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Chronic obstructive pulmonary disease (COPD) poses a significant economic burden on society, and a substantial portion is related to exacerbation of COPD. The most common cause of COPD exacerbation is infection including bacterial infection requiring treatment with antibiotics. Antibiotics use is a known risk factor for Clostridioides Difficile Colitis (CDI), however little is known about the prevalence and impact of CDI on patients admitted for COPD exacerbation. We performed a study to evaluate the prevalence and outcome of CDI in COPD exacerbation patients using the National Inpatient Sample (NIS) 2010-2014. METHODS: All patients $ 18 years old with acute COPD exacerbation (ICD 9 code 491.21) were selected in the NIS database for years 2010 to 2014 and stratified into two groups based on presence or absence of CDI. ??2 tests performed for prevalence of CDI among COPD exacerbation patients, and to analyze patients' comorbidity profile between the two groups (with and without CDI). Binary logistic regression was used to analyze the impact of CDI on in-patient mortality controlling for age, gender, race and comorbidities.

Ulcers in dialysis patients have multiple etiologies; uremic pruritis is common in dialysis patients and is associated with poor outcomes; however, it is more likely to be underdiagnosed as we usually think about more serious etiologies as calciphylaxis. Here, we present a case where uremic pruritis was the leading diagnosis.

Background Pulmonary rehabilitation (PR) has multiple benefits in COPD patients. There are multiple barriers to utilize PR including lack of knowledge about the benefits of PR by providers. Objective We are conducting a Quality Improvement project to improve the referral rate of patients hospitalized for acute exacerbation of COPD to PR. Methods All patients admitted with a primary diagnosis of acute exacerbation of COPD requiring systemic steroids to Rochester General Hospital in the period between 7/1/2019 and 7/31/2019 were reviewed retrospectively. Between 7/15/2020 and 11/15/2020, we started a PR stewardship program, where we daily review patients hospitalized with acute COPD exacerbation, and then a note will be placed in the chart for the primary team to consider referring patients to PR upon discharge, patients’ charts were reviewed after discharge. The rate of referral before and after the intervention was compared. Results During the pre-intervention period, 16 patients (mean age 67.7) with confirmed COPD by spirometry were hospitalized for COPD exacerbation, among them only 2 were referred to PR upon discharge (12.5%). During the post intervention period, 16 patients (mean age 65.0) were admitted with acute COPD exacerbation, among them 10 were referred to PR upon discharge (62.5%) [50% difference (16.5%–71%, 95% CI), P value = 0.004]. Conclusion In our QI improvement project, we conclude that having a PR stewardship program to review patients hospitalized with COPD exacerbation significantly improves the referral rate to PR, and might help to improve utilization of those programs by patients who need them.