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Acute respiratory distress syndrome (34.7%) and acute kidney injury (13.9%) were the most common complications. In-hospital mortality was 20.9%. PSI and CURB-65 showed the highest AUROC (0.835 and 0.825, respectively). qSOFA and MuLBSTA had a lower AUROC (0.728 and 0.715, respectively). qSOFA was the most specific score (specificity 95.7%) albeit its sensitivity was only 26.2%. PSI had the highest sensitivity (84.1%) and a specificity of 72.2%.

PSI and CURB-65, specific severity scores for pneumonia, were better than qSOFA and MuLBSTA at predicting mortality in patients with COVID-19 pneumonia. Additionally, qSOFA, the simplest score to perform, was the most specific albeit the least sensitive.
PSI and CURB-65, specific severity scores for pneumonia, were better than qSOFA and MuLBSTA at predicting mortality in patients with COVID-19 pneumonia. Additionally, qSOFA, the simplest score to perform, was the most specific albeit the least sensitive.Diagnostic errors are a source of unacceptable harm in health care. However, improvement efforts have been hampered by the lack of valid measures reflecting the quality of the diagnostic process. At the same time, it has become apparent that the healthcare work system, particularly in primary care, is chaotic and stressful, leading to clinician burnout and patient harm. We propose a new construct that health systems and researchers can use to measure the quality and safety of the diagnostic process that is sensitive to the context of the health care work system. This model focuses on three measurable practices considering "don't miss" diagnoses, looking for red flags, and ensuring that clinicians avoid common diagnostic pitfalls. We believe that the performance of clinicians with respect to these factors is sensitive to the health care work system, allowing for context-dependent measurement and improvement of the diagnostic process. Such process measures will enable more rapid improvements rather than exclusively measuring outcomes related to "correct" or "incorrect" diagnoses.
In 2020, roughly 25% of applicants who matched into internal medicine (IM) residencies were international medical graduates (IMGs). We examine 12-year trends in distribution of IMGs among IM training programs and explore differences in program perceptions towards IMG recruitment.

Since 2007, Association of Program Directors in Internal Medicine Annual Surveys have collected data about trainees by medical school graduate type. Sixteen additional questions regarding perceptions of IMGs were included in the 2017 spring survey.

The 2017 survey response rate was 63.3% (236/373) and ranged from 61.9 to 70.2% for the 2007-2019 Annual Surveys. During that 12-year period, 55-70% of community programs' and 22-30% of university programs' PGY1 positions were filled by IMGs. In 2017, 45% of community programs' and 15% of university programs' interview and ranking positions were allocated to IMGs. Departmental pressure (university 45.6% [95% CI 43.7-47.5]; community 28.2% [95% CI 26.6-29.7]; p = 0.007), institutional in disparities in IMG recruitment is needed, including exploring pressures, preferences, and potential biases associated with the recruitment of IMGs.
Given efforts to reduce opioid use, and because marijuana potentially offers a lower-risk alternative for treating chronic pain, there is interest in understanding the public health impact of marijuana legalization on opioid-related outcomes.

Assess the impact of recreational and medical marijuana legalization on opioid utilization among patients receiving pharmacotherapy for pain.

Retrospective claims-based study of commercially insured patients continuously eligible for pharmacy and medical benefits from July 8, 2014 to June 30, 2017. Index pain prescription period was defined between January 8, 2015 and June 30, 2015, and longer-term opioid use examined during 2-year follow-up. Marijuana state policy on July 1, 2015, was assigned none; medical only; or medical and recreational.

Patients aged 18-62 without cancer diagnosis.

Patient receiving (1) opioid at index; (2) > 7 days' supply of index opioid; (3) opioid during follow-up; and (4) ≥ 90 days' opioid supply during follow-up. selleck Multivariable recumulative follow-up opioid days' supply (aOR = 1.18, 95% CI = 1.07-1.29; P < 0.001) than those in states with no policy.

Our analysis does not support the supposition that access to marijuana lowers use of chronic opioids for pain.
Our analysis does not support the supposition that access to marijuana lowers use of chronic opioids for pain.Hyperkalemia is a potential life-threatening condition among chronic kidney disease (CKD) patients. Available estimates of the burden of this alteration in CKD are mainly derived from large administrative databases. Since K measurements in patients in these databases are often dictated by clinical reasons, longitudinal studies including pre-planned measurements of potassium independently of clinical complication/symptoms may produce more reliable estimates of the frequency and the risk factors underlying hyperkalemia in CKD patients. We estimated the prevalence and the incidence of hyperkalemia in a longitudinal study in 752 stages 2-5 CKD patients lasting 3 years and including up to seven pre-planned assessment of key biochemical measurements including K. At baseline, 203 out of 752 patients (27%) had serum K > 5.0 mM/L and 33% had acidosis (HCO3 ≤ 22 mmol/L). Among those without hyperkalemia at baseline (n = 549), 284 patients developed this alteration across the 3-year follow-up. The point prevalence of hyts developing de novo hyperkalemia over time.
Inflammatory response and tumor marker levels have been shown to correlate with the prognosis in several human tumors. However, only a few studies on these markers have been performed in gastric cancer (GC) patients; the clinical significance of the combined markers is unclear. We aimed to evaluate the role of the combination of preoperative neutrophil-to-lymphocyte ratio (NLR) and carbohydrate antigen 19-9 (CA19-9) for predicting the prognosis of patients with GC.

This retrospective study included 458 patients who underwent gastrectomy with curative intent between January 2013 and July 2014 in the second hospital of Lanzhou University. Receiver operating characteristic curve (ROC) was performed to determine the cut-off values for biomarkers, and their prognostic values were assessed using the Kaplan-Meier curve. The combined score indicators were established based on the optimal cut-off values, which range from 0 to 2. Prognostic significances for overall survival (OS) were assessed by univariate and multivariate Cox regression analysis.
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