scholarly journals Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department

2018 ◽  
Vol 7 (11) ◽  
pp. 386 ◽  
Author(s):  
Gringauz Irina ◽  
Cohen Refaela ◽  
Brom Adi ◽  
Davidi Avia ◽  
Hofstetter Liron ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Prospective Study ◽  
Medicine Department ◽  
Internal Medicine Department ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Significant Difference ◽  
L 14 ◽  
A Prospective Study ◽  
Alt Activity

Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL” questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died (p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality (p = 0.029). There was a significant correlation (p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.

scholarly journals Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predicts Length of Hospital Stay and Re-Admission: A Prospective Study of 980 Patients

2020 ◽  
Vol 9 (8) ◽  
pp. 2659 ◽  
Author(s):  
Sapir Anani ◽  
Gal Goldhaber ◽  
Adi Brom ◽  
Nir Lasman ◽  
Natia Turpashvili ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Admission ◽  
Prospective Study ◽  
Length Of Hospital Stay ◽  
Activity Level ◽  
Medicine Department ◽  
Frail Patients ◽  
Increased Risk ◽  
A Prospective Study ◽  
Alt Activity

Background: Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized in internal medicine departments could help better prognosticate patients in the realm of internal medicine. Methods: During a 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood alanine-amino transferase (ALT) activity, and mid-arm muscle circumference (MAMC) measurements. Results: We recruited 980 consecutive patients upon hospital admission (median age 72 years (IQR 65–79); 56.8% males). According to the FRAIL questionnaire, 106 (10.8%) patients were robust, 368 (37.5%) pre-frail, and 506 (51.7%) were frail. The median ALT value was 19IU/L (IQR 14–28). The median MAMC value was 27.8 (IQR 25.7–30.2). Patients with low ALT activity level (<17IU/L) were frailer according to their FRAIL score (3 (IQR 2–4) vs. 2 (IQR 1–3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30 days readmission in the whole cohort was 17.4%. Frail patients, according to the FRAIL score (FS), had a higher risk for 30 days readmission (for FS > 2, HR = 1.99; 95CI = 1.29–3.08; p = 0.002). Frail patients, according to low ALT activity, also had a significantly higher risk for 30 days readmission (HR = 2.22; 95CI = 1.26–3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥4 days (for FS > 2, HR = 1.87; 95CI = 1.39–2.52; p < 0.001). Frail patients, according to low ALT activity, were also at higher risk for LOS ≥4 days (HR = 1.87; 95CI = 1.39–2.52; p < 0.001). MAMC values were not correlated with patients’ LOS or risk for re-admission. Conclusion: Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

scholarly journals Acute Heart Failure in an Internal Medicine Department: A Prospective Study

2020 ◽  
Vol 18 (1) ◽  
pp. em263
Author(s):  
Rita Reis Correia ◽  
Pedro Leite Vieira ◽  
Marisa Linhares ◽  
Fábia Cruz ◽  
Sandra Martin ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Prospective Study ◽  
Acute Heart Failure ◽  
Medicine Department ◽  
Internal Medicine Department ◽  
A Prospective Study

scholarly journals Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predict Worse Short-term Clinical Outcomes. 1-Year, Prospective Study of 980 patients.

2020 ◽  
Author(s):  
Sapir Anani ◽  
Gal Goldhaber ◽  
Adi Brom ◽  
Nir Lasman ◽  
Natia Turpashvili ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Admission ◽  
Prospective Study ◽  
Clinical Outcomes ◽  
Activity Level ◽  
Short Term ◽  
Medicine Department ◽  
Frail Patients ◽  
Increased Risk ◽  
Alt Activity

Abstract Background. Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized to internal medicine departments could help better prognostication of patients in the realm of internal medicine. Methods. During 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood Alanine-amino transferase (ALT) activity and Mid-Arm Muscle Circumference (MAMC) measurements. Results. We recruited Nine-hundred and eighty consecutive patients upon hospital admission (median age 72 years (IQR 65-79); 56.8% males). According to the FRAIL questionnaire 106 (10.8%) patients were robust, 368 (37.5%) pre-frail and 506 (51.7%) were frail. The Median ALT value was 19IU/L (IQR 14-28). The median MAMC value was 27.8 (IQR 25.7-30.2). Patients with low ALT activity level (< 17IU/L) were more frail according to their FRAIL score (3 (IQR 2-4) vs. 2 (IQR 1-3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30-days readmission in the whole cohort was 17.4%. Frail patients according to the FRAIL score (FS) had a higher risk for 30-days readmission (for FS > 2, HR = 1.99; 95CI = 1.29-3.08; p = 0.002). Frail patients according to low ALT activity also had a significantly higher risk for 30-days readmission (HR = 2.22; 95CI = 1.26-3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥ 10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥ 4 days (for FS > 2, HR = 1.87; 95CI = 1.39-2.52; p < 0.001). Frail patients according to low ALT activity were also at higher risk for LOS ≥ 4 days (HR = 1.87; 95CI = 1.39-2.52; p < 0.001). MAMC values were not correlated with patients' LOS or risk for re-admission. Conclusion. Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

scholarly journals Acute pulmonary embolism in patients presenting pulmonary deterioration after admission to internal medicine wards for non-critical COVID-19.

2020 ◽  
Author(s):  
Hernan POLO FRIZ ◽  
Elia GELFI ◽  
Annalisa ORENTI ◽  
Elena MOTTO ◽  
Laura PRIMITZ ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Medicine Department ◽  
Internal Medicine Department ◽  
Increased Risk ◽  
Wells Score ◽  
Internal Medicine Wards ◽  
D Dimer

Abstract INTRODUCTION. Emerging evidence associates COVID-19 to an increased risk of acute pulmonary embolism (APE). The present study aimed to assess the prevalence of APE in patients admitted to internal medicine department wards for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects. METHODS. All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a Computer Tomography Pulmonary Angiography(CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study. RESULTS. Study populations: 41 subjects, median(IRQ) age: 71.7(63-76) years, CPTA confirmed APE=8(19.51%,CI95%:8.82%-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of D-dimer for predicting APE was 2454 ng/mL, sensitivity(CI95%):63(24-91), specificity:73(54-87), Positive Predictive Value:36(13-65), Negative Predictive Value: 89(71-98) and AUC:0.62(0.38-0.85). The standard and age-adjusted D-dimer cut-offs, and the Wells score > 2 did not associate with confirmed APE, albeit a cut-off value of D-dimer=2454 ng/mL showed an RR:3.21;CI95%:0.92-13.97;p=0.073.CONCLUSION. Among patients presenting pulmonary deterioration after admission to internal medicine wards for non-critical COVID-19, the prevalence of APE was high. The traditional diagnostic tools to identify high APE pre-test probability patients does not seem to be clinically useful. These results support the use of a low threshold of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.

scholarly journals Acute pulmonary embolism in acutely ill COVID-19 patients admitted to internal medicine wards.

2020 ◽  
Author(s):  
Hernan POLO FRIZ ◽  
Elia GELFI ◽  
Annalisa ORENTI ◽  
Elena MOTTO ◽  
Laura PRIMITZ ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Tools ◽  
Medicine Department ◽  
Internal Medicine Department ◽  
Increased Risk ◽  
Wells Score ◽  
D Dimer

Abstract INTRODUCTION. Emerging evidence linking COVID-19 to an increased risk of acute pulmonary embolism (APE). The aim of the present study was to assess the prevalence of APE in acutely ill COVID-19 patients admitted to internal medicine department wards and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE. METHODS. All consecutive patients admitted to the internal medicine department wards of a general hospital with a diagnosis of severe COVID-19, who performed a Computer Tomography Pulmonary Angiography(CTPA) for respiratory deterioration in April 2020, were included. RESULTS. Study populations: 41 subjects, median(IRQ) age: 71.7(63-76) years, CPTA confirmed APE=8(19.51%,CI95%:8.82%-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of D-dimer for predicting APE was 2454 ng/mL, sensitivity(CI95%):63(24-91), specificity:73(54-87), Positive Predictive Value:36(13-65), Negative Predictive Value: 89(71-98) and AUC:0.62(0.38-0.85). The standard and age-adjusted D-dimer cut-offs, and the Wells score > 2 did not associate with confirmed APE, albeit a cut-off value of D-dimer=2454 ng/mL showed an RR:3.21;CI95%:0.92-13.97;p = 0.073.CONCLUSION. In acutely ill COVID-19 patients admitted to internal medicine department wards who performed CTPA for respiratory deterioration, the prevalence of APE was high, and the traditional diagnostic tools to identify high APE pre-test probability patients did not show to be clinically useful. These results support the use of a lower threshold of suspicion to perform CTPA for excluding or confirming APE as the most appropriate approach in this clinical setting.

scholarly journals Persepsi Mahasiswa Terhadap Pelaksanaan Mini Clinical Examination Excercise (Mini-CEX) Pada Program Pendidikan Kepaniteraan Klinik

2012 ◽  
Vol 1 (2) ◽  
pp. 68
Author(s):  
Gusti Raditya K ◽  
Yoyo Suhoyo ◽  
Tridjoko Hadianto
Keyword(s):  
Internal Medicine ◽  
Professional Development ◽  
Clinical Skills ◽  
Student Perception ◽  
Medical Faculty ◽  
Assessment Methods ◽  
Medicine Department ◽  
Internal Medicine Department ◽  
Significant Difference ◽  
Perceptions Of Students

Background: Mini-CEX was developed to assess the clinical skills of students through direct observation and constructive feedback on student achievement. To test Mini-CEX well as assessment methods, it is necessary to evaluate the implementation of Mini-CEX as Mini-CEX assessment methods and benefits of the learning process, as well as the professional development of students as future doctors, in the form of assessment of students’ perceptions of the Mini- CEX implementation. The objective of this study are to validate an instrumen for measuring the level of student perceptions in the implementation of Mini-CEX in Faculty of Medicine, Universitas Gadjah Mada’s clerkship program, to know the student’s opinions about the implementation of Mini-CEX as a method of assessment in clerkship program and benefits to student learning and professional development, to know the relationship students’ Mini-CEX point to student’s perception in the implementation of Mini-CEX in clerkship program medical faculty of GMU, and to compare the perceptions of students in Mini-CEX implementation in clerkship program Medical Faculty of GMU based on the characteristics of the department.Method: Research was conducted with a cross sectional study design. The research utilized closed questionnaires, each contained 5 likert scales. The questionnaires were given to the students who conducted clerkship in Faculty of Medicine, Universitas Gadjah Mada during the period of September 2010–March 2011. A total number of 103 students who become subjects in this study, which are consisted of 72 students in Internal Medicine Department and 32 students in Neurology Department. The correlation between student perception and Mini-CEX score was analyzed by using spearman correlation test. Mann-Whitney test was used to analyze the differences student perception between both Departments.Results: Students who are conducting clerkship program in Internal Medicine Department and Neurology Department Faculty of Medicine Universitas Gadjah Mada agree that Mini-CEX can be as assessment and learning tools, and promote the development of student professionalism. Perceptions of students towards the implementation of Mini-CEX in clerkship are not associated with Mini-CEX score. There was no significant difference in students’ perceptions towards the implementation of Mini-CEX between Internal Medicine Department students and Neurology Department students.Conclusion: Students perceived the Mini-CEX to be a practical assessment tool with a positive impact on their learning and professionalism development during clerkship.

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