Internal medicine
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Background High-quality evidence proving the superiority of hospitalist services is lacking. We developed risk-adjusted performance indicators from a multilevel prediction model using a nationwide inpatient database to evaluate hospitalist medical care for patients with aspiration pneumonia. Methods We extracted cases diagnosed with aspiration pneumonia between 2014 and 2021 from the Diagnosis Procedure Combination (DPC) database. ⋯ Indicator 2 of poor outcome and discharges within the 25th percentile in 2017 at TGH were 1.110 (95% CI 0.784-1.375) and 1.458 (95% CI 1.272-1.597), respectively. Conclusions Utilizing a nationwide inpatient database, we developed risk-adjusted performance indicators using a multilevel prediction model to evaluate hospitalist medical care for patients with aspiration pneumonia. Given the reliable results shown in the working example, these indicators have potential benefits for the accurate evaluation of the quality of medical care.
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Tiopronin is a key drug used to treat cystinuria. A 41-year-old Japanese woman with cystinuria presented with eyelid edema and weight gain after the administration of tiopronin. Her serum albumin was 1.8 g/dL and her urinary protein level was 5.5 g/gCre. ⋯ A kidney biopsy showed membranous nephropathy (MN), and an immunofluorescence analysis revealed strong deposition of immunoglobulin G4 (IgG4). However, a previous case report of tiopronin-induced MN showed staining for IgG1 and IgG3. This case report suggests a novel etiology for tiopronin-induced MN.