scholarly journals Variables determining clinical complexity in hospitalized Internal Medicine patients: a workload analysis

2017 ◽  
Vol 11 (2) ◽  
pp. 202
Author(s):  
Valentina Tommasi ◽  
Alessandra Campolongo ◽  
Irene Caridi ◽  
Simone Gatti ◽  
Lorena Lagana ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Rating Scale ◽  
Univariate Analysis ◽  
Index Patient ◽  
Clinical Severity ◽  
Optimal Care ◽  
Workload Analysis ◽  
High Type ◽  
Clinical Complexity ◽  
Comorbidity Index

The clinical complexity of Internal Medicine patients is a daily challenge for clinicians. Although clinical complexity cannot be directly measured, several scores describe the variability of clinical severity and comorbidity. The aim of this study was to analyze staff workload by assessing the nursing and medical complexity of patients admitted to an Internal Medicine ward. We included 40 consecutive inpatients [52.5% females, mean age 71.2 (18.2) years] classified according to the index of clinical complexity (ICC, type A: very high; type B: high; type C: moderate) and the cumulative illness rating scale (CIRS) severity and comorbidity index. Patient outcomes, hospitalization duration, tests performed, number of daily medications and time to perform standard nursing tasks were analysed across groups. Mean duration of hospitalization was 15.6 (10.1) days; in-hospital mortality was 15%. Mean CIRS severity index (SI) was 1.03 (0.31) and median CIRS comorbidity index (CI) was 2 (range 1-5). Significant differences were observed among ICC groups in time spent performing specific tasks [univariate analysis of variance F(2.37)=17.26, P&lt;0.001]. No significant differences were found between the three groups for mean CIRS-SI [F(2.37)=3.033, P=0.060] and median CIRS-CI [Kruskal Wallis test: c<sup>2</sup>(2)= 1.672, P=0.433]. Clinical complexity and caring complexity were not correlated in our sample of Internal Medicine inpatients. Optimal care of Internal Medicine patients must take into account their complexity in both the medical and nursing aspects.

Effect of statin and metformin on survival in veterans (V) with B-cell lymphoproliferative disorders (BLD).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1602-1602
Author(s):  
Shanthi Srinivas ◽  
Melanie L. Gonzalez ◽  
Sunniya Khan ◽  
Arpita Gandhi ◽  
Barbara Crump ◽  
...  
Keyword(s):  
Rating Scale ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Cox Regression Analysis ◽  
Comorbidity Index ◽  
Beta 2 Microglobulin ◽  
Ecog Ps ◽  
The Impact ◽  
Statin Use

1602 Background: The incidence of BLD has been increasing in V. As many V are on statin and metformin for comorbid conditions, we evaluated the impact of their use on survival. Methods: In an IRB-approved protocol, we reviewed the records of 332 V diagnosed with BLD from January 1997 to Dec 2011 for demographics, height(H),weight(W), BMI,statin and metformin use, clinical and laboratory data and ECOG PS. Comorbidity was assessed using the Charlson Comorbidity Index (CCI),Kaplan-Feinstein Index (KFI) and Cumulative Illness Rating Scale (CIRS). Cox regression analysis was performed using SAS v 9.2. Results: There were 332 V with a median (M) age of 70 years (27-94). The M for H 70 inches (58-78), W 183lbs (99-356.5) and BMI 26.7 kg/m2 (15.54 -48.45). The M for hemoglobin(Hgb) 12.8 g/dl (7.3-17.4), albumin 3.9(1.2-5.4), lactate dehydrogenase( LDH) 183 IU/L (85-1905), beta 2-microglobulin 2.6 mg/dl (0.8-39) . The M for CCI was 4.7 (0.8-12), KFI 2 (0-3), CIRS15 3 (0-6), CIRS16 6(0 -14), CIRS17 1.9(0-6), CIRS18 0(0-3), CIRS19 0(0-3). M survival was 1297days(4-7468).The number of V receiving statin was 167 (51%) and metformin 46 (14%). Statin use was a predictor of survival by both univariate and multivariate analysis but metformin was a predictor only by univariate analysis. Conclusions: Statin use was an independent and significant predictor of survival in this group of V with BLD and needs to be validated in a larger group of patients. [Table: see text]

KECEMASAN PASIEN PENYAKIT GINJAL KRONIS YANG MENJALANI HEMODIALISA

2019 ◽  
Vol 4 (1) ◽  
pp. 1
Author(s):  
Devi Novita Damanik
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Rating Scale ◽  
Femoral Vein ◽  
Univariate Analysis ◽  
Sampling Technique ◽  
Emotional Disturbances ◽  
Hamilton Anxiety Rating Scale ◽  
One Year ◽  
Severe Anxiety

Background: Anxiety is a condition of psychological and physiological disorders characterized by cognitive, somatic, emotional disturbances and components of behavioral sequences. Purpose: This study aims to describe the anxiety of chronic kidney disease patients undergoing hemodialysis. Methods: This study uses univariate analysis which will describe the anxiety level of chronic kidney disease patients undergoing hemodialysis. The anxiety variable was measured using the HARS (Hamilton Anxiety Rating Scale) anxiety instrument with a validity value of 0.68 dd 0.93 and a reliability value of 0.93. The population in this study were all chronic kidney disease patients who underwent hemodialysis and experienced anxiety. The sampling technique used in this study was purposive sampling technique. The sample in this study were patients with chronic kidney disease who met the requirements of the study patients, namely: Patients who underwent hemodialysis for less than one year, patients undergoing hemodialysis with femoral vein puncture, patients undergoing hemodialysis twice a week. Results: The results showed that the study respondents had a mild anxiety rate of 9 patients (56.25%), moderate anxiety as many as 8 patients (21.875%) and severe anxiety as many as 8 patients (21.875%). Conclusion: conclusions and implications for nursing practice. The results showed a high incidence of anxiety in patients undergoing hemodialysis and distributed evenly on mild, moderate and severe anxiety.

scholarly journals Circulating Renalase as Predictor of Renal and Cardiovascular Outcomes in Pre-Dialysis CKD Patients: A 5-Year Prospective Cohort Study

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 210
Author(s):  
Ana Cerqueira ◽  
Janete Quelhas-Santos ◽  
Inês Ferreira ◽  
Susana Sampaio ◽  
Miguel Relvas ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Hospital Admissions ◽  
Univariate Analysis ◽  
Serum Levels ◽  
Ckd Progression ◽  
Renal Outcomes ◽  
Cerebrovascular Events ◽  
All Cause Mortality ◽  
Comorbidity Index

Chronic kidney disease (CKD) is an independent risk factor for adverse cardiovascular and cerebrovascular events (MACCEs), and mortality since the earlier stages. Therefore, it is critical to identify the link between CKD and cardiovascular risk (CVR) through early and reliable biomarkers. Acknowledging that CKD and CKD progression are associated with increased sympathetic tone, which is implicated in CVR, and that renalase metabolizes catecholamines, we aimed to evaluate the relationship between renalase serum levels (RNLS) and cardiovascular and renal outcomes. The study included 40 pre-dialysis CKD patients (19F:21M) with median age of 61 (IQ 45–66) years. At baseline, we measured RNLS as well as routine biomarkers of renal and cardiovascular risk. A prospective analysis was performed to determine whether RNLS are associated with CKD progression, MACCEs, hospitalizations and all-cause mortality. At baseline, the median level of RNLS and median estimated glomerular filtration rate (eGFR) were 63.5 (IQ 48.4–82.7) µg/mL and 47 (IQ 13–119) mL/min/1.73 m2, respectively. In univariate analysis, RNLS were strongly associated with eGFR, age and Charlson Index. Over the course of a mean follow-up of 65 (47 to 70) months, 3 (7.5%) deaths, 2 (5%) fatal MACCEs, 17 (42.5%) hospital admissions occurred, and 16 (40%) patients experienced CKD progression. In univariate analysis, RNLS were associated with CKD progression (p = 0.001), hospitalizations (p = 0.001) and all-cause mortality (p = 0.022) but not with MACCEs (p = 0.094). In adjusted analysis, RNLS predicted CKD progression and hospitalizations regardless of age, Charlson comorbidity index, cardiovascular disease, hypertension, diabetes and dyslipidemia. Our results suggest that RNLS, closely related with renal function, might have a potential role as predictor of renal outcomes, hospitalizations, and mortality in pre-dialysis CKD patients.

scholarly journals Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

2021 ◽  
Author(s):  
Salvatore Corrao ◽  
Alessandro Nobili ◽  
Giuseppe Natoli ◽  
Pier Mannuccio Mannucci ◽  
Francesco Perticone ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Barthel Index ◽  
Rating Scale ◽  
Depression Scale ◽  
Cognitive Status ◽  
Hospital Death ◽  
Glycemia Level ◽  
Male Sex

Abstract Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.

Risikoabschätzung einer akuten Exazerbation bei COPD-Patienten im Rahmen einer pneumologischen Anschluss-Rehabilitation anhand der Prävalenz und Schwergradausprägung von Komorbiditäten

Pneumologie ◽  
2021 ◽  
Author(s):  
P. Luu ◽  
S. Tulka ◽  
S. Knippschild ◽  
W. Windisch ◽  
M. Spielmanns
Keyword(s):  
Receiver Operating Characteristic ◽  
Charlson Comorbidity Index ◽  
Operating Characteristic ◽  
Rating Scale ◽  
Area Under The Curve ◽  
Sensitivität Und Spezifität ◽  
Comorbidity Index ◽  
Receiver Operating

Zusammenfassung Einleitung Akute COPD-Exazerbationen (AECOPD) im Rahmen einer pneumologischen Rehabilitation (PR) sind häufige und gefährliche Komplikationen. Neben Einschränkungen der Lebensqualität führen sie zu einem Unterbrechung der PR und gefährden den PR-Erfolg. Eine Abhängigkeit zwischen dem Krankheitsstatus und einem erhöhten Risiko für eine AECOPD ist beschrieben. Dabei stellt sich die Frage, ob der Charlson Comorbidity Index (CCI) oder die Cumulative Illness Rating Scale (CIRS) dafür geeignet sind, besonders exazerbationsgefährdete COPD-Patienten in der PR im Vorfeld zu detektieren. Patienten und Methoden In einer retrospektiven Untersuchung wurden die Daten von COPD-Patienten, welche im Jahr 2018 eine PR erhielten, analysiert. Primärer Endpunkt der Untersuchung war die Punktzahl im CCI. Alle Daten wurden dem Klinikinformationssystem Phönix entnommen und COPD-Exazerbationen erfasst. Die laut Fallzahlplanung benötigten 44 Patienten wurden zufällig (mittels Zufallsliste für jede Gruppe) aus diesem Datenpool rekrutiert: 22 Patienten mit und 22 ohne Exazerbation während der PR. CCI und CIRS wurden für die eingeschlossenen Fälle für beide Gruppen bestimmt. Die Auswertung des primären Endpunktes (CCI) erfolgte durch den Gruppenvergleich der arithmetischen Mittel und der Signifikanzprüfung (Welch-Tests). Weitere statistische Lage- und Streuungsmaße wurden ergänzt (Median, Quartile, Standardabweichung).Zusätzlich wurde mittels Receiver Operating Characteristic (ROC)-Analyse sowohl für den CCI als auch für den CIRS ein optimaler Cutpoint zur Diskriminierung in AECOPD- und Nicht-AECOPD-Patienten gesucht. Ergebnisse 244 COPD-Patienten erhielten eine stationäre PR von durchschnittlich 21 Tagen, wovon 59 (24 %) während der PR eine behandlungspflichtige AECOPD erlitten. Die ausgewählten 22 Patienten mit einer AECOPD hatten einen mittleren CCI von 6,77 (SD: 1,97) und die 22 Patienten ohne AECOPD von 4,32 (SD: 1,17). Die Differenz von –2,45 war zu einem Signifikanzniveau von 5 % statistisch signifikant (p < 0,001; 95 %-KI: [–3,45 ; –1,46]). Die ROC-Analyse zeigte einen optimalen Cutpoint für den CCI bei 6 mit einer Sensitivität zur Feststellung einer AECOPD von 81,8 % und einer Spezifität von 86.,4 % mit einem Wert der AUC (area under the curve) von 0,87. Der optimale Cutpoint für den CIRS war 19 mit einer Sensitivität von 50 %, einer Spezifität von 77,2 % und einer AUC von 0,65. Schlussfolgerung COPD-Patienten mit einer akuten Exazerbation während der pneumologischen Rehabilitation haben einen höheren CCI. Mithilfe des CCI lässt sich mit einer hohen Sensitivität und Spezifität das Risiko einer AECOPD von COPD-Patienten im Rahmen eines stationären PR-Programms einschätzen.

scholarly journals Depressive symptoms and disability in acute patients with comorbidities in departments of internal medicine

2012 ◽  
pp. 261-268
Author(s):  
Salvatore La Carrubba ◽  
Loredana Manna ◽  
Carmelina Rinollo ◽  
Antonino Mazzone ◽  
Gualberto Gussoni ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Depressive Symptoms ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Female Gender ◽  
Instrumental Activities ◽  
Comorbidity Index ◽  
Acute Patients

Introduction: There are few data on the prevalence of depression among acute patients with comorbidities. The current study aimed to determine the prevalence of depressive symptoms in hospitalized patients admitted to Internal Medicine Units and the correlation between these symptoms and comorbidities and disability indexes. Materials and methods: All consecutive patients admitted to 26 Internal Medicine Units of the Italian National Public Health System in Sicily, Italy, from September 2001 to March 2002 were screened. Within 24 hours of admission, patients were administered the Geriatric Depression Scale (GDS), Mini-Mental State Examination, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Charlson’s Comorbidity Index. Results: 1,947 subjects were included in the analyses. Of the patients, 509 (26.1%) showed depressive symptoms (indicated by GDS score > 15). Depression was significantly associated (univariate analyses) with hypertension (OR 1.45; CI 95% 1.18-1.79), diabetes (OR 1.48, CI 95% 1.17-1.87), cerebrovascular disease (OR 1.50, CI 95% 1.08-2.07), cirrhosis (OR 1.49, CI 95% 1.01- 2.19), ADL score (OR 0.72: CI 95% 0.63-0.82), and IADL score (OR 0.83; CI 95% 0.78-0.87), but not with Charlson’s Comorbidity Index (OR 1.04; CI 95% 0.98-1.10). Multivariate analysis showed that independent predictive factors for depression were age (OR 1.02, CI 95% 1.01-1.02), female gender (OR 2.29, CI 95% 1.83 - 2.87), and IADL score (OR 0.86, CI 95% 0.81 - 0.93). Conclusions: The data suggest that depressive symptoms are not linked to worse clinical conditions but are associated with the loss of autonomy in Instrumental Activities of Daily Living.

scholarly journals Factors Related to Anxiety Events in Parkinson's Patients in Dr. M Djamil Padang

2021 ◽  
Vol 7 (2) ◽  
pp. 242-246
Author(s):  
Yoga Setia Kurniawan ◽  
Yuliarni Syafrita ◽  
Restu Susanti
Keyword(s):  
Marital Status ◽  
Significant Relationship ◽  
Rating Scale ◽  
Univariate Analysis ◽  
P Value ◽  
Research Subjects ◽  
Duration Of Illness ◽  
Hamilton Anxiety Rating Scale ◽  
Age And Sex ◽  
Hamilton Anxiety

Introduction : Anxiety is one of the most non-motorized symptoms in patients with Parkinson's which greatly affects the quality of life, but in clinical practice it is often neglected. Anxiety in patients with Parkinson's can accelerate motor deterioration / disability and also increase mortality. Methods: This cross-sectional study was conducted at the Neurology polyclinic Dr. M Djamil Padang from July to December 2020 in patients who had been diagnosed with Parkinson's Disease (PD) by excluding secondary Parkinson's and a history of stroke. Anxiety was measured using the Hamilton Anxiety Rating Scale (HARS). The research subjects were 60 people. Univariate analysis to present baseline characteristics and bivariate tests assessed factors associated with anxiety and the relationship between variables. A p value <0.05 was considered statistically significant. Results: Most of the subjects were male (55%) with a mean age of 58.05 ± 9.7 years and disease duration of 6.35 ± 5.29 years. By examining the Hamilton Anxiety Rating Scale (HARS), it was obtained 38.3% of Parkinson's sufferers with anxiety. There is a significant relationship between marital status, duration of illness and degree of disease with the incidence of anxiety (p <0.05) and there is no significant relationship between age and sex with the incidence of anxiety in patients with Parkinson's. Conclusion: There is a significant relationship between marital status, duration of illness and degree of disease with the incidence of anxiety in patients with Parkinson's and there is no relationship between age and sex with the incidence of anxiety in patients with Parkinson's.

scholarly journals Gambaran Faktor Risiko Kejadian Penyakit Jantung Koroner di Poliklinik Jantung RSI Siti Rahmah Padang Tahun 2017-2018

2020 ◽  
Vol 3 (1) ◽  
pp. 20-28
Author(s):  
Yushera Atika Sari ◽  
Wisda Widiastuti ◽  
Betty Fitriyasti
Keyword(s):  
Internal Medicine ◽  
Medical Records ◽  
Univariate Analysis ◽  
Secondary Data ◽  
Sampling Technique ◽  
Cross Sectional ◽  
Long Period ◽  
Survey Results ◽  
Artery Disease ◽  
Descriptive Method

Introduction: CAD occurs indirectly, usually a person will experience a process of narrowing of the coronary arteries in quite a long period of time. Primary survey results that researchers have done at Siti Rahmah Padang Hospital, recorded from 2017-2018 the number of CAD events as many as 115 cases. Aims : To obtain information about an overview of risk factors for the occurrence of coronary artery disease in the heart policlinic of Siti Rahmah Hospital Padang in 2017-2018. Method: This research covers the field of internal medicine and cardiology, this study was conducted at the Islamic hospital Siti Rahmah Padang in May to November 2019. This research used a descriptive method with a cross sectional approach using secondary data from medical records. The affordable population of this study is CAD patients who seek treatment at Siti Rahmah Hospital in Padang in 2017-2018 with 51 samples using Total Sampling technique. Univariate analysis is presented in the form of a frequency distribution table. Results: Based on the results of the study the most age was at the age of 50-59 years, 21 people (41.2%), the most sex was female, 26 people (51%), hypertension, 27 people (52,9%), experienced DM 26 people (51%) were obese, 16 people (31,4%) and hyperlipidemia, 13 people (25,5%). Conclusion : Most age 50-59 years, most sexes of women, most have hypertension, less than half are obese, most have DM and less than half have hyperlipidemia. 

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

2019 ◽  
Vol 13 (2) ◽  
pp. 95-102 ◽  
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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