Screening of Depression Among Medical Outpatients Visiting the University Teaching Hospital of Kigali, Rwanda.

Background: Depression is a significant global public health concern, affecting individuals across different age groups and cultural backgrounds. However, screening for depression remains an essential but often neglected aspect of healthcare, particularly in outpatient settings. This study aimed to assess the prevalence of depression among outpatients visiting the internal medicine department of the University Teaching Hospital of Kigali in Rwanda and evaluate the feasibility of implementing a depression screening program in this setting. Methods: An institution-based cross-sectional study design was employed, involving 300 adult medical outpatients through convenience sampling, aged 18 years and above, who visited the internal medicine department between October 7 to November 6, 2019. The Patient Health Questionnaire-9 (PHQ-9) was used as the screening tool to assess depressive symptoms. Additionally, socio-demographic and clinical data were collected to explore potential risk factors associated with depression using a binary logistic regression model. Results: A high prevalence of depression was identified among internal medicine outpatients, with 45.7% of participants screened positive for depression, with moderate, moderately severe, and severe depression accounting for 21%, 17%, and 8%, respectively. The following factors were significantly associated with positive screening for depression: lack of formal education (OR=4.463, p=0.011, 95% CI= [1.410; 14.127]), secondary education (OR=3.402, p=0.003, 95% CI= [1.517; 7.630]), low-income (OR=2.392, p=0.049, 95% CI= [1.003; 5.706]) and headache as a chief complaint (OR=3.611, p=0.001, CI= [1.718; 7.591]). Conclusion: This study highlights the high prevalence of depression among medical outpatients. Due to the stigma associated with mental health, patients frequently seek help for physical symptoms such as headaches and other bodily complaints rather than mental health concerns. Introducing routine depression screening in medical departments could potentially facilitate early identification, and intervention, and lead to improved patient care. Future research should focus on evaluating such screening programs' effectiveness and long-term outcomes in resource-limited settings like Rwanda.

Differences in Demographics, in-Hospital Management and Short-Term Prognosis in Admissions for Acutely Decompensated Heart Failure to Cardiology vs. Internal Medicine Departments: A Prospective Study.

Heart failure (HF) is among the leading causes of unplanned hospital admissions worldwide. Patients with HF carry a high burden of comorbidities; hence, they are frequently admitted for non-cardiac conditions and managed in Internal Medicine Departments (IMD). The aim of our study was to investigate differences in demographics, in-hospital management, and short-term outcomes of HF patients admitted to IMD vs. cardiology departments (CD). A prospective cohort study enrolling consecutive patients with acutely decompensated HF either as primary or as secondary diagnosis during the index hospitalization was conducted. Our primary endpoint was a combined endpoint of in-hospital mortality and 30-day rehospitalization for HF. A total of 302 patients participated in the study, with 45% of them admitted to IMD. Patients managed by internists were older with less pronounced HF symptoms on admission. In-hospital mortality was higher for patients admitted to IMD vs. CD (21% vs. 6%, p < 0.001). The composite endpoint of in-hospital death and heart failure hospitalizations at 30 days post-discharge was higher for patients admitted to IMD both in univariate [OR: 3.2, 95% CI (1.8-5.7); p < 0.001] and in multivariate analysis [OR 3.74, 95% CI (1.72-8.12); p = 0.001]. In addition, the HF rehospitalization rate at 6 months after discharge was higher in IMD patients [HR 1.65, 95% CI (1.1, 2.4), p = 0.01]. Overall, HF patients admitted to IMD have worse short-term outcomes compared to patients admitted to CD.

Screening for late-onset Pompe disease in Internal Medicine departments in Spain.

BACKGROUND: The screening of high-risk populations using dried blood spots (DBS) has allowed the rapid identification of patients with Pompe disease, mostly in Neurology departments. The aim of the study was to determine the prevalence of late-onset Pompe disease (LOPD) among patients not previously diagnosed or tested for this entity despite presenting possible signs or symptoms of the disease in Internal Medicine departments in Spain. METHODS: This epidemiological, observational, cross-sectional, multicenter study included a single cohort of individuals with clinical suspicion of LOPD seen at Internal Medicine departments in Spain. The diagnosis of LOPD was initially established on the basis of the result of DBS. If decreased enzyme acid-alpha-1,4-glucosidase (GAA) activity was detected in DBS, additional confirmatory diagnostic measurements were conducted, including GAA activity in lymphocytes, fibroblasts, or muscle and/or genetic testing. RESULTS: The diagnosis of LOPD was confirmed in 2 out of 322 patients (0.6%). Reasons for suspecting LOPD diagnosis were polymyositis or any type of myopathy of unknown etiology (in one patient), and asymptomatic or pauci-symptomatic hyperCKemia (in the other). The time between symptom onset and LOPD diagnosis was 2.0 and 0.0 years. Both patients were asymptomatic, with no muscle weakness. Additionally, 19.7% of the non-LOPD cases received an alternative diagnosis. CONCLUSIONS: Our study highlights the existence of a hidden population of LOPD patients in Internal Medicine departments who might benefit from early diagnosis and early initiation of potential treatments.

Parameters of the complete blood count predict in hospital mortality.

INTRODUCTION: Mortality rates are used to evaluate the quality of hospital care after adjusting for disease severity and, commonly also, for age, comorbidity, and laboratory data with only few parameters of the complete blood count (CBC). OBJECTIVE: To identify the parameters of the CBC that predict independently in-hospital mortality of acutely admitted patients. POPULATION: All patients were admitted to internal medicine, cardiology, and intensive care departments at the Laniado Hospital in Israel in 2018 and 2019. VARIABLES: Independent variables were patients' age, sex, and parameters of the CBC. The outcome variable was in-hospital mortality. ANALYSIS: Logistic regression. In 2018, we identified the variables that were associated with in-hospital mortality and validated this association in the 2019 cohort. RESULTS: In the validation cohort, a model consisting of nine parameters that are commonly available in modern analyzers had a c-statistics (area under the receiver operator curve) of 0.86 and a 10%-90% risk gradient of 0%-21.4%. After including the proportions of large unstained cells, hypochromic, and macrocytic red cells, the c-statistic increased to 0.89, and the risk gradient to 0.1%-29.5%. CONCLUSION: The commonly available parameters of the CBC predict in-hospital mortality. Addition of the proportions of hypochromic red cells, macrocytic red cells, and large unstained cells may improve the predictive value of the CBC.

Risk factors associated with unintentional medication discrepancies at admission in an internal medicine department.

At admission, unintentional medication discrepancies (UMDs) can occur and may led to severe adverse events. Some of them are preventable through medication reconciliation (MR). As MR is a time-consuming activity, a better identification of high-risk patients of UMDs is mandatory. The objective was to identify risk factors associated with UMDs at admission in an internal medicine department. This prospective observational study was conducted from April 2017 to June 2019. At admission, inpatients had MR to obtain a complete list of home medications. This list was compared to prescriptions made at admission. All discrepancies were classified as intentional or UMDs. Univariate and multivariate analyses to identify the risk factors associated with UMDs were performed. MR was performed on 1157 patients (70.1 ± 16.8 years old); 550 MR (47.5%) contained at least one UMD. More than half of the UMDs (n = 892, 65.6%) corresponded to drug omission. The univariate analysis showed that age (> 60 years old), "living at home", medication preparation not performed by patient, medication-intake difficulties, number of sources consulted, MR duration, presence of a high-risk drug and the number of home medications were associated with UMDs. In the multivariate analysis, adjusted on the number of sources consulted, independent risk factors were "living at home" and the number of home medications. At admission to an internal medicine department, UMDs were frequent and associated with "living at home" and poly-medication. Our findings might help physicians to identify high-risk patients of UMDs since their admission.

Dietary and herbal supplements use among patients hospitalized in internal medicine departments.

OBJECTIVES: To assess consumption of dietary and herbal supplements (DHS) among patients in internal medicine departments and determine whether such use is documented in their medical files. METHODS: 267 patients from three internal medicine departments of an academic medical center in Haifa, Israel were assessed prospectively with questionnaires about their DHS use in the month preceding hospitalization. DHS were categorized into vitamins & minerals, herbal supplements and others. Further data was then collected from patients' medical records on socio-demographic and medical characteristics, as well as documentation of DHS use. RESULTS: 123 patients (50.6 %) used DHS on a daily basis. Most of them (53.7 %) were using more than one DHS. DHS use was more prevalent in older (OR = 1.02 [1.001-1.036], p = 0.034) and educated (OR = 0.482 [0.252-0.923], p = 0.028) patients. Vitamins & minerals were used mainly to enhance vitality and address laboratory abnormalities, whereas herbal supplements were used mainly for gastrointestinal problems (p < 0.001). DHS use was reported to the physicians by 42 % of the patients, mostly at the patients' initiative [92 (82.1 %), p < 0.001)]. Vitamins and minerals were the most reported category of DHS (94 (57.3 %), p < 0.001). The use of DHS was reported to physicians for 112 DHS (41.8 %) but only 32 DHS (11.9 %) were documented in their medical files. The documentation of vitamins and minerals was significantly higher compared to herbal supplements documentation (29 (17.7 %) & 3 (2.9 %) respectively, P < 0.001). CONCLUSIONS: DHS are commonly used by patients hospitalized in the internal medicine departments. Many patients do not report such use to the physicians, and more strikingly, physicians do not document DHS use in patient medical files. This communication gap may have serious medico-legal ramifications due to DHS side effects and DHS interactions with other DHS and with conventional drugs.

How biomarkers can improve pneumonia diagnosis and prognosis: procalcitonin and mid-regional-pro-adrenomedullin.

Aim: The diagnostic and prognostic role of procalcitonin (PCT) and mid-regional-pro-adrenomedullin (MR-proADM) were investigated in patients with pneumonia. Material & methods: A total of 168 and 77 patients with pneumonia enrolled in two different hospital settings, an internal medicine unit and an emergency unit were included in the study. PCT and MR-proADM plasma concentrations and pneumonia severity index score were measured. Median values were compared by Mann-Whitney's test. Receiver operating characteristic analysis and rank correlation were used to define the diagnostic and prognostic accuracy. Results: PCT confirmed the diagnostic role at values 0.08-0.10 ng/ml and MR-proADM the prognostic role for severe pneumonia. Significant correlation (p < 0.0001) between MR-proADM and pneumonia severity index score indicated expression of pneumonia severity. Conclusion: This combination of biomarkers presents a high positive predictive value in pneumonia diagnosis and prognosis.

Factores de riesgo y mortalidad hospitalaria de los pacientes quirúrgicos y no quirúrgicos con delirium / Risk Factors and Hospital Mortality in Surgical and Non-surgical Patients with Delirium

resumen Introducción: El delirium es un síndrome neuropsiquiátrico frecuente y con graves consecuencias, especialmente para los pacientes ancianos y con deterioro cognitivo preexistente. Métodos: Estudio descriptivo de una única cohorte retrospectiva. El objetivo es comparar los factores de riesgo y la mortalidad según el tipo de tratamiento (quirúrgico y no quirúrgico) en un grupo de pacientes con delirium hospitalizados. Resultados: Se analizó a 184 pacientes con delirium hospitalizados, por causas quirúrgicas el 29,3% y no quirúrgicas el 70,7%. El 50,5% eran mujeres; el 50% de los pacientes tenían 74 anos o menos (intervalo intercuartílico, 27 arios), con diferencias estadísticas, siendo mayores los no quirúrgicos (p = 0,002). El 42,9% de los pacientes presentaban deterioro cognitivo previo, con mayor proporción entre los no quirúrgicos (el 50,8 frente al 24,1%) y diferencias significativas (p = 0,001). El 89,7% recibía medicamentos anticolinérgicos y el 99,5%, más de 3 medicamentos, sin diferencias significativas. La mitad de los pacientes permanecieron en hospitalización 16,3 días o menos (intervalo intercuartílico, 23 días), y fue significativamente más larga la estancia en el grupo quirúrgico (p < 0,001); el 14,7% de los pacientes murieron en el hospital, sin diferencias estadísticas entre los grupos (p = 0,073). Discusión: No hubo diferencias significativas en la mortalidad entre los grupos, si bien fue mayor en el no quirúrgico (el 17,7 frente al 7,4%). En cuanto a la edad, se encontró que el grupo de mayor mortalidad (el no quirúrgico) tenía una edad y un deterioro cognitivo significativamente mayores, lo cual coincide con la literatura científica.

ABSTRACT Introduction: Delirium is a common neuropsychiatric syndrome with severe consequences, especially for elderly patients with pre-existing cognitive impairment. Methodology: Descriptive study of one retrospective cohort, with the aim of comparing risk factors and mortality between surgical treatment and non-surgical treatment in a group of hospitalised patients with delirium. Results: Of the 184 hospitalised patients with delirium analysed, 29.3% were for surgical causes and 70.7% for non-surgical causes. Just over half (50.5%) were women, and 50% of the patients were 74 years or less (interquartile range, 27 years), with statistical differences (P=.002). Prior cognitive impairment was observed in 42.9% of patients, with a greater proportion of non-surgical (50.8% vs 24.1%) with significant differences (P=.001). Anticholinergic medications were received by 89.7% of patients, and almost all of them (99.5%) received three or more medicines, with no significant differences. Half (50%) of the patients remained in hospital for 16.3 days or less (interquartile range, 23 days). Hospitalisation was significantly longer in the surgical group (P<.001). The hospital mortality was 14.7%, with no statistical differences between groups (P=.073). Discussion: Although there were no significant differences in mortality between the groups, it was higher in the non-surgical (17.7% vs. 7.4%). Increased mortality was found in the older group (non-surgical) that also had significantly greater cognitive impairment, which coincides with that in the scientific literature.

Risk Factors and Hospital Mortality in Surgical and Non-surgical Patients with Delirium. / Factores de riesgo y mortalidad hospitalaria de los pacientes quirúrgicos y no quirúrgicos con delirium.

INTRODUCTION: Delirium is a common neuropsychiatric syndrome with severe consequences, especially for elderly patients with pre-existing cognitive impairment. METHODOLOGY: Descriptive study of one retrospective cohort, with the aim of comparing risk factors and mortality between surgical treatment and non-surgical treatment in a group of hospitalised patients with delirium. RESULTS: Of the 184 hospitalised patients with delirium analysed, 29.3% were for surgical causes and 70.7% for non-surgical causes. Just over half (50.5%) were women, and 50% of the patients were 74 years or less (interquartile range, 27 years), with statistical differences (P=.002). Prior cognitive impairment was observed in 42.9% of patients, with a greater proportion of non-surgical (50.8% vs 24.1%) with significant differences (P=.001). Anticholinergic medications were received by 89.7% of patients, and almost all of them (99.5%) received three or more medicines, with no significant differences. Half (50%) of the patients remained in hospital for 16.3 days or less (interquartile range, 23 days). Hospitalisation was significantly longer in the surgical group (P<.001). The hospital mortality was 14.7%, with no statistical differences between groups (P=.073). DISCUSSION: Although there were no significant differences in mortality between the groups, it was higher in the non-surgical (17.7% vs. 7.4%). Increased mortality was found in the older group (non-surgical) that also had significantly greater cognitive impairment, which coincides with that in the scientific literature.

Impact of a training program on adherence to recommendations for care of venous lines in internal medicine departments in Spain.

A high percentage of venous lines (VLs) are placed in non-ICU patients, particularly those treated in the internal medicine department (IMD). We assessed adherence to VL care after a training program aimed at nurses and clinicians attending patients admitted to Spanish IMDs. We performed a multicenter prospective observational point prevalence study in 14 Spanish IMDs in 2013 and 2016. We included all adult patients (> 18 years) admitted to IMDs on the study day and reviewed nursing records for patients with VL in place before and after a 1-year training program during 2015. Answers from an interview with head nurses of the IMDs regarding commonly used practices in the daily management of VLs were also compared. A total of 638 and 693 patients were seen during each period, respectively, and 530 and 598 patients had ≥ 1 VL implanted (83.1 vs. 86.3%). Catheters were considered unnecessary in 12.8 and 15.0% of cases (p = 0.28). Daily recording of the need for catheter use increased from 43.8 to 71.8% (p < 0.001). Furthermore, daily monitoring of the insertion site remained very frequent (94.4 vs. 92.2%; p = 0.16). The date of insertion was recorded in 86.3 and 85.5% of cases (p = 0.73), and no combination of closed connectors with open caps increased from 74.8 to 90.3% (p < 0.001). Overall, head nurses' knowledge improved in 4 out of 14 recommendations assessed (28.6%). A simple and easy program for training on management of VLs in Spanish IMDs was associated with improved quality of care.

Factors of insulin injection-related knowledge among registered nurses of internal medicine department of Grade 3 generalized hospitals in Shanghai / 现代临床护理

Objective To investigate the insulin injection-related knowledge of the registered nurses in first-class general hospitals in Shanghai and look into its influence factors. Methods Totally 331 nurses in the hospitals were enrolled in this study. Univariate and multivariate stepwise regression were used to analyze the factors which influenced the insulin injection-related . Results The aggregate score of insulin injection-related knowledge was 54.20 ± 7.64, and the score index was 67.75%. Multiple linear regression analysis showed that such factors as professional title and nursing experience and training in the endocrinology department were the main factors of insulin injection-related knowledge (all P<0.05). Conclusion We should enhance the training to promote the injection skills so that they can assist the patients to effectively control blood sugar and improve the quality of life.