Infectious disease consultations and newly diagnosed cancer patients

Hadano, Yoshiro; Watari, Takashi; Yagi, Hiroshi

doi:10.1097/md.0000000000020876

Cited by 3 publications

(5 citation statements)

References 27 publications

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“…Second, we did not have some specialty departments, such as the department of infectious diseases, which deals with patients with fever or inflammation of undetermined origin. 13 , 33 , 34 This would increase the percentage of fever and elevated C-reactive protein in CCs, and might have affected the results. Third, the rate of definite new diagnoses with the agreement of the two researchers was relatively low (approximately 20%).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of General Internal Medicine Consultations for Diagnosis from Specialists in a Tertiary Hospital: A Retrospective Observational Study

Yokose¹,

Harada²,

Hanai³

et al. 2022

IJGM

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Purpose The data on the diagnostic contribution of general internal medicine (GIM) consultations for undiagnosed health problems from specialists are scarce. This study aims to explore the role of generalists as diagnostic medicine consultants in tertiary care settings. Patients and Methods We conducted a retrospective observational study at a Japanese university hospital. GIM consultations for diagnosis from other departments on outpatients aged ≧ 20 years from January 2018 to December 2020 were included. Data were extracted from electronic medical records. The primary outcome was new diagnosis rates. The secondary outcomes were new diagnosis rates with clinical significance and clinical outcomes at 90 days from the index visit. Results A total of 328 patients were included. The top five consulting departments were orthopedics (17.0%), cardiovascular (10.3%), otorhinolaryngology (8.8%), neurology (8.8%), and gastroenterology (7.9%). GIM identified 456 chief complaints (CCs), and the top five were fever (10.9%), abnormal laboratory results (8.3%), fatigue (5.9%), and pain (7.4%) or numbness (4.6%) in the extremities. There were 139 (104/328 patients: 31.8%) specialty consultations from GIM, and the top five departments were rheumatology (21.1%), gastroenterology (19.2%), orthopedics (9.6%), psychiatry (9.6%), and neurology (9.6%). In total, 277 new diagnoses were established in 232 patients (70.7%), and 203 patients had new diagnoses with clinical significance (61.8%). Clinical outcomes at 90 days from the time of the index visit were resolution/improvement (60.7%), unchanged/worsened (22.3%), and unknown (17.0%). Conclusion Over 70% of GIM consultations from other departments established new diagnoses with favorable outcomes in >60% of the patients.

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Section: Discussionmentioning

confidence: 99%

Outcomes of General Internal Medicine Consultations for Diagnosis from Specialists in a Tertiary Hospital: A Retrospective Observational Study

Yokose¹,

Harada²,

Hanai³

et al. 2022

IJGM

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“…The cases related to the diagnosis were solid tumors, particularly colon cancer and hematological malignancies. In a previous study, the frequency of establishing new diagnoses during ID consultation was low (1.6%) [8]. The most common malignancies of neoplastic fever are lymphoma, especially non-Hodgkin's, leukemia, renal cell carcinoma, hepatocellular carcinoma, or other tumors metastatic to the liver [12,15].…”

Section: Plos Onementioning

confidence: 92%

“…As a result, ID consultants must not only encounter IDs but also learn about non-IDs, especially in terms of diagnosis. A previous study showed six (1.6%) inpatients received a new cancer diagnosis among the 380 inpatients who underwent ID consultations [8]. However, no epidemiologic studies have been conducted on the presentation of non-IDs during ID consultations.…”

Section: Introductionmentioning

confidence: 99%

“…Diagnostic consultations in cases of unexplained fever or symptoms are challenging for ID consultants. Although the final diagnoses in many ID consultations are IDs, at times, the final diagnoses are non-infectious diseases (non-IDs), such as drug fever, collagen vascular disease, autoimmune disease, and cancer [5][6][7][8][9]. As a result, ID consultants must not only encounter IDs but also learn about non-IDs, especially in terms of diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Non-infectious diseases in infectious disease consultation: A descriptive study in a tertiary care teaching hospital

Hadano,

Matsumoto

2023

PLoS ONE

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In this retrospective study, we aimed to investigate the frequency, trend, and nature of non-infectious diseases (non-IDs) as the final diagnosis for patients during an infectious disease (ID) consultation in an acute care hospital in Japan. This study included adult inpatients who underwent ID consultations between October 2016 and March 2018. The demographic data, clinical manifestations, and final non-ID diagnoses of cases were explored. Among the 502 patients who underwent ID consultations, 45 (9.0%) were diagnosed with non-IDs. The most common diagnoses were tumors (22.2%, n = 10), connective tissue and collagen vascular diseases (13.3%, n = 6), other inflammatory diseases (8.9%, n = 4), and drug-induced fever (8.9%, n = 4). Multiple logistic regression analysis showed that the presence of consultations for diagnosis (odds ratio [OR], 22.0; 95% confidence interval [CI], 10.1–48.2; p<0.01), consultations from the internal medicine department (OR, 2.5; 95% CI, 1.2–5.2; p = 0.02), and non-bacteremia cases (OR, 5.2; 95% CI, 1.4–19.3; p = 0.01) were independently associated with diagnosed non-IDs. Non-IDs after ID consultations were mainly tumor-related, inflammatory diseases, and drug fever. The presence of consultations for diagnosis, consultations from the internal medicine department and non-bacteremia cases were related to non-IDs among ID consultations. Further research is needed to explore the frequency and pattern of non-IDs to improve the quality of ID consultations in daily practice.

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“…Therefore, it is necessary to share the resources of IDSs within local communities to promote the appropriate use of antimicrobial agents and to improve the quality of infectious disease treatment. Although published clinical research on IDCs in Japan has been increasing, [5][6][7][8][9][10][11][12] epidemiological data regarding part-time IDCs and their importance are limited. [13] In April 2018, 1 board-certified clinical IDS started working part-time at a tertiary-care teaching hospital in Tokyo, Japan.…”

Section: Introductionmentioning

confidence: 99%

The importance of infectious disease specialists consulting on a weekly basis in a Japanese tertiary care hospital: A retrospective observational study

et al. 2023

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Limited data are available regarding part-time infectious disease consultations (IDCs) and their importance in tertiary care teaching hospitals in Japan. This is a retrospective review of IDCs from June 2016 to March 2021 and describes IDC services provided by part-time infectious disease specialists once a week for 4 hours, and their impact on the quality of medical care, including antimicrobial stewardship. Data, such as the requesting department, requesting reasons, and final diagnoses, were analyzed. In April 2018, part-time infectious disease specialists launched consultation services and attended an antimicrobial stewardship team conference. Meropenem, tazobactam/piperacillin, and cefepime monthly days of therapy (DOT) were calculated to assess the effect of each intervention; a pre-post analysis was conducted using the Kruskal-Wallis test. Additional quality improvement (QI) projects related to infectious diseases were implemented. There were 237 IDCs during the study period. Consultations were mostly requested by the General Internal Medicine, Emergency Medicine, and Cardiology departments. The most common diagnoses were bone/joint, respiratory, and genitourinary infections. Infectious disease services, even on a part-time basis, achieve good outcomes in patient management, antimicrobial stewardship, and QI projects.DOT/1000 patient-days were reduced for meropenem and cefepime, while it increased for tazobactam/piperacillin. The DOT/1000 patient-days for the 3-antipseudomonal agents significantly decreased during this period. After implementing the QI tetanus vaccination project in the Emergency Room, the number of tetanus toxoid vaccinations per month increased.

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Infectious disease consultations and newly diagnosed cancer patients

Cited by 3 publications

References 27 publications

Outcomes of General Internal Medicine Consultations for Diagnosis from Specialists in a Tertiary Hospital: A Retrospective Observational Study

Outcomes of General Internal Medicine Consultations for Diagnosis from Specialists in a Tertiary Hospital: A Retrospective Observational Study

Non-infectious diseases in infectious disease consultation: A descriptive study in a tertiary care teaching hospital

The importance of infectious disease specialists consulting on a weekly basis in a Japanese tertiary care hospital: A retrospective observational study

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