Purpose-Candida infective endocarditis (IE) is uncommon but often fatal. Most epidemiologic data are derived from small case series or case reports. This study was conducted to explore epidemiology, treatment patterns, and outcomes of patients with Candida IE.

Purpose: Due to the coronavirus disease-19 (COVID-19) global pandemic, the Association of American Medical Colleges (AAMC) recommended that medical students be removed from contact with patients testing positive or patients under suspicion (PUIs) for COVID-19. As a result of Detroit being a highly affected area, the Wayne State University (WSU) medical students assigned to hospital clerkships during this time were essentially prevented from performing any direct patient care activities. A model for the Internal Medicine (IM) clerkship was developed incorporating a clinical telehealth component, in order to create a safe environment for students to continue to perform meaningful patient care. Objectives: To model a curriculum whereby students have a diverse patient care experience while increasing their skill and confidence in the performance of telehealth, as measured by self-report in a required pre- and post-clerkship assessment. Participant population: Twenty, third-year medical students at the end of their academic year, assigned to the IM clerkship at the Detroit Medical Center. Methods: Students were instructed to complete the American College of Physicians (ACP) module on telehealth, given an orientation via the Zoom online platform by clinical faculty, and placed on a weekly telehealth clinic schedule, precepted by residents and attendings in IM. Survey data was collected covering students’ knowledge, skills, and attitudes surrounding telehealth at the beginning of the rotation. A mid-clerkship feedback session was held with the clerkship director, and the resultant qualitative data was assessed for themes to be compared against the baseline assessment. Determination of incremental change between pre- and post-assessment reports will be evaluated at the completion of the clerkship, with that data forthcoming. Results: Baseline survey revealed that 90% of students believed the telemedicine experience would be a valuable addition to their IM clerkship. Most were confident that, with training, they could effectively complete a telemedicine visit and 80% felt that telehealth would play an important role in their future careers. Students were pleased with the telemedicine visit logistics and with their role in actively assisting patients with the Zoom online platform. Despite initial anxiety over effectively communicating with patients prior to beginning the telemedicine experience, students demonstrated a common trend towards comfort with that aspect of the visit. Students were impressed with the amount of guidance given by resident and attending physicians in expressing empathy via a virtual platform. Overall, students were pleased with the variety of cases seen and the prompt feedback they received from resident and attending physicians after the telemedicine encounters. At the midpoint assessment, students expressed satisfaction with the overall experience and appreciated the opportunity to continue interacting with patients despite the limitations the pand...

Background: In the last decade, the proportion of people with asthma in the USA grew by nearly 15%, with 479,300 hospitalizations and 1.9 million emergency department visits in 2009 alone. The primary objective of our study was to evaluate in-hospital outcomes in patients admitted with asthma exacerbation in terms of mortality, length of stay (LOS) and hospitalization costs. Methods: We queried the HCUP's Nationwide Inpatient Sample (NIS) between 2001 and 2010 using the ICD9-CM diagnosis code 493 for asthma (n = 760,418 patients). The NIS represents 20% of all hospitals in the USA. Multivariate logistic regression analysis was used to evaluate predictors of in-hospital mortality. LOS and hospitalization costs were also analyzed. Results: The overall LOS was 3.9 days and as high as 8.3 days in patients requiring mechanical ventilation. LOS has decreased in recent years, though it continues to be higher than in 2001. The hospitalization cost increased steadily over the study period. The overall in-hospital mortality was 1% and as high as 9.8% in patients requiring mechanical ventilation. Multivariate predictors of longer LOS, higher hospitalization costs and in-hospital mortality included increasing age and hospitalizations during the winter months. Private insurance was predictive of lower hospitalization costs and LOS as well as lower in-hospital mortality. Conclusion: Asthma continues to account for significant in-hospital mortality and resource utilization, especially in mechanically ventilated patients. Age, admissions during winter months and the type of insurance are independent predictors of in-hospital outcomes.

BackgroundTo investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines.Methods and ResultsUsing data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in‐hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF‐associated admissions occurred. Rates (95% confidence intervals) of admissions and in‐hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%–3.5%) and 3.5% (2.9%–4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions was more in 2006 to 2009 (ie, 3.4% versus 1.1%; P=0.02). In 2010 to 2014, primary HF admission continued to decline by an average annual rate of 4.3% (95% confidence interval, 3.9%–5.1%), but this was not significantly different from 2006 to 2009 (P=0.14). In contrast, there was no further decline in in‐hospital mortality trend after the guideline‐release years. For hospitalizations with HF as the secondary diagnosis, there was an upward trend in admissions in 2001 to 2005. However, the trend began to decline in 2006 to 2009, with an average annual rate of 2.4% (95% confidence interval, 0.8%–4%). Meanwhile, there was a consistent decline in in‐hospital mortality by an average annual rate of 3.7% (95% confidence interval, 3.3%–4.2%) during the study period, but the decline was more in 2006 to 2009 compared with 2001 to 2005 (ie, 5.4% versus 3.4%; P<0.001). Beyond 2009, admission and in‐hospital mortality rates continued to decline, although this was not significantly better than the preceding interval.ConclusionsFrom 2001 to 2014, HF admission and in‐hospital mortality rates declined significantly in the United States; the greatest improvements coincided with the publication of the 2005 American College of Cardiology/American Heart Association HF guidelines.