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DAILY SURVEILLANCE WITH EARLY WARNING SCORES HELP PREDICT IN HOSPITAL MORTALITY
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 color Doppler sonography showed thrombosis of left common femoral veins. Pathergy test and HLA B 51 were positive. Ophthalmologic examination showed bilateral anterior uveitis. All stabilized by colchicines, corticosteroids and anticoagulantand therapy. Conclusion: Behçet’s disease affects the young adult but has to be evoqued even at an advanced age, in order to treat adequately and prevent complications. Only an adequate and early treatment may prevent the ophthalmic and severe systemic complications in these patients.
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about the problems with the management and getting information related with the nurses’ work besides negative conditions such as work overload, to work instead of someone else despite not being volunteer. Among the nurses, 53.1% have pointed out that there were many barriers to professional improvement like shortness of the number of nurses, work overload, lack of time, economical problems and lack of financial support. Conclusions: It is important to determine and share the relevant factors in arranging descriptive characteristics and working conditions of the nurses working in internal clinics in such a manner that care and treatment services be improved qualitatively and quantitatively.
SPORADIC CJD PRESENTING WITH APHASIA DIAGNOSED IN MEDICAL ADMISSIONS UNIT Common Krystina1, Ahmed Abbas1, Adrian Hall1, Kayvan Khadjooi2, Randa Abasaeed-Elhag1, Kamran Rostami1,3. 1Department of Acute Medicine and *Radiology, Dudley Group of Hospitals NHS Foundation Trust, Birmingham, United Kingdom; 2Department of Neurosciences, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom; 3School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom Background: Creutzfeldt-Jakob disease (CJD) - a rare progressive neurodegenerative disease - belongs to the group of transmissible spongiform encephalopathies also known as prion diseases and affects one person per million per year [1]. It is not known how sporadic CJD is transmitted [2], and it is characterized by rapidly progressive dementia, ataxia, myoclonus and pyramidal and extrapyramidal motor symptoms leading to death as no effective treatment exists [2]. We present a patient with unusual clinical signs diagnosed with sporadic CJD. Case report: A 53 year old previously healthy man presented with a fourmonth history of progressive cognitive decline which was initially treated as depression. Over the past month he had rapid deterioration with aphasia being the predominant symptom. He was also ataxic, had myoclonus, personality changes and cognitive impairment. MRI showed restricted diffusion in the left cerebrum, right frontal and parietal lobes, left caudate and lentiform nuclei. The cerebrospinal fluid showed a raised protein and positive protein 14-3-3. Clinical presentation, neuroimaging findings and a positive protein 14-3-3 were compatible with diagnosis of sporadic CJD. Conclusion: Sporadic CJD is rarely diagnosed in the Medical Admissions Unit but Acute Physicians should have an index of suspicion in patients with rapidly progressive cognitive impairment, even with unusual symptoms such as predominant aphasia. References 1. Wilenius et al; Magnetoencephalographic Abnormalities in CreutzfeldtJakob Disease: A Case Report; Case Resp Neurol 2010;2 :122-7. 2. WHO factsheet on Creutzfeldt-Jakob disease. QUALIFICATIONS, WORKING CONDITIONS AND PROBLEMS OF NURSES WORKING IN INTERNAL MEDICINE CLINICS IN TURKEY Feray Gökdoùan, Sultan Tasç×, Nuran Akdemir, Ayfer Karadakovan, Nalan Akbayrak, Nimet Ovayolu, Mukadder Mollaoùlu, Sabire Yurtsever, Sakine Memiü, Aysel Bad×r, Fügen Göz, Sevgi K×z×lc×, Nesrin Nural, Hicran Ayd×n Bektaü, Nuran Tosun, Sevgisun Kapucu, Leyla Özdemir, Emine K×yak, Güler Balc× Alparslan, Yeliz Akkuü, Melahat Saylam, úmatullah Akyar, Ülkü Görgülü, Meltem Matrak Serttaü, Hafize Özdemir, Selda Yaral×. Turkish Internal Medicine Society Nurses Working Group Background: The aim of present study was to determine qualifications, working conditions and problems of nurses working in internal medicine clinics in Turkey. Methods: In this cross-sectional study, 2222 nurses who have been working for at least 3 months in internal medicine clinics and accepted to participate in the study were recruited by stratified sampling method chosen proportionally (5%) according to geographical regions. Results: Of the nurses working in the participated hospitals, 18.9% were working in internal medicine clinics, 45.7% had duration of work for 41-48 hours/week and less than 40 hours/week (34.2%). Number of beds in the clinics was between 20 and 24 besides (13.2%) changing according to the clinic type. 51.9% of the nurses lived “over-fatigue” due to work and 85.9% stated that they were carrying out other works of the clinic except for nursing practices. 54.7% of the nurses were satisfied with working in the internal medicine clinic. Nurses had mentioned about favorable thoughts such as taking a day off when needed, paying importance to teamwork, speaking
BACTERIEMIA BOVIS Belén Martín Puig, Inmaculada Muñoz Roldan, María Ferrer Civeira, Mariví Villalba, Cristina López Gonzalez-Cobos. Internal medicine, HGU Gregorio Marañón, Spain Background: It is well established the isolation of Streptococcus bovis in blood is associated with high frequency of IE and colon cancer. Recent studies proposed SBB is also associated with liver disease and extra colonic malignancy. Methods: Retrospective analysis of cases of SBB detected in our Hospital from January 2004 to December 2010. Patients´ clinical records were systematically reviewed in order to compare SBB with to without IE. Results: 26 episodes of SBB were identified, 14 (54%) presented infective endocarditis (9 males, median age 72). Patients without IE (91.6% were men, median age 63): 3 had a hepatobiliary source of infection, 1 associated with Pneumonia and 8 primary bacteremia. Principal underlying disease of SBB with IE compared to without IE were: valvular heart disease 57 vs 25%, hepatobiliary pathology 36 vs 59%, gastrointestinal disease 28.6 vs 66%, history of malignancy 21.4 vs 25% respectively. All cases with IE were caused by biotype I, whereas in no IE: 9 biotype I, 3 biotype II and 3 polymicrobial bacteremia. Colonoscopy was performed in 87% of cases with EI and 58% without IE. A colon lesion was detected in 100% of EI: 3 tubulovillous, 1 villous, 1 polyp with moderate dysplasia, 2 adenocarcinoma and inflammatory bowel disease in several. SBB without EI were found 1 tubulovillous, 1 tubular, none with cancer. Conclusion: SBB with IE: high frequency of valvular disease, biotype I, underwent colonoscopy and pre-malignancy and cancer colon. SBB without IE: hepatobiliary and gastrointestinal disease, I, II, or polymicrobial and less colonoscopy performed. DAILY SURVEILLANCE WITH EARLY WARNING SCORES HELP PREDICT IN HOSPITAL MORTALITY Mine Durusu Tanriover, Burcin Halacli, Bilgin Sait, Arzu Topeli Iskit. Hacettepe University Faculty of Medicine, Department of Internal Medicine Background: Simple physiological systems using early warning scores (EWS) are used in the acute medicine units and emergency departments to guide triage. However, data on their routine use in patient wards to help identify inpatients who are, or who may become, critically ill is lacking. Table Reasons of hospitalization and comorbidities (each patients may have one more reasons) % Reasons of Hospitalization Planned work up for various diseases Planned treatment schemes Shortness of breath Gastrointestinal problems Renal and electrolytes abnormalities Edema Impaired general condition Comorbidities Hypertension Diabetes mellitus Coronary artery disease Malignancies Heart failure Chronic renal failure Rheumatologic diseseas Endocrinopaties Gastrointestinal diseases Respiratory diseases Thrombotic events
22.9 20.2 18.6 14.4 14.2 11 10 45.3 27 18.6 16.6 16.1 15.1 14.2 13.4 8.4 7.5 4.9
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Methods: 182 patients hospitalized at Internal Medicine wards from September 2009 to July 2010 were prospectively recruited. Modified EWS were calculated at 4 hourly intervals, or more frequently when the total score is 3 or above. Patients who were hospitalized for the day, terminal cancer and who were transferred from the intensive care unit were excluded. Results: Patients who lacked a daily score calculation in more than 30% of their admission days were excluded from analysis (64 patients). The mean age of the remaining 118 patients were 56.1±19.8 and 50.8% of them were female. The major reasons for hospitalization were planned procedures and treatment for various diseases and acute shortness of breath (Table). The
most frequent comorbities were hypertension, diabetes mellitus and coronary artery disease. On follow up, 85.6% of patients were discharged. The hospital mortality was 5.9%. When the patients were compared with regard to hospital mortality, the difference between mean daily score totals were significantly higher in those who died (p< 0.001). Conclusions: Daily surveillance of early warning scores may be used to predict the hospital mortality of medical patients and to guide triage to the intensive care unit. However, extra nursing workforce that this surveillance requires should be considered.
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about the problems with the management and getting information related with the nurses’ work besides negative conditions such as work overload, to work instead of someone else despite not being volunteer. Among the nurses, 53.1% have pointed out that there were many barriers to professional improvement like shortness of the number of nurses, work overload, lack of time, economical problems and lack of financial support. Conclusions: It is important to determine and share the relevant factors in arranging descriptive characteristics and working conditions of the nurses working in internal clinics in such a manner that care and treatment services be improved qualitatively and quantitatively.
SPORADIC CJD PRESENTING WITH APHASIA DIAGNOSED IN MEDICAL ADMISSIONS UNIT Common Krystina1, Ahmed Abbas1, Adrian Hall1, Kayvan Khadjooi2, Randa Abasaeed-Elhag1, Kamran Rostami1,3. 1Department of Acute Medicine and *Radiology, Dudley Group of Hospitals NHS Foundation Trust, Birmingham, United Kingdom; 2Department of Neurosciences, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom; 3School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom Background: Creutzfeldt-Jakob disease (CJD) - a rare progressive neurodegenerative disease - belongs to the group of transmissible spongiform encephalopathies also known as prion diseases and affects one person per million per year [1]. It is not known how sporadic CJD is transmitted [2], and it is characterized by rapidly progressive dementia, ataxia, myoclonus and pyramidal and extrapyramidal motor symptoms leading to death as no effective treatment exists [2]. We present a patient with unusual clinical signs diagnosed with sporadic CJD. Case report: A 53 year old previously healthy man presented with a fourmonth history of progressive cognitive decline which was initially treated as depression. Over the past month he had rapid deterioration with aphasia being the predominant symptom. He was also ataxic, had myoclonus, personality changes and cognitive impairment. MRI showed restricted diffusion in the left cerebrum, right frontal and parietal lobes, left caudate and lentiform nuclei. The cerebrospinal fluid showed a raised protein and positive protein 14-3-3. Clinical presentation, neuroimaging findings and a positive protein 14-3-3 were compatible with diagnosis of sporadic CJD. Conclusion: Sporadic CJD is rarely diagnosed in the Medical Admissions Unit but Acute Physicians should have an index of suspicion in patients with rapidly progressive cognitive impairment, even with unusual symptoms such as predominant aphasia. References 1. Wilenius et al; Magnetoencephalographic Abnormalities in CreutzfeldtJakob Disease: A Case Report; Case Resp Neurol 2010;2 :122-7. 2. WHO factsheet on Creutzfeldt-Jakob disease. QUALIFICATIONS, WORKING CONDITIONS AND PROBLEMS OF NURSES WORKING IN INTERNAL MEDICINE CLINICS IN TURKEY Feray Gökdoùan, Sultan Tasç×, Nuran Akdemir, Ayfer Karadakovan, Nalan Akbayrak, Nimet Ovayolu, Mukadder Mollaoùlu, Sabire Yurtsever, Sakine Memiü, Aysel Bad×r, Fügen Göz, Sevgi K×z×lc×, Nesrin Nural, Hicran Ayd×n Bektaü, Nuran Tosun, Sevgisun Kapucu, Leyla Özdemir, Emine K×yak, Güler Balc× Alparslan, Yeliz Akkuü, Melahat Saylam, úmatullah Akyar, Ülkü Görgülü, Meltem Matrak Serttaü, Hafize Özdemir, Selda Yaral×. Turkish Internal Medicine Society Nurses Working Group Background: The aim of present study was to determine qualifications, working conditions and problems of nurses working in internal medicine clinics in Turkey. Methods: In this cross-sectional study, 2222 nurses who have been working for at least 3 months in internal medicine clinics and accepted to participate in the study were recruited by stratified sampling method chosen proportionally (5%) according to geographical regions. Results: Of the nurses working in the participated hospitals, 18.9% were working in internal medicine clinics, 45.7% had duration of work for 41-48 hours/week and less than 40 hours/week (34.2%). Number of beds in the clinics was between 20 and 24 besides (13.2%) changing according to the clinic type. 51.9% of the nurses lived “over-fatigue” due to work and 85.9% stated that they were carrying out other works of the clinic except for nursing practices. 54.7% of the nurses were satisfied with working in the internal medicine clinic. Nurses had mentioned about favorable thoughts such as taking a day off when needed, paying importance to teamwork, speaking
BACTERIEMIA BOVIS Belén Martín Puig, Inmaculada Muñoz Roldan, María Ferrer Civeira, Mariví Villalba, Cristina López Gonzalez-Cobos. Internal medicine, HGU Gregorio Marañón, Spain Background: It is well established the isolation of Streptococcus bovis in blood is associated with high frequency of IE and colon cancer. Recent studies proposed SBB is also associated with liver disease and extra colonic malignancy. Methods: Retrospective analysis of cases of SBB detected in our Hospital from January 2004 to December 2010. Patients´ clinical records were systematically reviewed in order to compare SBB with to without IE. Results: 26 episodes of SBB were identified, 14 (54%) presented infective endocarditis (9 males, median age 72). Patients without IE (91.6% were men, median age 63): 3 had a hepatobiliary source of infection, 1 associated with Pneumonia and 8 primary bacteremia. Principal underlying disease of SBB with IE compared to without IE were: valvular heart disease 57 vs 25%, hepatobiliary pathology 36 vs 59%, gastrointestinal disease 28.6 vs 66%, history of malignancy 21.4 vs 25% respectively. All cases with IE were caused by biotype I, whereas in no IE: 9 biotype I, 3 biotype II and 3 polymicrobial bacteremia. Colonoscopy was performed in 87% of cases with EI and 58% without IE. A colon lesion was detected in 100% of EI: 3 tubulovillous, 1 villous, 1 polyp with moderate dysplasia, 2 adenocarcinoma and inflammatory bowel disease in several. SBB without EI were found 1 tubulovillous, 1 tubular, none with cancer. Conclusion: SBB with IE: high frequency of valvular disease, biotype I, underwent colonoscopy and pre-malignancy and cancer colon. SBB without IE: hepatobiliary and gastrointestinal disease, I, II, or polymicrobial and less colonoscopy performed. DAILY SURVEILLANCE WITH EARLY WARNING SCORES HELP PREDICT IN HOSPITAL MORTALITY Mine Durusu Tanriover, Burcin Halacli, Bilgin Sait, Arzu Topeli Iskit. Hacettepe University Faculty of Medicine, Department of Internal Medicine Background: Simple physiological systems using early warning scores (EWS) are used in the acute medicine units and emergency departments to guide triage. However, data on their routine use in patient wards to help identify inpatients who are, or who may become, critically ill is lacking. Table Reasons of hospitalization and comorbidities (each patients may have one more reasons) % Reasons of Hospitalization Planned work up for various diseases Planned treatment schemes Shortness of breath Gastrointestinal problems Renal and electrolytes abnormalities Edema Impaired general condition Comorbidities Hypertension Diabetes mellitus Coronary artery disease Malignancies Heart failure Chronic renal failure Rheumatologic diseseas Endocrinopaties Gastrointestinal diseases Respiratory diseases Thrombotic events
22.9 20.2 18.6 14.4 14.2 11 10 45.3 27 18.6 16.6 16.1 15.1 14.2 13.4 8.4 7.5 4.9
S112
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Methods: 182 patients hospitalized at Internal Medicine wards from September 2009 to July 2010 were prospectively recruited. Modified EWS were calculated at 4 hourly intervals, or more frequently when the total score is 3 or above. Patients who were hospitalized for the day, terminal cancer and who were transferred from the intensive care unit were excluded. Results: Patients who lacked a daily score calculation in more than 30% of their admission days were excluded from analysis (64 patients). The mean age of the remaining 118 patients were 56.1±19.8 and 50.8% of them were female. The major reasons for hospitalization were planned procedures and treatment for various diseases and acute shortness of breath (Table). The
most frequent comorbities were hypertension, diabetes mellitus and coronary artery disease. On follow up, 85.6% of patients were discharged. The hospital mortality was 5.9%. When the patients were compared with regard to hospital mortality, the difference between mean daily score totals were significantly higher in those who died (p< 0.001). Conclusions: Daily surveillance of early warning scores may be used to predict the hospital mortality of medical patients and to guide triage to the intensive care unit. However, extra nursing workforce that this surveillance requires should be considered.