Different Hypercoagulable Profiles in Patients with COVID-19 Admitted to the Internal Medicine Ward and the Intensive Care Unit

AbstractAcute pancreatitis, the most frequent hospitalization reason in internal medicine ward among gastrointestinal diseases, is burdened by high mortality rate. The disease manifests mainly in a mild form, but about 20-30% patients have a severe progress that requires intensive care. Patients presenting with acute pancreatitis should be clinically evaluated for organ failure signs and symptoms. Stratifying patients in the first days from symptoms onset is essential to determine therapy and care setting. The aim of our study is to evaluate prognostic factors for acute pancreatitis patients, hospitalized in internal medicine wards, and moreover, understanding the role of various prognostic scores validated in intensive care setting in predicting in-hospital mortality and/or admission to intensive care unit. We conducted a retrospective study enrolling all patients with diagnosis of acute pancreatitis admitted took an internal medicine ward between January 2013 and May 2019. Adverse outcome was considered in-hospital mortality and/or admission to intensive care unit. In total, 146 patients (137 with positive outcome and 9 with adverse outcome) were enrolled. The median age was (67.89 ± 16.44), with a slight prevalence of male (55.1%) compared to female (44.9%). C protein reactive (p = 0.02), creatinine (p = 0.01), sodium (p = 0.05), and troponin I (p = 0.013) after 48 h were significantly increased in patients with adverse outcome. In our study, progression in SOFA score independently increases the probability of adverse outcome in patients hospitalized with acute pancreatitis. SOFA score > 5 is highly predictive of in-hospital mortality (O.R. 32.00; C.I. 6.73-152.5; p = 0.001) compared to other scores. The use of an easy tool, validated in intensive care setting such as SOFA score, might help to better stratify the risk of in-hospital mortality and/or clinical worsening in patients hospitalized with acute pancreatitis in internal medicine ward.

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Internal medicine resident education in the medical intensive care unit: The impact on education and patient care of a scheduling change for didactic sessions

Yearbook of Pulmonary Disease ◽

10.1016/s8756-3452(08)70508-5 ◽

2007 ◽

Vol 2007 ◽

pp. 337-338

Author(s):

J.A. Barker

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Patient Care ◽

Resident Education ◽

Medical Intensive Care Unit ◽

Internal Medicine Resident ◽

Medicine Resident ◽

Medical Intensive Care ◽

The Impact

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Intensity of medical care in internal medicine: impact on outcomes from a trend analysis over six years

Italian Journal of Medicine ◽

10.4081/itjm.2019.1140 ◽

2019 ◽

Vol 13 (2) ◽

pp. 95-102 ◽

Cited By ~ 1

Author(s):

Walter Spagnolli ◽

Dimitri Peterlana ◽

Stefania Dorigoni ◽

Marta Rigoni ◽

Emanuele Torri ◽

...

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Medical Care ◽

Clinical Judgment ◽

Clinical Severity ◽

Early Warning Score ◽

Organizational Model ◽

Bed Management ◽

Clinical Instability

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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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

Journal of Medical Virology ◽

10.1002/jmv.26585 ◽

2020 ◽

Cited By ~ 1

Author(s):

Aldo Pezzuto ◽

Antonella Tammaro ◽

Giuseppe Tonini ◽

Massimo Ciccozzi

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Italian Experience ◽

Internal Medicine Unit

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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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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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