased length of hospital stay, healthcare cost, and mortality. The objective of this resident-driven quality improvement (QI) intervention was to determine if a standardized resident admission protocol could reduce the ‘decision-to-admit’ (DTA) time of patients being assessed for admission to internal medicine (IM) at 3 tertiary care teaching hospitals.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Indications and practice of enteral nutrition

2014 ◽  
Vol 155 (51) ◽  
pp. 2028-2033 ◽  
Author(s):  
Judit Hallay ◽  
Dániel Nagy ◽  
Béla Fülesdi
Keyword(s):  
Risk Factors ◽  
Treatment Outcome ◽  
Enteral Nutrition ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Nutrition Therapy ◽  
Present Review ◽  
Hospitalised Patients ◽  
Impact On Treatment ◽  
Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

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