Impact of a Hospitalist-Run Procedure Service on Time to Paracentesis and Length of Stay.

Hospitals are establishing procedure services to address resident training and patient safety. We examined whether a hospitalist procedure service affects a patient's hospital length of stay (LOS) and the time from admission to paracentesis (A2P). We queried our electronic medical records for all inpatient peritoneal fluid samples from July 1, 2016, to May 31, 2019. LOS and A2P time were compared among patients who had paracentesis by the procedure service, by residents, or by radiology. Of the 1,321 procedures, 509 (38.5%) were performed by the procedure service. In the adjusted analysis, as compared with procedure service, the group that underwent paracentesis by the radiology service had a 27% longer LOS (95% CI, 2%-58%) and 40% longer A2P time (95% CI, 5%-87%). The resident group had shorter A2P (-19%; 95% CI, -33% to 0.2%; P = .05) than the procedure service group but similar LOS. To our knowledge, this is the first study that suggests patient-centered benefits of a hospitalist procedure service.

Central line-associated bloodstream infections and completion of the central line insertion checklist: A descriptive analysis comparing a dedicated procedure team to other providers.

A primary strategy of central line-associated bloodstream infection (CLABSI) prevention is standardized, aseptic insertion of central lines. We compared hospital-wide CLABSI rate pre- and post-implementation of a dedicated procedure team as well as central line checklist completion and patient-specific variables between the procedure team and other providers. No significant differences were found. Further CLABSI prevention should focus on central line maintenance.

The relationship between urinary genistein levels and serum alanine aminotransferase levels in adults in the USA: National Health and Nutrition Examination Survey 1999-2010.

BACKGROUND: Genistein, a phytoestrogen with similarities to female sex hormones, has been shown to protect against oxidative stress and fibrosis in nonalcoholic fatty liver injury in animal studies. However, few studies have examined genistein's effects on liver function in humans. PARTICIPANTS AND METHODS: We analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2010. Individuals younger than 21 years, with viral hepatitis, or with serum alanine aminotransferase (ALT) at the extremes of distribution (5% on each extreme) were excluded. Urinary genistein was normalized by urinary creatinine levels. The relationship between normalized urinary genistein (nUG) and serum ALT was examined using linear regression models with and without adjustment for potential confounders, and the differential effect of sex was examined using an interaction term. RESULTS: Of the 9864 participants, 52% were female, 50% were White, 24% were elderly, 36% had hypertension, 12% had diabetes, and 8.1% were heavy alcohol drinkers. Serum ALT was significantly lower in the highest quartile compared with the lowest quartile of nUG (22.3 vs. 23.5 U/l; P<0.001). In adjusted models, individuals in the highest quartile had 0.75 U/l lower ALT levels than those in the lowest quartile (P=0.02). We found a significant difference in ALT levels between the lowest and highest quartiles of nUG in males, but not in females (difference in differences=1.77 U/l, interaction P=0.04). CONCLUSION: We found a statistically significant association between higher nUG and lower serum ALT in males, but not in females. The sex-specific role of genistein in mitigating liver disease merits further study.

A case report of locally invasive Aspergillus fumigatus infection in a patient on canakinumab.

BACKGROUND: Canakinumab is a human monoclonal interleukin-1 antibody that has been studied in the Canakinumab Anti-Inflammatory Thrombosis Outcome Study (CANTOS) trial and shown to prevent recurrent cardiovascular events, while increasing the incidence of neutropenia and risk of severe infections. CASE SUMMARY: This is a case report of a locally invasive aspergillus infection in a patient with uncontrolled diabetes mellitus who was receiving canakinumab for 3.5 years as part of the CANTOS trial. He presented with headaches and left eye pain and was found to have a large left ethmoid sinus mass extending into the orbit on computed tomography scan of the head. Cultures from an endoscopic biopsy of left ethmoid sinus grew Aspergillus fumigatus. Canakinumab was discontinued, and he was discharged on voriconazole with improvement in his headaches and left eye pain. DISCUSSION: The anti-inflammatory properties of canakinumab could have blunted the patient's immune response allowing the mycetoma to invade adjacent tissue. If canakinumab was approved for the secondary prevention of cardiovascular events then it is important to be cognizant of its potential to delay the presentation of any infection.