A Rare Cause of Cardiac Tamponade

Case Presentation: A 70‐year‐old white female patient was admitted fora subarachnoid hemorrhage and underwent aneurysm clipping of the anterior communicating artery. Postoperatively she complained of angina‐like pain and subsequently became hypotensive with systolic blood pressures [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on A Rare Cause of Cardiac Tamponade

Hepatoblastoma Presenting as Severe Osteopenia and Pathologic Fracture in a Medically Complex Child

Case Presentation: A 1‐year‐old girl with multiple medical problems including trisomy 18, tetralogy of Fallot, and gastroesophageal reflux presented with a 3‐week history of fever and irritability. In addition, she had had several weeks of [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Hepatoblastoma Presenting as Severe Osteopenia and Pathologic Fracture in a Medically Complex Child

A Case of Paradoxical Vocal Cord Movement

Case Presentation: A 24‐year‐old woman with no significant medical history was admitted for stridor. One month before, the patient had an uncomplicated laparoscopic cholecystectomy. She had an EGD 3 days before admission. The EGD was [...]

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Back to the Future: Redesigning the Emergency Department Admission Process to Improve Throughput

Background: At FirstHealth Moore Regional Hospital (FMRH), emergency department (ED) visits since 2003 have continued to increase at an average rate of more than 2.5%. In FY 2006 alone, visits totaled 57,678, a 3% increase [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Back to the Future: Redesigning the Emergency Department Admission Process to Improve Throughput

Habits for Lifelong Learning of Core Competencies in Hospital Medicine for Physician Assistants

Background: In 2006 both the American Academy of Physician Assistants and the Society of Hospital Medicine published core competencies (CCs) in the practice of medicine. There is no published literature on the application of CCs [...]

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Reduction in Utilization of Intravenous Proton Pump Inhibitors Following Implementation of a Computerized Physician Order Entry Order Set

Background: A number of studies reported in the literature suggest there is overuse of proton pump inhibitor (PPI) medications in hospitalized patients. Purpose: The goals of the study were to implement a computerized physician order [...]

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Preparedness of Hospitalized Patients to Quit Smoking

Background: Although counseling of inpatient smokers is a hospital quality measure, few hospitals assess preparedness of smokers to quit, an important predictor of future quit behaviors. This study aimed to assess the preparedness of hospitalized [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Preparedness of Hospitalized Patients to Quit Smoking

Improvement of Academic Inpatient Attending Physicians' Performance Scores: How Long Until Underperforming Rookies Bat the Department Average?

Background: Most inpatient physicians learn how to be attending physicians through experience, not formal training. Yet little has been written about how the performance of attending physicians changes over time. Methods: We evaluated attending physicians [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Improvement of Academic Inpatient Attending Physicians' Performance Scores: How Long Until Underperforming Rookies Bat the Department Average?

Predictive Value of Hemoglobin A1c in Type 2 Diabetic Patients Undergoing Elective Joint Arthroplasty

Background: Hospitalized diabetic patients do worse than nondiabetic patients, and the level of inpatient hyperglycemia is associated with some of this excess morbidity. We endeavored to identify if preoperative hemoglobin A1c (HbA1c) could predict the [...]

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Resource Utilization among Total Hip Arthroplasty Patients Cared for on Specialty Orthopedic Nursing Units

Background: The use of specialized orthopedic nursing units (SONUs) for patients undergoing elective total hip arthroplasty (THA) is a well‐established practice. Whether such units improve outcomes or are cost effective has not been evaluated. Our [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Resource Utilization among Total Hip Arthroplasty Patients Cared for on Specialty Orthopedic Nursing Units

Brain Abscess Following Self‐inflicted Trauma with Weaving Needle

Case Presentation: A 40‐year‐old blind woman presented with progressively altered mental status 1 week after an emergency department visit for a “viral URI.” PMH was significant for giant optic glioma, anxiety, neurodermatitis, and mild mental [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Brain Abscess Following Self‐inflicted Trauma with Weaving Needle

Tumefactive Multiple Sclerosis Presenting as Ring‐Enhancing Lesions on Computerized Tomography of the Brain in a 27‐Year‐Old Man

Case Presentation: A 27‐year‐old man presented to the emergency department with 1 week of right‐hand weakness and ataxia. Three weeks earlier, he had developed flulike symptoms consisting of headache, fatigue, and nausea. He took Theraflu, [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Tumefactive Multiple Sclerosis Presenting as Ring‐Enhancing Lesions on Computerized Tomography of the Brain in a 27‐Year‐Old Man

Radiocontrast‐Induced Acute Thrombocytopenia

Case Presentation: An 89‐year‐old white man presented to the emergency department with diffuse abdominal pain of several days' duration. He was afebrile, an abdominal exam was benign, and a stool sample was negative for occult [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Radiocontrast‐Induced Acute Thrombocytopenia

Simplifying Bed Selection Results in More Optimal Patient Care That Is Cost Effective

Background: Sleep support surfaces play an important role in preventing pressure injury in hospitalized patients. There are hundreds of specialty beds and mattresses available through scores of companies. Because of differences in terminology, facility contracts, [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Simplifying Bed Selection Results in More Optimal Patient Care That Is Cost Effective

Pediatric Observation vs. Admission Designation: Optimizing Performance Through Rapid‐Cycle Improvement

Background: In the age of declining reimbursement and insurance‐driven health care, it has become increasingly important for hospital systems to proactively address their compliance and revenue patterns. In 2003 our institution began to designate all [...]

By | 2007-05-24T12:00:35+00:00 May 24th, 2007|Uncategorized|Comments Off on Pediatric Observation vs. Admission Designation: Optimizing Performance Through Rapid‐Cycle Improvement