Evaluating the Outcome of Multi-Morbid Patients Cared for by Hospitalists: a Report of Integrated Medical Model in Korea

BACKGROUND: The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. METHODS: A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). RESULTS: HG LOS (median, interquartile range [IQR], 8 [5–12] days) was lower than NHG LOS (median [IQR], 10 [7–15] days), (P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant (P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5–12] vs. 10 [7–16] days, respectively, P < 0.001) with CCI of ≥ 5 points. CONCLUSION: Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.

Cumulative Positive Rate of Consecutive Sputum Polymerase Chain Reaction in Pulmonary Tuberculosis / 대한내과학회지

OBJECTIVES: The conventional methods such as smear or culture of Mycobacteria have been proved either low sensitivity and specificity or time-consuming. Polymerase chain reaction (PCR) is a rapid and sensitive alternative method to diagnose mycobacterial infection. We investigated the positive rate of sputum PCR for Mycobacterium tuberculosis by consecutive tests for its application in clinical practice. METHODS: Sputum AFB smear, culture and serial AFB PCR test were performed in all patients who were suspected of pulmonary tuberculosis. Among them, 128 patients with positive sputum PCR test were enrolled from January 1996 through March 1997. The diagnostic criteria of pulmonary tuberculosis were sputum AFB smear positive, culture positive or pathologically proven granuloma. TB-CR TM kit (Bioneer, seoul, Korea), which amplifies insertion sequence (IS6110) of Mycobacterium tuberculosis complex, was used for sputum AFB PCR. RESULTS: Of 128 patients, active pulmonary tuberculosis were 107 (male:74, female:33, mean age:48.9 year). Cumulative positive rate of sputum AFB PCR test was 89% at 1st test, 95% at 2nd test, 98% at 3rd test and 100% at 4th test. The sensitivity of sputum PCR, smear and culture was 98.0% (105/107), 85.0% (91/107) and 82.8% (77/107), respectively. The positive predictive value of sputum PCR was 83.6% (107/128). There were 21 patients who showed positive PCR test did not meet the diagnostic criteria of active tuberculosis. They had old tuberculosis with destroyed lung, history of anti- tuberculous medication (9/21), extrapulmonary tuberculosis (6/21) and other diseases (6/21). CONCLUSION: Sputum PCR test is a sensitive diagnostic tool in early diagnosis of pulmonary tuberculosis when it has been performed serially, we recommend at least 2 consecutive PCR test to achieve the sensitivity of 95%.

Salt Consumption as a risk factor of Gastric Cancer and Helicobacter pylori Infection / 대한내과학회지

OBJECTIVES: Gastric cancer is one of the most important malignancy of the gastrointestinal tract. High salt intake has been suggested as a risk factor of gastric cancer and promoting Helicobacter pylori infection. Few studies have been addressed about the relation between excessive salt intake and gastric cancer. This study was performed to investigate the relation of high salt intake to H. pylori infection and gastric cancer. METHODS: Between May 1996 and July 1997, hospitalized patients with epigastric pain or dyspepsia were prospectively recruited. Patients with underlying diseases which could reduce kidney function were excluded. Salt consumption was estimated by the urine sodium to creatinine ratio(U-Na/Cr) on fresh single urine sample. Gastric cancer was diagnosed by endoscopic biopsies. H. pylori infection was evaluated by CLOtest. Gastric cancer was classified histologically by Lauren classification. RESULTS: Ninety seven patients, 52 patients with gastric cancer and 45 patients with chronic gastritis were enrolled. There was no statistically significant difference in the sodium to creatinine ratio between gastric cancer group (173.60+/-123, range; 21-665.2) and chronic gastritis group (164.02+/-138, range; 20.4-482.7) (p=0.361). In gastric cancer, the sodium to creatinine ratio was not different between CLOtest positive and negative group (p=0.201), and among intestinal, diffuse and mixed type (p=0.419), either. CONCLUSION: This study does not support the causal relation of high salt diet on gastric carcinogenesis. There is no significant difference in H. pylori infection rate between CLOtest positive group and negative group.