HM2011 Abstract Number: 1018

Coinfection with Babesiosis and Lyme Disease in a 61‐Year‐Old Woman

Case Presentation: Ms. Y. is a 61‐year‐old salad bar chef with a medical history of dyslipidemia and osteoporosis who was admitted with fever, chills, hot flushes, and extreme fatigue for 2 days. On the day [...]

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HM2011 Abstract Number: 1017

A 24‐Year‐Old Man with Hepatitis‐Associated Aplastic Anemia

Case Presentation: Mr. Z. is a 24‐year‐old landscaper without significant medical history who presented with easy bruising and bleeding for several days. Three months prior to his presentation, he had complained of nausea, vomiting, and [...]

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HM2011 Abstract Number: 1016

Pulmonary Sporotrichosis Masquerading As Non‐Hodgkin's Lymphoma

Case Presentation: A 61‐year‐old female nonsmoker was noted to have small nodular opacities in the right lung on a routine chest roentgenogram (CXR). Subsequently, a chest computerized tomography (CT) revealed multiple nodules with primarily upper [...]

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HM2011 Abstract Number: 1015

Cough, Dyspnea, and Interstitial Lung Disease in a 20‐Year‐Old Smoker

Case Presentation: A 20‐year‐old female smoker with history of bulimia presented to the emergency department with a syncopal episode. Computerized tomography (CT) of the cervical spine was performed, which incidentally revealed cavitary pulmonary nodules in [...]

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HM2011 Abstract Number: 1014

Subacute Combined Degeneration of the Spinal Cord Associated 2Ith N2O Abuse

Case Presentation: A 28‐year‐old nursing student with a history of bipolar disorder presented to Tucson Medical Center with symptoms of ataxia and bilateral lower‐extremity weakness of a few weeks’ duration. She had paresthesias that started [...]

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HM2011 Abstract Number: 1013

Pathological Crying in a Patient with Basal Ganglia Bleeding

Case Presentation: A 62‐year‐old right‐handed white man suddenly started crying at work without clear reason. En route to the emergency room (ER), he had multiple intermittent crying spells each lasted for about 5 minutes. On [...]

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HM2011 Abstract Number: 1012

Chronic Sinusitis Complicated by Thymoma: Good's Syndrome

Case Presentation: A 62‐year‐old man was admitted to the hospital for shortness of breath, weakness, and chills. The patient had a history of chronic, recurrent sinus infections treated with multiple antibiotics over the last 3 [...]

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HM2011 Abstract Number: 1011

Cranial Nerves Ii–Xii Not Intact: Palsies to Remember

Case Presentation: A 33‐year‐old white woman with type 2 diabetes presented with left‐sided facial weakness, dysphagia, xerostomia, and decreased hearing on the left. She was presumptively diagnosed with Bell's palsy and empirically treated with a [...]

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HM2011 Abstract Number: 1010

A Masquerading Case of Meningitis

Case Presentation: A 44‐year‐old woman was admitted in early October with fever, headache, and malaise. She was employed in an elementary school cafeteria where there had been several sick children. She was treated empirically with [...]

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HM2011 Abstract Number: 435

Axial Gouty Arthropathy Causing Cord Compression

Case Presentation: A 50‐year‐old man with a history of hypertension and gout presented with 2 weeks of bilateral lower‐extremity weakness and generalized fatigue. He was diagnosed 10 years ago with gout, initially controlled with antihyperuricemic [...]

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HM2011 Abstract Number: 434

Hydralazine‐Induced Anca‐Associated Microscopic Polyangiitis

Case Presentation: A 70‐year‐old man presented to the emergency department with a recent 15‐pound weight loss over 2 months and hearing loss in this right ear. Medical history was significant for hypertension and coronary artery [...]

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HM2011 Abstract Number: 433

It's Not a Horse or Even a Zebra! a Rare Cause of a Common Condition

Case Presentation: A 40‐year‐old G9P8 Yemeni woman with hypertension and diabetes mellitus at 32 weeks of pregnancy presented to the emergency room with 11 days of left otalgia and facial droop. She also had intermittent [...]

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HM2011 Abstract Number: 432

What's Your Gut Feeling? An Unusual Cause of Intractable Diarrhea

Case Presentation: A 63‐year‐old white woman with a medical history of hypothyroidism, hypertension, hypercholesterolemia, and recent deep vein thrombosis on Coumadin presented to the emergency department with dehydration because of intractable diarrhea and intermittent emesis. [...]

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HM2011 Abstract Number: 431

A Confusing Case of Confusion

Case Presentation: A 19‐year‐old African American man was “not acting right,” so he was brought to the emergency room (ER) by his mother. Last year, he was treated for syphilis and diagnosed with HIV but [...]

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HM2011 Abstract Number: 430

Decision‐Making in the Face of Ethical Uncertainty

Case Presentation: A 51‐year‐old man with a history of depression and both oral hyperesthesia and stroke suffered during a recent dental procedure was admitted for profound weight loss, malnutrition, and constipation. During admission, he consistently [...]

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HM2011 Abstract Number: 429

Hurst Disease: A Case Report and Literature Review

Case Presentation: A 32‐year‐old woman presented to the emergency department with 2 days of diplopia, worsening headache, pharyngitis, and lethargy. She also reported at that time 1 month of abdominal pain, nausea, vomiting, and diarrhea. [...]

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HM2011 Abstract Number: 428

Cryptococcal Meningitis in an Immunocompetent Patient

Case Presentation: A 38‐year old Ethiopian man with a history of HIV, tuberculosis, and malaria was admitted to our institution for evaluation of progressively altered mental status. The patient immigrated from Ethiopia 2 weeks prior [...]

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HM2011 Abstract Number: 427

Penile Calciphylaxis: A Case Report and Review of the Literature

Case Presentation: A 45‐year‐old man with diabetes mellitus and hypertension presented with acute renal failure and multiple lesions on his penis and lower extremities. His presenting creatinine was 18, blood urea nitrogen 150, calcium 5.9, [...]

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HM2011 Abstract Number: 426

Blue Toe Syndrome in Setting of Deep Vein Thrombosis: Decisions …

Case Presentation: A 71‐year‐old woman with hypertension presented from an outside hospital for a second opinion. Five months prior to admission she discovered that she had factor V Leiden and developed a deep vein thrombosis [...]

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HM2011 Abstract Number: 425

Abdominal Pain in an Adult—considering the Totality

Case Presentation: A 35‐year‐old man was admitted with right upper quadrant pain, nausea, vomiting, and obstipation. He had had 9 presentations with 4 admissions for the same in the preceding 3 months. Recent history included [...]

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HM2011 Abstract Number: 424

When Fever, Headache, and Nuchal Rigidity Are Not Meningitis

Case Presentation: A 19‐year‐old man presented with several days of worsening fevers, severe headache, neck stiffness, and photophobia. He reported a sore throat, cough, and malaise 1 week earlier. He denied confusion, vision changes, dizziness, [...]

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HM2011 Abstract Number: 423

A Case of Rapidly Progressive Dementia with Myoclonus

Case Presentation: A 38‐year‐old man presented with gradual onset of forgetfulness, trembling, falling, and both visual and auditory hallucinations. A few months prior to admission, he became forgetful, had mood swings, and developed an unsteady [...]

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HM2011 Abstract Number: 422

Red Herrings: The Difficult Diagnosis of an Idiopathic Hypereosinophilic Syndrome Presenting As a Rare T‐Cell Lymphoma Variant

Case Presentation: A 76‐year‐old white man on chronic azathioprine therapy for presumed autoimmune kidney disease presents with marked weight loss, chronic cough, night sweats, and functional decline over several months. He was afebrile with an [...]

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HM2011 Abstract Number: 421

A Well‐Traveled Clot: Splenic Infarct from a Paradoxical Embolism

Case Presentation: A healthy 19‐year‐old white man presented with sudden‐onset severe sharp left upper quadrant (LUQ) abdominal pain radiating to the left shoulder. He was hemodynamically stable, with LUQ tenderness to mild palpation but without [...]

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HM2011 Abstract Number: 420

Mortality from Quantiferon‐Negative Miliary Tuberculosis: Missed Opportunities?

Case Presentation: A 69‐year‐old woman presented with 3 months of fever and dyspnea that remained undiagnosed after an extensive workup in a local hospital. History was pertinent for remote partially treated latent tuberculosis (TB), diabetes, [...]

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HM2011 Abstract Number: 419

Vancomycin‐Induced Acute Interstitial Nephritis

Case Presentation: A 60‐year‐old man with type 2 diabetes and hypertension was admitted for low‐grade fever and worsening rash. The patient was on intravenous vancomycin (1 g daily) for 4 weeks for right knee joint methicillin‐resistant [...]

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HM2011 Abstract Number: 418

Takotsubo Cardiomyopathy After Laparoscopic Hysterectomy

Case Presentation: A 47‐year‐old woman was referred to us from the gynecology department at our institution after she complained of chest pain. She was admitted to the hospital for abnormal uterine bleeding and pelvic pain [...]

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HM2011 Abstract Number: 417

Raising the Red Flags

Case Presentation: A 45‐year‐old woman presented with 5 months of progressive right lumbar back pain radiating to the right abdomen. She denied any history of trauma or neurological symptoms. Associated symptoms included hot flashes, diaphoresis, [...]

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HM2011 Abstract Number: 416

Fanconi Insipidus

Case Presentation: A 41‐year‐old man presented with 3 weeks of nausea, vomiting, and a 10‐pound weight loss. His medical history included hemophilia A and HIV, for which he was taking highly active antiretroviral therapy (HAART). [...]

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HM2011 Abstract Number: 415

The A,b(19) and Cs of Acute Renal Failure

Case Presentation: A 48‐year‐old man was referred from the clinic with worsening acute renal failure. He reported nausea without emesis but no other symptoms. His creatinine was 8.3 mg/dL (increased from his baseline of 1.4 mg/dL 12 [...]

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HM2011 Abstract Number: 414

Okham's Razor Revisited

Case Presentation: A 14‐year‐old African American girl with no medical history presented to the emergency room (ER) with acute diffuse abdominal pain associated with nausea and vomiting. The workup included basic laboratory evaluation and abdominal [...]

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HM2011 Abstract Number: 413

Varicella Zoster Virus Meningoencephalitis: A Case Report and Literature Review

Case Presentation: A 23‐year‐old man with untreated acquired immune deficiency syndrome (AIDS) presented with headache and new‐onset generalized seizure. He had recently been hospitalized at a local community hospital for confusion and behavior changes where [...]

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HM2011 Abstract Number: 412

Understanding the Gist of a Retroperitoneal Mass

Case Presentation: A 63‐year‐old African American woman presented with 2 weeks of progressively worsening right lower quadrant abdominal pain. She noted early satiety, constipation, and an unintentional 10‐pound weight loss. On exam, her abdomen was [...]

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HM2011 Abstract Number: 411

Microscopic Polyangiitis: Report of a Young Woman Presenting Initially with Severe Localized Myalgia

Case Presentation: A18‐year‐old healthy female presented to her primary care physician in early April with isolated right calf pain. Her initial workup included an ANA, D‐dimer, Epsteinn‐Barr virus, erythrocyte sedimentation rate (ESR), creatine kinase, and [...]

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HM2011 Abstract Number: 410

Dysgerminoma: The Nonsexy Germ Cell

Case Presentation: A 22‐year‐old woman presented to the emergency department with fever and a rash. Daily fevers had been occurring for 1 month, for which she took cephalexin and high doses of ibuprofen. She had [...]

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HM2011 Abstract Number: 409

Nephritic Syndrome with Aplastic Anemia: What Is the Unifying Diagnosis?

Case Presentation: A 51‐year‐old woman was admitted to the hospital with severe headaches, nausea, and vomiting. In the weeks preceding her admission, the previously healthy patient on no medications had developed headaches and saw her [...]

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HM2011 Abstract Number: 408

The Missing Test: A Case of Delayed Diagnosis

Case Presentation: A 57‐year‐old man with diabetes mellitus, hypertension and hyperlipidemia presented to the emergency department (ED) with fevers, rigors, and malaise for 72 hours. In the ED, vitals were normal except for temperature of [...]

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HM2011 Abstract Number: 407

Cardiac Arrest in the Hospitalized Patient and Termination of Resuscitation: A Case Report and Discussion

Case Presentation: A 56‐year‐old man was admitted to the referring hospital with progressive anemia—hemoglobin of 7.8 g/dL. He received 2 units of red blood cells. Four days later he was tachypneic and tachycardic, with a hemoglobin [...]

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HM2011 Abstract Number: 406

Iliac Vein Compression Syndrome in Pregnancy: A Case Report and Literature Review

Case Presentation: A 28‐year‐old healthy woman presented with 6 hours of severe left leg pain and swelling 1 day after an episode of syncope. She had no family history of venous thromboembolism and denied smoking [...]

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HM2011 Abstract Number: 405

When a Stiff Neck Is Not Meningitis

Case Presentation: A 13‐year‐old white female presented to the emergency room with complaints of fever, neck stiffness, headache, sore throat, phonophobia, photophobia, nausea, and malaise. She was febrile, in obvious discomfort, and on exam had [...]

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HM2011 Abstract Number: 404

Dubious Tuberculosis

Case Presentation: A 26‐year‐old man presented 4 months of a painful, growing left neck mass with purulent drainage and a 1‐week history of a bleeding suprascapular superficial skin lesion with pain. The patient tried topical [...]

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HM2011 Abstract Number: 403

A Convincing Case of Nitrofurantoin‐Induced Systemic Inflammation Response Syndrome

Case Presentation: A 79‐year‐old woman with a history of recurrent urinary tract infections (UTIs) presented with a 1‐week history of fever, chills, nausea, vomiting, and abdominal discomfort. She was treated 3 days prior by her [...]

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HM2011 Abstract Number: 402

Sweet Urine Is Not Always Diabetes!

Case Presentation: A 29‐year‐old African American man with no significant medical history presented with generalized fatigue, unintentional 25‐pound weight loss, and arthralgias. Physical examination was unremarkable. Blood work revealed creatinine 2.31 mg/dL, bicarbonate 25.2 mmol/L, glucose [...]

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HM2011 Abstract Number: 401

A Pill for Every Ill—know the Better and Bitter!

Case Presentation: A 20‐year‐old white man was admitted with a 2‐week history of intermittent right flank pain. Abdominal CT showed a 2‐mm nonobstructing stone in the lower pole of the left kidney and a 3‐mm [...]

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HM2011 Abstract Number: 400

Dysgeusia, Facial Diplegia, and Paresthesias—a Rare Variant of Guillain–´ Barre Syndrome

Case Presentation: Guillain–Barré syndrome (GBS) is widely perceived in the medical community as an autoimmune, monophasic ascending polyneuropathy with a fairly limited set of core clinical features and very similar and predictable course in the [...]

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HM2011 Abstract Number: 399

Hyperdense Middle Cerebral Artery Sign (Hmcas)—an Early Sign of Ischemic Stroke

Case Presentation: A 70‐year‐old right‐handed white man with a medical history significant for but not limited to coronary artery disease and hypertension presented to the emergency department with acute left‐sided hemiplegia, facial droop, and slurred [...]

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HM2011 Abstract Number: 398

An Unusual Case of Acute Lymphoblastic Leukemia Presenting As Multiple Bone Infarcts

Case Presentation: A 27‐year‐old African American man with a history of scoliosis status post spinal surgery as a child presented to our institution for evaluation of bone pain that began approximately 4 months prior to [...]

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HM2011 Abstract Number: 397

A Case of Ehrlichiosis Presenting As Neutropenic Fever with Typhilitis

Case Presentation: A 57‐year‐old healthy woman with no medical history was transferred to our institution for evaluation of fever, abdominal pain, and neutropenia. Patient reported that she developed abdominal pain 5 days prior to presentation [...]

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HM2011 Abstract Number: 396

Salmonella Osteomyelitis in a Patient on the Anti‐Tnf Agent Adalimumab

Case Presentation: A 62‐year‐old woman with a medical history of rheumatoid arthritis (RA), diabetes mellitus, and hypertension presented with fever of 102°F and 10/10 diffuse abdominal, lower back, and flank pain for the past week. [...]

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HM2011 Abstract Number: 395

Multiple Liver Abscesses Caused by Streptococcus Constellatus

Case Presentation: A 54‐year‐old African American woman with a history of asthma presented with a 3‐week history of left lower quadrant (LLQ) pain associated with subjective fever, nausea, and vomiting. Her medical history was unremarkable [...]

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HM2011 Abstract Number: 394

Emerging Dengue Fever in New York City

Case Presentation: A 35‐year‐old Hispanic woman from New York City presented with a 7‐day history of fever, headache, retro‐orbital pain, and myalgia. Her symptoms began during her visit to Puerto Rico, where she suffered from [...]

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HM2011 Abstract Number: 393

Rare but Fatal: The Seventh Sickle Cell Nephropathy

Case Presentation: A 34‐year‐old African American woman with history of sickle cell trait (SCT) presented with acute onset of pain in the right hip and buttock radiating down the posterior aspect of the right leg [...]

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HM2011 Abstract Number: 392

When Tumor Is the Rumor (The Converse Can Also Be True)

Case Presentation: A 78‐year‐old woman presented with 1 month of weakness and falls. She had had a 50‐pound weight loss over the previous year. Previously, she was diagnosed with breast cancer and treated with a [...]

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HM2011 Abstract Number: 391

Thicker Than Blood

Case Presentation: A 48‐year‐old man with a history of hypertension, diabetes, and hepatitis C presented to the ED after being found disorientated. He remembered driving to the grocery store, at which point he became confused, [...]

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HM2011 Abstract Number: 390

Telescoping Intestine in an Adult

Case Presentation: A 44‐year‐old male patient was admitted for recurrent progressively worsening colicky abdominal pain and bleeding per rectum of about 2 months’ duration. There was also an episode of lightheadedness and clear vomiting on [...]

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HM2011 Abstract Number: 389

A Case of Hyperpigmentation and Hypotension—finding a Unifying Diagnosis

Case Presentation: A 65‐year‐old African American man patient had a 2‐month history of generalized weakness, loss of appetite, loss of weight, and dizziness. He required hospitalization 6 weeks earlier because of hypotension, hyponatremia, hyperkalemia, and [...]

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HM2011 Abstract Number: 388

The Nile Ain't Just a River

Case Presentation: A 32‐year‐old man experienced several days of hallucinations and strange behavior. He was brought in by a coworker from an industrial ship that had sailed from India. He had been in bed for [...]

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HM2011 Abstract Number: 387

Sarcoidosis and Cryptococcal Infection: A Rare Clinical Association

Case Presentation: A 42‐year‐old African American woman presented to the hospital with a 1 week history of nasal congestion, sore throat, and fever of 38.8°C. Over 12 hours, she developed acute headache, photophobia, and neck [...]

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HM2011 Abstract Number: 386

An Orange a Day Keeps the Hospitalist Away

Case Presentation: A 31‐year‐old white man with a history of schizoaffective disorder, nonadherent to therapy, was brought to the emergency department for paranoia. The patient had developed a fear of eating, initially of most protein [...]

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HM2011 Abstract Number: 385

Case Report: Factitious Breast Cancer with Pancytopenia Secondary to Cyclophosphamide

Case Presentation: A 29‐year‐old white woman with a stated a history of stage 1 breast cancer was admitted for pancytopenia secondary to cyclophosphamide. The pancytopenia was discovered when a complete blood count (CBC) was drawn [...]

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HM2011 Abstract Number: 384

Fever, Weight Loss, Lymph Nodes—not so Bad

Case Presentation: A 13‐year‐old girl with no medical history was admitted with a 1‐month history of intermittent fever, 20‐pound weight loss, fatigue, dry cough, and 2 months of left neck mass, initially painful but now [...]

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HM2011 Abstract Number: 383

Think Zebras: Late Stage of Churg–Strauss Syndrome

Case Presentation: A 61‐year‐old woman presented to the emergency department with a painful, nonpruritic rash over the palms of the hands, elbows, face, and behind the ears for 1 week. Associated symptoms included weakness and [...]

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HM2011 Abstract Number: 382

Vitamin D Toxicity: Rare or Underdetected?

Case Presentation: Case 1 is a 58‐year‐old man presenting with obtundation, fatigue, polydipsia, and polyuria of 3 weeks’ duration. Labs showed calcium (Ca) 15 mg/dL, creatinine (Cr) 1.78 mg/dL, and normal phosphorus, magnesium, SPEP, and UPEP. Intact [...]

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HM2011 Abstract Number: 381

Diarrhea and Malabsorption in the Adult Patient: When Gluten Enteropathy Is Not a “Guten” Explanation

Case Presentation: A 64‐year‐old woman presented with diarrhea, 100‐pound weight loss, and occasional abdominal discomfort ongoing for 6 months prior to presentation. She endorsed profuse watery, green, foul‐smelling diarrhea as frequently as 6–8 times per [...]

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HM2011 Abstract Number: 380

Acute Bilateral Facial Nerve Paralysis and Negative Workup

Case Presentation: A 46‐year‐old man presented with a 1‐week history of bilateral lower facial nerve paralysis and 3 weeks of fever, headache, mild transaminitis, and hepatosplenomegaly. Illness began with acute onset of fever (103°F), headache, [...]

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HM2011 Abstract Number: 379

Reap the Harvest on Time!

Case Presentation: A 61‐year‐old white man with significant history of hypertension was brought to the emergency department with sudden onset shortness of breath, epigastric pain, diaphoresis, and light‐headedness for 30 minutes. Examination was positive for [...]

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HM2011 Abstract Number: 378

A Grave Masquerader!

Case Presentation: A 55‐year‐old white man without a significant medical history presented to the emergency department (ED) with acute onset of lightheadedness, confusion, and speech difficulty for 2 hours’ duration. Although he was hypotensive, peripheral [...]

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HM2011 Abstract Number: 377

Empyema Necessitans Resulting from a Stab Wound

Case Presentation: A 62‐year‐old man was found unresponsive with a stab wound to the posterior chest wall 2 weeks prior to admission and presented to our hospital with a full‐thickness wound on the infrascapular region. [...]

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HM2011 Abstract Number: 376

Jumping the Gun on Diagnosis of Colon Cancer

Case Presentation: A previously healthy 86‐year‐old white woman presented to the hospital with complaints of left leg swelling and pain of 4 days’ duration. On examination, the left leg was significantly swollen compared with the [...]

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HM2011 Abstract Number: 375

The Great Masquerader Strikes Again?

Case Presentation: A 31‐year‐old Mexican male migrant worker was admitted with 7 months of gradually worsening cough, hemoptysis, night sweats, fevers, and weight loss. Physical exam revealed bilateral upper‐lobe wheezing and rhonchi. Chest x‐ray showed [...]

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HM2011 Abstract Number: 374

A Rabid Progression to Death

Case Presentation: A 19‐year‐old man presented with 1 day of pain and numbness in his left arm accompanied by left‐sided facial numbness. The patient reported chest pain, neck pain, nausea, and a dry cough as [...]

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HM2011 Abstract Number: 373

In a Case of Sarcoidosis: Are Mycobacteria Innocent or Guilty As Charged?

Case Presentation: A 66‐year‐old woman presented with vomiting, bilateral leg pain, and a fall. Over the past 6 months, the patient had complained of an unsteady gait, intermittent shooting pains from the knees to the [...]

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HM2011 Abstract Number: 372

When the Blind Can See—case Report of Charles Bonnet Syndrome

Case Presentation: A 75‐year‐old woman presented with a 3‐week history of visual hallucinations and fomication. She reported seeing insects, cars, and snakes in her house and acknowledged the hallucinations were inappropriate. She reported anxiety secondary [...]

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HM2011 Abstract Number: 371

Rap on Rapamune: Pulmonary Alveolar Hemorrhage Mimicking Infection in a Renal Transplant Patient

Case Presentation: A 50‐year‐old renal transplant patient presented to the emergency room with mild respiratory symptoms. Medications included sirolimus, cyclosporine, and prednisone. Vital signs were temperature 37.9°C, pulse 98/minute, blood pressure 109/64 mm Hg, respiratory rate [...]

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HM2011 Abstract Number: 370

Cardiac Perforation: A Rare Cause of a Bloody Heartache!

Case Presentation: An 81‐year‐old woman comes to the emergency department with acute‐onset shortness of breath and left‐sided, nonradiating chest pain. A month prior, she had a dual‐chamber pacemaker implantation for a diagnosis of sick sinus [...]

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HM2011 Abstract Number: 369

Agitation and Encephalopathy in a 16 Year Old: An Unusual Presentation of Subdural Empyema and Pott's Puffy Tumor

Case Presentation: The patient is a 16‐year‐old male who was transferred to a tertiary‐care center after being evaluated in a local emergency department (ED) for acute onset of confusion and agitation. He was restrained by [...]

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HM2011 Abstract Number: 368

Two Types of Necrotizing Fasciitis

Case Presentation: Case 1 is a 62‐year‐old woman with a history of end‐stage renal disease and poorly controlled diabetes mellitus who presented with confusion, fever, and an abscess on the posteromedial aspect of the left [...]

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HM2011 Abstract Number: 367

Bc Powder Causing Intracerebral Bleed: Pitfalls of Overlooking Dosage of Seemingly Innocuous Otc Formulations

Case Presentation: A 70‐year old woman had 2 episodes of intracranial bleed over 6 months and was referred to hematology to rule out bleeding diathesis. Neurological exam showed a mild right‐sided facial palsy. Blood pressure, [...]

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HM2011 Abstract Number: 366

Adenocarcinoma of the Lung Presenting As a Skull Mass

Case Presentation: A 60‐year‐old, previously healthy woman presented with intermittent right‐sided numbness. She also had a lump on the left parietal scalp for a year with no symptoms. This was assessed outpatient and was adjudged [...]

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HM2011 Abstract Number: 365

A 67‐Year‐Old Man with Diarrhea and Weight Loss

Case Presentation: A 67‐year‐old man presented to his doctor with 3 months of poor appetite, weight loss, and persistent nonbloody diarrhea. He complained of fatigue and intermittent chest pain with a chronic nonproductive cough. He [...]

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HM2011 Abstract Number: 364

A Case of Gastrointestinal Bleed with a Congenital Twist

Case Presentation: A 48‐year‐old woman presented with 2 episodes of bright red blood per rectum. Medical history included diverticular disease responsible for a previous episode of gastrointestinal bleed and congenital adrenal hyperplasia from 21‐hydroxylase deficiency. [...]

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HM2011 Abstract Number: 363

Intussusception: A Rare Complication of Hereditary Angioedema

Case Presentation: This is a 16‐year‐old African American male with a history of hereditary angioedema of unknown type, diagnosed at age 12, who presented with abdominal pain. He reported a 1‐week history of intermittent non‐bloody [...]

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HM2011 Abstract Number: 362

Rare Case of Breast Cancer Metastasis to Colon

Case Presentation: A 59‐year‐old white woman with a history of breast cancer presented with a 3‐day history of sharp, crampy right lower abdominal pain, radiating to the left lower quadrant and associated with nonbloody diarrhea [...]

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HM2011 Abstract Number: 361

Postoperative Chylous Ascites

Case Presentation: A 65‐year‐old woman presented with progressive abdominal distension for 2 months. It started after she underwent nephrectomy for left‐sided renal cell carcinoma, followed by splenectomy for injury sustained during nephrectomy. She noticed abdominal [...]

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HM2011 Abstract Number: 360

Goltz Syndrome: Rare Syndrome with Multiorgan System Involvement

Case Presentation: A baby girl was born about 6 months ago after a cesarean section at 36 weeks with APGARs of 8 and 8 and body weight of 2030 g and received routine resuscitation. Mother is [...]

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HM2011 Abstract Number: 359

Fishing for a Diagnosis

Case Presentation: A 48‐year‐old Chinese man reported a 1‐day history of paresthesias, shortness of breath, anxiety, and profound total‐body weakness. The evening prior to presentation he had prepared some dried blowfish that he had brought [...]

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HM2011 Abstract Number: 358

A Strange Habit Causing Hacek Aicd Lead Infection and Endocarditis

Case Presentation: A 20‐year‐old man with a history of congenital long QT syndrome status post–automatic implantable cardiac defibrillator (AICD), intravenous drug abuse, and hepatitis C presented with 1 week of low‐grade fever and myalgia. Last [...]

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HM2011 Abstract Number: 357

Attacked from All Sides: A Confounding Case of Renal Failure

Case Presentation: A 63‐year‐old man with chronic stag‐horn nephrolithiasis and chronic kidney disease presented with generalized arthralgias of 3 weeks’ duration, worse in the morning. In the days prior to presentation, he noticed pink urine [...]

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HM2011 Abstract Number: 356

Severe Thrombocytopenia Secondary to Phenytoin Toxicity

Case Presentation: A 48‐year‐old white woman was brought in by her husband for dizziness, unsteady gait, altered mental status, and 1 episode of fall. Symptoms started about 1 week earlier following an upper respiratory infection [...]

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HM2011 Abstract Number: 355

Recurrent Syncope: A Plethora of Causes

Case Presentation: A 69‐year old man with a history of congestive heart failure was admitted for recurrent syncope. He initially presented with 4 months of progressive dyspnea on exertion and facial swelling. Subsequently, he developed [...]

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HM2011 Abstract Number: 354

Gallstone Pancreatitis in a Previously Healthy 22‐Year Old Man: What Does Not Fit?

Case Presentation: A 22‐year old previously healthy man developed acute‐onset right upper quadrant pain, vomiting, and jaundice. He consumed 4–6 alcoholic drinks occasionally and denied diarrhea, bloody stools, or fevers. Medical history was notable for [...]

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HM2011 Abstract Number: 353

Acute Eosinophilic Pneumonia Secondary to Daptomycin: A Potentially Fatal Adverse Drug Reaction

Case Presentation: A 78‐year‐old man with no history of lung disease presents with increasing dyspnea on exertion. Two weeks prior to presentation, the patient underwent endovascular stenting of his left femoral artery that was complicated [...]

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HM2011 Abstract Number: 352

A Battle for Glucose

Case Presentation: An 82‐year‐old man presented with recurrent episodes of severe hypoglycemia requiring frequent hospitalizations at an outside facility. He was first diagnosed with hypoglycemia 4 months ago when found unconscious by his wife. These [...]

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HM2011 Abstract Number: 351

Celiac Curveball

Case Presentation: A 47‐year‐old woman presented with a 2‐day history of lower back pain and acute onset of abdominal pain that was associated with an episode of nausea and emesis. She was afebrile with elevated [...]

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HM2011 Abstract Number: 350

Terbinafine‐Induced Pustular Psoriasis: A Case Report and Literature Review

Case Presentation: A 67‐year‐old man presented with a 2‐week history of worsening diffuse body rash. The patient had initiated oral terbinafine 250 mg daily 1 month prior for toenail onychomycosis; he denied any other new medications. [...]

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HM2011 Abstract Number: 349

Pneumatosis Intestinalis: A Curious Combination of a Drug and a Bug

Case Presentation: A 51‐year‐old white woman was admitted with a 3‐day history of recurrent generalized abdominal cramping and bloating with 10–15 nonbloody watery diarrhea stools per day. She denied nausea, vomiting, fever, chills, or sweats. [...]

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HM2011 Abstract Number: 348

Nicolau Syndrome: Recognition and Management of an Uncommon Reaction to Intramuscular Injections

Case Presentation: A 40‐year‐old white woman received an intramuscular injection of medroxyprogesterone in her right deltoid. Within minutes she experienced excruciating pain in her entire right arm, mild finger paresthesias, and a mottled, reticular, livedoid [...]

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HM2011 Abstract Number: 347

Fluoroscopy‐Induced Chronic Radiation Dermatitis (Ficrd) After Catheter Ablation of Atrial Flutter

Case Presentation: A 71‐year‐old man with history of chronic atrial fibrillation was admitted to our hospital with an acute flare of chronic obstructive pulmonary disease. On examination, in addition to signs of respiratory distress and [...]

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HM2011 Abstract Number: 346

A Fatal Case of Gastrointestinal Zygomycosis in an Immunosuppressed Host

Case Presentation: A 62‐year‐old man with a history of Wegener's granulomatosis presented to the emergency department with abdominal discomfort, low‐grade fever, and increasing confusion. The patient was on standard immunosuppressive therapy with cyclophosphamide, and a [...]

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HM2011 Abstract Number: 345

Adult Epiglottis

Case Presentation: A 70‐year‐old man presented with sore throat, cough, and increasing respiratory distress. He was tachycardic and tachypneic, with a fever of 101.5°F. His breathing was labored and stridorous. He had no angio‐edema. His [...]

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HM2011 Abstract Number: 344

A Case of Thoracic Aorta Thrombus As a Cause of Renal and Peripheral Artery Emboli

Case Presentation: A 41‐year‐old white woman with history of peripheral vascular disease presented with a syncopal episode and leg pain. She reported bilateral lower‐extremity pain for the past 5 days. Because of a history of [...]

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HM2011 Abstract Number: 343

Not Your Usual Suspect: Two Cases of Anca Vasculitis

Case Presentation: Case 1 is a 47‐year‐old man with a 30‐year history of cocaine abuse who was admitted with recurrent cellulitis. Seven months prior he had suffered trauma to his left hand complicated by septic [...]

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HM2011 Abstract Number: 342

Back to Basics: Bedside Chemistry and Urine Microscopy

Case Presentation: A 56‐year‐old man with recently diagnosed HIV‐associated toxoplasma encephalitis presented after a generalized seizure. Two weeks prior, he began treatment for toxoplasmosis with pyrimethamine, sulfadiazine, and leu‐covorin. His course was complicated by a [...]

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HM2011 Abstract Number: 341

Dyspnea Can Be a Long‐Winded Story

Case Presentation: A 68‐year‐old white male patient presented with progressive dyspnea on exertion, weakness, and an unintentional 50‐pound weight loss over the prior 6 months. He had a history of coronary artery disease, hypertension, and [...]

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HM2011 Abstract Number: 340

Pott's Puffy Tumor: A Rare but Important Complication of Sinusitis

Case Presentation: This is an 11‐year‐old male who was well until 3 days prior to admission, when he developed nasal congestion, fever, and a tender swelling of the forehead. The patient's medical history was significant [...]

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HM2011 Abstract Number: 339

Ovarian Hyperstimulation—too Much of a Good Thing?

Case Presentation: Ovarian hyperstimulation syndrome (OHSS) is a complication of exogenous gonadotropin stimulation, used in infertility cases. Most cases are mild and self‐limited, but occasionally they can become severe and require hospitalization. A 31‐year‐old woman [...]

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HM2011 Abstract Number: 338

Cutaneous Nocardiosis in an Immunocompetent Patient

Case Presentation: A 71‐year‐old man was admitted to the hospital for worsening left leg cellulitis. He had noticed a “pimple” on the dorsum of his foot on Sunday. He cleaned the area with hydrogen peroxide, [...]

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HM2011 Abstract Number: 337

Neurotoxicity Resulting from Prolonged Metronidazole: A Case Report

Case Presentation: A 64‐year‐old Hispanic retired truck driver with type 2 diabetes mellitus presented with a 1‐week history of left foot pain. His initial blood cultures were positive for Klebsiella species. MRI findings were consistent [...]

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HM2011 Abstract Number: 336

Feeling Your Way Through a Diagnosis

Case Presentation: A 48‐year‐old man presented with 2 weeks of ascending numbness and tingling of the right leg and toes. The numbness continued to ascend to the level of the umbilicus. He also noted 1 [...]

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HM2011 Abstract Number: 335

A Rare Diagnosis for a Commonly Encountered Problem

Case Presentation: A 36‐year‐old man presented with 6 weeks of abdominal pain, bloody stools, and fatigue. Pain was described as dull, 6 of 10 in intensity, nonradiating, in bilateral upper quadrants and epigastrium, lasting minutes [...]

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HM2011 Abstract Number: 334

A Perfect Storm: Percocet, Pinot, and Previous Bowel Surgery

Case Presentation: A 78‐year‐old woman with a history of small bowel obstructions with subsequent resections presented with a 3‐week history of progressive abdominal distention, escalating pain, and nausea. Her symptoms reached maximum intensity in the [...]

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HM2011 Abstract Number: 333

A 20‐Year‐Old Woman with Breathlessness, Pleuritic Chest Pain, Dry Cough, and Pericardial Effusion

Case Presentation: A 20‐year‐old woman presented with 2 weeks of worsening dyspnea, pleuritic chest pain, and dry cough. She was previously healthy. No weight loss, night sweats, fevers, or chills were reported in the past. [...]

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HM2011 Abstract Number: 332

Spontaneous Acquired Benign Tracheoesophageal Fistula in a Patient with Mediastinal Tracheostomy

Case Presentation: A 76‐year‐old white man presented with a1‐year history of abdominal fullness, bloating, episodic choking spells, and wheezing. These episodes worsened with food, usually to liquids, but had become more frequent over the last [...]

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HM2011 Abstract Number: 331

A Case of Steroid and Mycophenolate Mofetil‐Resistant Neuromyelitis Optica Exacerbation Treated with Plasma Exchange

Case Presentation: A 58‐year‐old woman with a history of Sjogren's syndrome, neuromyelitis optica (NMO; Devic's disease) diagnosed 12 years ago, transverse myelitis, and sleep apnea presented with worsening left leg weakness for 4 months. The [...]

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HM2011 Abstract Number: 330

Vancomycin: A Rare Cause of Thrombocytopenia

Case Presentation: Vancomycin, an antibiotic frequently used in the treatment of Methicillin‐resistant Staphylococcus Aureus, can cause many adverse reactions. Vancomycin has seldom been implicated as a cause of thrombocytopenia, and there is limited evidence that [...]

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HM2011 Abstract Number: 329

Isolated Right Heart Failure: A Rare Complication of Thyrotoxicosis

Case Presentation: A 40‐year‐old woman with recently diagnosed Graves’ disease and atrial fibrillation presented with a 3‐week history of abdominal distension, shortness of breath, and palpitations. She had associated diarrhea and a 20‐pound weight loss. [...]

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HM2011 Abstract Number: 328

An Atypical Case of Henoch‐Schonlein Purpura in an Adult

Case Presentation: A 44‐year‐old man with no medical history presented to the emergency department with a purpuric rash for 1 week. The rash originated in the trunk and upper extremities and progressed to involve the [...]

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HM2011 Abstract Number: 327

Colorful Eyes: Kawasaki Disease Presenting with Jaundice

Case Presentation: A 3‐year‐old healthy Hispanic female presented with a 7‐day history of persistent fevers and 3 days of jaundice, abdominal pain, and emesis. She was noted to be irritable and had just developed a [...]

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HM2011 Abstract Number: 326

Digital Ischemia Secondary to Essential Thrombocythemia

Case Presentation: A 52‐year‐old woman was sent to the hospital by her vascular surgeon for pain and dry gangrene at the tip of the right second digit. Two weeks prior, her symptoms began with a [...]

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HM2011 Abstract Number: 325

Pulmonary Vein Thrombosis: A Case Report and Literature Review

Case Presentation: A 76‐year‐old man with scoliosis and hypertension presented with acute onset of dyspnea associated with cough and chest tightness. Physical exam was remarkable for a temperature of 102.3°F, RR of 25, and oxygen [...]

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HM2011 Abstract Number: 324

Acute Hyponatremic Cerebral Edema After Preparation for Colonoscopy

Case Presentation: An 80‐year‐old woman with hypertension and hyperthyroidism was found obtunded in the morning by a family member and brought in to the emergency department. Patient had taken polyethylene glycol electrolyte solution and bisacodyl [...]

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HM2011 Abstract Number: 323

Smelling a Rat: Supratherapeutic INR in a Patient Not Taking Warfarin

Case Presentation: A 39‐year‐old pharmacy technician was referred by her local physician for continued outpatient evaluation of bruising, epistaxis, and diarrhea. These conditions had been present for 3 months. She had been on disability leave [...]

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HM2011 Abstract Number: 322

Spontaneous Pneumothorax: A Whistleblower for Future Cancers!

Case Presentation: A 68‐year‐old African American man with a medical history of gastric carcinoma status post resection and history of left‐sided spontaneous pneumothorax was admitted to the hospital with gross hematuria for 1 day. He [...]

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HM2011 Abstract Number: 321

Cupid's Arrow: Real or a Contaminant?

Case Presentation: A 63‐year‐old woman with history of bariatric surgery, gastroparesis, daily emesis, on parenteral nutrition, aortic insufficiency, and mitral regurgitation (presumed secondary to past use of anorectic drugs) was admitted with fever, lethargy, orthostatic [...]

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HM2011 Abstract Number: 320

Trimethoprim/sulfamethoxazole‐Associated Aseptic Meningitis in an Immunocompetent Person: A Case Report

Case Presentation: A 64‐year‐old woman presented with 12 hours of fevers and confusion. She had gone to her primary care doctor 1 day earlier with complaints of dysuria. She was diagnosed with a urinary tract [...]

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HM2011 Abstract Number: 319

An Eye for a Life

Case Presentation: A 60‐year old woman with type 2 diabetes mellitus presented with a 1‐week history of worsening left eye pain, redness, and gradual vision loss following a recent outside hospitalization. She also complained of [...]

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HM2011 Abstract Number: 318

A Sinister Tale of 2 Swollen Kidneys

Case Presentation: An 83‐year‐old woman with a history of invasive ductal breast cancer in remission status post lumpectomy and radiation presented with complaints of generalized weakness. Her vital signs were stable, and exam was remarkable [...]

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HM2011 Abstract Number: 317

A Rare Case of Atraumatic Bilateral Anterior Compartment Syndrome

Case Presentation: The patient was a 28‐year‐old man with history of bipolar disorder with psychotic features, polysubstance abuse, and hyperlipidemia. He had been chronically institutionalized in a psychiatric hospital for 7 years prior this presentation. [...]

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HM2011 Abstract Number: 316

Erysipelas‐Like Cellulitis with Pasteurella Multocida Bacteremia—a Rare Presentation

Case Presentation: A 79‐year‐old man with a medical history of gout presented with fever of 103°F, chills, palpitations, left lower‐extremity pain, swelling, and redness. Patient denied any trauma to his limb. Physical exam was unremarkable [...]

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HM2011 Abstract Number: 315

Meningitis Secondary to a Sphenoid Defect

Case Presentation: A 45‐year‐old woman with a history of chronic migraines and diabetes was brought to the emergency room for decreased responsiveness with hypoxic respiratory failure. She had been treated for migraines at an outside [...]

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HM2011 Abstract Number: 314

Intravenous Iron Causing a Pustular Eruption

Case Presentation: A 58‐year‐old woman presented to the emergency room for evaluation of a progressive pruritic rash. She initially noticed the eruption 72 hours after receiving intravenous iron sucrose for the first time. Past medical [...]

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HM2011 Abstract Number: 313

Erythroderma, Severe Psoriasis … or Not?

Case Presentation: A 45‐year‐old woman presented from a rescue mission with 1 month of worsening pruritis and a scaling rash. She had multiple emergency room visits during this time for a pruritic, scaly eruption that [...]

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HM2011 Abstract Number: 312

Another Cause of Pneumonitis and Ards

Case Presentation: An 84‐year‐old cattle farmer presented to the emergency room with a 5‐day history of dry cough, progressive shortness of breathb and temperature to 39.4°C. Past medical history included coronary artery disease and atrial [...]

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HM2011 Abstract Number: 311

A Rare Cause of Neonatal Seizures

Case Presentation: An 8‐day‐old girl born full term, normal spontaneous vaginal delivery, with transient tachypnea of the newborn requiring a 5‐day stay in the neonatal intensive care unit, presented to her private medical doctor for [...]

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HM2011 Abstract Number: 310

In the Blood: A Case of Too Much Inhibition

Case Presentation: A 79‐year‐old man with a history notable for hyperlipidemia and stage I prostate cancer presented to his physician with fatigue and easy bruising for 3 weeks after returning from a recent 2‐month trip [...]

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HM2011 Abstract Number: 309

Recognizing the Obvious: Elevated INR in Patients with Polycythemia

Case Presentation: A 67‐year‐old man with polycythemia vera was admitted for management of elevated hematocrit (Hct). The patient denied chest pain, headache, paresthesias, easy bruisability, epistaxis, or melena. He reported red eyes and generalized pruritis. [...]

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HM2011 Abstract Number: 308

Anaplasmosis: A Case Report and Literature Review

Case Presentation: We describe a 79‐year‐old man with a history of hypertension and benign prostatic hypertrophy who presented with 5 days of fevers to 103°F and myalgias. The patient also complained of a dry cough [...]

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HM2011 Abstract Number: 307

Intradermal Malignant Melanoma: The Great Enigma

Case Presentation: A 31‐year‐old woman who was 8 weeks pregnant presented to her obstetrician for an initial prenatal examination. On physical exam, a firm, fixated 4 × 5 cm mass was palpated in the midline of [...]

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HM2011 Abstract Number: 306

Remembering Wernicke's; Maintaining a High Suspicion for Thiamine Deficiency

Case Presentation: A 62‐year‐old African American man with a questionable history of heavy alcohol use was admitted to the urology service for incision and drainage of a scrotal abscess. At the time of incision and [...]

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HM2011 Abstract Number: 305

Community‐Acquired Methicillin‐Resistant Staphylococcus Aureus Prostatic Abscess

Case Presentation: A 50‐years‐old diabetic man presented with cough, fever, weight loss, malaise, and diffuse abdominal pain of 2 weeks’ duration. He denied dysuria, recent hospitalization, sick contacts, or visits to any long‐term care facility. [...]

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HM2011 Abstract Number: 304

A Case of Morvan Syndrome in a 16‐Year‐Old

Case Presentation: Patient is a 16‐year‐old Hispanic male who was transferred to our tertiary‐care center with hypertension that was refractory to antihypertensive medications. He reported a 1‐month history of profuse sweating, itching, and muscle fasciculations [...]

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HM2011 Abstract Number: 303

The Catatonic Stuporous Child: A Severe Case of Anti–Nmda Receptor Encephalitis

Case Presentation: A former 27‐week‐gestation Hispanic male aged 2 years and 9 months with a history of grade 2 intraven‐tricular hemorrhage in the neonatal period presented with sub‐acute onset of ataxia, difficulty with hand coordination, [...]

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HM2011 Abstract Number: 302

Spinal Cord Injury and Autonomic Dysreflexia: A True Medical Emergency

Case Presentation: A 64‐year‐old man with a history of quadri‐plegia at the C5–C6 level more than 25 years ago secondary to a motor vehicle accident presented with blisters on both feet and worsening positional hypertension. [...]

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HM2011 Abstract Number: 301

A Case of Mistaken Capacity

Case Presentation: An 87‐year‐old Russian‐speaking man with a history of peptic ulcer disease presented to the emergency department (ED) with 1 week of abdominal distension, nausea, and vomiting. An abdominal CT scan showed gastric outlet [...]

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HM2011 Abstract Number: 300

Awareness of Patients’ Health Insurance Status: Underutilized Tool in Optimizing in Quality of Care

Case Presentation: Case I—a 45‐year‐old man was admitted to the hospitalist service with fever and leg swelling. Physical examination was significant for tachycardia, hypotension, and gangrene of left leg. From blood cultures, complete blood count, [...]

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HM2011 Abstract Number: 299

Fatal Type B Lactic Acidosis in an HIV Patient with Non‐Hodgkin Lymphoma

Case Presentation: A 37‐year‐old HIV‐positive obese man on highly active antiretroviral therapy (HAART) was admitted with progressive dyspnea and right upper quadrant pain without tenderness to palpation. His chest x‐ray revealed a right pleural effusion. [...]

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HM2011 Abstract Number: 298

Antidotes to Antifreeze

Case Presentation: A 31‐year‐old man with bipolar disorder presented with nausea, vomiting, abdominal pain, and blurry vision several hours after consuming antifreeze and alcohol in a suicide attempt. He was afebrile with a heart rate [...]

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HM2011 Abstract Number: 297

Primary Cutaneous Histoplasmosis Masquerading As Lupus Panniculitis

Case Presentation: The patient is a 53‐year‐old white woman with a history of systemic lupus erythematosus, WHO class 3A lupus nephritis on mycophenolate and pred‐nisone 10 mg/day. Two months prior to presentation she developed multiple erythematous [...]

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HM2011 Abstract Number: 296

Sinusitis—not Always of Infectious Origin

Case Presentation: Sinonasal symptoms are very common in the general community, and most cases are successfully treated with empirical antibiotics, unlike our patient. The patient is a 47‐year‐old white man with a medical history of [...]

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HM2011 Abstract Number: 295

Severe Staphylococcal Sepsis in a 7‐Year‐Old

Case Presentation: A 7‐year‐old Hispanic male presented to the emergency department (ED) with a 4‐day history of fever and worsening ankle pain and swelling. He was otherwise healthy prior to the onset of symptoms. The [...]

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HM2011 Abstract Number: 294

May–Thurner Syndrome: An Anatomic Predisposition to Venous Thrombosis

Case Presentation: A 34‐year‐old woman presented with 6 weeks of worsening left calf pain, described as sharp, shooting, and increased on weight bearing. She had a 20 pack‐year smoking history and was taking oral contraceptive [...]

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HM2011 Abstract Number: 293

Etanercept—an Eagle to Prometheus

Case Presentation: A 54‐year‐old man presented with 4 weeks of progressive pruritis, diarrhea, and jaundice. He denied herbal medications, acetaminophen ingestion, recent travel, alcohol use, intravenous drug use, sexual activity, tattoos, or environmental exposures. Eight [...]

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HM2011 Abstract Number: 292

Anasarca of an Unusual Etiology

Case Presentation: A 46‐year‐old man presented with 2 months of worsening anasarca. He had a history of AIDS, Kaposi's sarcoma (KS), and hypothyroidism. The patient endorsed worsening orthopnea, dyspnea, and weight gain for several months, [...]

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HM2011 Abstract Number: 291

A Tree Leading to the Root Cause of Encephalopathy

Case Presentation: A 50‐year‐old woman presented with acute‐onset confusion and seizure‐like episodes. She had experienced recent fatigue, generalized weakness, dyspnea on exertion, and ataxia for several days. She did not drink alcohol or use illicit [...]

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HM2011 Abstract Number: 290

Cause or Effect?

Case Presentation: A 48‐year‐old man without significant medical history presented to our hospital with 3 weeks of increasing abdominal girth. Imaging revealed moderate ascites as well as extensive omental and peritoneal implants, diffuse lymphadenopathy, and [...]

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HM2011 Abstract Number: 289

Mixed Connective Tissue Disease Leading to Cardiac Tamponade

Case Presentation: A 10‐year‐old African American male presented with progressive chest pain, dyspnea, and fever. One month prior, the child was hospitalized for fevers associated with right knee pain and swelling. Arthrocentesis revealed leukocytosis but [...]

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HM2011 Abstract Number: 288

Counterfeit Cancer

Case Presentation: Our patient is a 65‐year‐old woman from the Philippines with a medical history significant for rheumatoid arthritis and diabetes mellitus who presented to an outside medical facility with complaints of increased abdominal girth, [...]

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HM2011 Abstract Number: 287

Villaret's Syndrome from Skull Base Aspergillosis in a Diabetic Man: A Case Report

Case Presentation: A 72‐year‐old Dominican man with history of diabetes, hypertension, dementia, chronic renal insufficiency, epilepsy, cholesteatoma, and smoking presented for generalized weakness, confusion, otorrhea, otalgia, progressive hoarseness, and weight loss of 11 kg over 2 [...]

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HM2011 Abstract Number: 286

Spontaneous Portal‐Systemic Shunt As Cause of Refractory Encephalopathy

Case Presentation: A 56‐year‐old white man was admitted with 3 days of worsening mentation refractory to increasing doses of lactulose. History included remote alcohol abuse, alcohol‐induced cirrhosis diagnosed after a sentinel variceal bleed, and chronic [...]

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HM2011 Abstract Number: 285

Myasthenia Gravis Presenting with Acute Respiratory Failure

Case Presentation: An 80‐year‐old woman with diabetes, hypertension, and hypothyroidism was admitted with 1 week of generalized weakness. She also reported persistent left‐sided neck pain. In the office, her systolic blood pressure was 240 mm Hg, [...]

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HM2011 Abstract Number: 284

Elevated Lactic Acid in Severe Asthma

Case Presentation: This is a 27‐year‐old woman transferred from the university emergency department to our Maryland General Hospital for management of severe asthma exacerbation. A few days prior to this visit, she was having coldlike [...]

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HM2011 Abstract Number: 283

Not Just Myasthenia Gravis: A Patient with Thymoma and Paraneoplastic Limbic Encephalitis

Case Presentation: A 56‐year‐old woman with a history of thymoma completely resected 4 months earlier presented with 2 weeks of intermittent facial flushing, facial twitching, lacrimation, hypertension, and a sense of déjà vu. The episodes [...]

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HM2011 Abstract Number: 282

Candida Epididymo‐Orchitis in a Diabetic Patient: Characterizing a Rare Infection

Case Presentation: Genitourinary tract infections in adult men are typically bacterial in origin. However, fungal infections are a rare but serious cause of acute genitourinary pathology with notable morbidity. A 69‐year‐old African American man with [...]

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HM2011 Abstract Number: 281

Daptomycin‐Induced Eosinophilic Pneumonia

Case Presentation: A 77‐year‐old man presented to the hospital with a chief complaint of fever and weakness. Six weeks prior to this admission he underwent elective left total hip arthroplasty, which was complicated by a [...]

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HM2011 Abstract Number: 280

A Challenging Clinical Constellation: The Exquisite Presentation of Legionnaire's Disease

Case Presentation: A 36‐year‐old man living in the United States since 1996 (born in a sub‐Saharan country) presented with 4 days of fever, malaise, watery diarrhea, progressive dyspnea, and dry cough. He subsequently developed slurred [...]

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HM2011 Abstract Number: 279

Tap Water Enema and Cryptosporidium Infection in Acute HIV Infection

Case Presentation: A 20‐year‐old African American man with a history of MSM (having sex with men) and previously treated for syphilis was admitted with 3 weeks of watery nonbloody diarrhea. Two weeks after symptoms started, [...]

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HM2011 Abstract Number: 278

Constellation of Nuisance Hiccups, Apnea Spells, and Unilateral Diaphragmatic Fluttering: Importance of Physical Examination Findings—a Case Report

Case Presentation: A 64‐year‐old man presented with sporadic hiccups, transient apnea, severe left‐sided chest pain, and diaphoresis for 6 months. The above constellation was associated with epigastric/left‐sided pulsatile motions under the left thoracic cage, herein [...]

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HM2011 Abstract Number: 277

One Too Many: Severe Hyponatremia

Case Presentation: A 57‐year‐old man was “found down” at home. The patient reported seizures for 2 days. He denied chronic medical conditions including history of seizures. He reported drinking a case of beer daily. Physical [...]

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HM2011 Abstract Number: 276

Tick‐Ed Off by a Pint: Hemolysis in a Cirrhotic Patient

Case Presentation: A 58‐year‐old man with alcoholic cirrhosis presented with anemia and hematochezia. Five weeks prior, he had received 2 units of red cells and 3 units each of platelets and plasma for anemia, thrombocytopenia, [...]

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HM2011 Abstract Number: 275

Reversible Man‐in‐the‐Barrel Syndrome from Septic Shock

Case Presentation: A 66‐year‐old woman presented with pneumonia, severe sepsis, acute respiratory failure requiring mechanical ventilation, acute kidney injury, and disseminated intravascular coagulation. Her medical history included diabetes and hypertension. Her temperature was 103.9°F, blood [...]

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HM2011 Abstract Number: 274

Primary Adrenocortical Carcinoma: A Rare Diagnosis with Common Symptoms

Case Presentation: A 51‐year‐old white man with a medical history of acid reflux and Bell's palsy presented to the clinic with several months’ history of nausea, abdominal fullness, bloating, and left upper quadrant pain with [...]

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HM2011 Abstract Number: 273

Ocular Syphilis: Staring Straight at You

Case Presentation: A 54‐year‐old heterosexual man presented with a 4‐month history of progressive photophobia of the left eye. He denied any diplopia, pustule discharge, and visual field defects. Four months previously, he was treated with [...]

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HM2011 Abstract Number: 272

Microscopic Polyangiitis: Case Report in Coexistence with Sle Nephritis

Case Presentation: A 66‐year‐old white woman with a history of biopsy confirmed class III systemic lupus erythematosus (SLE) nephritis presented with shortness of breath, fatigue, myalgias, and recurring rash on her right lower extremity. Past [...]

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HM2011 Abstract Number: 271

Colonoscopy‐Induced Pancreatitis

Case Presentation: A 59‐year‐old man with a history of cirrhosis, hepatitis C, diabetes mellitus, and hypertension was admitted with melena. Home medications were lisinopril and metformin. Vital signs were normal, and physical exam revealed coffee‐ground [...]

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HM2011 Abstract Number: 270

Trichobezoars As a Cause of Upper Gastrointestinal Bleeding: A Case Presentation

Case Presentation: A 39‐year‐old African American woman presented with nausea, postprandial emesis, early satiety, abdominal distension/pain for 1 week, and 2 days of hematemesis. Physical exam revealed a diffusely distended, tender abdomen and a firm, [...]

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HM2011 Abstract Number: 269

Delayed Diagnosis of Venous Thromboembolism Resulting from Multiple System Errors

Case Presentation: A 55‐year‐old man with developmental delay underwent cervical fusion. He was discharged with a urinary catheter to a rehabilitation center. He developed urosepsis and was readmitted to the hospital 1 month later. On [...]

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HM2011 Abstract Number: 268

It Only Hurts When I Breathe

Case Presentation: A 55‐year‐old woman presented with 2 months of progressively worsening dyspnea on exertion, cough productive of yellow sputum, and occasional hemoptysis. She had noted edema of the lower extremities. Her lungs were clear [...]

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HM2011 Abstract Number: 267

A Dramatic Presentation with a Happy Ending—a Story of Silo Filler's Disease

Case Presentation: This is a 39‐year‐old farmer admitted with dyspnea and productive cough with dark sputum. The patient stepped into a closed silo 3 days prior to admission. Approximately 8 hours later, he developed significant [...]

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HM2011 Abstract Number: 266

Langerhans Cell Histiocytosis, Diabetes Insipidus, and Pregnancy—a Bad Combination

Case Presentation: This is an 18‐year‐old woman diagnosed with pulmonary Langerhans cell histiocytosis (LCH) 3 months prior to becoming pregnant. She was treated at the time with etoposide and dexamethasone. She remained asymptomatic until 27 [...]

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HM2011 Abstract Number: 265

The North Woods: Heart‐Stopping Beauty? An Unusual Case of Lyme Carditis

Case Presentation: A previously healthy 43‐year‐old man from northwestern Wisconsin presented to his local medical center with 3 days of generalized malaise, arthralgias, low‐grade fever, and constant left‐sided chest pain, worse with deep inspiration and [...]

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HM2011 Abstract Number: 264

Hsv‐1 Pneumonia in a Renal Transplant Patient

Case Presentation: A 36‐year‐old man with a history of congenital obstructive uropathy status post cadaveric renal transplant in 2006 presented with fever, shortness of breath, and cough for 3 days. He had had a recent [...]

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HM2011 Abstract Number: 263

Hemophagocytic Lymphohistiocytosis or Macrophage Activation Syndrome: A Case Report

Case Presentation: A 47‐year‐old white man with no past history presented with 4 days of periumbilical abdominal pain, nausea, and fevers to 102°F. A few days prior to presentation, he and his wife ate at [...]

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HM2011 Abstract Number: 262

New, Persistent T‐Wave Changes in a 19‐Year‐Old with Chest Pain

Case Presentation: Ms. L. is a 19‐year‐old with history of asthma who presented with persistent right scapula pain and intermittent left chest pain for 2 weeks without an inciting event. She had had chest pain [...]

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HM2011 Abstract Number: 261

History of Pe/dvt + Vertebroplasty + Dyspnea = ?

Case Presentation: Mr. J. is a 79‐year‐old man with a history of pulmonary embolism (PE)/deep vein thrombosis (DVT), coronary artery disease status post coronary artery bypass graft with ICM ejection fraction (EF) of 36% in [...]

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HM2011 Abstract Number: 260

Can Cutaneous T‐Cell Lymphoma Have Extracutaneous Manifestations?

Case Presentation: Ms. V. is a 64‐year‐old woman with a history of psoriasis, hypothyroidism, and grade IIb cutaneous T‐cell lymphoma (CTCL) treated with chemotherapy, radiation, and light therapies recently hospitalized with community‐acquired pneumonia and sepsis [...]

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HM2011 Abstract Number: 259

Vancomycin‐Induced Vasculitis

Case Presentation: The patient is a 61‐year‐old woman with a medical history of hypertension, non–small cell lung cancer which was resected 6 weeks prior to admission, coronary disease, and previous cecal ulcer and polyps. She [...]

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HM2011 Abstract Number: 258

Bactrim‐Induced Hepatoxicity

Case Presentation: A 39‐year‐old woman with a benign medical history presented with a 5‐day history of abdominal pain and fever. She had been on Bactrim for a urinary trace infection for a week prior to [...]

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HM2011 Abstract Number: 257

Calciphylaxis in a Patient Without Chronic Kidney Disease: A Case Report and Review of the Literature

Case Presentation: This is a 65‐year‐old woman with history of Crohn's disease and prolonged surgical hospitalization 14 weeks prior to admission for perforated colon secondary to diverticulitis requiring lower anterior resection with end‐ileostomy. Her course [...]

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HM2011 Abstract Number: 256

Thrombotic Thrombocytopenic Purpura: To Plex Without Schistiocytes?

Case Presentation: A 53‐year‐old man presented with fever, altered mental status, headache, and diarrhea. He had a creatinine of 3.86 mg/dL (with no known prior renal disease) and a platelet count of 8000/μL. His hemoglobin was [...]

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HM2011 Abstract Number: 255

A Mortal Case of Moonshine

Case Presentation: A 50‐year‐old male painter with a history of depression presented to the emergency room with altered mental status. His wife stated he had been acting strangely the night prior to admission and was [...]

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HM2011 Abstract Number: 254

A Presentation of Dress (Drug Rash with Eosinophilia and Systemic Symptoms) Syndrome to the Medical Service

Case Presentation: This is a 51‐year‐old woman with a medical history significant for a seizure disorder diagnosed after she had a tonic‐clonic type seizure at age 16. She was treated with phenytoin, but this was [...]

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HM2011 Abstract Number: 253

Not Just Another Case of Acute Pericarditis

Case Presentation: A 60‐year‐old white woman with a history of coronary artery disease presented with a 2‐day history of dyspnea and pleuritic chest pain. The chest pain varied in its intensity, and it increased with [...]

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HM2011 Abstract Number: 252

Hypertension … and a Bruit?

Case Presentation: A 34‐year‐old woman with no medical history presented with complaints of severe, intermittent headaches and dizziness of 3 months’ duration. Her primary care physician had diagnosed her with “malignant hypertension” and initiated treatment [...]

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HM2011 Abstract Number: 251

The Portal Systems Sinister Side

Case Presentation: A 57‐year‐old woman with hepatitis C presented with sudden‐onset, large‐volume hematemesis. After initial resuscitation, an urgent upper endoscopy was performed. This revealed isolated gastric varices with evidence of a recent bleed. Despite no [...]

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HM2011 Abstract Number: 250

Kikuchi–Fujimoto Disease: An Uncommon Presentation of Persistent Fever

Case Presentation: A 28‐year‐old woman, previously in good health, was admitted to the hospital after presenting with 4 weeks of myalgias, chills, night sweats, and persistent fevers. She had no upper respiratory symptoms, photophobia, or [...]

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HM2011 Abstract Number: 249

Not All Fever with Lymphadenopathy Is of Infectious, Malignant, or Autoimmune Etiology

Case Presentation: A 41‐year‐old African American woman presented with a 3‐week history of low‐grade fever, malaise, generalized arthralgia, unintentional 20‐pound weight loss, and tender left posterior cervical lymphadenopathy. She reported no animal exposure, international travel, [...]

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HM2011 Abstract Number: 248

Case Report: Brucellar Spondylodiscitis and Psoas Abscess

Case Presentation: This is a 71‐year‐old Mexican American woman who was admitted with a 2‐month history of progressively worsening lower back pain, weight loss, and night sweats. She was treated with ketorolac injections in Mexico [...]

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HM2011 Abstract Number: 247

Not Just Another Vegetation: A Rare Complication of Infective Endocarditis

Case Presentation: A 47‐year‐old man with a history of hepatitis C infection, hypertension, diabetes, and bicuspid aortic valve presented with 2 weeks of fevers, chills, and rigors. He was afebrile and hemodynamically stable at the [...]

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HM2011 Abstract Number: 246

Chest Pain from a Kissing Bug

Case Presentation: A 59‐year‐old Hispanic man presented with 3 days of intermittent substernal chest pain radiating to the left axilla, occurring at rest, and associated with shortness of breath, diaphoresis, and nausea. His medical history [...]

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HM2011 Abstract Number: 245

Tuberculous Meningitis in a Honduran Immigrant

Case Presentation: A 43‐year‐old woman without any medical history presented to the emergency room with a severe headache, neck pain, chills, vomiting, and photophobia for 7 days. She also had complaints of recent loss of [...]

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HM2011 Abstract Number: 244

An Unusual Case of Candida Esophagitis

Case Presentation: A 45‐year‐old woman was admitted with vomiting. Her medical history was notable for Down syndrome, type 2 diabetes, and moderate aortic stenosis. Four weeks before admission she presented to her physician with a [...]

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HM2011 Abstract Number: 243

Hantavirus Pulmonary Syndrome Acquired in New York State

Case Presentation: A healthy 44‐year‐old man presented with a 4 day history of myalgia, cough, fever, and dyspnea after a hiking expedition. Two weeks prior to admission he had traveled to the Catskill Mountains, sleeping [...]

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HM2011 Abstract Number: 242

The Gathering Storm: A Case of Fever and Neck Pain

Case Presentation: A 47‐year‐old man with a history of ul‐cerative colitis (UC) was admitted for malaise, fever, and neck pain. On arrival he was ill‐appearing, febrile (39.2°C), hypotensive (80/63 mm Hg), and tachycardic (163 bpm) with [...]

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HM2011 Abstract Number: 241

Yersinia Enteritis: A New Look for an Old Friend

Case Presentation: A 17‐year‐old white boy was admitted for 12 days of high fevers, nonbloody diarrhea, mild hearing loss, and a 5‐kg weight loss. He denied sick contacts or recent travel and had no significant [...]

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HM2011 Abstract Number: 240

How Low Can It Go?

Case Presentation: A 65‐year‐old undomiciled man without known medical history presented to the hospital with fever amd right shoulder and knee pain. Following arthrocentesis, he was diagnosed with methicillin‐sensitive Staphylococcus aureus (MSSA) polyarthritis, thought to [...]

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HM2011 Abstract Number: 239

A Case of Megacolon: An Adult Presentation of Hirschsprung's Disease?

Case Presentation: C.M. is a 38‐year‐old man who presented to the hospital with severe abdominal distention that developed over 1 month. Four days prior to admission, he had some diarrhea. Past medical history included constipation [...]

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HM2011 Abstract Number: 238

Hereditary Adult‐Onset Alexander Disease

Case Presentation: A 47‐year‐old white man with a history of alcohol abuse was transferred to our hospital with loss of consciousness and subsequently intubated en route for airway protection. His medical history was unremarkable. On [...]

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HM2011 Abstract Number: 237

Familial Mediterranean Fever Refractory to Colchicine: What Can the Hospitalist Do?

Case Presentation: This is a 35‐year‐old Hispanic woman with a history of familial Mediterranean fever (FMF) on disability for 6 years given the severity and frequency of the FMF attacks. The patient had been unable [...]

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HM2011 Abstract Number: 236

Esophageal Perforation: Can We Hold the Tray and Spare the Knife?

Case Presentation: A 38‐year‐old African American man with a medical history of hiradenitis suppurativa (HS) presented with 1‐year history of left leg ulcer with a 2‐week increase in size and malodorous discharge. He denied any [...]

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HM2011 Abstract Number: 235

Bed Bugs Can Cause Bed Shortages

Case Presentation: A 58‐year‐old man with a medical history of chronic obstructive pulmonary disease (COPD) came to the emergency department (ED) with complaints of worsening cough and shortness of breath and was admitted for COPD [...]

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HM2011 Abstract Number: 234

Mantle Cell Lymphoma Presenting with Paraorbital Swelling and Ptosis

Case Presentation: A 69‐year‐old Hispanic man presented with several months of progressive bilateral paraorbital swelling and ptosis. The patient had presented 1 year ago to an outside physician complaining of sudden‐onset bilateral eyelid swelling. At [...]

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HM2011 Abstract Number: 233

The Cough That Would Not Quit

Case Presentation: A 22‐year‐old woman with a 4‐year history of active systemic lupus erythematosus (SLE) presented with a 4‐day history of fever, nonproductive cough, and shortness of breath. Two months earlier she had been admitted [...]

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HM2011 Abstract Number: 232

Atrial Fibrillation in Noncompaction Cardiomyopathy: A Rare Complication of an Unusual Syndrome

Case Presentation: A 36‐year‐old white man presented with a 4‐week history of palpitations, presyncope, and progressive dyspnea on exertion. He reported a significant decrease in his exercise tolerance over the last few months. Family history [...]

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HM2011 Abstract Number: 231

One Bad Egg

Case Presentation: A 58‐year‐old African American woman presented with the acute onset of exquisite left thigh pain and erythema. Her medical history was significant for idiopathic thrombocytopenia purpura, autoimmune hemolytic anemia, and pernicious anemia because [...]

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HM2011 Abstract Number: 230

Recurrent, Nontender Skin Abscesses That Do Not Respond to Antibiotics

Case Presentation: A 28‐year‐old white woman with allergic rhinitis was seen in our clinic with a 1‐week history of a hard, reddishviolet nodule on her right forearm. The nodule was pruritic but not painful. She [...]

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HM2011 Abstract Number: 229

Worsening Dyspnea in Scleroderma: What Gave It Away?

Case Presentation: A 48‐year‐old man with Raynaud's and recently diagnosed CREST syndrome presented with 1 month of exercise intolerance and progressive shortness of breath, with no chest pain, peripheral edema, weight gain, cough, fever, or [...]

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HM2011 Abstract Number: 228

Cauda Equina Lymphoma: A Case Report with Postmortem Exam

Case Presentation: A previously healthy 59‐year‐old man developed low back pain, symptoms of lumbar radiculopa‐thy following a cross‐country drive. MRI showed mild lumbar spinal stenosis. Over 3 months, he developed paraplegia and urinary/fecal incontinence. Laboratory [...]

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HM2011 Abstract Number: 227

Facial and Scrotal Swelling in a 40‐Year‐Old Man

Case Presentation: A 40‐year‐old white man presented with a chief complaint of fevers and lip and scrotal swelling. Two weeks prior, he had chills and sore throat, followed by right submandibular and cheek swelling and [...]

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HM2011 Abstract Number: 226

A Case of Acute Gastric Perforation

Case Presentation: An 85‐year‐old woman with chronic obstructive lung disease, hypertension, and a history of cere‐brovascular accident presented to the hospital with chest pain for 1 day that was worse with deep inspiration. She also [...]

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HM2011 Abstract Number: 225

Idiopathic Ovarian Vein Thrombosis

Case Presentation: A 32‐year‐old African American woman presented to the emergency room (ER) with a 1‐week chief complaint of right lower‐quadrant abdominal pain that was sharp in nature and exacerbated by movement. There was no [...]

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HM2011 Abstract Number: 224

“The Great Masquerader”: A Case of an Uncommon and Frequently Delayed Diagnosis

Case Presentation: A 56‐year‐old Mexican woman with no prior medical history presented to an outside hospital with otitis media refractory to antibiotics, culture‐negative mas‐toiditis, and a facial nerve palsy that resolved with steroids. After transfer [...]

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HM2011 Abstract Number: 223

Blame It on the Birds: An Unusual Cause of Dyspnea in a Young Woman

Case Presentation: A 26‐year‐old woman with a medical history of asthma presented to the emergency department with a 3‐day history of nonproductive cough, dyspnea on exertion, diaphoresis, and right‐sided chest pain. She also noted an [...]

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HM2011 Abstract Number: 222

Tissue Is the Issue!

Case Presentation: Our patient is a 42‐year‐old African American woman with a significant history of a locally advanced ductal cancer of left breast (T2N1M0) after a modified radical mastectomy 1 year earlier. She also received [...]

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HM2011 Abstract Number: 221

Rhabdomyolysis and Acute Renal Failure Following Alcohol‐Induced Crush Syndrome

Case Presentation: A 46‐year‐old right‐handed man with no significant medical history presented to our hospital with a 5‐day history of progressive, painful swelling of his left upper extremity. He was a frequent binge drinker, and [...]

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HM2011 Abstract Number: 220

Massive Splenomegaly: To Cut or Not to Cut

Case Presentation: A 20‐year‐old woman with no medical history presented with splenomegaly by outside imaging. She described 7 months of left upper quadrant pain that intensified prior to admission, was 8/10, nonradiating, and worse with [...]

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HM2011 Abstract Number: 1009

A Novel Approach to the Adult Pediatric Patient

Background: One of the growing challenges in today's health care system is the increase in the number of childhood illnesses that are survived and the number of adults who continue to live with the disease. [...]

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HM2011 Abstract Number: 1008

Oral: Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach

Background: Prolonged emergency department boarding times have been associated with poor patient satisfaction, adverse clinical outcomes, longer hospital stays, increased ambulance diversion, reduction in the possibility of increased revenue from additional patient services, and increased [...]

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HM2011 Abstract Number: 1007

Plenary: Using Toyota Production System Tools to Reengineer an Academic Medical Service

Background: Most responses to Accreditation Council for Graduate Medical Education (ACGME) regulations such as floats, nonteaching services, and midlevel providers have sought to preserve the traditional call system. As a result, hand‐offs have increased, compromising [...]

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HM2011 Abstract Number: 219

Who's Taking Care of This Patient? A Novel Provider Tracking and Paging System

Background: Communication failure is the most common cause of preventable disability or death in the hospital. Accurate and efficient communication is the cornerstone of multidisciplinary health care. Multiple clinicians and other personnel need to identify [...]

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HM2011 Abstract Number: 218

Wikis to Better Manage Shared Information in a Hospitalist Group

Background: The Internet's penetration onto hospital floors, into patient rooms, and on our mobile devices has profoundly altered the way hospitalists access knowledge resources. Information management and sharing increasingly takes place online and in real [...]

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HM2011 Abstract Number: 217

Is Peer Assessment Feasible for Teaching Central Venous Catheter (Cvc) Insertion During Intern Hospital Orientation?

Background: CVC placement is frequently performed by residents. Training of clinical procedures using simulation‐based instruction and modeling with guided practice has been shown to decrease complications. Programs aimed at improving residents’ knowledge and skills often [...]

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HM2011 Abstract Number: 216

From the Kotter Playbook: Patient Experience As a Model for Creating a Sense of Urgency and a Working Coalition for Change

Background: Patient satisfaction is measured across hospitals through a uniformly administered patient survey called the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). This was developed by the Centers for Medicare & Medicaid [...]

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HM2011 Abstract Number: 215

Discharge Appointment Service: Supporting House Staff and Improving Transitions of Care

Background: Follow‐up appointments are a crucial part of the discharge home. This step can be time consuming as physicians try to navigate each outpatient office's unique system. In 2008 one of our interns identified the [...]

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HM2011 Abstract Number: 214

Multifaceted Approach to Improving the Inpatient Management of Infants with Hyperbilirubinemia

Background: Neonatal jaundice is a common condition that can result in devastating consequences if not treated aggressively. Despite evidence‐based guidelines for monitoring and treating hyperbilirubinemia, variation in care persists that can result in suboptimal outcomes. [...]

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HM2011 Abstract Number: 213

A Curriculum in the Business of Medicine for Hospitalist Training Track Residents in Internal Medicine

Background: Internal medicine residents lack formal training of concepts that pertain to the business of medicine. Previous studies of graduates of various specialties found young practitioners to have little knowledge about basic financial accounting principles [...]

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HM2011 Abstract Number: 212

A Care Coordination Model of Unit‐Based Staffing: A Paradigm Shift in Hospital Medicine

Background: The evolving political and regulatory climes in recent times pose several challenges to hospital medicine. There is a need for a “consumer‐driven” approach to health care that emphasizes both quality of care and consumer [...]

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HM2011 Abstract Number: 211

The “I Plan” Approach to Becoming a Better Bedside Teacher: A Faculty Development Workshop

Background: Although educators espouse the benefits of bedside teaching and faculty and trainees report they would prefer more bedside teaching, the proportion of time on rounds spent at the patient bedside has decreased markedly, from [...]

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HM2011 Abstract Number: 210

Impact of Targeted Individual Feedback on Provider Patterns of Stat Laboratory Test Ordering Frequency

Background: The literature suggests that stat laboratory tests are frequently ordered inappropriately by physicians. In fact, up to 65% of laboratory tests are ordered as stat in teaching hospitals. Previous studies also suggest that reporting [...]

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HM2011 Abstract Number: 209

The Impact of Interdisciplinary Anticoagulation Safety Rounds at a Large Urban Teaching Hospital

Background: The Anticoagulation Safety Taskforce established a comprehensive Anticoagulation Safety Program over the last 2 years with the overall goal of reducing harm surrounding the use of the 3 most commonly used anticoagulants—heparin, warfarin, and [...]

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HM2011 Abstract Number: 208

A Standardized Discharge Process to Reduce Unplanned Hospital Readmissions

Background: Hospital readmissions, a consequence of fragmentation of care, has recently been described as a crisis of health care safety, cost, and patient experience. Reducing unplanned readmissions is especially challenging. Despite the emergence of a [...]

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HM2011 Abstract Number: 207

Implementing Postdischarge Transition Care in a Hospitalist System

Background: Postdischarge care is a challenge, and the readmission rate remains high especially in elderly patients. Because discontinuity is a concern after discharge, post‐discharge transition care (PDTC) needs to be incorporated into hospitalist‐care systems. Purpose: [...]

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HM2011 Abstract Number: 206

New Interns Drive Transformation Toward High Reliability: Viewing July As a Glass Half Full

Background: July has been implicated as a time of increased medical errors because of its association with the onset of residency training. The abrupt transfer of patient care responsibilities at the beginning of each academic [...]

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HM2011 Abstract Number: 205

An Innovative Approach to Improving Functional Mobility on a Hospitalist Unit

Background: Lack of functional mobility in hospitalized patients results in a substantial loss of lower‐extremity strength and has been associated with increased falls, skin breakdown, and overall worse medical outcomes. Aside from physical therapy consultation [...]

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HM2011 Abstract Number: 204

A Multidisciplinary Central Line Schedule Did Not Improve the Rate of Central Venous Catheter Placement in Septic Patients

Background: Sepsis is a common condition associated with high mortality. Abundant literature, including the Dillinger guidelines, suggests that prompt placement of a central venous catheter (CVC) is essential in treating sepsis effectively. Numerous barriers prevent [...]

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HM2011 Abstract Number: 203

Multidisciplinary Team Rounding Leads to Increased Patient Satisfaction

Background: Joint Commission on Accreditation of Healthcare Organizations sentinel event reporting demonstrates that 70% of preventable medical errors are due to communication errors. The national patient safety goals for 2006 include improving “the effectiveness of [...]

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HM2011 Abstract Number: 202

A Process for Improving Utilization in the Management of Cirrhotic Patients with Gastrointestinal Bleeds

Background: Given the current health care reform movement, it is clear that hospital utilization will be paramount for hospitals to provide adequate health care while limiting costs. Purpose: To examine the utilization data for cirrhotic [...]

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HM2011 Abstract Number: 201

Project Boost at Queen's Medical Center: Looking Into the Future

Background: Project BOOST (Better Outcomes for Older Adults through Safe Transitions) is a Society of Hospitalist Medicine project aimed at improving the care of patients as they transition from hospital to home. Queen's Medical Center [...]

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HM2011 Abstract Number: 200

Use of an Interactive Web Site to Improve Communication and Education at an Academic Hospitalist Program

Background: Over 12 months, our academic hospitalist section expanded by nearly 50% and was intimately involved with major changes in the residency ward structure. Section members repeatedly cited the need for improved communication about administrative [...]

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HM2011 Abstract Number: 199

Improving Glycemic Control in the Hospital with a Multidisciplinary Quality Improvement Process

Background: Glycemic control in hospitalized patients can improve outcomes and shorten length of stay, whereas hypoglycemia can raise in‐hospital mortality. To improve glycemic control in our tertiary‐care academic hospital, we initiated a multidisciplinary quality improvement [...]

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HM2011 Abstract Number: 198

Hospitalists’ Critical Role in Public Health: Tackling HIV Awareness with Inpatient Health Educators

Background: HIV/AIDS is now better understood with regard to disease treatment and prevention but is still not a disease that we can eradicate through preventive measures such as vaccines or elimination of high‐risk behaviors. It [...]

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HM2011 Abstract Number: 197

Assessing Perception of a Newly Implemented Hospitalist Feedback Model

Background: Physician feedback is typically sporadic after residency training is completed. The literature suggests that feedback given in letter form or only for poor performance is ineffective in changing physician behavior and can lead to [...]

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HM2011 Abstract Number: 196

Geriward: An Interprofessional Team‐Based Curriculum on Care of the Hospitalized Older Adult

Background: Regardless of specialty or discipline, the majority of health care profession students care for hospitalized older adults during their training and in their future careers. It is therefore crucial that students have educational experience [...]

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HM2011 Abstract Number: 195

Using Teach‐Back to Reduce Readmission Rates in Hospitalized Heart Failure Patients

Background: Studies have demonstrated that patients forget 40%–80% of the information they receive almost immediately after hearing it. In addition, nearly half of the information they retain is incorrect. Given the importance of understanding one's [...]

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HM2011 Abstract Number: 194

Direct Observation of Clinical Encounters (Doce) of Medical Students Prerounding in the Hospital: Development of a Pilot Program and Observation Checklist

Background: Medical educators have opined that the clinical, communication, and professionalism skills of medical students are best taught and assessed by faculty directly observing clinical encounters between students and patients. Nonetheless, the medical literature suggests [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Direct Observation of Clinical Encounters (Doce) of Medical Students Prerounding in the Hospital: Development of a Pilot Program and Observation Checklist

HM2011 Abstract Number: 193

Development of a Post‐Fall Multidisciplinary Checklist to Evaluate the Inpatient Fall

Background: Falls suffered by hospitalized patients are an important reportable event. Approximately 4%–6% of inpatient falls result in serious injury. Recurrent falls or delayed recognition of injury can harm patients and represent a medicolegal risk. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Development of a Post‐Fall Multidisciplinary Checklist to Evaluate the Inpatient Fall

HM2011 Abstract Number: 192

Teaching Residents Effective Transitions of Care: Examining the Patient Handover from Admission to Discharge

Background: Patient handovers represent vulnerable points in time during a hospitalization. Although changes in the practice of medicine and changes in residency work‐hour restrictions have led to increased patient handovers, training programs have not uniformly [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Teaching Residents Effective Transitions of Care: Examining the Patient Handover from Admission to Discharge

HM2011 Abstract Number: 191

Preoperative Blood Management—paving the Path to Bloodless Surgery

Background: The risks associated with blood transfusions in tandem with spiraling health care costs have placed the spotlight on blood management programs. In addition, Joint Commission on Accreditation of Healthcare Organizations performance measures related to [...]

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HM2011 Abstract Number: 190

The Use of Prodrome and San Francisco Syncope Rule in Managing Patients with Syncope

Background: Syncope, a frequent diagnosis encountered in the emergency department (ED) and inpatient setting, creates risk assessment and disposition challenges. The San Francisco Syncope Rule (SFSR) was developed to help identify lower‐risk syncope patients less [...]

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HM2011 Abstract Number: 189

Interdisciplinary Teamwork Reduces Glycemic Medication Errors in Hospitalized Patients

Background: Insulin is a “high‐alert medication” carrying increased risk of significant harm when used in error. The complex nature of inpatient glycemic control requires a team approach. Team structure may be multidisciplinary, utilizing the skills [...]

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HM2011 Abstract Number: 188

Decreasing Readmission Rates: 2 Interventions That Worked

Background: About 18%–20% of Medicare beneficiaries who are discharged from a hospital are readmitted within 30 days. The health care spending related to this has been estimated at $17 billion. Furthermore, Congress and President Obama [...]

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HM2011 Abstract Number: 187

Incident Tracker: An Intranet‐Based Decision Support Tool for Analyzing, Aggregating, and Reporting Sentinel Events

Background: Hospitals are required to review sentinel events (SEs) and develop root cause analyses (RCA), implement action plans, and monitor the effectiveness of implemented plans. Vague definitions of safety terms and nonstandardized review processes impede [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Incident Tracker: An Intranet‐Based Decision Support Tool for Analyzing, Aggregating, and Reporting Sentinel Events

HM2011 Abstract Number: 186

Improving Quality, Efficiency, and Patient/provider Satisfaction with Electronic Medication Reconciliation and Discharge Instructions

Background: Effective transitions of care are essential to improving health care delivery and include high‐quality medication reconciliation and discharge instructions. These are an important focus of the Joint Commission and of the meaningful use of [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Improving Quality, Efficiency, and Patient/provider Satisfaction with Electronic Medication Reconciliation and Discharge Instructions

HM2011 Abstract Number: 185

An Intervention to Prevent Medication Reconciliation Errors: The Discharge Timeout

Background: Improving transitions of care is a quality and patient safety imperative for hospital‐based providers. Inaccurate medication reconciliation during the discharge transition is a known cause of preventable medication errors, patient confusion regarding medication regimens, [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on An Intervention to Prevent Medication Reconciliation Errors: The Discharge Timeout

HM2011 Abstract Number: 184

Professional Development for Hospital Medicine Physicians: Process and Outcomes in a Hybrid Academic–Community Program

Background: An estimated 30,000 hospital medicine physicians practice in the United States today. Many of these physicians are challenged to engage in nonclinical activities, including administrative leadership, quality improvement projects, and educational initiatives. Yet residency [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Professional Development for Hospital Medicine Physicians: Process and Outcomes in a Hybrid Academic–Community Program

HM2011 Abstract Number: 183

Assessing Safety Culture Within an Academic Department of Medicine

Background: A positive safety culture is an essential component of enhancing patient safety. As hospitalists assume leadership roles within health systems, the capacity to measure a system's safety culture can serve as a key first [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Assessing Safety Culture Within an Academic Department of Medicine

HM2011 Abstract Number: 182

Reducing General Medicine Readmissions Through Multidisciplinary Team Engagement

Background: Readmissions are a low‐value outcome for patients and costly to society. In the current environment there is ample motivation for hospitals and providers to improve this important patient outcome. Studies have demonstrated important reduction [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Reducing General Medicine Readmissions Through Multidisciplinary Team Engagement

HM2011 Abstract Number: 181

Ibcd: Development and Testing of a Checklist to Improve Quality of Care for Hospitalized General Medical Patients

Background: Although checklists have been used to improve quality of care in surgery and intensive care unit settings, it is unclear if they are helpful for hospitalized medical patients. We developed a checklist to address [...]

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HM2011 Abstract Number: 180

Hospitalist‐Led Research Mentorship Program: A Mutual Path for You and Your House Staff to Conduct Successful Research

Background: An untapped mutualism between house staff and hospitalists exists in academic teaching hospitals. On the one hand, many hospitalists struggle to conduct meaningful research without needed funding for research assistants. On the other hand, [...]

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HM2011 Abstract Number: 179

Getting House Staff on Board: Success Using Inpatient Quality Metrics with Residents

Background: In many health care settings providers are given regular performance feedback via data dashboards, and financial incentives are often tied to these data. Although this structure is now commonplace for physicians and an important [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Getting House Staff on Board: Success Using Inpatient Quality Metrics with Residents

HM2011 Abstract Number: 178

Reviving Cardiac Physical Diagnosis: Teaching the Teachers

Background: The failure of recent generations of physicians to be proficient in physical diagnosis is well known in the medical community, and recently even the mainstream media have taken to reporting on the problem. However, [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Reviving Cardiac Physical Diagnosis: Teaching the Teachers

HM2011 Abstract Number: 177

Engaging Interns in Quality Improvement Through Readmission Case Reviews

Background: The Institute for Healthcare Improvement recommends that any unplanned readmission within 30 days of discharge prompt a formal case review to identify systematic flaws in discharge processes. Residency programs are also being charged to [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Engaging Interns in Quality Improvement Through Readmission Case Reviews

HM2011 Abstract Number: 176

Development of a Balanced Scorecard in an Academic Hospitalist Group

Background: Hospitalist groups face increasing pressure to substantiate quality and efficiency of care through performance data. Academic groups are expected to advance the field through scholarly work and provide quality education to students and house [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Development of a Balanced Scorecard in an Academic Hospitalist Group

HM2011 Abstract Number: 175

Leading Quality Change One Beat at a Time: Telemetry Reduction in a University Hospital

Background: Telemetry use has escalated in hospitals in general, causing some unexpected problems including a tethering effect for patients, with reduction of ambulation, potential for increased falls, and even a potential for increased length of [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Leading Quality Change One Beat at a Time: Telemetry Reduction in a University Hospital

HM2011 Abstract Number: 174

The Pillbox Format: Novel Use in Discharge Medication List

Background: The transition from hospital to home is critical for patients, especially for those with a complicated medication regimen. Patients often report problems understanding and using the traditional medication discharge list. The authors created a [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on The Pillbox Format: Novel Use in Discharge Medication List

HM2011 Abstract Number: 173

Improving Patient Engagement and Education to Help Reduce Preventable Rehospitalizations

Background: Preventable rehospitalizations are disconcerting for patients, contribute to high health care costs, and are partly due to deficiencies in patients’ ability to execute the posthospital care plan. Effective patient and family care‐giver engagement and [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Improving Patient Engagement and Education to Help Reduce Preventable Rehospitalizations

HM2011 Abstract Number: 172

Educational Blast in Management of Inpatient Diabetes Using Electronic Orders As a Standard Approach

Background: Despite published inpatient hyperglycemia treatment guidelines, most hospitals have not yet adopted them. In our hospital 50% of inpatients have diabetes, and neither uniform hypoglycemia treatment nor insulin protocol was available on the computerized [...]

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HM2011 Abstract Number: 171

Incorporating Pharmacists Into Medication Reconciliation

Background: The challenges of medication reconciliation at hospital admission and discharge are well recognized, and best practices remain to be fully defined. The accuracy of the preadmission medication list (PAML) may be compromised by patient [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Incorporating Pharmacists Into Medication Reconciliation

HM2011 Abstract Number: 170

The Va Ann Arbor Hospital Outcomes Program of Excellence (Hope) Initiative: Qualitative Needs Assessment to Guide Quality Improvement

Background: The Hospital Outcomes Program of Excellence (HOPE) Initiative is an effort to improve the inpatient medical care provided at the Ann Arbor VA Medical Center. Our goal is to expand and enhance the systems [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on The Va Ann Arbor Hospital Outcomes Program of Excellence (Hope) Initiative: Qualitative Needs Assessment to Guide Quality Improvement

HM2011 Abstract Number: 169

Patient Flow Composite Scoring

Background: Hospital patient flow and its measurement are a complex organizational issue. Composite measures may provide a holistic picture of patient flow for monitoring and improving. Purpose: To describe a patient flow composite score tool [...]

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HM2011 Abstract Number: 168

Framework for Quantifying and Matching Workload and Workforce in Healthcare Settings

Background: Health care workload (WL) and workforce (WF) are complex and dynamic. A significant challenge is measuring and defining the match of WL and WF to optimize processes of care. Purpose: To develop and obtain [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Framework for Quantifying and Matching Workload and Workforce in Healthcare Settings

HM2011 Abstract Number: 167

Development of a Departmental Acgme‐Compliant Core Curriculum for Subspecialty Fellows

Background: The Accreditation Council for Graduate Medical Education (ACGME) sanctioned new accreditation standards that define core competencies in research and other scholarly activities for subspecialty fellows in 2007. There are few descriptions of organizational models [...]

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HM2011 Abstract Number: 166

Collaborative Leadership in Hospital Medicine: An Innovative Regional Model

Background: Fragmentation of inpatient care has precluded collaboration among neighboring institutions. Hospitals in large urban areas characteristically function as separate silos. Yet the increased complexity of inpatient care necessitates a different approach. The advent of [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Collaborative Leadership in Hospital Medicine: An Innovative Regional Model

HM2011 Abstract Number: 165

Innovative Approach to C. Difficile Colitis Management

Background: Clostridia are anaerobic spore‐forming rods (bacilli). C. difficile is the most serious cause of antibiotic‐associated diarrhea (AAD) and can lead to pseudomembra‐nous colitis. This form of colitis often results from eradication of the normal [...]

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HM2011 Abstract Number: 164

Design and Implementation of an Automated E‐Mail Notification System for Results of Tests Pending at Discharge

Background: Physicians are aware of approximately 40% of the final results of tests pending at discharge (TPADs). Few institutions have standardized systems to manage TPADs. Automated systems using “push” notification may improve awareness of TPADs; [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Design and Implementation of an Automated E‐Mail Notification System for Results of Tests Pending at Discharge

HM2011 Abstract Number: 163

Purposeful Visits for Hospitalized Elderly Patients: Program Impact on Orientation, Agitation, and Mood

Background: Hospitalization can be an isolating and disorienting experience for elderly patients who find themselves cut off from normal routines and social support. Providing structure to social and cognitive stimulation provided by specially trained hospital [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Purposeful Visits for Hospitalized Elderly Patients: Program Impact on Orientation, Agitation, and Mood

HM2011 Abstract Number: 162

Patient‐Centered Postdischarge Appointment Scheduling Improves Readmission Rates

Background: Patients who see a physician shortly after hospital discharge have improved outcomes and reduced read‐missions. To promote follow‐up, Henry Ford Hospital will schedule patients for postdischarge follow‐up appointments (PDFUAs) prior to discharge. Yet patients [...]

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HM2011 Abstract Number: 161

Readmissions, Facebook and Information Sharing: Lessons Learned for Future Paths

Background: The hospitalist model of care may adversely affect the transition to or from the hospital by interrupting the flow of information between providers. The resulting information chasm has been related to readmissions, adverse events, [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Readmissions, Facebook and Information Sharing: Lessons Learned for Future Paths

HM2011 Abstract Number: 160

Electronic Documentation of Central Line‐Days; Validation Is Essential

Background: Beginning in January 2011, hospitals will report central line‐associated bloodstream infections (CLABSIs) to the National Healthcare Safety Network (NHSN) per Center for Medicare and Medicaid Services (CMS) payment rules. The NHSN definition of CLABSI [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Electronic Documentation of Central Line‐Days; Validation Is Essential

HM2011 Abstract Number: 159

Readmissions—the Same Old Thing?

Background: Hospitalized patients are frequently readmitted within 30 days of their discharge. It is believed that many patients are readmitted because of a recurrence or worsening of the same condition for which they were originally [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Readmissions—the Same Old Thing?

HM2011 Abstract Number: 158

Resident Case Review at the Departmental Level: A Win–Win Scenario

Background: In 2001 our residency program developed a quality improvement elective. Our goals were to provide residents with hands‐on experience in peer review root cause analysis (RCA) and performance improvement, which would also satisfy the [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Resident Case Review at the Departmental Level: A Win–Win Scenario

HM2011 Abstract Number: 157

Right Patient, Right Bed

Background: Our program admits approximately 15,000 patients a year. Bed assignment depends on availability and level of care required. Incorrect placement occurs frequently, leading to delays in patient care and causing a drain on nursing, [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Right Patient, Right Bed

HM2011 Abstract Number: 156

The Ward Attending Scholars Program (Wasp): A Multimodal, Collaborative Faculty Development Program for Teaching Attendings

Background: Clinician‐educators are responsible for more information and sicker patients than in the past. Yet they face greater time pressures. Faculty development programs ought to teach clinician‐educators to handle these conflicting responsibilities while retaining excellence [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on The Ward Attending Scholars Program (Wasp): A Multimodal, Collaborative Faculty Development Program for Teaching Attendings

HM2011 Abstract Number: 155

Teaching Death Pronouncement: Reinforcing Didactics with Systems‐Based Improvements

Background: Handling deaths is a stressful but unfortunately common event for hospital‐based trainees. This experience is a key component of the practice of palliative care. Training in palliative care is a responsibility and a requirement [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Teaching Death Pronouncement: Reinforcing Didactics with Systems‐Based Improvements

HM2011 Abstract Number: 154

Implementation of a Pulmonary Arterial Hypertension (Pah) Preoperative Algorithm for Noncardiac Surgery

Background: Noncardiac surgery in patients with pulmonary arterial hypertension (PAH) is associated with a morbidity of 42% and a mortality of 7%. The most important pathophysiologic consideration is the effect of increased pulmonary vascular resistance [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Implementation of a Pulmonary Arterial Hypertension (Pah) Preoperative Algorithm for Noncardiac Surgery

HM2011 Abstract Number: 153

Hospital Medicine Proceduralists and a Comprehensive Program to Eliminate Central Line–Associated Bloodstream Infections

Background: Central line–associated bloodstream infections (CLABSIs) increase length of stay, add an additional $10,000 in costs per event, and increase mortality. Education, procedure carts, and checklists to improve compliance with evidence‐based, sterile procedures have been [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Hospital Medicine Proceduralists and a Comprehensive Program to Eliminate Central Line–Associated Bloodstream Infections

HM2011 Abstract Number: 152

Developing a Curriculum for Medical Students Completing Their Core Pediatrics Clerkship on an Attending‐Only Hospitalist Service

Background: The number of attending‐only services in traditional teaching hospitals has increased. This trend is largely a result of decreased patient coverage by residents in response to ACGME duty‐hour restrictions, as well as planned growth [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Developing a Curriculum for Medical Students Completing Their Core Pediatrics Clerkship on an Attending‐Only Hospitalist Service

HM2011 Abstract Number: 151

Balancing Hospitalist Productivity and Satisfaction with Patient Care Continuity Utilizing Software‐Based Scheduling

Background: Many hospitalist groups recognize the importance of ensuring that the individual preferences, strengths, and practice styles of their providers are taken into account while determining the work schedule for the practice. Rigid schedules with [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Balancing Hospitalist Productivity and Satisfaction with Patient Care Continuity Utilizing Software‐Based Scheduling

HM2011 Abstract Number: 1006

Evaluation of Health Literacy As a Mechanism for Identifying Patients for Pharmacist‐Provided Counseling on High‐Risk Medications

Background: Many hospitals lack adequate resources to provide pharmacist‐delivered discharge counseling for all inpatients. We hypothesized that health literacy testing could identify a manageable subset of high‐risk diabetic and anticoagulation patients in need of additional [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Evaluation of Health Literacy As a Mechanism for Identifying Patients for Pharmacist‐Provided Counseling on High‐Risk Medications

HM2011 Abstract Number: 1005

Failure of a Hospital‐Wide Chlorhexidine Bath Admission Protocol in Preventing Hospital‐Acquired Methicillin‐Resistant Staphylococcus Aureus Infection

Background: Hospital‐acquired methicillin‐resistant Staphylococcus aureus (HA‐MRSA) infections annually affect almost 21,000 patients nationwide. Randomized controlled trials have demonstrated the efficacy of chlorhexidine gluconate (CHG) in preventing HA‐MRSA infections associated with invasive procedures. Several small studies [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Failure of a Hospital‐Wide Chlorhexidine Bath Admission Protocol in Preventing Hospital‐Acquired Methicillin‐Resistant Staphylococcus Aureus Infection

HM2011 Abstract Number: 1004

Understanding Unsuccessful Procedures on a Hospitalist Procedure Service

Background: Ultrasonography (US) has improved the yield of bedside invasive procedures over the last decade; however, unsuccessful procedures still occur. As benchmarks for the yield of procedures using US are limited, we aimed to quantify [...]

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HM2011 Abstract Number: 1003

Evaluation of an Electronic Discharge Summary for Timeliness and Quality Compared with Dictation

Background: The Center for Medicaid and Medicare Services requires that a discharge summary be completed only within 30 days of discharge. This rule is inadequate to ensure safe care transitions, as outpatient physicians must receive [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Evaluation of an Electronic Discharge Summary for Timeliness and Quality Compared with Dictation

HM2011 Abstract Number: 1002

The Derivation of the Lung Injury Severity Score (Liss): A Prognostic Index for In‐Hospital Mortality in Acute Lung Injury

Background: Acute lung injury (ALI) is a frequently fatal cause of respiratory failure among hospitalized patients, and a practical and easily obtainable prognostic index at the time of ALI diagnosis is needed for risk prediction. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on The Derivation of the Lung Injury Severity Score (Liss): A Prognostic Index for In‐Hospital Mortality in Acute Lung Injury

HM2011 Abstract Number: 1001

Oral: Clinical Outcomes Among Non–Mechanically Ventilated Patients with Acute Lung Injury

Background: Acute lung injury (ALI) is a common cause of respiratory failure among hospitalized patients. Large studies have been limited to patients requiring mechanical ventilation, and little is known about non–mechanically ventilated adults with ALI. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Oral: Clinical Outcomes Among Non–Mechanically Ventilated Patients with Acute Lung Injury

HM2011 Abstract Number: 1000

Plenary: Financial Impact of Presenting Lab Cost Data to Providers at the Time of Order Entry: A Randomized Controlled Clinical Trial

Background: Hospital care consumes a large percentage of U.S. health care costs, yet providers practicing in the hospital are often unaware of the actual costs of the diagnostic tests they order. We hypothesized that displaying [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Plenary: Financial Impact of Presenting Lab Cost Data to Providers at the Time of Order Entry: A Randomized Controlled Clinical Trial

HM2011 Abstract Number: 150

Opportunity Lost: End‐of‐Life Discussions in Cancer Patients Who Die in the Hospital

Background: The majority of patients with serious illness die in an acute care hospital. The dying process is often filled with clinically and ethically challenging decisions. Frequently, patient care at the end of life is [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Opportunity Lost: End‐of‐Life Discussions in Cancer Patients Who Die in the Hospital

HM2011 Abstract Number: 149

Comparison of the Glasgow Blatchford and Clinical Rockall Scoring System to Predict Need for Clinical Intervention for Patients with Nonvariceal Upper Gastrointestinal Tract Bleeding

Background: Upper gastrointestinal bleeding is a common indication for admission to the hospital. Several risk score systems are designed for triage patients with acute nonvariceal upper gastrointestinal bleeding (UGIB). Glasgow Blatchford score (GBS) and clinical [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Comparison of the Glasgow Blatchford and Clinical Rockall Scoring System to Predict Need for Clinical Intervention for Patients with Nonvariceal Upper Gastrointestinal Tract Bleeding

HM2011 Abstract Number: 148

Validation of Claims Data for Determination of In‐Hospital Cardiac Arrest Incidence

Background: The incidence of in‐hospital cardiac arrest (IHCA) in the United States is unknown but has been estimated using administrative data from large nationally representative samples such the Medicare and Nationwide Inpatient Sample databases. However, [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Validation of Claims Data for Determination of In‐Hospital Cardiac Arrest Incidence

HM2011 Abstract Number: 147

Sex Disparities in Cardiopulmonary Resuscitation Quality and Outcomes in the Hospital

Background: Several previous studies have documented lower initial survival in men than women following cardiac arrest, primarily in the out‐of‐hospital setting. However, the etiology of this discrepancy and its translation into the in‐hospital environment is [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Sex Disparities in Cardiopulmonary Resuscitation Quality and Outcomes in the Hospital

HM2011 Abstract Number: 146

Burnout, Sense of Calling, and Career Resilience Among Hospitalists and Primary Care Physicians: A National Survey

Background: Physicians’ levels of burnout shape the trajectory of their professional development, ultimately affecting their career resilience. Burnout poses a challenge to long‐term career resilience by preventing physicians from responding to their intrinsic motivations. However, [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Burnout, Sense of Calling, and Career Resilience Among Hospitalists and Primary Care Physicians: A National Survey

HM2011 Abstract Number: 145

Association Between Hospital Noise Levels and Inpatient Sleep Among Middle‐Aged and Older Adults: Far from a Quiet Night

Background: Sleep disturbances are prevalent among hospitalized seniors and often neglected by clinicians, despite their potential for negative health outcomes. One of the primary reported causes of sleep loss in hospitals is environmental noise, a [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Association Between Hospital Noise Levels and Inpatient Sleep Among Middle‐Aged and Older Adults: Far from a Quiet Night

HM2011 Abstract Number: 144

Impact of a Hospitalist‐Led Multidisciplinary Stroke Care Team

Background: Each year approximately 795,000 persons in the United States experience a stroke. Data from the Paul Coverdell National Acute Stroke Registry suggest many acute stroke patients do not receive treatment according to established guidelines. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Impact of a Hospitalist‐Led Multidisciplinary Stroke Care Team

HM2011 Abstract Number: 143

Boost: Impact of a Quality Improvement Project to Reduce Rehospitalizations

Background: The hospital discharge transition can be dangerous for patients with a high risk of failed follow‐up and adverse events. Moreover, about 20% of hospitalized Medicare patients are readmitted within 30 days of discharge. Although [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Boost: Impact of a Quality Improvement Project to Reduce Rehospitalizations

HM2011 Abstract Number: 142

Public Reporting and Racial Disparities: Does It Affect the Disparity Gap?

Background: Racial disparities in the quality of health care are well recognized in the United States. Multiple factors drive this disparity gap in quality, but few strategies have proven successful in decreasing the gap. Quality [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Public Reporting and Racial Disparities: Does It Affect the Disparity Gap?

HM2011 Abstract Number: 141

Work Life and Satisfaction of Hospitalists

Background: The number of hospitalists in the United States continues to grow rapidly, yet little is known about the work life of hospitalists to inform whether hospital medicine is a viable long‐term career for physicians. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Work Life and Satisfaction of Hospitalists

HM2011 Abstract Number: 140

Satisfaction and Variability in Hospitalist Practice Models

Background: Nearly two thirds of U.S. hospitals are served by hospitalists who work under a variety of practice models. Differences in hospitalist practice patterns and satisfaction of individual hospitalists across these models are unknown. Methods: [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Satisfaction and Variability in Hospitalist Practice Models

HM2011 Abstract Number: 139

A Simplified Frailty Index to Predict Perioperative Risk in the Orthopedic Population

Background: There are limited tools to aid in stratifying peri‐operative risk in orthopedic surgical patients. Frailty has been associated with poor clinical outcomes yet is difficult to measure. We sought to better understand the implications [...]

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HM2011 Abstract Number: 138

Diabetes and Perioperative Risk Evaluation in Medical Practice

Background: Assessing perioperative risk is a common challenge in daily internal medicine practice. Risk models are sparse and focus primarily on cardiac and pulmonary risk. Little has been established regarding the implications of more common [...]

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HM2011 Abstract Number: 137

Process‐of‐Care Outcomes for Patients with Sepsis: Medical Icu Versus Overflow Icu

Background: Sepsis is a major cause of death in hospitalized patients. The preferred setting to care for patients with sepsis is the medical intensive care unit (MICU). However if the MICU is full, patients are [...]

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HM2011 Abstract Number: 136

Use and Appropriateness of Fresh Frozen Plasma Transfusions Among Adult Inpatients

Background: Inappropriate fresh frozen plasma (FFP) prescriptions may account for at least some of the dramatic increase seen in FFP transfusions. In particular, FFP prescribed for bleeding prophylaxis prior to invasive procedures may be largely [...]

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HM2011 Abstract Number: 135

Icu Bedside Assessments of Delirium: Sustainability and Reliability

Background: Delirium affects 50% of intensive care unit (ICU) patients and is associated with increased mortality and long‐term cognitive impairment. Instruments can accurately measure delirium; however, the sustainability and reliability of delirium measurement tools are [...]

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HM2011 Abstract Number: 134

The Transfusion Practices of Hospitalists at a Single Tertiary‐Care Center and Their Response to an Educational Intervention

Background: Blood transfusion raises many questions of safety and economics. We examined blood usage and its characteristics in patients taken care of by hospitalists, a group of physicians for whom there is a scarcity of [...]

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HM2011 Abstract Number: 133

A Systematic Approach to Increasing Pneumococcal and Influenza Vaccination Rates Among Hospitalized Patients

Background: Inadequate vaccination of eligible inpatients against influenza and pneumococcal infections is a gap in quality care that contributes to the spread of disease in the community. Rates of vaccination at Emory University hospitals were [...]

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HM2011 Abstract Number: 132

A Cross‐Sectional Statewise Study of Preventable Hospitalization Rates Among Medicaid Recipients

Background: States in the United States have wide latitude in administering Medicaid, thus creating an opportunity to study interstate differences in quality and outcomes among Medicaid recipients. Studying statewise variations in preventable hospitalization (PH) rates [...]

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HM2011 Abstract Number: 131

How Clinically Experienced Are the Physician Assistants Who Are Joining the Hospitalist Workforce?

Background: Hospital medicine is the fastest‐growing medical field in the United States. Given a pressing shortage of hospi‐talist physicians and restrictions on resident duty hours, the number of physician assistants (PAs) in hospital medicine is [...]

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HM2011 Abstract Number: 130

Prevalence of Community‐Acquired Methicillin‐Resistant Staphylococcus Among Children with Skin and Soft‐Tissue Infections

Background: The prevalence of community‐acquired methi‐cillin‐resistant Staphylococcus aureus (CA‐MRSA) infections among the pediatric population has been gradually increasing over the years. Similarly, the resistance to other families of antibiotics has also developed rapidly in community [...]

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HM2011 Abstract Number: 129

Inferior Vena Cava Diameter Before and After Intravenous Furosemide in Patients Admitted with Acute Heart Failure Exacerbation

Background: Sonographic measurement of the inferior vena cava (IVC) diameter is straightforward and reliably performed by noncardiologists using hand‐carried ultrasound (HCU) at patients’ bedsides. It provides a noninvasive estimate of the right atrium pressure and [...]

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HM2011 Abstract Number: 128

The Impact of Drug and Alcohol Disorders in a University‐Affiliated Public Hospital—a Call to Action

Background: The National Epidemiologic Survey on Alcohol and Related Conditions indicates that American adults have a 30% lifetime prevalence of any alcohol disorder and a 10% lifetime prevalence of any drug disorder. The purpose of [...]

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HM2011 Abstract Number: 127

A Cost Effective Panel of Seniors Shapes Attitudes of Medical Students During Early Clinical Education

Background: Today's medical students frequently lack positive opportunities for interaction with elderly people because of restructuring and distribution of families according to age. However, the elderly patient will be disproportionately represented in many clinicians’ practices, [...]

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HM2011 Abstract Number: 126

Determining the Most Appropriate Resource for Making Telephone Follow‐Up After Hospitalization

Background: Patients frequently encounter questions or problems shortly after discharge. Telephone follow‐up has become an essential part of transitions of care interventions to address postdischarge problems, increase patient satisfaction, and decrease readmission rate. There is [...]

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HM2011 Abstract Number: 125

Communication Between Hospitalists and Nurses: A Time–Motion Study

Background: Communication between nurses and physicians has been studied in settings of intensive care units, internal medicine wards, operating rooms, and labor and delivery. These studies have shown that this communication can affect nursing retention [...]

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HM2011 Abstract Number: 124

Scoring Hospitalist Etiquette

Background: As physicians are forced to spend more time in “indirect” patient care activities, particularly on documentation, it has become difficult to establish meaningful physician–patient relationships. Dr. Michael Kahn proposed a checklist of 6 etiquette‐based [...]

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HM2011 Abstract Number: 123

Retrospective Review of Patients Admitted with Self‐Mutilation Injuries in a Nonuniversity Teaching Hospital

Background: Self‐mutilation has been defined as the deliberate commission of recurrent socially unacceptable direct physical harm to one's own body without conscious suicidal motivation. There is evidence that self‐mutilation has become more prevalent in the [...]

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HM2011 Abstract Number: 122

In‐Hospital Strokes in a Nonuniversity Teaching Hospital

Background: In‐hospital stroke (IHS) represents 5%–15% of all hospitalized acute stroke cases and is associated with poor outcomes. These patients may be excellent candidates for rapid assessment and potential thrombolytic therapies. This project aimed to [...]

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HM2011 Abstract Number: 121

Collaboration of Pharmacists and Hospitalists to Increase Use of Ada‐Recommended Insulin Regimens in Internal Medicine Patients: Implementation of a Pilot Program

Background: American Diabetes Association (ADA) goals for hospitalized patients include: premeal blood glucose (BG) < 140 mg/dL, random BG < 180 mg/dL, and avoid hypoglycemia (BG < 70 mg/mL). To achieve these goals, the ADA recommends use of basal‐mealtime‐supplemental (BMS) insulin regimens, avoidance of [...]

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HM2011 Abstract Number: 120

Combined Effect of Multidisciplinary Bedside Rounding and Real‐Time Visualization of Prophylaxis Status on Hospital‐Acquired Venous Thromboembolism in a Surgical Intensive Care Unit

Background: Hospital‐acquired venous thromboembolism (HA‐VTE) is a predictable complication that increases morbidity and mortality. Despite overwhelming evidence supporting the effectiveness of VTE prophylaxis, safe, effective, and cost‐efficient methods to prevent VTE remain underutilized. In the [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Combined Effect of Multidisciplinary Bedside Rounding and Real‐Time Visualization of Prophylaxis Status on Hospital‐Acquired Venous Thromboembolism in a Surgical Intensive Care Unit

HM2011 Abstract Number: 119

Evaluation of the Accuracy of Information in Quality Improvement Sedation Forms in Comparison with Medical Charts

Background: Ongoing evaluation of sedation programs and individual physician performance are important elements in a successful sedation program. In our institution, quality improvement (QI) forms are used to track adverse events occurring during procedural sedation. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Evaluation of the Accuracy of Information in Quality Improvement Sedation Forms in Comparison with Medical Charts

HM2011 Abstract Number: 118

Decreased Rate of Complications with Propofol Sedations by a Hospitalist Group Through Identification and Reduction of Risk Factors

Background: Propofol is widely used to sedate children for radiological procedures. Because propofol is an anesthetic, its use in the past was restricted to anesthesiologists. The hospitalist group at St. Louis Children's Hospital (SLCH) successfully [...]

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HM2011 Abstract Number: 117

Talk the Walk to Do More: Localizing Hospitalist Physician Assistant Teams to a Single Unit Improves Work Flow

Background: Localization of medical teams to a hospital unit is an attractive way to organize hospitalist services but its operational impact on work flow has not been examined. Methods: Between April 1, 2010, and July [...]

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HM2011 Abstract Number: 116

Outcomes of Localizing Hospitalist‐Physician Assistant Teams to a Nursing Unit

Background: Localization of medical teams to a hospital unit has been shown to improve nurse–provider communication, but its affect on patient outcomes is unknown. Methods: Between April 1, 2010, and July 10, 2010, we conducted [...]

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HM2011 Abstract Number: 115

Patients Value Verbal Communication About Discharge Care Plans

Background: Studies show that hospitalized patients do not understand their postdischarge care plan. Increased patient involvement in care has been found to improve outcomes; understanding the care plan is the first step in engaging patients. [...]

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HM2011 Abstract Number: 114

A Unit‐Localized Hospitalist System and Its Impact on Patients Requiring Complex Discharge Planning

Background: A unit‐localized hospitalist physician is often utilized to improve the overall efficiency of patient care. The effect of this type of system specifically on discharge time of day and length of stay (LOS) in [...]

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HM2011 Abstract Number: 113

Assessing Level of Agreement Between 3 Risk Stratification Models to Prevent Venous Thromboembolism in Hospitalized Medical Patients

Background: Venous thromboembolism (VTE) is a common preventable cause of inpatient mortality. Pharmacologic methods are the preferred mode of prophylaxis according to guidelines. Various risk‐assessment tools are available to assist physicians in identifying patients who [...]

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HM2011 Abstract Number: 112

Robodoc: Impact of a Hospitalist Triage Cop on Medicine Admissions and Ed Overcrowding

Background: Similar to national trends, the emergency department (ED) at our 960‐bed institution faced increasing volume and overcrowding, resulting in delays in treatment, lower patient satisfaction, and concerns about quality. Between January 2009 and June [...]

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HM2011 Abstract Number: 111

Up in Smoke! Treating Tobacco Addiction in the Hospital and Policy Implications

Background: Hospital‐based tobacco cessation counseling is critical, especially among African Americans, who suffer a disproportionate burden of tobacco‐related disease. Recently updated cessation guidelines are available, and quality measures for counseling are tied to physician reimbursement. [...]

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HM2011 Abstract Number: 110

The Use of Pharmacists As an Effective Strategy to Improve Venous Thromboembolism Prophylaxis

Background: Venous thromboembolism (VTE) represents significant morbidity and mortality challenges for hospitals. Despite the implementation of risk stratification methodologies and admission order sets to ensure VTE prophylaxis at most hospitals, studies indicate that a significant [...]

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HM2011 Abstract Number: 109

Use of 24‐Hour Electronic Alerts to Increase Venous Thromboembolism (Vte) Prophylaxis Usage in Medicine Patients

Background: Deep vein thrombosis (DVT)–related pulmonary embolism (PE) is the most common cause of preventable death in hospitalized patients. A large tertiary‐care academic medical center focused on increasing venous thromboembolism (VTE) prophylaxis for all medicine [...]

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HM2011 Abstract Number: 108

A Multilayered Strategy to Improve Venous Thromboembolism Events at an Academic Medical Center

Background: Venous thromboembolism (VTE) is an AHRQ safety measure. VTE rates at our academic medical center were higher than other University HealthSystem Consortium peers. Relative to best practices at leading hospitals, we identified numerous improvement [...]

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HM2011 Abstract Number: 107

Sustained Reductions in Inappropriate Packed Red Blood Cell Utilization Through Mandatory Transfusion Order Set and Complementary Educational Campaign

Background: Five million patients receive packed red blood cell (PRBC) transfusions annually in the United States and Canada, and 43,000 units of PRBCs are transfused daily. Although PRBCs augment oxygen delivery, they also increase the [...]

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HM2011 Abstract Number: 106

Survival of Elderly Patients with Dementia After Percutaneous Feeding Tube Placement

Background: Dementia is a progressive neurodegenerative syndrome. The percutaneous endoscopic gastrostomy/jejunostomy (PEGJ) tube was first introduced in clinical practice in 1980 as a means to provide nutrition to children. PEGJs are often placed in elderly [...]

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HM2011 Abstract Number: 105

Predictors of Length of Stay in Patients Undergoing Total Knee Replacement Surgery

Background: Very few studies have focused on patient characteristics that influence length of stay (LOS) after total knee arthroplasty (TKR). The primary goal of this retrospective study was to identify patient characteristics associated with LOS [...]

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HM2011 Abstract Number: 104

Lack of Clinical Risk Stratification for Pulmonary Embolism and Overuse of Ct Angiography

Background: Current recommendations for diagnosing pulmonary embolism (PE) include using a clinical pretest probability (PTP) assessment as the initial screening tool. However, research has shown that physicians do not consistently use clinical assessment tools, such [...]

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HM2011 Abstract Number: 103

Comparison of Postdischarge and Experience Sampling Method Measurement of Pain in Hospitalized Patients

Background: Postdischarge assessments of pain and pain control among recently hospitalized patients are an established element of hospital quality measurement. However, retrospective assessments may not accurately measure pain because patient experience varies over time and [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Comparison of Postdischarge and Experience Sampling Method Measurement of Pain in Hospitalized Patients

HM2011 Abstract Number: 102

Financial Responsibility of Hospitalized Patients Who Left Against Medical Advice: Medical Urban Legend?

Background: Every year, 1%‐2% of hospitalized patients leave the hospital against medical advice (AMA), placing them at risk for increased readmission and 30‐day mortality. Although 1 prior emergency department study suggested clinicians often counsel patients [...]

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HM2011 Abstract Number: 101

The Impact of Specialty Care on Intensity of Utilization and Outcomes: A Comparison of Analytic Methods

Background: The literature argues that regions with greater availability of health care services have high‐intensity patterns of care that raise costs but do not improve outcomes. It has been proposed that limiting the supply of [...]

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HM2011 Abstract Number: 100

Compliance with New Acgme Duty‐Hour Requirements Can Improve Patient Care Measures

Background: New ACGME duty‐hour requirements limiting intern shifts to fewer than 16 continuous hours go into effect July 1, 2011. Little is known about how this work‐hour reduction might affect patient outcomes. Our objective was [...]

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HM2011 Abstract Number: 99

“I’m One of the Hospitalists”: Hospitalists’ Communication About Their Role in Patient Care in Admission Encounters

Background: Although concerns have been raised about the effect of the hospitalist model on the doctor–patient relationship, hospitalists now care for many hospitalized patients. How hospitalists explain their role may influence patients’ perception of the [...]

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HM2011 Abstract Number: 98

Readmission Rates on a Sickle Cell Service Run by Hospitalists and Sickle Cell Specialists: A Quality Improvement Pilot Project

Background: Sickle cell disease (SCD) patients are overre‐presented in emergency department and inpatient settings, requiring more than $2 billion annually for hospitalization. Average length of stay (LOS) is 5.3 days, whereas 14‐day readmission rates can [...]

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HM2011 Abstract Number: 97

Prevalence and Impact of Anemia in Hospitalized Patients: An Epidemiological Study of 10 Years of Inpatient Admissions

Background: Prevalence of anemia is increasing in the general population along with other comorbidities. Anemia is associated with higher morbidity and mortality in a variety of settings. Most studies have analyzed elderly patients or specific [...]

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HM2011 Abstract Number: 96

An Evaluation of the Effect of Electronic Medication Reconciliation on the Rate of Medication Errors at the Time of Hospital Admission

Background: The eighth National Patient Safety Goal, developed by the Joint Commission in 2009, emphasizes the significance of reconciliation of medications during the entire period of hospitalization. Inaccuracies in the home medication list may lead [...]

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HM2011 Abstract Number: 95

The Inverse Relationship Between Low Body Iron Stores and Platelet Count Is Modified by Age

Background: Elevated platelet count is frequently reported to be associated with iron deficiency. However, the causes underlying iron deficiency vary with age and may have differential effect on platelet count. Therefore, we hypothesized that the [...]

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HM2011 Abstract Number: 94

Platelet Distribution Width Is an Independent Predictor of All‐Cause and Cardiovascular Mortality Among Healthy U.S. Adults

Background: Platelet distribution width (PDW) is a quantitative measure of variability in platelet size. It has been hypothesized that increased PDW may be a predictor of mortality. However, this hypothesis has not been examined in [...]

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HM2011 Abstract Number: 93

Have the Types of Research Done by Hospitalists Changed Over the Past 5 Years?

Background: Little is known about the type of research done by hospitalists. The Society of Hospital Medicine (SHM) has selected abstracts for presentation at its annual meeting since 2006. Methods: Three academic hospitalists independently reviewed [...]

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HM2011 Abstract Number: 91

Harmless Acute Pancreatitis Score (Haps) As an Initial Predictor of Nonsevere Disease in Acute Pancreatitis

Background: Acute pancreatitis may manifest as mild to severe disease. Severe acute pancreatitis requires management in an intensive care unit, whereas mild acute pancreatitis may only need brief supportive care. Because it is difficult to [...]

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HM2011 Abstract Number: 90

Risk Factors for 30‐Day Readmissions

Background: Hospital readmission within 30 days of discharge is an area of emphasis of health care reform. Recent reports reveal that readmissions are costly and potentially preventable in many cases. Limited research is available on [...]

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HM2011 Abstract Number: 89

Improving Glycemic Control with the Use of a Nurse‐Driven Protocol for the Transition from Intravenous to Subcutaneous Insulin Therapy

Background: Optimal conversion to a subcutaneous insulin regimen following an insulin infusion requires knowledge of patients’ current clinical status, medical history, and most recent intravenous (IV) insulin drip requirements. This up‐to‐date information is most available [...]

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HM2011 Abstract Number: 88

Medical Student and Resident Clinical and Educational Experience with Defensive Medicine

Background: Defensive medicine is defined as a deviation from sound medical practice induced primarily by a threat of liability and is categorized as assurance or avoidance behaviors. Assurance behaviors include the provision of additional services [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Medical Student and Resident Clinical and Educational Experience with Defensive Medicine

HM2011 Abstract Number: 87

Absence of Focal Neurological Signs Accurately Excludes Need for Emergent Neurosurgery Among Patients with Nontrauma Neurological Complaints

Background: A large majority of emergency cranial computed tomography (CCT) scans performed in the evaluation of nontrauma neurological complaints neither reveal clinically significant abnormalities nor result in emergent interventions. Over‐utilization of imaging modalities results in [...]

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HM2011 Abstract Number: 86

Utility of Anion Gap As a Predictor of Lactic Acidosis in Patients in the Emergency Department

Background: Lactic acid is a marker of life‐threatening illness, and any delay between recognizing an increased level and initiating treatment may be dangerous. The presence or absence of an anion gap (AG) has classically been [...]

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HM2011 Abstract Number: 85

Use of Electrocardiographic Telemetry Monitoring on a Medicine Service

Background: Guidelines for the use of EKG telemetry monitoring for inpatients with cardiac diagnoses, such as myocar‐dial infarction, are provided by the American Heart Association. However, no guidelines exist for its use specifically in patients [...]

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HM2011 Abstract Number: 84

Pharmacist Glycemic Control Team Improves Glycemic Control and Reduces Hospital Readmissions in Non–Critically Ill Surgical Patients

Background: Perioperative hyperglycemia is a risk factor for increased morbidity and mortality. Improved glycemic control has been demonstrated to reduce surgical site infections and reduce perioperative morbidity and length of stay. However, safe and effective [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Pharmacist Glycemic Control Team Improves Glycemic Control and Reduces Hospital Readmissions in Non–Critically Ill Surgical Patients

HM2011 Abstract Number: 83

Postdischarge Issues and Nursing Interventions: A Case Series of Follow‐Up Phone Calls After Hospital Discharge

Background: Posthospitalization phone calls have been proposed as a means to reduce postdischarge adverse events, increase patient satisfaction, and reduce costly return visits to the hospital. Some programs have utilized hospital‐based nurses to provide follow‐up [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Postdischarge Issues and Nursing Interventions: A Case Series of Follow‐Up Phone Calls After Hospital Discharge

HM2011 Abstract Number: 82

Decreasing Barriers in Prevention of Hospital‐Acquired Clostridium Difficile Colitis

Background: Nearly all hospital‐acquired infections are preventable. There has been at least a twofold increase in hospital‐acquired Clostridium difficile–associated diarrhea (HA‐CDAD) across the country. Hospitalized patients with CDAD can have 3 times the length of [...]

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HM2011 Abstract Number: 81

Impact of Workload on Patient Safety and Quality of Care: A Survey of an Online Community of Hospitalists

Background: Studies of the impact of provider workload on patient safety and quality of care have primarily focused on nurses and resident physicians, but not hospitalists. We examined the relationship between workload and patient safety [...]

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HM2011 Abstract Number: 80

Cystatin C Levels and Age May Predict Successful Attenuation of Hormonal Activation in Heart Failure Patients

Background: Initial treatment of heart failure is empiric and requires frequent monitoring and medication adjustment. Predicting which patients require more intensive treatment may improve outcomes and decrease hospital length of stay. Cystatin C, a novel [...]

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HM2011 Abstract Number: 79

High Glycemic Variability and Hypoglycemia in Patients with Diabetes and Sepsis in a Non–Critical Care Setting: Can We Predict Hypoglycemic Events?

Background: Believed related to oxidative stress, the long‐term effects of glycemic variability (GV) are associated with progression of microvascular complications in diabetics. Short‐term effects on increased mortality have been shown in nondiabetic, critically ill patients. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on High Glycemic Variability and Hypoglycemia in Patients with Diabetes and Sepsis in a Non–Critical Care Setting: Can We Predict Hypoglycemic Events?

HM2011 Abstract Number: 78

A Survey of Demographics, Employment Settings, and Scope of Practice of Hospitalists Trained in Family Medicine

Background: Physicians trained in family medicine represent a growing population of hospitalists in the United States. Based on the 2007–2008 Society of Hospital Medicine (SHM) annual survey, hospitalists trained in family medicine made up 3.7% [...]

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HM2011 Abstract Number: 77

Dvt/pe Awareness Among At‐Risk Hospital Patients and At‐Risk Oncology Patients Compared with Dvt/pe Awareness Among the General Public

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) impose a major public health burden, affecting up to 600,000 individuals and accounting for approximately 100,000 deaths in the United States each year. There is a [...]

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HM2011 Abstract Number: 76

Deep Vein Thrombosis and Pulmonary Embolism: Awareness and Prophylaxis Practices Reported by Recently Hospitalized Patients

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) impose a major public health burden in the United States, affecting an estimated 350,000–600,000 individuals and accounting for approximately 100,000 deaths in the United States each [...]

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HM2011 Abstract Number: 75

Retrospective Study of Fractional Excretion of Uric Acid in Acute Kidney Injury

Background: Acute kidney injury (AKI) is a common presenting problem accounting for 1% hospital admission and also a major complication developing during in‐hospital stay for other reasons. Rapid identification and treatment of reversible causes of [...]

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HM2011 Abstract Number: 74

Use of Clinical Predictors Increase the Yield of Telemetry Monitoring in Unexplained Syncope

Background: Syncope accounts for 1%–2% of ED visits. History, physical exam, and ECG establish the etiology of syncope about 50% of the time, but many patients are admitted for observation and telemetry monitoring seeking evidence [...]

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HM2011 Abstract Number: 73

The Economic Impact of a Bedside Procedure Team from the Perspective of a Hospitalist Group Leader

Background: Despite fewer general internists performing central venous catheter (CVC) insertion, lumbar puncture, paracentesis, and thoracentesis, the demand for these procedures has not dropped. Because hospitalists are charged with the responsibility of coordinating inpatient care, [...]

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HM2011 Abstract Number: 72

Emotional Exhaustion, Life Stress, and Perceived Control Among Medicine Ward Attending Physicians: A Randomized Trial of 2‐ Versus 4‐Week Ward Rotations

Background: The duration of rotations for medicine ward attending physicians has declined. Whereas monthlong ward rotations had been common, 2‐week rotations are now the norm. One driver for this change is the perception that shorter [...]

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HM2011 Abstract Number: 71

Effects of Hand‐Carried Ultrasound Echocardiography by Hospitalists Among Inpatients Referred for Standard Echocardiography: A Randomized Trial

Background: The projected role of hand‐carried ultrasound echocardiography (HCUE) is not to replace state‐of‐the‐art standard echocardiography (SE) but instead to precede and, in some cases, obviate it with simple and routine assessments by frontline physicians. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Effects of Hand‐Carried Ultrasound Echocardiography by Hospitalists Among Inpatients Referred for Standard Echocardiography: A Randomized Trial

HM2011 Abstract Number: 70

Hospitalists in Medical Education: Results from a National Survey

Background: Hospital medicine is growing rapidly across the nation, with more than 10,000 hospitalists in practice today. Although initially focused in the community sector, hospitalists have had an increasing presence within academic centers. The University [...]

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HM2011 Abstract Number: 69

Impact of a Standardized Curriculum on Reducing Thoracentesis‐Induced Pneumothorax

Background: Pneumothorax is a known potential complication of thoracentesis, with an estimated incidence rate of 6.0% according to a recent meta‐analysis. Several interventions can reduce this accidental iatrogenic complication. At Jackson Memorial Hospital (JMH), in [...]

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HM2011 Abstract Number: 68

Understanding Barriers and Solutions to Implementing Medication Reconciliation in Emergency Departments: A Qualitative Study

Background: Medication reconciliation is a process whereby medication lists are crosschecked and verified at significant points of contact with the health care system, so that a record of which medications are appropriately stopped, changed, or [...]

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HM2011 Abstract Number: 67

Patients’ Perspectives on Maintaining Their Personal Medication Information to Improve Patient—provider Communication and Facilitate Shared Decision Making: A Survey

Background: Transfer of accurate medication information across patient care settings is crucial to preventing medication errors and promoting patient safety. Patient participation is a key factor in obtaining complete and accurate medication information as patients [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Patients’ Perspectives on Maintaining Their Personal Medication Information to Improve Patient—provider Communication and Facilitate Shared Decision Making: A Survey

HM2011 Abstract Number: 66

Early Withdrawal of Care Following Sudden Cardiac Arrest: Defining Patient Profiles

Background: Severe neurological impairment is a tragic outcome in survivors of sudden cardiac arrest (SCA). Standard practice to assess neurological recovery requires clinical and diagnostic evaluation 3–4 days after SCA. It is unclear whether this [...]

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HM2011 Abstract Number: 65

Risk Factors for Acquisition of Carbapenem‐Resistant Klebsiella Pneumoniae: A Case–Control Study

Background: Carbapenemresistant Klebsiella pneumoniae (KPC‐KP) has become a major nosocomial pathogen over the past decade. The first KPC‐KP was isolated in an Emory University–affiliated hospital in 2006, and since then the number of isolates has [...]

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HM2011 Abstract Number: 64

Trends in Transfers to Children's Hospitals

Background: Access to care is a critical issue for child health. Although most of the focus on access is availability of primary care, the availability of hospital care for children is an underappreciated issue. Data [...]

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HM2011 Abstract Number: 63

Magnesium Deficiency and Replacement Among Hospitalized Patients

Background: Hypomagnesemia is often neither adequately replaced nor appropriately followed in hospitalized patients. In particular, because the average magnesium deficiency in hypomagnesemia is 50–100 mEq, a single parenteral dose of 2 g of magnesium sulfate is [...]

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HM2011 Abstract Number: 62

Medical Students in the Clinic: The Patients’ Perspective

Background: Current health care reform calls for an increase of 46,000 full‐time equivalent primary care providers by 2025, requiring a significant expansion of teaching and training venues. Questions arise as to whether there are sufficient [...]

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HM2011 Abstract Number: 61

Management of Bronchiolitis in the Emergency Department from 2001 to 2008: Influence of Evidence‐Based Guidelines?

Background: Bronchiolitis is one of the most common conditions for which infants and young children are evaluated in the emergency department (ED). Recent practice guidelines from the American Academy of Pediatrics recommend limiting the use [...]

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HM2011 Abstract Number: 60

Mandatory and Dedicated Time for Verbal Handovers May Reduce Errors, Improve Physician Satisfaction, and Decrease Length of Stay

Background: Transitions of care occur any time a patient moves from 1 care setting to another or from 1 provider to another. A higher frequency of errors has been described during these vulnerable periods, and [...]

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HM2011 Abstract Number: 59

Readmission Case Reviews with Interns on a Quality Improvement Rotation

Background: The Institute for Healthcare Improvement recommends that unplanned readmissions within 30 days of discharge prompt a formal case review to identify systematic flaws in discharge processes. As frontline providers, residents may have insights that [...]

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HM2011 Abstract Number: 58

Premedical Student Exposure to Interaction with the Pharmaceutical Industry

Background: Physician interaction with the pharmaceutical industry begins early in medical education. Several studies demonstrate that exposure to the pharmaceutical industry occurs throughout the medical training process, from the first years of medical school on [...]

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HM2011 Abstract Number: 57

Reducing the Children's Ed Blood Culture Contamination Rate by 50%

Background: Blood cultures are frequently obtained by providers in the emergency department (ED) to evaluate pediatric patients presenting with fever. In pediatrics, nurses and laboratory personnel often obtain blood cultures at the time of placement [...]

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HM2011 Abstract Number: 56

Factors Associated with Inappropriate Definitive Antimicrobial Therapy for Bloodstream Infection from Methicillin‐Resistant Staphylococcus Aureus

Background: Approximately three quarters of all invasive methicillin‐resistant Staphylococcus aureus (MRSA) infections in the United States are bloodstream infections (BSIs). Many patients with MRSA BSIs are not treated with effective definitive therapy even when antibiotic [...]

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HM2011 Abstract Number: 55

Inappropriate Testing for Urinary Tract Infection in Hospitalized Patients: An Opportunity for Improvement

Background: Urinary tract infection (UTI) is the second most common bacterial infection leading to hospitalization, accounting for 40% of nosocomial infections. Despite the high prevalence of UTI, variability in diagnostic testing and treatment of UTI [...]

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HM2011 Abstract Number: 54

Medication Adjustment in Renal Impairment: Insight Into the Resident Mind

Background: Chronic kidney disease (CKD) affects 13% of adults in the United States, and acute renal failure (ARF) is present in up to 7% of hospitalized patients. Individuals with CKD are at an elevated risk [...]

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HM2011 Abstract Number: 53

Overutilization of Cardiac Monitoring in the Nonintensive Care Setting

Background: Cardiac monitoring has become increasingly available in noncritical beds. Most clinicians assume that this practice enhances patient care and improves outcomes, but such benefits have not been systematically proven. In 2004, the American Heart [...]

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HM2011 Abstract Number: 52

Integrated Multidisciplinary Training and Practiced Coaching of Teamstepps Improves Reporting of Teamwork in Code Blue and Rapid Response Performance

Background: Practiced teamwork with good communication is a necessary component of safe, quality health care. Communication failures are the leading root cause of harm in hospitalized patients; poor teamwork is associated with worse health care [...]

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HM2011 Abstract Number: 51

Residents’ Perceptions of Factors Limiting the Quality of Hospital Discharge

Background: Hospital discharge is a critical transition in care, yet recent data show much room for improvement: 1 in 5 patients experiences an adverse event or readmission within 30 days of discharge. Presently, metrics for [...]

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HM2011 Abstract Number: 50

Improving Discharge Care for the Homeless Patient: Perspectives from the Shelter

Background: Acute care transitions are particularly difficult for patients experiencing homelessness, yet there are limited data from the perspective of this high‐risk population to guide hospital‐based interventions to improve the quality of discharge care specifically. [...]

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HM2011 Abstract Number: 49

Interruptions and Side Conversations in Hospitalist Hand‐Offs: An Observational Study

Background: The Society of Hospital Medicine (SHM) has made hand‐offs one of the core competencies of hospital medicine and released recommendations for hospitalist hand‐offs. To date, most hand‐off studies have focused on the sender. A [...]

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HM2011 Abstract Number: 48

New Models for Hospital‐Based Stroke Care: Leveraging Hospitalists and Telemedicine to Build a Joint Commission Certified Primary Stroke Center

Background: Stroke is a leading cause of mortality and morbidity. Only 10% of the hospitals in the United States have stroke centers certified by the Joint Commission. Many other hospitals lack the ability to give [...]

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HM2011 Abstract Number: 47

The Potential Role of Hospitalists in Preventing Catheter‐Associated Urinary Tract Infection: Results of a Statewide Initiative

Background: Catheter‐associated urinary tract infection (CAUTI) is the most common health care–associated infection (HAI), accounting for more than 40% of all HAIs. Approximately 15% of patients admitted to acute care hospitals in the United States [...]

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HM2011 Abstract Number: 46

Hospitalists and House Staff Supervision: A Marriage of Convenience?

Background: In 2010, the Accreditation Council for Graduate Medical Education (ACGME) announced recommendations that focus on enhancing on‐site house staff supervision. To meet these standards, many residency programs have looked to hospitalists to fill that [...]

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HM2011 Abstract Number: 45

Impact of a Pediatric Hospital Medicine Program on Resource Utilization for Children with Respiratory Disorders

Background: Asthma and bronchiolitis are the most frequent causes of hospital admissions among children in the United States. Pediatric hospitalists focusing on process improvement are well positioned to optimize resource utilization for common respiratory disorders. [...]

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HM2011 Abstract Number: 44

Acute Appendicitis in Children: The Painful Truth

Background: Acute appendicitis (AP) is the most common surgical emergency in childhood. Despite the disproportionate morbidity and length of stay of children with perforated AP, there have been no longitudinal national studies to date focusing [...]

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HM2011 Abstract Number: 43

Experience Sampling Measurement of Inpatient Pain and Pain Managment

Background: Timely treatment of pain is a key measure of quality of pain control for hospitalized patients. However, this is usually measured by retrospective patient reports that may be inaccurate. The experience sampling method (ESM) [...]

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HM2011 Abstract Number: 42

Congestive Heart Failure in a Community Hospital: Do We Document the Pertinent Findings and Interpret the Data Correctly? Will Improved Documentation or Interpretation Lead to Improved Classification?

Background: Congestive heart failure (CHF) can be a difficult diagnosis, requiring the physician to integrate a symptom complex with physical and x‐ray findings. The introduction of brain natriuretic peptide (BNP) when used correctly has improved [...]

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HM2011 Abstract Number: 41

History Revisited: 50 Years Later Are We Still Reviving Hearts Too Young to Die?

Background: The landmark article on “application of external cardiac massage” published in 1961 reported survival to discharge in 24% of patients sustaining cardiac arrest. Cardiopulmonary resuscitation (CPR) emerged as a strategy of care for “hearts [...]

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HM2011 Abstract Number: 40

Desperate Heroics Versus 2010 Medicine: Intensive Resource Utilization Post‐Cardiac Arrest

Background: In an effort to standardize health care delivery and improve outcomes, agencies such as the AHA and ILCOR have developed guidelines for the initial care of the out‐of‐hospital cardiac arrest patient. These guidelines are [...]

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HM2011 Abstract Number: 39

Impact of Hyponatremia on the Readmission Rates of Hospitalized Patients

Background: Readmission rates are becoming an important quality and reimbursement metric in our health care system. Hospitalists are held accountable for patients who require premature readmission. Little is known about the impact of hyponatremia (HN) [...]

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HM2011 Abstract Number: 38

The Cms Policy on Venous Thromboembolism As a Hospital Acquired Condition: Projected Revenue and Cost Impact of Potential Expansion to Include Medical and Surgical Patients

Background: The Centers for Medicare and Medicaid Services (CMS) executed a policy denying reimbursement for hospital‐acquired conditions (HACs)—“never events.” Venous thromboembolism (VTE) was identified as a HAC in patients undergoing total hip/knee replacement, partial hip [...]

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HM2011 Abstract Number: 37

Epidemiologic and Cost Analysis of Frequently Hospitalized Patients at a Large Academic Medical Center

Background: Although many studies have described patients who frequently utilize emergency department and psychiatry services, little is known of the population frequently admitted to inpatient medicine services. This study characterized the frequently hospitalized group in [...]

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HM2011 Abstract Number: 36

Potential Impact of an Automated E‐Mail Notification System for Results of Tests Pending at Discharge

Background: Physician awareness of tests pending at discharge (TPADs) is poor (∼40%). We designed and implemented an automated e‐mail notification system to “push” the finalized results of selected TPADs to responsible inpatient physicians. The aim [...]

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HM2011 Abstract Number: 35

Reduction of Catheter‐Associated Urinary Tract Infections Through a Bundled Intervention in a Community Hospital

Background: Urinary tract infections (UTIs) are the most common type of hospital‐acquired infection, and 80% are associated with indwelling urinary catheters. The relatively high frequency of catheter‐associated UTIs (CAUTIs) leads to significant clinical and financial [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Reduction of Catheter‐Associated Urinary Tract Infections Through a Bundled Intervention in a Community Hospital

HM2011 Abstract Number: 34

Prognostic Significance of Abnormal Liver Function Tests in Acute Decompensated Heart Failure

Background: Hepatic congestion leading to abnormal liver function tests (LFTs) is a common finding in patients with acute decompensated heart failure. The aim of this study was to determine the prognostic significance, if any, of [...]

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HM2011 Abstract Number: 33

Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary‐Care Center: Tracking the “Idle” Central Venous Catheter

Background: Although central line (CVC) dwell time is a major risk factor for central line‐associated bloodstream infections (CLABSIs), there is little information about how often CVCs are retained when not needed (“idle”). We describe the [...]

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HM2011 Abstract Number: 32

Variation in Triage Practices Among Veterans Affairs Hospitals

Background: Regional variation in critical care use has been described, but the reason for this variation remains unclear. Multiple factors contribute to the decision to admit patients to the intensive care unit (ICU), including local [...]

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HM2011 Abstract Number: 31

Public Reporting for Percutaneous Coronary Interventions in New York State

Background: Prior studies of public reporting on risk‐adjusted mortality for coronary artery bypass grafting (CABG) have found that public reports have strong predictive validity and likely encourage poor‐quality surgeons to leave practice. However, except for [...]

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HM2011 Abstract Number: 30

Epidemiology of Hospital‐Acquired Urinary Tract–Related Bloodstream Infection: 2000–2008

Background: Urinary tract infection (UTI) is the most frequent hospital‐acquired infection in the United States. Bloodstream infection (BSI) secondary to UTI occurs less frequently but is associated with significant morbidity and mortality. Despite renewed interest [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Epidemiology of Hospital‐Acquired Urinary Tract–Related Bloodstream Infection: 2000–2008

HM2011 Abstract Number: 29

Standardized Patients to Improve Work Rounds and Discharge Encounters

Background: Discussions with patients during work rounds and at the time of hospital discharge are encounters that require substantial skill. High‐quality execution of these interactions can improve satisfaction and quality of care. Standardized patients (SPs) [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Standardized Patients to Improve Work Rounds and Discharge Encounters

HM2011 Abstract Number: 28

Cicle: Creating Incentives and Continuity Leading to Efficiency

Background: The Joint Commission and Institute of Medicine have stressed that provider discontinuity of inpatient care poses many hazards to patient care. This fragmentation is thought to threaten patient safety and may influence length of [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Cicle: Creating Incentives and Continuity Leading to Efficiency

HM2011 Abstract Number: 27

A Dirty Business: Implementation of Contact Precautions at a University Teaching Hospital

Background: The incidence of health care–associated infections is a significant cause of morbidity and a driver of excess costs in U.S. hospitals. Compliance with contact precautions is important in reducing transmission of multidrug‐resistant organisms (MDRO) [...]

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HM2011 Abstract Number: 26

How Can We Decrease the Readmission Rates of Patients with Congestive Heart Failure?

Background: Heart failure is one of the most frequent causes of hospitalizations and readmissions in the United States. Several peridischarge interventions were reported to decrease the readmission rates. The objective was to assess the feasibility [...]

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HM2011 Abstract Number: 25

Readmissions: A Missed Learning Opportunity for Hospitalists

Background: Hospitalists are often not aware when a patient whom they have cared for is readmitted to the hospital. However, there may be much to learn from readmissions, both in terms of clinical care and [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Readmissions: A Missed Learning Opportunity for Hospitalists

HM2011 Abstract Number: 24

Hospitalists’ Communication Behaviors Around the Time of Hospital Discharge

Background: The quality of provider–provider and patient‐provider communication at discharge is associated with patient satisfaction, adherence to treatment plans, and clinical outcomes. However, the ways in which providers communicate with each other and with patients [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Hospitalists’ Communication Behaviors Around the Time of Hospital Discharge

HM2011 Abstract Number: 23

A Multidisciplinary Approach to Reducing Heart Failure Readmissions

Background: Patients hospitalized with congestive heart failure are more likely to be readmitted than any other group. We found our hospital's 30‐day readmission rate for heart failure patients to be 22% for any cause and [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on A Multidisciplinary Approach to Reducing Heart Failure Readmissions

HM2011 Abstract Number: 22

Deep Vein Thrombosis As a Predictor of Mortality in Patients Hospitalized with Congestive Heart Failure: Results from the Nationwide Inpatient Sample (1998–2007) of Healthcare Cost and Utilization Project

Background: The prevalence of congestive heart failure (CHF) in the United States has been on the rise over the last decade. This is likely because of the standardized management of hospitalized patients with CHF decompensation, [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Deep Vein Thrombosis As a Predictor of Mortality in Patients Hospitalized with Congestive Heart Failure: Results from the Nationwide Inpatient Sample (1998–2007) of Healthcare Cost and Utilization Project

HM2011 Abstract Number: 21

Serum Matrix Metalloproteinases (Mmps) and Their Tissue Inhibitor (Timp) Levels and Outcomes in Heart Failure

Background: Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are involved in cardiac remodeling through regulation of extracellular matrix. Reports on their association with heart failure (HF) outcomes have been conflicting. Methods: We prospectively examined [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Serum Matrix Metalloproteinases (Mmps) and Their Tissue Inhibitor (Timp) Levels and Outcomes in Heart Failure

HM2011 Abstract Number: 20

Serum Matrix Metalloproteinases (Mmps), Their Tissue Inhibitor (Timp) Levels, and Length of Stay in Hospitalized Patients with Heart Failure

Background: Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are involved in cardiac remodeling through regulation of extracellular matrix and eventually development of heart failure. We explored their association with heart failure (HF)‐related hospital length [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Serum Matrix Metalloproteinases (Mmps), Their Tissue Inhibitor (Timp) Levels, and Length of Stay in Hospitalized Patients with Heart Failure

HM2011 Abstract Number: 19

A Prospective Evaluation of E/m Coding Variability

Background: Consistent and accurate documentation with proper coding for physician services is the fiscal foundation of a successful medical practice. There may be, however, significant variability in interpretation of the Centers for Medicare and Medicaid [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on A Prospective Evaluation of E/m Coding Variability

HM2011 Abstract Number: 18

Improving Patient Safety During Bedside Procedures: Successfully Implementing the Universal Protocol

Background: The Universal Protocol was created by the Joint Commission to eliminate the occurrence of wrong‐site, wrong‐procedure, and wrong‐person surgery. This study evaluated the effects of an innovative reengineered process for bedside procedures with an [...]

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HM2011 Abstract Number: 17

Hospital Medicine Proceduralists Inserting Long‐Term Central Venous Catheters Improves Throughput

Background: Limited access to interventional radiology (IR) services may delay placement of long‐term central venous catheters (LT‐CVCs). This can impair hospital throughput and escalate costs by increasing length of stay. We developed and implemented a [...]

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HM2011 Abstract Number: 16

Effectiveness of Rapid Response Call Criteria: A Systematic Review and Meta‐Analysis

Background: In‐hospital adverse events such as unplanned intensive care unit transfers (UICUTs), cardiopulmonary arrests (CAs), and unanticipated mortality are frequently preceded by clinical instabilities. Rapid response systems (RRSs) have been advocated to detect and intervene [...]

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HM2011 Abstract Number: 15

Exenatide, a Glucagon‐Like Peptide‐1 Mimetic, Improves Left Ventricular Ejection Fraction in Patients with Stable Ischemic Cardiomyopathy and Left Ventricular Ejection Fraction ≤ 40%

Background: Glucagon‐like peptide‐1 (GLP‐1) receptors are present in human cardiac myocytes. Myocardial cells demonstrate insulin resistance in the setting of left ventricular dysfunction. Exenatide is a synthetic GLP‐1 mimetic molecule with insulinotropic and insulinomimetic properties. [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Exenatide, a Glucagon‐Like Peptide‐1 Mimetic, Improves Left Ventricular Ejection Fraction in Patients with Stable Ischemic Cardiomyopathy and Left Ventricular Ejection Fraction ≤ 40%

HM2011 Abstract Number: 14

Thoracentesis Bleeding Risk Factors: They're Not What You Think

Background: Postprocedural bleeding is a significant adverse outcome. Clinicians routinely assess bleeding risk by ordering coagulation labs (INR, PTT, platelets) and administer blood products to correct any discovered coagulopathies. Certain “bleeding risk” medications are also [...]

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HM2011 Abstract Number: 13

Real‐Time Ratings of Hand‐Off Quality by Hospitalist Clinicians

Background: Hand‐offs are a core competency of hospitalists. Although the Society of Hospital Medicine and others recommend improving hand‐offs, monitoring and improving hand‐off quality are limited by lack of reliable tools to measure hand‐off quality. [...]

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HM2011 Abstract Number: 12

Participation in Unprofessional Behaviors Among Hospitalists: A Multisite Study

Background: Unprofessional behaviors can undermine the hospital learning environment and patient care. To date, no study has examined unprofessional behaviors in hospitalists. Methods: A 35‐item survey of unprofessional behaviors adapted from prior studies was administered [...]

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HM2011 Abstract Number: 11

Proton Pump Inhibitor Use in Hospitalized Medical Patients

Background: Acid suppressive medications, including histamine2‐receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), are widely used to treat conditions associated with the overproduction of acid. Accepted indications include upper gastrointestinal bleeding, erosive esophagitis or gastritis, [...]

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HM2011 Abstract Number: 10

Impact of Hyponatremia on Patient Outcomes and Health Care Resource Utilization in Hospitalized Patients

Background: Hyponatremia (HN) is the leading electrolyte abnormality among hospitalized patients. In the absence of symptoms, HN is often overlooked as a condition that warrants aggressive intervention. However, a careful history often reveals symptoms associated [...]

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HM2011 Abstract Number: 9

Duration of Risk of Venous Thromboembolism in Real‐World U.S. Patients Hospitalized for Medical Illness

Background: Patients hospitalized for medical illness are at an increased risk of developing venous thromboembolism (VTE). The present study retrospectively assessed the incidence and time course of symptomatic VTE events following hospitalization in a large, [...]

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HM2011 Abstract Number: 8

Relationship Between 25‐Hydroxyvitamin D and All‐Cause and Cardiovascular Mortality: Results from the National Health and Nutritional Examination Survey Linked Mortality Files, 2001–2004

Background: Observational studies have reported significant protective associations between 25‐hydroxyvitamin D [25(OH) D] and all‐cause and cardiovascular (CV) mortality. We believe that these associations have nonlinear relationships and 25(OH) D probably offers greater protection at [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Relationship Between 25‐Hydroxyvitamin D and All‐Cause and Cardiovascular Mortality: Results from the National Health and Nutritional Examination Survey Linked Mortality Files, 2001–2004

HM2011 Abstract Number: 7

Hospitalist Screening of Emergency Medicine Triage Decisions Does Not Improve Triage Accuracy

Background: Hospital care accounts for more than 30% of health care expenditures in the United States. In an effort to reduce inappropriate admissions, we implemented hospital medicine attending screening of non–intensive care unit (ICU) medicine [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Hospitalist Screening of Emergency Medicine Triage Decisions Does Not Improve Triage Accuracy

HM2011 Abstract Number: 6

Streamlining Discharge Process Utilizing Lean Methodology—experience of a Nursing Unit

Background: The cohesiveness of the discharge process is critical for ensuring the safety and quality of transition of patient care from the inpatient setting to the next level of care. The discharge process is often [...]

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HM2011 Abstract Number: 5

Antifactor Xa Activity After Prophylactic Dose of Enoxaparin (40 Milligrams) in Hospitalized Patients with Less Than 55 Kilograms of Weight

Background: Low‐molecular‐weight heparins are the most commonly used for thromboembolic disease prophylaxis, probably because of their security profile and once‐daily administration. Contrary to therapeutic doses, prophylactic recommended doses are fixed (40 mg once a day for [...]

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HM2011 Abstract Number: 4

Assessment of Pain in Patients Undergoing Bone Marrow Biopsy at a Community Teaching Hospital: A Multidisciplinary Practice Improvement Project

Background: Bone marrow examination is useful in the diagnosis and staging of hematologic disease, as well as in the assessment of overall bone marrow cellularity. The procedure can be a difficult experience for the patient. [...]

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HM2011 Abstract Number: 3

Incidence of Venous Thromboembolism in a Homebound Population: A Retrospective Cohort Study

Background: Venous thromboembolism (VTE) is a source of morbidity and mortality for high‐risk populations. The risk of VTE in homebound patients is unknown, and therefore it is unclear whether they should be offered VTE prophylaxis [...]

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HM2011 Abstract Number: 2

Safety of Arthrocentesis in Patients on Chronic Warfarin Therapy with Therapeutic INR

Background: Patients often need arthrocentesis for diagnostic and therapeutic reasons while on chronic warfarin therapy. Often the procedure is delayed or avoided because of concern about bleeding. The aim of this retrospective study was to [...]

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HM2011 Abstract Number: 1

Evaluation of HIV Screening Utility and Practicability in an Inpatient Medicine Ward Setting

Background: The Centers for Disease Control and Prevention recommended in 2006 to test all patients for HIV without requiring counseling or written consent. The CDC suggested “opt‐out” testing to increase adoption. In 2007, California removed [...]

By | 2011-05-10T16:16:22-04:00 May 10th, 2011|Uncategorized|Comments Off on Evaluation of HIV Screening Utility and Practicability in an Inpatient Medicine Ward Setting