Predictors and inpatient outcomes of aspiration pneumonia in patients with percutaneous endoscopic gastrostomy tube: An analysis of national inpatient sample.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are commonly inserted to provide a route for enteral feeding in patients who are unlikely to have adequate oral intake for prolonged periods of time. This study aims to determine the incidence of aspiration pneumonia among PEG tube patients. METHODS: We conducted a retrospective analysis of NIS database records (October 2015 to December 2020) for patients with PEG. Primary and secondary outcomes were assessed using ICD-10-CM/PCS codes. RESULTS: We identified a total of 2,053,560 weighted hospitalizations involving patients with PEG tube. Those with aspiration pneumonia were older (mean age 67.01 vs. 63.85, p<0.01) and were predominantly male. At baseline, the aspiration pneumonia group had higher rates of dementia (AOR 1.22, 95% CI: 1.19-1.24), malnutrition (AOR 1.13, 95% CI: 1.11-1.15), cerebrovascular disease (AOR 1.29, 95% CI 1.25-1.33), cardiac arrhythmias (AOR 1.05, 95% CI 1.03-1.08), congestive heart failure (AOR 1.20, 95% CI 1.17-1.24), COPD (AOR 1.18, 95% CI 1.15-1.20), paralysis (AOR 1.06, 95% CI 1.03-1.09), alcohol abuse (AOR 1.12, 95% CI 1.07-1.17), and psychoses (AOR 1.07, 95% CI 1.02-1.13). Those with aspiration pneumonia exhibited increased mortality (p<0.01, AOR 1.59, 95% CI 1.54-1.65), higher incidence of severe sepsis (AOR 2.03, 95% CI 1.98-2.07) and longer hospital stays, and accrued greater hospital charges (p<0.01). Notably, while GERD is typically considered a risk factor for AP, our findings indicated that GERD was associated with a decreased risk of AP in this patient population. CONCLUSION: Patients with a PEG tube who develop aspiration pneumonia experience increased mortality rates, extended hospitalizations, a higher frequency of septic shock, and augmented healthcare consumption. Notably, old male, congestive heart failure, cerebrovascular disease, dementia, and COPD play a pivotal role in predicting these outcomes.

Impact of anticoagulation therapy on outcomes in patients with cirrhosis and portal vein thrombosis: A large-scale retrospective cohort study.

INTRODUCTION: Portal vein thrombosis in cirrhotic patients presents a significant clinical challenge. This study aims to (1) explore the impact of anticoagulation therapy on patient outcomes; (2) comparative outcomes in portal vein thrombosis treated between direct oral anticoagulant and Vitamin K Antagonist (VKA). MATERIALS AND METHODS: We leveraged the TriNetX database to analyze a cohort comprising 4224 patients with liver cirrhosis and PVT who were treated with anticoagulation, alongside a comparison group of 15,300 patients with the same conditions but not receiving anticoagulation therapy. RESULTS: The anticoagulated group showed a significant reduction in mortality (27.9 % vs. 34.2 %, HR = 0.723, 95 % CI: 0.678-0.770, P < 0.001). When comparing direct oral anticoagulant versus. VKA, in compensated liver cirrhosis, the direct oral anticoagulant group exhibited significantly lower mortality rates compared to VKA (17.7 % vs. 26.5 %, HR = 0.655, 95 % CI: 0.452-0.951, P = 0.025), with no significant difference in liver transplantation rates (4.0 % vs. 4.7 %, P = 0.080). In decompensated liver cirrhosis, the direct oral anticoagulant group exhibited lower mortality compared to the VKA group (23.6 % vs. 30.6 %, HR = 0.732, 95 % CI: 0.629-0.851, P < 0.001), and a higher frequency of liver transplantation was observed in the VKA group (10.6 % vs. 16.0 %, HR = 0.622, 95 % CI: 0.494-0.784, P < 0.001). Hospitalization rates were significantly lower in the direct oral anticoagulant group compared to the VKA group in decompensated cirrhosis (33.4 % vs. 38.3 %, HR = 0.830, 95 % CI: 0.695-0.992, P = 1.937). CONCLUSIONS: Our study offers compelling evidence supporting the use of anticoagulation therapy in liver cirrhosis with portal vein thrombosis. The use of DOACs in patients with both compensated and decompensated liver cirrhosis showed a marked mortality benefit.

Should primary care physicians consult on their admitted patients? A single-center survey study.

Background: With the rise of hospital medicine, care has become fragmented between inpatient and outpatient settings. Having primary care physicians (PCPs) consult on their admitted patients through televisits could improve patient and hospital outcomes, but perspectives on this model are unknown in adult hospital medicine. Methods: A single-center cross-sectional survey was conducted to compare PCP and hospitalist attitudes regarding PCP telemedicine consultation for admitted patients in a large US academic hospital. Results: A total of 120 participants (52 hospitalists and 68 PCPs) responded to the survey. Most hospitalists believed that their patients would benefit from PCP consultation, with 45.8% believing it was slightly important, 18.8% moderately important, and 22.9% quite important. The level of importance did not seem to influence the effort required, as most hospitalists would put in only a little effort (35.4%) to obtain a PCP consultation. PCPs were more inclined to consult on their admitted patients; 18.6% considered it slightly important to obtain their consultation, 35.6% believed it was moderately important, and 23.7% believed it was quite important. PCPs were willing to put more effort into setting up a PCP consultation (some effort, 45.8%) vs hospitalists (little effort, 35.4%). The most common challenge perceived by both groups was time commitment (hospitalists, 78.8%; PCPs, 75.0%). Conclusions: Both hospitalists and PCPs agree that a PCP consultation would benefit the patient's medical care in specific situations. However, views on the importance and frequency of PCP consultations vary between the two groups.

Feasibility and Safety of Intracardiac Echocardiography Guidance in Mitral Transcatheter Edge-to-Edge Repair: Analysis of the National Inpatient Sample Data From 2015 to 2020.

Data on the use of intracardiac echocardiography (ICE) guidance in mitral transcatheter edge-to-edge repair (mTEER) procedure is limited to case reports and small case series. Our study aims to assess the feasibility, safety, utilization patterns, and clinical outcomes of mTEER procedure with ICE guidance using a nationally representative real-world cohort of patients. This study used the National Inpatient Sample database from quarter 4 of 2015 to 2020. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A P value of < 0.05 was considered significant. A total of 38,770 weighted cases of mTEER were identified. Of the included patients 665 patients underwent ICE-guided mTEER while 38,105 had TEE-guided mTEER. There were no differences in the in-hospital mortality between both groups (2.5% vs 3.0%, P = 0.58). Adjusted odds of in-hospital mortality (aOR 0.83, 95%CI [0.42-1.64]) were not significantly different. There were no differences in periprocedural complications including cardiac (aOR 0.85, 95%CI [0.54-1.35]), bleeding (aOR 1.45, 95%CI [0.93-2.33]), respiratory (aOR 0.88, 95%CI [0.61-1.25]), and renal (aOR 0.89, 95%CI [0.66-1.20]) complications between patients undergoing ICE-guided vs TEE-guided mTEER. There was no difference in GI complications between both groups (aOR 1.11, 95%CI [0.46-2.70]). The adjusted length of stay was less among ICE-guided mTEER (median: 1 vs 2, P < 0.01) with lower inflation-adjusted costs of hospitalization ($35,513 vs $47,067, P < 0.01). ICE-guided mTEER is safe when compared with TEE guided mTEER with no significant differences in in-hospital mortality, cardiac, bleeding, respiratory, and renal complications.

Extramedullary chronic lymphocytic leukemia disguised as urinary tract infection.

Extramedullary and nonlymphoid organ involvement in chronic lymphocytic leukemia (CLL) is exceedingly rare, with only a few cases of bladder infiltration reported to date. Here, we present a case of a 71-year-old man with advanced-stage CLL who presented with gross hematuria initially thought to be secondary to a urinary tract infection. However, a cystoscopy with biopsy confirmed the diagnosis of extramedullary CLL with bladder involvement. The patient was started on venetoclax with improvement in symptoms and no recurrence of hematuria.

Physician attire: physicians perspectives on attire in a community hospital setting among non-surgical specialties.

Background: Several studies have demonstrated a patient preference for physicians wearing a white coat associated with improved patient satisfaction. There are few studies on physicians' perceptions of attire mainly done in the outpatient and surgical specialties. Objective: Assess non-surgical physicians' perception of attire in the hospital and to identify if any difference in the choice of attire amongst generation X and millennial physicians. Methods: We surveyed 86 physicians in the hospital with six sets of pictures of commonly worn physician attires in the hospital setting with a two-part questionnaire. Key Results: Formal attire with a white coat was found to be most favored, followed by formal without a white coat. Casual attire without a white coat was the least preferred across the surveyed attributes. The results were similar in generation X and millennial physicians. Only 49% concordance was observed with what physicians preferred and what they wore. Conclusion: Our study showed that physicians felt wearing a white coat was the best to convey specific attributes like honesty, confidence, professionalism, among others, similar to prior studies done in patients. However, less than half of the physicians surveyed themselves followed the preferred attire.

Rapid Intervention Through Telephone Encounters for Blood Pressure Control by Residents in an Outpatient Resident Clinic.

Introduction Sixty-seven million Americans have hypertensionthat costs the nation $47.5 billion each year. The aim of this study was to determine if regular phone calls by residents helped achieve better blood pressure control. Methods The study was a randomized open-labeled study in a resident-run outpatient clinic in Rochester, New York. A total of 57 poorly controlled hypertensives in the clinic were divided into two groups. All the patients received scheduled phone calls once every two weeks for a total of 24 weeks. In one group, the medications were adjusted over the phone and the other group was referred to be seen in the clinic for elevated blood pressures. Both the groups were compared to the usual standard of care group. Results Fifty-eight patients were recruited for the trial out of which 53 were used for the final data analysis. Eleven patients completed the trial and had a mean drop of systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 28 and 11 mmHg with p < 0.01 and p < 0.03, respectively. Among the patients who did not complete the trial but answered at least one phone call, the mean drop of SBP and DBP was 29 and 8 mmHg with a p < 0.001 and p < 0.008, respectively. When these were compared to the usual standard of care group, the mean drop in SBP was 28.36 (12.36-48.36), 29.85 (11.85-47.85), and 0.76 (8.04-9.56) with a p < 0.02. Conclusions Patients enrolled in the trial had much better blood pressure control compared to the usual standard of care. Residents can take greater ownership of patients to help achieve better blood pressure control. To our knowledge this is the first such study done exclusively by residents in a resident-run clinic.

Breast abscess, an early indicator for diabetes mellitus in non-lactating women: a retrospective study from rural India.

INTRODUCTION: Breast abscess is commonly seen in lactating and non-lactating women. Diabetes mellitus (DM) frequently predisposes to soft tissue infections and has many different presentations. But DM presenting in the form of breast abscess is yet to be studied, and we believe our study is the first to explore this connection. METHODS: We collected 30 cases of breast abscess in women who presented to our hospital from May 2010 to June 2011 retrospectively. They were classified into lactating and non-lactating women, and their glycemic status was evaluated, together with length of hospital stay, management, recurrence, and follow-up status after 6 months. RESULTS: We found that of the 30 patients in our study, 20% had high blood sugar levels. And 37.5% of the non-lactating women were diagnosed newly with DM. CONCLUSIONS: This study shows that DM can present as breast abscess in non-lactating women. Therefore, non-lactating women with a breast abscess should be evaluated for DM.