{"title":"Comparative analysis of patient demographics and outcomes in teaching and non-teaching hospitals in Iran.","authors":"Niusha Shahidi Sadeghi, Mohammadreza Maleki, Hassan Abolghasem Gorji, Soudabeh Vatankhah, Bahram Mohaghegh, Ali Behmanesh","doi":"10.1080/21548331.2025.2455931","DOIUrl":"10.1080/21548331.2025.2455931","url":null,"abstract":"<p><strong>Aims: </strong>This study investigates the differences in patient demographics and outcomes between teaching and non-teaching hospitals in Iran. By analyzing these differences, it aims to provide useful information for policymakers to optimize resource allocation, improve patient care, and balance educational and service delivery goals in teaching hospitals.</p><p><strong>Materials and methods: </strong>In this cross-sectional investigation, both teaching and non-teaching general hospitals were examined. A comprehensive analysis was carried out on 13 non-teaching and 25 teaching hospitals with homogeneity, utilizing Health Information System (HIS) data comprising 10,611,647 records through census sampling in 2019. Before employing the logistic regression models to clarify the relationship between a binary dependent variable (distinguishing teaching or non-teaching hospitals) and independent variables, we utilize the Recursive Feature Elimination (RFE) technique to select the most crucial predictor variables.</p><p><strong>Findings: </strong>the optimal logistic regression model revealed that the teaching status of hospitals played a crucial role as an indirect predictor for variables including referral patients, length of stay (<24 hours), patients with partial improvement, and those who received less than 3 services. It also emerged as a direct predictor for variables such as length of stay (>30 days), patients receiving more than the mean services, death rate, and patients with complete improvement. Moreover, the teaching status had an indirect impact on variables like outpatient cases, length of stay (>30 days), and paraclinical services, while directly predicting variables such as patients with supplementary insurance and vulnerable groups insurance type, rehabilitation services, clinic wards, and length of stay (between 4-30 days).</p><p><strong>Conclusion: </strong>In Iranian teaching hospitals, we observed an increase in patient numbers, extended length of stay, a rise in both the quantity and complexity of services, and more intricate patient admissions. It appears that small teaching hospitals in Iran have transitioned from being referral centers to functioning as outpatient centers with active clinics.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2455931"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital practice (1995)Pub Date : 2025-02-01Epub Date: 2024-12-15DOI: 10.1080/21548331.2024.2440305
Cristina Martínez Cuevas, María Del Carmen Rebollo Nájera, Jessica Abadía Otero, Miriam Gabella Martín, Mónica de Frutos Serna, José María Eiros Bouza, Luis Corral Gudino, José Pablo Miramontes González
{"title":"Impact of type 2 diabetes mellitus on mortality and recurrence of clostridioides difficile infection.","authors":"Cristina Martínez Cuevas, María Del Carmen Rebollo Nájera, Jessica Abadía Otero, Miriam Gabella Martín, Mónica de Frutos Serna, José María Eiros Bouza, Luis Corral Gudino, José Pablo Miramontes González","doi":"10.1080/21548331.2024.2440305","DOIUrl":"10.1080/21548331.2024.2440305","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. The infection is associated with a high mortality rate and risk of recurrence. We assessed risk factors for death or recurrent CDI (CDI) in patients with diabetes mellitus (DM).</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a single institution from 2019 to 2020. CDI was defined as a positive toxin assay for C. difficile. CDI was defined as a repeat positive toxin assay within ≤ 60 days of stopping CDI treatment. Logistic regression models were used to identify risk factors for CDI-related mortality, recurrence, and the combined outcome of mortality and recurrence.</p><p><strong>Results: </strong>Of the 252 enrolled patients with CDI, 19% had DM. Only 49% of patients with DM fully recovered after the first CDI occurrence, whereas 69% of patients without diabetes fully recovered (<i>p</i> = 0.021); 23% of patients with DM vs. 17% of patients without DM had recurrences (<i>p</i> = 0.200); and 23% of patients with DM vs. 15% of patients without DM died (<i>p</i> = 0.169). DM was associated with mortality (OR 2.75, 95% CI 0.94-8.06) and the combined outcome (OR 2.10, 95% CI 1.05-4.18). Nosocomial transmission, immunosuppression, CKD, and age were associated with mortality.</p><p><strong>Conclusions: </strong>Diabetes is associated with a worse prognosis in patients with CDI. Prevention efforts should be optimized in patients with diabetes by reducing CDI transmission and avoiding nonessential medications, such as PPIs or antibiotics when they are not necessary. [Figure: see text].</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2440305"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital practice (1995)Pub Date : 2025-02-01Epub Date: 2025-12-09DOI: 10.1080/21548331.2025.2600245
Omar Ismail, Karam Albdour, Kamel Jaber, Yazan Jaber, Amin Alsaras, Ahmad Younis, Ubadah Froukh, Yazan Momani, Sami Abu-Halaweh
{"title":"The efficacy of melatonin as a preoperative anxiolytic in real-world setting: a randomized controlled trial.","authors":"Omar Ismail, Karam Albdour, Kamel Jaber, Yazan Jaber, Amin Alsaras, Ahmad Younis, Ubadah Froukh, Yazan Momani, Sami Abu-Halaweh","doi":"10.1080/21548331.2025.2600245","DOIUrl":"10.1080/21548331.2025.2600245","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is linked to various adverse effects on anesthesia, intraoperative vital signs, and postoperative outcomes. Despite its widespread impact, managing preoperative anxiety is not consistently implemented, partly due to concerns over the efficacy and side effects of anxiolytic drugs. Previous clinical trials on the anxiolytic effect of melatonin showed conflicting results regarding its effect. Furthermore, they involved placing the patients in settings that deviate of real-world clinical practice.</p><p><strong>Objective: </strong>We sought to assess the efficacy of melatonin as a preoperative anxiolytic in real-world settings.</p><p><strong>Methods: </strong>This is a triple-blinded, randomized, controlled clinical trial that enrolled 87 patients aged 18 to 65 planned for elective surgery under general anesthesia. They were divided into three groups to receive melatonin, diazepam, or a placebo and were placed in the same waiting rooms as other non-enrolled patients. Preoperative anxiety was assessed at baseline and one-hour post-treatment using the Visual Analog Scale (VAS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS). Secondary outcomes included changes in orientation and sedation levels.</p><p><strong>Results: </strong>Of the 87 enrolled participants, 76 completed the second assessment. The median age of the participants was 38 years (IQR = 18.5), and 50.6% were females. Our study showed no significant effect of melatonin on preoperative anxiety, sedation, or orientation compared to diazepam or placebo.</p><p><strong>Conclusion: </strong>Our study highlights the need for incorporating other factors in future clinical trials on preoperative anxiety to better translate the results into a real-world setting.</p><p><strong>Clinical trial registration number: </strong>NCT06103188.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2600245"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital practice (1995)Pub Date : 2025-02-01Epub Date: 2026-02-04DOI: 10.1080/21548331.2026.2625018
Mary Kordei Oblitey, Jared Nii Oblitey, Kwame Yeboah, Klenam Dzefi-Tettey
{"title":"Diagnostic accuracy of the Wells score versus duplex ultrasound for deep vein thrombosis in a Ghanaian cohort.","authors":"Mary Kordei Oblitey, Jared Nii Oblitey, Kwame Yeboah, Klenam Dzefi-Tettey","doi":"10.1080/21548331.2026.2625018","DOIUrl":"10.1080/21548331.2026.2625018","url":null,"abstract":"<p><strong>Introduction: </strong>The Wells score, which is a 9-item clinical rule, is used to assess the diagnostic probability of deep vein thrombosis (DVT) in suspected patients. However, the accuracy of the Wells rule has not been investigated in Ghanaians.</p><p><strong>Methods: </strong>In a cross-sectional design, 138 suspected DVT patients underwent pretest probability of DVT using the Wells rule. Thereafter, a compressive duplex ultrasound study (CDUS) was performed on both legs to confirm the presence of DVT. Using the CDUS as the gold standard, the accuracy and reliability of the Wells rule were assessed as sensitivity, specificity, predictive values and accuracy diagnostic odds. Youden's index was used to determine the optimal cutoff of Wells score to predict DVT.</p><p><strong>Results: </strong>The prevalence of DVT was 38.8% and it was associated with localized tenderness [OR (95% CI) = 3.4 (1.49 - 7.76), <i>p</i> = 0.003], calf swelling [3.72 (1.7 - 8.12), <i>p</i> = 0.001] and previous DVT [4.69 (1.74 - 12.61), <i>p</i> = 0.001]. The sensitivity, specificity, and accuracy diagnostic odds ratio for the 2-level Wells score were 38.3%, 93.3%, 73.9% and 8.44 respectively. From the receiver operator characteristic analysis, the area under curve for the 2-level Wells score was 0.76 and the optimal Wells score cut-point for diagnosing DVT based on Youden's index was >1, with sensitivity, specificity, positive and negative predictive values of 69.4%, 72.1%, 58.6% and 80.5% respectively.</p><p><strong>Conclusion: </strong>The prevalence of DVT in suspected patients in our study population was 38.8% and associated with localized tenderness, calf swelling and previous DVT. Reducing the cut-point of the Wells score to 1 increased the sensitivity and accuracy of the Wells rule in our study population.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2625018"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valeria Rella, Cinzia Rotondo, Raffaele Barile, Francesca Erroi, Francesco Paolo Cantatore, Addolorata Corrado
{"title":"Glucocorticoids treatment and adverse infectious events in rheumatic diseases.","authors":"Valeria Rella, Cinzia Rotondo, Raffaele Barile, Francesca Erroi, Francesco Paolo Cantatore, Addolorata Corrado","doi":"10.1080/21548331.2024.2423598","DOIUrl":"10.1080/21548331.2024.2423598","url":null,"abstract":"<p><p>It is well known that rheumatic diseases are characterized by an increased infection risk, due to several factors, such as an intrinsically dysfunctional immune system, disease activity, and the use of immunosuppressive drugs. Glucocorticoids are widely used therapeutic agents for treating several chronic inflammatory and immune diseases, due to their anti-inflammatory and immunosuppressive effects. Their use is burdened by well-known side effects in dose- and duration of use-dependent manner. Physicians need to be aware of the mechanism of action of glucocorticoids, their side effects, particularly infectious side effects, and the significance of cumulative dose and duration of glucocorticoid treatment. Additionally, physicians shoultdleveld have knowledge of each patient and their comorbidities. They could use appropriate tools for assessing glucocorticoid-related toxicity and morbidity, particularly in the context of chronic glucocorticoid administration. This comprehensive understanding is crucial for ensuring the proper and safe use of these drugs, particularly in terms of minimizing infectious risks. The aim of this review is to focus on available data concerning the infectious risk associated to glucocorticoid treatment in rheumatic diseases, highlighting the role of the correct drug management in clinical practice and the role of the disease itself in the occurrence of this worthy side effect. We conducted a review of randomized controlled trials and observational studies about glucocorticoid use in autoimmune/rheumatic diseases, analyzing the infectious risk during glucocorticoid therapy, and its relationship with the used dose and duration of treatment.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keshav Khanijow, Nicole Rosendale, Scott Wright, Rita S Lee, Scott Nass, Angela Keniston, Monika Dalal, Leah R Jager, Tyler Anstett
{"title":"Characterizing hospitalists' comfort and familiarity with LGBTQ clinical topics.","authors":"Keshav Khanijow, Nicole Rosendale, Scott Wright, Rita S Lee, Scott Nass, Angela Keniston, Monika Dalal, Leah R Jager, Tyler Anstett","doi":"10.1080/21548331.2024.2414734","DOIUrl":"10.1080/21548331.2024.2414734","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper's objective was to understand hospitalists' comfort with LGBTQ health.</p><p><strong>Methods: </strong>A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients.</p><p><strong>Results: </strong>Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (<i>p</i> < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients.</p><p><strong>Conclusions: </strong>Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists' ability to more confidently and competently serve LGBTQ patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanjay Bandyopadhyay, Shambo Samrat Samajdar, Sirshendu Chaudhuri, Saibal Das
{"title":"An insight into the updated pharmacotherapy of metabolic-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatohepatitis (MASH) in lean individuals: a review.","authors":"Sanjay Bandyopadhyay, Shambo Samrat Samajdar, Sirshendu Chaudhuri, Saibal Das","doi":"10.1080/21548331.2024.2412513","DOIUrl":"10.1080/21548331.2024.2412513","url":null,"abstract":"<p><p>Metabolic-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatohepatitis (MASH) in lean individuals represents a distinctive subset of MASH. Current pharmacotherapies, for MASH as demonstrated in clinical trials, predominantly target obese patients with limited consideration for lean MASH. We aimed to systematically review the literature on the pharmacotherapy of lean MASH. We searched standard medical databases, such as PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov to identify eligible studies published in English up to 31 December 2023 regarding the effect of pharmacological interventions in individuals with lean MASH. We have summarized the role of various drug classes including peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, vitamin E, farnesoid X receptor agonists, selective thyroid hormone receptor-β agonists, and selective cholesterol absorption inhibitors. Consequently, lifestyle interventions, encompassing dietary modifications, exercise, and weight loss particularly directed at visceral obesity or achieving a reduction in body weight are recommended for all non-obese individuals with MASH. A highlight on the only available treatment recommendation for lean MASH is also presented. The available evidence regarding the efficacy of various drugs for the treatment of lean MASH is limited. Conclusive evidence is warranted from clinical trials exclusively involving lean individuals with MASH.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rayyan M Almusally, Hatem Elbawab, Hasan Alswiket, Ryad Alamry, Hawra Aldar, Maram Alismail, Zahra Albahrani, Zeead Alghamdi, Farouk AlReshaid, Mohammed Sabri
{"title":"Chest tube size selection for pleural effusion: from the perspective of thoracic surgeons and pulmonologists.","authors":"Rayyan M Almusally, Hatem Elbawab, Hasan Alswiket, Ryad Alamry, Hawra Aldar, Maram Alismail, Zahra Albahrani, Zeead Alghamdi, Farouk AlReshaid, Mohammed Sabri","doi":"10.1080/21548331.2024.2401315","DOIUrl":"https://doi.org/10.1080/21548331.2024.2401315","url":null,"abstract":"<p><strong>Background: </strong>The current discourse within the thoracic surgical and pulmonological communities pertains to a contentious debate over the optimal selection criteria for thoracostomy tube diameters utilized in the management of pleural effusions. A comprehensive examination of the variables that inform the clinical decision-making paradigm for the determination of appropriate chest tube calibers is imperative to enhance patient management and elevate the prognostic results.</p><p><strong>Objectives: </strong>The objective of this inquiry is to elucidate the determinants that influence thoracic surgeons and pulmonologists in their selection of chest tube size for the management of pleural effusions.</p><p><strong>Methods: </strong>This cross-sectional study was based on an electronic questionnaire that was sent to the targeted populations through e-mail or a professional WhatsApp. The survey assessed the considerations of chest tube size selection as well as the respective advantages, disadvantages, and potential complications related to each size.</p><p><strong>Results: </strong>The conducted study encompassed participants, with a nearly even distribution between thoracic surgeons (49.1%) and pulmonologists (50.9%). Most of these practitioners are within tertiary-level medical institutions (82.1%). A preference for small-bore chest tubes (SBCT), defined as < 14 French (Fr), was indicated by 54.8% of participants. The drawbacks associated with SBCT, such as kinking (60%) and blockage (70%), influenced the decision-making process negatively, while pain was a significant factor in the selection against LBCT (64%). Ultrasound guidance was a positive influence for the selection of SBCT (55%). Complications associated with LBCT included visceral and vascular injuries (55.7%), wound infection (45.3%), re-expansion pulmonary edema (43.3%), and subcutaneous emphysema (57.5%). In contrast, malposition was a complication more commonly associated with SBCT (49.1%).</p><p><strong>Conclusion: </strong>The decision regarding chest tube size was influenced by several critical factors which included the nature of pleural effusion, the volume of pleural fluid, and potential complications specific to the size of the chest tube used.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elie Bou Sanayeh, Carolla El Chamieh, Georges Khattar
{"title":"Prescription for crisis: the compounding effect of community drug shortages on Lebanon's healthcare system.","authors":"Elie Bou Sanayeh, Carolla El Chamieh, Georges Khattar","doi":"10.1080/21548331.2024.2401316","DOIUrl":"https://doi.org/10.1080/21548331.2024.2401316","url":null,"abstract":"<p><p>The multifaceted crises that Lebanon is facing have led to a shortage of medications in the country's community pharmacies. This shortage has triggered a cascade of adverse effects, rippling throughout the nation's healthcare system. In this report, we examine the causes, which range from economic turmoil to inadequate resource distribution, along with the profound impacts on public health, such as increased length of hospital stays and compromised patient care. The paper also proposes a suite of solutions aimed at mitigating the immediate challenges and paving the way for a more resilient healthcare framework.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital practice (1995)Pub Date : 2024-08-01Epub Date: 2024-07-26DOI: 10.1080/21548331.2024.2383556
Mercedes Martinez Gil, Rodrigo Fonseca, Leila K Tehrani, Janna C Castro, Shon E Meek, Bithika M Thompson, Curtiss B Cook
{"title":"Assessing outcomes of intravenous insulin therapy in non-intensive care patients.","authors":"Mercedes Martinez Gil, Rodrigo Fonseca, Leila K Tehrani, Janna C Castro, Shon E Meek, Bithika M Thompson, Curtiss B Cook","doi":"10.1080/21548331.2024.2383556","DOIUrl":"10.1080/21548331.2024.2383556","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare outcomes of using intravenous insulin infusion (IVII) therapy for managing hyperglycemia in a non-intensive care unit (ICU) versus an ICU setting.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on patients who received IVII for hyperglycemia. The analysis compared variables associated with hypoglycemic events while on IVII, and point-of-care blood glucose control and insulin regimens at discharge. Insulin administration errors occurring on IVII were determined.</p><p><strong>Results: </strong>Between November 2020 and August 2022, 881 patients received 1,106 IVIIs (780 in ICU and 326 non-ICU). A cumulative 468 days were spent on IVII in the non-ICU setting and 1564 in the ICU (total 2,032 days). The frequency of hypoglycemia on IVII was higher when provided in the non-ICU vs ICU (1.4% vs 0.7%), <i>p</i> < 0.01). Non-ICU patients had significantly higher average blood glucose during the last 24 h of the hospital stay (185 mg/dL vs 160 mg/dL, non-ICU vs. ICU, Pp < 0.01) and were more likely discharged with basal-bolus insulin therapy (<i>p</i> < 0.01). After adjusting for other variables, the probability of having hypoglycemia (OR 2.35; 95% CI 1.62-3.42; <i>p</i> < 0.001) was higher for the non-ICU cohort. In addition, patients who received IVII in the non-ICU settings had mean glucose levels nearly 26 mg/dL higher (95% CI 19.40-32.9, <i>p</i> < 0.001) at discharge vs. ICU. Seven cases of insulin errors were reported while on IVII in the non-ICU settings, compared to one in the ICU.</p><p><strong>Conclusions: </strong>A large number (468) of ICU days were avoided by providing IVII in the non-ICU setting. Of the more than 400 days of IVII therapy provided in the non-ICU, only 7 medication errors occurred. Further studies are needed to optimize IVII strategy for non-ICU patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"98-104"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}