Background: Reducing preventable hospital readmissions is a complex and challenging goal without a clear roadmap for successful attainment. The problem is compounded by the lack of consensus on the defining criteria for preventable readmissions. We [...]
Background: There has been considerable interest in development of strategies to reduce avoidable readmissions after hospital discharges. Studies have shown that home visits after discharge can result in readmission prevention, improved patient satisfaction, understanding and [...]
Background: Effective hospital work rounds require attention to multiple components: physicians should be able to review patients' course, test results, and treatment plan while attending to their comfort and answering questions. In general, it also [...]
Background: Handoffs are a core competency of hospitalists. While the Society of Hospital Medicine and others recommend improving handoffs, there is a lack of validated tools for teaching and assessing handoff quality. The specific aims [...]
Background: While well studied in the pediatric setting, little is known about the application of patient– and family–centered rounds (PFCR) to the adult population, but the potential for care improvement is great. PFCR is a [...]
Background: Failures in communication among healthcare personnel during intrahospital handoffs in care are known threats to patient safety. In August, 2009, our healthcare system held a multistakeholder summit on handoffs, developed consensus around the need [...]
Background: Nurse–physician communication is essential to ensure consistent and complete discharge instructions to patients. Though comprehensive discharge education can improve patient understanding and may reduce unnecessary rehospitalization, little is known about nurse and physician communication [...]
Background: To improve patient safety, The Joint Commission has called for standardization of physician–to–physician handoffs of patient information. The handoff from Emergency Medicine (EM) to Internal Medicine (IM) providers at the time of patient admission [...]
Background: Communication between primary care physicians (PCPs) and hospitalists occurs only 3–20% of the time. The aim of this study is to assess the PCPs' response to information requests at the time of their patients' [...]
Background: Hospitalists are charged with addressing the gaps in transitional care, which manifest as adverse events (AEs) and readmissions after discharge. The Centers for Medicare & Medicaid Services plan to lower reimbursement to hospitals with [...]
Background: Patients frequently admitted to the hospital use a disproportionate amount of healthcare resources. However, scant information exists about the clinical and social characteristics of this population, as well as the quality of their transitions [...]
Background: Older adults have a 19% risk of 30–day readmission, and medication safety plays an important role in reducing this risk. We conducted telephone–based interviews as part of a qualitative study to better understand the [...]
Background: Interdisclinlinary rounds (IDR) are commonly used to improve collaboration among hospital team members. To our knowledge, no studies have evaluated teamwork during IDR.Methods: This study was conducted on six general medicine units (three teaching [...]
Background: The search for alternative care structures that improve quality and lower costs is intensifying. Alternative care organizations (ACOs) offer promise but must demonstrate their cost–effectiveness for widespread adoption to occur. Readmissions to the hospital [...]
Background: Readmissions after hospital discharge are a common and costly occurrence in our health care system. Published models describing risk factors for hospital readmission inadequately stratify low–risk and high–risk patients. Patients with psychiatric illness or [...]
Background: Recently adopted resident work hour restrictions from the Accreditation Council for Graduate Medical Education have encouraged separate day and night patient care models. Dividing day and night responsibilities results in "admission handoffs," in which [...]
Background: Approximately 20% of patients are either readmitted or have additional visits to emergency rooms or urgent care clinics within 30 days of hospital discharge. Patients discharged from our urban, academic safety net hospital are [...]
Background: Because of recent efforts to improve safe transitions from hospital to home, ensuring quality care for patients hospitalized with asthma and COPD has become a priority. A critical factor for safe care transitions may [...]
Background: Poor handoffs may lead to adverse health outcomes. We sought to determine rates of self–reported handoffs from inpatient to outpatient providers, to examine predictors of successful handoffs, and to determine the association between successful [...]
Background: Thirty–day readmissions in chronic obstructive pulmonary disease (COPD) patients are frequent and costly. National efforts to reduce 30–day readmissions often suggest a follow–up visit with a physician despite conflicting evidence about the value of [...]
Background: Despite recent improvement in knowledge of sepsis physiopathology, severe sepsis, and septic shock still represent a leading cause of death among inpatients all around the world. Although bundled care of sepsis has shown to [...]
Background: Most systems for measuring medical errors rely on voluntary reporting of errors and near–miss events. The IHI Global Trigger Tool (IHIGTT) is a manual retrospective review of a random sample of inpatient hospital records [...]
Background: Treatment of non–purulent cellulitis and cellulitis associated with an abscess is a common reason for hospital admission. Methicillin resistant staph aureus (MRSA) is well documented be a common cause of purulent skin infections, while [...]
Background: Despite recommendations by the American Academy of Pediatrics against routine imaging in acute bronchiolitis, chest radiography (CXR) is often performed during admission for bronchiolitis. There have been no studies in the United States that [...]
Background: Acute viral bronchiolitis is responsible for over 150,000 pediatric admissions per year in the United States. Respiratory syncytial virus (RSV) testing is frequently performed in this population. However, there are few studies addressing whether [...]
Background: Structural measures of hospital quality describe the characteristics of resources, including people, geographic locations, information technology, organizations, and systems of care. Accountable day–to–day management of inpatient unit process and performance represents a potential opportunity [...]
Background: According to the guidelines of the American Society of Chest Physicians, medical, and surgical oncology patients continue to be at increased risk for venous thromboembolic events (VTE). Undiagnosed and untreated pulmonary embolism is a [...]
Background: Rapid Response Teams (RRT) were created with the concept of bringing intensive care management to the bedside during medical emergencies on the wards. Despite widespread use, their overall benefit has been controversial. Although some [...]
Background: The most effective strategy for administration of loop diuretics in patients hospitalized with acute decompensated heart failure (ADHF) still needs to be determined. Delivery of optimal dosing for rapid and safe diuresis must include [...]
Background: In–hospital cardiac arrest (IHCA) outcomes vary widely between hospitals, even after adjusting for patient characteristics, suggesting variations in resuscitation practice as a potential etiology. However, little is known about the actual standard of resuscitation [...]
Background: The use of hospice care has increased in the United States over the past decade. However, data for hospitalizations preceding hospice remains sparse. The objective of this study is to examine the clinical and [...]
Background: C. difficile is a predominant cause of nosocomial diarrhea. It is most commonly associated with prior antibiotics use, and seen in conjunction with other risk factors such as increasing age, severe underlying illness, impaired [...]
Background: Implementation of computerized provider order entry (CPOE) with drug–drug and drug–allergy checking is an important patient safety measure. The most commonly used CPOE systems, however, generate numerous warnings, which may lead to "alert fatigue." [...]
Background: Cellulitis is a common reason for admission to the hospital. The disease is often over–diagnosed due to difficultly in differentiating it from chronic venous stasis and stasis dermatitis. The natural history and etiology of [...]
Background: Although sleep is important for recovery from acute illness, it is often hampered by noise in hospitals. Interestingly, some patients are more vulnerable to noise disruptions, which is now a publicly reported quality measure [...]
Background: Laboratory testing accounts for a significant percentage of the direct costs of hospitalization. Testing also imposes burdens on the patient due to phlebotomy, which not only causes pain, leads to anemia, and may necessitate [...]
Background: The increasing use of central venous catheters in hospitalized patients has led to a rising incidence of upper extremity deep venous thrombosis (DVT). The use of venous thromboembolism (VTE) pharmacoprophylaxis in hospitalized patients has [...]
Background: Atrial fibrillation represents one of the leading diagnoses for hospitalized patients. Patients with atrial fibrillation are five times more likely to have a stroke than those without this condition and approximately 60% of these [...]
Background: New guidelines by the American College of Physicians (ACP) recommend assessment of the risk of bleeding in medical patients prior to initiation of prophylaxis for venous thromboembolism (VTE). Thus, a routine pharmacoprophylaxis approach for [...]
Background: Timely access to primary care follow–up is an important factor in preventing hospital readmissions. Patients that lack primary care follow–up within four weeks of discharge are more likely to be readmitted. Moreover, resident clinics [...]
Background: Many hospitals rely on improved throughput to maintain high volume in the face of limited inpatient capacity. Earlier discharges may free up inpatient beds, decrease the strain on a crowded Emergency Department (ED), and [...]
Background: Data suggest that adherence to contact isolation precautions reduces transmission of multi–drug resistant organisms and C. difficile. Compliance with both hand hygiene and contact isolation precautions is suspected to be poor. This study aims [...]
Background: We examined the relationship between workload and patient safety via a survey of an online community of Hospitalists. This analysis examines the predictors of providers reporting an "unsafe" workload, identifying potential targets for quality [...]
Background: American college of physicians' clinical practice guidelines raises the question of mortality benefit from venous thromboembolism (VTE) prophylaxis and excessive bleeding risk based on newer research outcomes. In this context, a study was designed [...]
Background: Use of computerized provider order entry (CPOE) is on the rise in U.S. hospitals. Order sets are often used in CPOE systems to facilitate efficient order entry; many order sets contain orders for laboratory [...]
Background: In–Hospital strokes (IHS) account for 4–17% of all ischemic strokes and are associated with increased morbidity and mortality compared to strokes with onset in the community. As with all strokes, early identification of IHS [...]
Background: Research suggests the optimal method for identifying hospital adverse events (AEs) is a two stage approach using manual chart abstraction. First, clinicians abstract the entire medical record to identify potential AEs using screening criteria. [...]
Background: There are over 500,000 hospitalizations annually for patients with community–acquired pneumonia (CAP). While a great deal of attention has been paid to the diagnosis, assessment of severity, and selection and timing of antimicrobial therapy [...]
Background: The incidence of acute diarrhea in the US is 375 million and mortality is 6,000/year. Acute diarrhea is defined as <14 days per WGO and less than 21 days for ACG. One million hospitalizations [...]
Background: Venous thromboembolism (VTE) is a common yet preventable complication affecting hospitalized patients. Appropriate VTE prevention has emerged as an important hospital quality measure with emphasis on enforcing routine risk assessment and compliance with VTE [...]
Background: Avoidable hospital readmissions may be reflective of poor quality of inpatient healthcare and may be used as a metric to guide reimbursement rates to hospitals. Most existing risk prediction models rely on administrative databases [...]
Background: Despite much evidence and clearly elucidated expert guidelines, VTE prophylaxis remains underutilized, resulting in significant morbidity, mortality, and economic burden. Fear of bleeding has been identified as a barrier to optimal adherence. We hypothesized [...]
Background: Urinary tract infection (UTI) is the most frequent healthcare–associated infection in the US. Although bloodstream infection (BSI) secondary to nosocomial UTI occurs less often, it is associated with substantial morbidity, mortality, and additional costs. [...]
Background: Though there is little evidence examining the use of intravenous heparin nomograms, concerns about difficulty maintaining therapeutic aPTT levels have led to the adoption of dose–adjustment nomograms at many hospitals. Nomograms can promote standardized [...]
Background: In a recent study, antimicrobial stewardship opportunitites in the treatment of skin and soft tissue infections (SSTIs) were identified. The authors reported that although Staphylococcus and Streptococcus were the only organisms identified in 97% [...]
Background: Compliance with the Centers for Medicare & Medicaid Services (CMS) core measures is a quality target for many hospitals. The discharge summary is an approved data source for auditing compliance with CMS core measures. [...]
Background: The "July effect" refers to a drop in the quality of medical care due to trainees' changeover at the beginning of academic year in July. Greater teaching team workload is associated with worse patient [...]
Background: Proton pump inhibitors (PPIs) are one of the most commonly prescribed medications. Numerous studies have shown that they are overused during inpatient admissions, despite being linked to an increased rate of pneumonia, Clostridium difficile [...]
Background: Obtaining a urine culture in hospitalized patients is extremely common. Positive cultures frequently trigger antimicrobial therapy, but the appropriateness of this treatment remains unclear. We sought to describe physician management of positive urine cultures [...]
Background: While graduated supervision is necessary for residents to progress to independence, it is currently unclear what factors influence housestaff autonomy. This study examined if attending factors and secular trends predicted faculty perceptions of housestaff [...]
Background: Effective communication between attending physicians (AP) and residents is crucial to patient care. As Pediatric Hospitalists we recognize this need further when supervising residents on general inpatient pediatric teams. To date there have been [...]
Background: Hospital–associated venous thromboembolism (VTE) is estimated to affect up to 15% of hospitalized general medical patients and is believed to be the most preventable cause of death in the hospital. Pharmacologic prophylaxis reduces the [...]
Background: Hospital performance measurement efforts often use risk adjusted mortality data. Most existing risk models use administrative data and are disease specific. Importantly, administrative data models increase chances for measurement bias whereas disease specific models [...]
Background: Preoperative non–invasive cardiac stress testing (NIT) is generally not indicated for asymptomatic patients undergoing intermediate–risk noncardiac surgery, such as elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). Current guidelines and evidence suggest [...]
Background: Catheter associated UTI's (CA–UTI) are preventable and high impact secondary to associated costs and poor outcomes. Our UTI prevention group has worked to prevent CA–UTIs, implementing a nursing driven foley removal protocol, prevention guidelines [...]
Background: A "universal precaution" approach for all inpatients should be used to ensure adequate education for safe discharge home. However, identification of vulnerable, high–risk (e.g., low health literacy) patients may be necessary in resource–limited hospital [...]
Background: Venous thromboembolism (VTE) is a known complication of hospitalization; implementation of proven prophylactic modalities should reduce VTE rates. One potential strategy is the use of computerized order sets. The objective of this study is [...]
Background: A positive safety culture is essential to patient safety. Validated assessment tools can identify areas for improvement and highlight differences between clinical settings. Few studies have assessed medical student perceptions of safety and none [...]
Background: 2–9% of adult patients who fall in the hospital suffer serious injury. There is little evidence–based literature to guide physicians when assessing hospitalized patients for fall–related injury. This study was designed to (1) identify [...]
Background: Little information exists about how much work individual patients actually contribute to the workload of a physician. We conducted this study to determine the amount of time internal medicine interns spend on new patient [...]
Background: One of the key components of the Institute for Healthcare Improvement's 100,000 Lives campaign was developing rapid response systems. The adult data regarding their effectiveness is equivocal. There is paucity in the literature with [...]
Background: Pharmacologic prophylaxis is recommended for general medical inpatients (GMI) at risk of DVT; this includes GMI who are not fully ambulating. However, full ambulation is not well defined in the current literature. In addition, [...]
Background: Hospitalized patients are often subject to numerous, and sometimes daily, blood draws to obtain complete blood counts (CBC). Frequent phlebotomies can cause discomfort and pain, which adversely affects patient satisfaction. In addition, these laboratory [...]
Background: For pregnant women with pre–existing diabetes, tight glycemic control is recommended to reduce the risk of fetal anomalies, macrosomia, delivery complications, stillbirth, and neonatal hypoglycemia. We performed a systematic review to determine the comparative [...]
Background: Acute lower gastrointestinal bleeding (LGIB) accounts for about 30 percent of episodes of gastrointestinal bleeding. It encompasses a wide spectrum of symptoms ranging from trivial hematochezia to massive hemorrhage with shock. Identifying those who [...]
Background: Proton pump inhibitors and H2receptor antagonists (PPI/H2RA) are frequently prescribed in hospitalized patients with cirrhosis. There are conflicting reports regarding the risk of spontaneous bacterial peritonitis (SBP) in hospitalized patients with cirrhosis using acid–suppressive [...]
Background: Fidaxomicin, recently approved for the treatment of C. difficile associated diarrhea, demonstrates bactericidal activity against C. difficile and was superior in clinical trials to vancomycin (VAN) in its sustained clinical response. In this study, [...]
Background: Fidaxomicin was recently approved for the treatment of Clostridium difficile associated diarrhea. This is a novel narrow spectrum antibacterial agent that demonstrates potent bactericidal activity against C. difficile. In recent clinical trials with over [...]
Background: Simulation–based training has been extensively evaluated in non–medical disciplines, and has been shown to have value in procedure–based medical education. However, fewer data are available with respect to the role of simulation in teaching [...]
Background: Asthma and obesity are chronic conditions with incidences that have increased substantially in the pediatric population in New York City and nationally over the past several decades. According to the New York State Department [...]
Background: Low serum 25(OH) D levels are associated with higher prevalence of peripheral arterial disease (PAD). It has been proposed that this inverse relationship is non–linear in that the association diminishes with rising 25(OH) D [...]
Background: More that 1.5 million fractures result from osteoporosis annually in the United States at a cost of fifteen billion dollars. Less than 25% of patients who sustain a fragility fracture receive treatment for osteoporosis. [...]
Background: Delirium, an acute decline in attention and cognition, is present in 11–24% of elderly patients on hospital admission, and another 6–56% will develop delirium during their hospital stay. Off–label intravenous (IV) administration of haloperidol [...]
Background: How inpatient physician teams function is often thought of in terms of the skill sets of individuals on the team, e.g., having a "strong" resident or "good" intern. While individual skills are important, an [...]
Background: Expert guidelines recommend getting blood cultures for all patients admitted with community–acquired pneumonia (CAP). Blood cultures have been used as a measure of quality of care. However, this diagnostic tool has a low yield [...]
Background: A few studies have linked chronic renal disease to increased risk and poor outcomes in Clostridium difficile infection (CDI). We studied renal function and clinical outcomes in a large database of CDI patients treated [...]
Background: Risk–based HIV testing has been shown to miss a substantial number of patients infected with HIV. The Centers for Disease Control and Prevention (CDC) released recommendations in 2006 that patients between the ages of [...]
Background: Venous thromboembolism (VTE) is a common and costly complication of total hip and knee replacement (THR and TKR). Although potent prophylaxis regimens now exist to significantly reduce the risk of VTE, their wide spread [...]
Background: In June 2006, our 760–bed academic institution began a Hospitalist Service employing six physician providers. Similar to national trends, the needs quickly outpaced the supply of hospitalists resulting in poor provider satisfaction, delays in [...]
Background: ESBLs are extremely broad spectrum Beta–Lactamase enzymes found in a variety of Enterobacteriaceae to include Klebsiella pneumoniae, other Klebsiella species and Escherichia coli (E.Coli). These ESBL–producing bacteria are highly effective at inactivating various Beta–Lactam [...]
Background: Patients with a higher level of education, more access to medical information, and generous health insurance coverage may be more likely to participate in their medical decision making process. However, few studies directly measure [...]
Background: Pediatric hospitalists are frequently and increasingly asked to provide sedation for a variety of painful procedures in children. There are a wide variety of agents available for sedation including ketamine, fentanyl, ketofol, and nitrous [...]
Background: Frequently hospitalized patients are a large burden to the healthcare system, both in terms of hospital days and cost. For many patients, this is due to the severity of their underlying medical comorbidities. However, [...]
Background: Hospital medicine's claim to fame has been shorter length of stay (LOS) and equal, if not better, adherence to quality measures without sacrificing patient satisfaction. Comparative studies highlighting these strong characteristics of hospital medicine [...]
Background: Cocaine is a well known risk factor for the development of early atherosclerosis and myocardial infarction (MI). Several studies in the medical literature have reported the increasing incidence of cocaine use in the American [...]
Background: Practice Parameters for prognostication after out–of–hospital cardiac arrest, set forth by the American Academy of Neurology, stress the importance of the neurologic exam findings at 72 hours after successful resuscitation. Absent pupillary or corneal [...]
Background: There are limited data regarding contemporary trends in management and outcomes of patients with COPD who develop acute myocardial infarction (AMI). The objective of this population–based study was to describe the management and short–term [...]
Background: Most studies of human metapneumovirus (hMPV) have been done in pediatric populations. Many of these studies compare hMPV with respiratory syncytial virus or are case reports of hMPV infection in the immunosuppressed. Though there [...]
Background: There is an extensive literature on geographic variation in utilization intensity. Although system capacity (e.g. hospital bed, physician, and scanner density) has been implicated as a factor, the drivers of this variation have not [...]
Background: An estimated 1 million people in the US develop symptomatic venous thromboembolism (VTE) at a cost of $1.5 billion annually. The American College of Chest Physicians recommends treating deep vein thrombosis (DVT) outpatient whenever [...]
Background: Red blood cell (RBC) parameters (hemoglobin [Hgb], hematocrit [Hct], mean corpuscular volume [MCV], and red cell distribution width [RDW]) are reported in complete blood count reports and have been hypothesized to be associated with [...]
Background: Heart failure is characterized by multiple hospital readmissions and increased risk of death. Our study assesses acute change in NT–proBNP (a cardiac biomarker) and its association with readmission and mortality using a parametric analysis. [...]
Background: While whole blood viscosity (WBV) has been shown to be related to the pathogenesis of various diseases, including cardiovascular diseases, laboratory measurement of WBV is time consuming and tedious. WBV can be estimated reliably [...]
Background: Falls are the most frequently reported adverse events in inpatient settings. About 30%of people over 65 years will fall every year – making it a major socioeconomic problem in elderly. Hyponatremia is the most [...]
Background: The evidence about the safety and effectiveness of outpatient care as opposed to inpatient care in selected low–risk patients with acute pulmonary embolism (PE) is accumulating. Most patients enter or remain in the hospital [...]
Background: The 2006 American Academy of Pediatrics (AAP) management guidelines for bronchiolitis recommends reducing the misuse and over–use of short acting beta agonist bronchodilator therapy for pediatric patients with bronchiolitis. Our institution has participated in [...]
Background: Medicare payments around episodes of inpatient surgery vary as much as 40–70% across hospitals. Although such variation is attributable to multiple factors, differential use of physician services is one key component. In this context, [...]
Background: Critical care makes up nearly 1% of the US gross domestic product, but there is wide hospital variation in critical care resource use. It is possible that some hospitals have higher ICU admission rates [...]
Background: Relatively little is known about the impact of renal dysfunction on morbidity and mortality in patients with pneumonia, especially in non–severe disease. The contribution of intravenous computed tomography contrast dye to renal dysfunction in [...]
Background: VTE is common after total hip (THR) or knee (TKR) replacement. Anticoagulants reduce the risk of VTE but result in bleeding, requiring assessment of benefit–risk.Methods: To improve estimates of treatment effects on low–frequency events, [...]
Background: The incidence of new or recurrent acute pulmonary embolism in patients on warfarin with an INR of = 2 is unknown. Also, the utility of using a modified Wells score in diagnosing acute pulmonary [...]
Background: Hospitals are focusing more on patient admission status as inpatient or observation due to changes in reimbursement and increased scrutiny from regulatory agencies. Observation units allow for more efficient and appropriate care for patients [...]
Background: Hospitals vary in their procedures for assigning patients to "observation" status (OBS). This outpatient designation has a number of implications including reduced hospital payments, lower patient co–payments, and often results in OBS time not [...]
Background: Severe sepsis, defined as infection causing new organ dysfunction, is the most common non–cardiac reason for ICU admission. Interventions to remedy the dismal outcomes related to severe sepsis have focused primarily in the ICU. [...]
Background: Opportunities exist to re–create hospital units as effective and reliable microsystems. We used specific structure, process, and management design features to re–launch a hospital medicine unit: 1. Unit–based physician teams, 2. Structured Interdisciplinary Bedside [...]
Background: Failure to resume perioperative statins after high–risk or vascular surgery is known to increase the risk of postoperative cardiac events. The effect of statin withdrawal on outcomes after moderate risk surgery is unknown. We [...]
Background: Health care reform has had a focus on access to care. For pediatrics this usually means access to ambulatory services. Hospitalization is an uncommon pediatric event but access to pediatric beds may be a [...]
Background: Recent studies report the incidence of C. difficile infections (CDI) in children is increasing across the nation and that CDI may occur outside the traditional risk factors.Our objective: To describe clinical factors associated with [...]
Background: Background: Social media is a powerful tool for providing specialized information to large target audiences. Parents and teens now frequently turn to social media as a quick method of obtaining health information. Objective:Introduce a [...]
Background: Hospital Medicine (HM) has become one of the fastest growing U.S. medical specialties, and many academic medical centers have developed HM programs. Concerns have been raised regarding the challenges that face HM researchers, particularly [...]
Background: Roflumilast, a FDA–approved, once–daily, oral, selective phosphodiesterase–4 inhibitor, has been shown to reduce the risk of chronic obstructive pulmonary disease (COPD) exacerbations in patients with severe COPD associated with chronic bronchitis and a history [...]
Background: Recruiting new hospitalists is expensive and turnover remains a challenge. Monitoring morale may help leaders improve retention. There are no published instruments that quantify hospitalist morale. Our study describes the Hospitalist Morale Assessment (HMA), [...]
Background: Dronedarone is an antiarrhythmic drug approved by the FDA in 2009.Small–vessel vasculitis has not been previously reported in association with dronedarone.Methods: 71 year old male was admitted with 1 week history of generalized skin [...]
Background: Since 1996, Hospital Medicine grew faster than any other specialty in the history of medicine, and now reaches institutions around the world. The Core Competencies of Hospital Medicine, published by the Society of Hospital [...]
Background: Carbon monoxide (CO) poisoning is the most common cause of death from poisoning in the United States. Cardiovascular complications and their contribution to acute outcomes are yet to be defined.Methods: We retrospectively reviewed the [...]
Background: American Heart Association (AHA) guidelines for the use of telemetric EKG monitoring focus primarily on patients admitted with cardiac diagnoses. There is limited data to guide the use of telemetry in patients admitted with [...]
Background: Roflumilast, a once–daily oral selective phosphodiesterase–4 inhibitor, has been shown to reduce the risk of chronic obstructive pulmonary disease (COPD) exacerbations in patients with severe COPD associated with chronic bronchitis and a history of [...]
Background: COPD is a leading cause of mortality in the US, and COPD exacerbations increase mortality risk, hospitalizations, and healthcare costs, accelerate disease progression, and decrease quality of life. Exacerbations increase in frequency with more [...]
Background: Nurse Practitioners (NPs) and Physician Assistants (PAs) have been shown to be cost–effective substitutes for physicians with similar outcomes in primary care and surgical settings. The Veterans Health Administration (VHA) is one of the [...]
Background: The electronic health record (EHR) is recognized as a key component of the modern practice of medicine. Despite numerous advantages, EHR have enabled frequent copy–paste events (CPE). While previous studies show that CPE occur [...]
Background: Despite initial recovery from critical illness requiring intensive care unit (ICU) admission, many patients remain at risk of subsequent deterioration and unplanned readmission to the ICU. Readmitted patients have higher mortality rates and significantly [...]
Background: Pediatric Hospital Medicine has seen tremendous growth in the last ten years. The Washington University program has been representative of that growth. Many of our former hospitalists chose our program as a transition to [...]
Background: Hospital Medicine has contributed to improvements in patient throughput with associated reductions in hospital length of stay (LOS). Despite overall downward LOS trends, a small group of outliers continue to have long LOS. A [...]
Background: Teamwork is key to safe, effective healthcare, but care systems are often not designed to support teamwork. The ABIM has developed an assessment of interprofessional teamwork for hospitalists, which gives physicians concrete, actionable feedback [...]
Background: As in the private sector, the Veterans Health Affairs (VHA) has seen a steady increase in the number of hospitalist programs. Currently, nearly 90% of VHA hospitals have hospitalists admit at least a portion [...]
Background: Pediatric Hospital Medicine has seen tremendous growth in the last ten years, with diverse staffing models at individual programs. The program at Washington University provides a broad range of clinical services. In 2000, we [...]
Background: Care provided at night is the soft underbelly of any care delivery system. Disease onset and progression knows no diurnal boundary. However, resource allocation in terms of care delivery is frugal compared to day [...]
Background: The growth of academic hospital medicine (AHM) over the past 15 years has been shaped by numerous forces. For leaders of academic hospitalist programs to keep pace, it is useful to understand the factors [...]
Background: Inter–hospital transfer (IHT) is a high–risk transition of care that often involves patients with complex and worsening medical problems. Ineffective hand–offs between providers may contribute to errors and adverse events during IHTs. Even within [...]
Background: At our tertiary care center hospitalists were charged to improve throughput by discharging patients in a timely fashion. Using Lean methodology, we developed multiple rapid improvement events (RIEs) to tackle various facets of the [...]
Background: As hospitalists, our continuum of care extends beyond a patient's hospital stay and includes a safe transition to home or a care facility. Improving discharge planning, including the patient's paperwork, eases this transition. In [...]
Background: Effectively transitioning patients from the hospital to home is an important priority for many hospitals and health care providers. Increasingly, reports have highlighted gaps in the quality of care that arise during and after [...]
Background: Hospital discharge documentation are the primary documents communicating a patient's care plan to the post–hospital care team. Usually, it is the only form of communication that accompanies a patient to the next setting of [...]
Background: Discharging a patient from the hospital is a complex and high–risk task. Patients require clear and understandable instructions from their discharging providers in order to successfully transition from the hospital back to the home [...]
Background: Preventable rehospitalizations are disconcerting for patients, contribute to high costs, and are partly due to deficiencies in patients' ability to execute post–discharge care plans. Increasing patient engagement and self–empowerment through use of an evidence–based [...]
Background: The immediate post–discharge period is a vulnerable time both for patients and their care providers. Several studies have been published highlighting safety issues identified during the immediate post–discharge period. To address these problems, we [...]
Background: Since the advent of resident hour restrictions in 2003, hand–offs between providers have become increasingly prevalent. The process of hand–offs can require a substantial amount of time depending on the number of patients being [...]
Background: The July 2011 ACGME guidelines mandate that residency programs monitor and ensure resident competency in patient handoffs. The guidelines' concomitant restrictions on resident duty hours are likely to increase both the volume and complexity [...]
Background: Every handoff of patient care between physicians poses a risk for error. New duty hours have increased the number of handoffs occurring between residents. Residents must be trained to deliver accurate, consistent, and efficient [...]
Background: Handoffs of hospitalized patients represent critical points in patient care. Poor quality handoffs carry the risk of poor outcomes for patients and physicians. The Joint Commission and Society of Hospital Medicine (SHM) have published [...]
Background: Healthcare delivery has become divided into discrete silos of care. With a growing separation between inpatient and outpatient services, transitions of care have become an increasingly vulnerable time for patients. For patients at San [...]
Background: High–quality communication is required for safe hospital discharge and is accomplished primarily through the discharge summary. Clear, concise, and meaningful correspondence between providers is essential and yet, first year medical residents are generally charged [...]
Background: Approximately 20% of hospitalized patients are rehospitalized within 30 days of discharge. The presence of depression, anxiety, and substance abuse in a hospitalized patient increases the patient's risk for rehospitalization. By identifying and treating [...]
Background: Congestive heart failure (CHF) affects nearly 5 million people in US. Thirty day re–hospitalization rate for Medicare beneficiaries hospitalized for congestive heart failure is 27% of which 90% are unplanned. The reimbursement by CMS [...]
Background: Hospital discharge represents a "voltage drop" in care that can lead to unexpected problems including costly readmission. Post–discharge phone calling is a strategy advocated by national and local organizations to improve the quality of [...]
Background: A mentored Project BOOST pilot was undertaken at North Memorial Medical Center, a level I trauma center serving north Minneapolis and the northwestern metropolitan area on the A6 cardiac telemetry unit. BOOST target tool [...]
Background: Patients with a prior hospitalization in the last 6 months are at increased risk of readmission. However, given our current system of care, providers may be unaware that a patient was previously admitted to [...]
Background: Patients often struggle with managing their medications after hospital discharge, and it is estimated that up to 40% of discharge prescriptions go unfilled. For institutions without an in–house discharge pharmacy, novel solutions are needed [...]
Background: Communication between hospitalists and nurses can lead to frustration on both sides when it is fragmented, incomplete and complicates patient care. As part of a year long LEAN project at our institution to improve [...]
Background: With the many workflow changes that the inpatient EHR will require of the clinical staff, the EHR Device Committee determined there was a potential need for a device that is more portable and has [...]
Background: Conducting Family–Centered Rounds (FCR) has become a common practice in pediatric hospital medicine. As many learners may be a part of the pediatric inpatient team for a brief time, orientation to the goals and [...]
Background: Assignment of a patient to a ward team is a challenging task. If one were to take into account every variable involved in order to maximize quality of care, placing a patient on a [...]
Background: The hospital is an urban facility with 453 licensed beds. The hospitalist group is the only hospitalist service operating in the hospital and will perform over 14,000 admissions in 2011. In 2009, we recognized [...]
Background: The Centers for Medicare and Medicaid Services (CMS) provide financial incentives to hospitals that demonstrate meaningful electronic health record (EHR) implementation. The American Recovery and Reinvestment Act of 2009 specifies meaningful use; for hospitals, [...]
Background: Patients' poor understanding of medical information discussed during their hospital admission can result in lack of adherence to treatment plans and poorer health outcomes. Improving communication with patients can not only improve patient satisfaction [...]
Background: The Institute of Medicine report on health literacy called for incorporation of health literacy assessment into healthcare information systems, as well as large–scale epidemiologic studies of the effects of health literacy on clinical outcomes. [...]
Background: Hospital discharge is a vulnerable moment for patients, and poor primary care access threatens follow–up. New models that include hospitalists in post–discharge care could improve post–discharge access.Purpose: The Post Discharge Clinic (PDC), a hospitalist–staffed [...]
Background: Hospital discharge is a stressful and hazardous venture for older adults. Recent research documents that up to 49% of patients experience at least one medical error, and one in five patients discharged from the [...]
Background: A coordinated, standardized hospital discharge process helps to ensure a safe and adequate transition in care. All patients need to clearly understand discharge instructions, have access to discharge medications and have a plan for [...]
Background: Patient satisfaction is an important quality performance measure directly impacts the reputation of the hospital and long–term financial performance of the hospital. In our hospital, Press–Ganey patient satisfaction scores for medical floors/hospitalists' were in [...]
Background: Neonatal jaundice is a common condition that can result in acute bilirubin encephalopathy if not treated appropriately. Despite evidence–based guidelines for monitoring and treating hyperbilirubinemia, variation in care persists. Previously published quality improvement efforts [...]
Background: Mandates to shift our care delivery systems from a focus on quality or cost to one of value is challenging. Unnecessary and expensive diagnostic tests contribute to wasteful spending that does little to improve [...]
Background: Routine blood tests are performed in the early morning hours at most hospitals. Timely review of those laboratory tests during morning rounds is critical for safe and efficient patient care. However, availability of those [...]
Background: Our hospital medicine practice noted a high number of admissions and readmissions to the internal medicine service for the specific purpose of acute detoxification from alcohol dependence. We noted a lack of a clear [...]
Background: Sickle cell vaso–occlusive pain crises (VOC) are associated with considerable morbidity and mortality, prolonged hospital stays and significant resource utilization. Suboptimal treatment of pain during VOC is associated with increased morbidity and mortality. Standardized [...]
Background: The management of acute vaso–occlusive crisis remains a challenge. Long Island Jewish Medical Center is a 500–adult bed tertiary care facility with more than 500 reported admissions for acute vaso–occlusive crisis in 2009. Suboptimal [...]
Background: Congestive heart failure (CHF) is a leading cause of hospitalization nationwide in people over more than 65. Moreover, CHF exacerbation is one of the leading causes of readmission –— creating a substantial financial burden [...]
Background: Lung cancer is the leading cause of cancer death in both men and women worldwide. Given that pulmonary nodules are a common finding on chest CT, a judicious plan for follow–up is necessary. A [...]
Background: Nationally, manifestations of poor glycemic control are one of Medicare's Hospital Acquired Conditions that are publically reported and no longer reimbursed. Insulin is also one of the JC's top five high –risk medications. Furthermore, [...]
Background: 1.2 million people in the United States are living with an HIV infection and one in five is unaware of their infection. In Chicago, there are currently over 20,000 people living with HIV/AIDS and [...]
Background: In–hospital venous thromboembolism (VTE) remains a major cause of morbidity and mortality in US hospitals and is known to be preventable. Despite an extremely high level of compliance with VTE prophylaxis guidelines at our [...]
Background: In 1999, the Accreditation Council for Graduate Medical Education identified six general competencies in which residents must be trained. Among these are two relatively abstract and complex competencies: Practice–Based Learning & Improvement (PBLI) and [...]
Background: Electronic Medical Record (EMR) systems are becoming more prevalent in clinical settings. However, students generally receive little formal instruction regarding effective use of the EMR during their undergraduate medical training. Since the implementation of [...]
Background: Experience in invasive bedside procedures is increasingly difficult to acquire for both resident and attending physicians. Inconsistent training, work hours restrictions, decreasing emphasis on procedural training, and lack of confidence can lead to a [...]
Background: Approximately $700B of annual healthcare spending is wasted, with physicians directly influencing 87% of this expenditure. Medical training has emphasized quality improvement but few programs are addressing the ACGME requirement that physicians–in–training now "incorporate [...]
Background: The American Board of Internal Medicine (ABIM) states that Internists who perform procedures must obtain the appropriate training to safely and competently perform that procedure. ABIM also recommends initial training in these procedures be [...]
Background: Integrating healthcare quality into the Internal Medicine resident training curriculum has been a focus of our institution's Educational Innovations Program of the ACGME. Five years ago, at Baystate Medical Center we began a PGY2 [...]
Background: Documentation of Advance Care Planning (ACP) is often driven by outpatient providers. However, in–patient hospitalization presents a unique opportunity to elicit and document end–of–life wishes, and additionally strengthen communication between inpatient and outpatient providers. [...]
Background: Formal training in quality improvement (QI) has become increasingly important. Both theAccreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine(ABIM) have created competencies in the areas of practice–based learning [...]
Background: As Hospitalist demand continues to grow, a growing number of programs are utilizing Physician's Assistants (PAs) and Nurse Practitioners (NPs) to assist with delivery of care on the inpatient medical wards. Since the field [...]
Background: Properly designed, hospital units have potential to optimize outcomes for patients, staff, and trainees. Such units would be of great value if they converge high high–performing teams with active management while promoting principles of [...]
Background: ICU patients account for over 18 million patient days annually in the United States and cost 1 % of GDP. The Leapfrog group recommended that ICU patients be managed exclusively by board–certified intensivists for [...]
Background: Institutions that focus on patient–family centered care have seen improvements in their patient and staff satisfaction. Bedside rounding with the patient/family involved is a tool that hospitalists can use to deliver care that centers [...]
Background: Hospital –based medicine could be more effective when there is collaboration and open communication from sub specialties, nursing and discharge planning. To facilitate this effort the hospitalist group partnered with nursing leadership to establish [...]
Background: Developing collaborative practice models is emerging as a core strategy in creating an ideal patient safety climate, improving patient care outcomes, and increasing patient satisfaction. However structuring a workflow for team members that allows [...]
Background: Hospitalist groups strive to perform at a high level on multiple measures, including readmissions and patient satisfaction. Individual hospitalists, however, may find it difficult to become actively involved in quality improvement (QI) due to [...]
Background: Medication reconciliation (MR) was identified as a National Patient Safety Goal in 2006 and during the summer of 2011 the Joint Commission is tracking it as a part of the accreditation process. Beyond its [...]
Background: The Joint Commission requires that pregnancy and lactation information for a patient must be accessible to practitioners who participate in the management of the patient's medications. To facilitate this process, we developed computer–based decision [...]
Background: Core measures are publicly reported measures that gauge the quality of the process of patient care reflecting compliance to standards of care. This organization has employed many real–time electronic record enabled tools and clinical [...]
Background: The average time of discharge at a hospital is more than the average time of admission and this creates a bottleneck in patient flow. Patients have to wait longer for an available bed. Pushing [...]
Background: Today's healthcare industry is in transition, moving from paper based processes to highly customizable electronic medical records (EMR). This technology opens new opportunities to provide clinical staff information to develop treatment plans, ensure consistent [...]
Background: Christiana Care Health System (CCHS) is a 1100–bed hospital system with all telemetry enabled beds. Continuous cardiac monitoring (CCM) is ordered for a default period of 72 hours at the time of admission on [...]
Background: Medical simulation training has rapidly emerged as an effective model of clinical skill development. A validated educational approach, this technique allows practitioners the ability to gain proficiency and confidence in ongoing professional practices such [...]
Background: Communication failures are frequently cited as contributing to patient care errors and delays, specifically with regards to discharge planning. The common medical model, usually structured as a physician service team, houses patients across multiple [...]
Background: Process improvement projects often lack the structure and buy–in to achieve their goals. The Rapid Process Improvement Workshop (RPIW) is one quality improvement tool to make QI projects more effective.Purpose: To utilize RPIWs to [...]
Background: Approximately two million neurons are lost every minute during an ischemic stroke. University of Colorado has a median time of 71 minutes for door to tissue plasminogen activator (t–PA) administration. The American Stroke Association [...]
Background: Approximately 795,000 strokes occur each year in the United States; Stroke is a leading cause of death nationally and remains the leading cause of long–term disability. Only ten percent of the hospitals in the [...]
Background: High–volume, high–cost patients pose a challenge to healthcare institutions due to fragmented care, socioeconomic issues,and lack of outpatient resources. Recently, New York's Medicaid program adopted a measure to reduce payment to hospitals with a [...]
Background: Clinical decision support systems are useful tools to discourage the use of potentially inappropriate medications (PIMs) in the geriatric inpatient population. These interventions have had variable success, in large part because geriatric medication decisions [...]
Background: Many providers find E/M coding rules confusing and frustrating. Tasking hospitalists with completing charge tickets often leads to delinquent or inaccurate charges. Hospitalist groups have incorporated various education methods and incentives to improve documentation, [...]
Background: Academic productivity is a key component of advancement in academic medicine and development of expertise, however many new attendings lack the knowledge and experience to publish a paper. For example, a multi–institutional survey of [...]
Background: Unprofessional behaviors undermine the hospital learning environment and patient care quality.A prior needs assessment of residents and hospitalists regarding lapses in professionalism was utilized to identify clinical scenarios which increased during internship at our [...]
Background: Starting a new job with a hospitalist group can be stressful and exhausting as new hires adapt to changes in processes, workloads, and institutional culture. Surveys have indicated high hospitalist attrition rates between 13–22% [...]
Background: Recognition of poor value in US healthcare is leading to reform of the hospital payment system. Effective physician leadership will be crucial for the potential gains from aligning incentives to be translated into improved [...]
Background: Medical hospitalists typically manage hospitalized patients. However hospital medicine is evolving to meet the changing demands of hospitals and communities. A recent innovation, surgical co–management is now part of the standard repertoire of most [...]
Background: Observation services are provided for clinical conditions that do not meet inpatient admission criteria but require a period of observation for evaluation and treatment. Dedicated observation units can serve this purpose and are found [...]
Background: The advent of hospitalists has greatly improved the afterhours care in the hospital. A majority of the care planning happens when the hospitalists round in the daytime and the afterhours care is limited to [...]
Case Presentation: A 73–year–old man presented with symptom of locked jaw for one day. On further enquiry, he reported that he suffered an injury to the right leg after stepping on a rusty steel object [...]
Case Presentation: We report a case of a 43–year–old African American female with a 30 years history of tobacco use who presented with complaints of severe retrosternal chest pain for 4 hours associated with mild [...]
Case Presentation: An 89–year–old man with past medical history of hypothyroidism, coronary artery disease, and atrial fibrillation on warfarin, is sent from his primary care physician for two week history of new onset diarrhea. The [...]
Case Presentation: A 59–year–old man presented with sudden onset left–sided facial droop, aphasia, and left upper and lower extremity weakness. His medical history included hepatitis C, cirrhosis, and hepatocellular carcinoma. CT of the brain showed [...]
Case Presentation: A 37–year–old woman with a past medical history of depression, anxiety and migraine, who presented to emergency complaining of severe left leg pain and swelling which is sudden in onset. Pain is 10/10, [...]
Case Presentation: A 28–year–old man presented with a 4–day history of progressively worsening left calf pain and swelling that began after he was bitten by a dog. He also complained of fevers and rigors. Initial [...]
Case Presentation: A 52–year year–old Caucasian female presented with history of wide based ataxic gait for four days. Head CT showed possible pontine stroke, however the MRI was interpreted as normal. Patient denied any dyspnea [...]
Case Presentation: A 70–year–old man presented with confusion, mumbling, malaise, and headache after having recently taken oral antibiotics for a skin lesion on his forehead. His prior history was complicated by previously treated chronic lymphocytic [...]
Case Presentation: A 65–year–old male with a history of Parkinson's, hypertension, and smoking presented 2 weeks after an uncomplicated left shoulder arthoplasty with one week of worsening shortness of breath, fever, cough, and profound hyoxemia. [...]
Case Presentation: This is a 17–year–old–man who is part of a strict religious community in Brooklyn, NY, with no significant past medical history who presents to the emergency room with the complaint of diarrhea for [...]
Case Presentation: Ms. P was frustrated after her neurosurgeon cancelled a scheduled lumbar laminectomy to correct her spinal stenosis. The surgeon had concluded this 73–year–old woman was a prohibitive surgical risk due to hypertension, COPD [...]
Case Presentation: A 44–year–old non–smoking, physically active male presented to our hospital with acute onset substernal chest pressure of one hour duration with associated right arm numbness and diaphoresis. His past medical history is relevant [...]
Case Presentation: A 50–year–old African American woman with history of tobacco use (35 pack–years) and hypersensitivity pneumonitis presented with shortness of breath and chest pain for the past 2 weeks. Chest pain is pressure in [...]
Case Presentation: A 42–year–old man who works for the Justice Department stationed in Ghana presented with 3 days history of headache, fatigue fever (105°F) and sore throat. He was treated with anti–malarial and antibiotics. Few [...]
Case Presentation: A 4–year–old Hispanic male presented to the emergency department (ED) with 4 weeks of fever and increasing cervical lymphadenopathy. His mother reported daily fevers of approximately 38.3°C with neck pain and swelling. He [...]
Case Presentation: A 45–year–old white female with a remote history of bulimia, chronic mild hypokalemia, and a recent upper respiratory infection presented with two 2 days of ascending muscle weakness and paralysis. Physical exam showed [...]
Case Presentation: A 55–year–old man with a history of eosinophilic esophagitis requiring repeated stricture dilations presented to the Emergency Department with headache, fevers, nuchal rigidity, nausea, vomiting, photosensitivity, and myalgias. These symptoms followed a recent [...]
Case Presentation: We present a 56–year–old male, who came to the emergency room with diffuse abdominal pain, decreased oral intake and constipation. Laboratory values showed that hemoglobin had dropped to 9.7 grams per deciliter (from [...]
Case Presentation: A 56–year–old asymptomatic male presented with a rash since 5 days. He noticed the rash on his legs which then spread to his arms. Rash was non tender and non–pruritic. Patient had chills [...]
Case Presentation: This is a 73–year–old white male with a history of recent strokes and residual left hemiparesis who presented status post mechanical fall and worsening left sided weakness over 1 week. The patient was [...]
Case Presentation: A previously healthy 20–year–old woman presented to the emergency room (ER) with several days of fevers, sore throat, myalgias, and a diffuse rash. The rash emerged as papules on the back of one [...]
Case Presentation: A 63–year–old man presented with four 4 days of palpitations, progressive dyspnea on exertion, and orthopnea. He denied chest pain, cough, or fever. He had no personal history of arrhythmia or ischemic heart [...]
Case Presentation: A 52–year year–old female presented with a chief complaint of 5 days dyspnea, four pillow orthopnea, chest pain when lying supine, and a non productive cough. She denied fevers, chills and night sweats [...]
Case Presentation: A 58–year–old Caucasian male presented to the emergency department with a three–month history of worsening dyspnea, productive cough, low–grade fevers and chills. Past medical history was significant for 60 pack year smoking history, [...]
Case Presentation: A 52–year–old woman with seropositive (RF,CCP) ANA negative rheumatoid arthritis (RA) diagnosed in 1999, controlled with methotrexate, hydroxychloroquine, and then infliximab (since 2007; last dose 8 weeks prior to admission (PTA)) now admitted [...]
Case Presentation: A 25–year–old previously healthy man, presented with a 3–month history of intermittent pleuritic chest pain, dyspnea and intermittent hemoptysis after returning from a trip to Europe. He was treated with oral antibiotics for [...]
Case Presentation: A 39–year–old woman was admitted for severe gastroesophageal reflux (GERD) with nausea and emesis. The patient had 20 years with heartburn which evolved to intermittent episodes of food impaction requiring multiple esophageal dilatations [...]
Case Presentation: A 65–year–old Black woman with PMH of hypertension presented with 1 hour history of an acute onset of nausea, vomiting, epigastric discomfort, diaphoresis and dizziness. She denied any significant chest pain or shortness [...]
Case Presentation: This is a 22–year–old female with history of SCD and MAC, diagnosed one month prior, who presented with complaints of shortness of breath, pain in lower back and legs, nausea and vomiting. Chest [...]
Case Presentation: This is a 28–year–old male with history of Type 1 diabetes, polysubstance abuse and childhood asthma who was admitted for complaints of fatigue, night sweats and bilateral pleuritic chest pain that had been [...]
Case Presentation: An 87–year–old female presented with weakness. She reported fatigue over several weeks, now unable to walk. She denied fever, chest pain, or shortness of breath. Past medical history includes CAD, DVT, hypertension, ophthalmic [...]
Case Presentation: We report a previously healthy 18–year–old female who presented to an urgent care clinic with low–grade fever and sore throat, she was given a 5–day course of Azithromycin for pharyngitis. Three days into [...]
Case Presentation: An 84–year–old male with type 2 diabetes, hypertension, and a remote history of pulmonary TB presented with fevers, dysphagia, and scant hemoptysis. Physical exam remarkable for fevers to 38.8 C and bibasilar rhonchi. [...]
Case Presentation: A 51–year–old Mexican female, with past medical history of hypothyroidism, rheumatoid arthritis, nephrolithiasis, and GERD, presented to our ED with abrupt, sharp, epigastric pain, increasing in intensity and radiating to the back. Pain [...]
Case Presentation: A 17–year–old Caucasian female presented to our hospital with complaints of severe, throbbing, fronto–temporal headache for 5 days; associated with photophobia, nausea and non projectile vomiting. There was an isolated episode of 102°F [...]
Case Presentation: A 51–year–old uninsured African American female with no past medical history presented to clinic with bilateral leg swelling, generalized weakness and unintentional weight loss. Her exam was notable for temporal wasting, conjunctival pallor, [...]
Case Presentation: A 71–year–old woman with diabetes, hypertension and GERD presented with massive hematemesis and syncope. She was a former smoker who drank alcoholic occasionally. Seven months earlier she has mild pancreatitis without gallstones (edema [...]
Case Presentation: A 62–year–old male with a history of hypertension and dyslipidemia presented to the emergency room with distal extremity paresthesia and proximal muscle weakness. Ten days prior, he noticed dysuria and tried over–the–counter phenazopyridine [...]
Case Presentation: RB was a 6 week old full term infant who presented with lack of expected weight gain. Birth weight was 2.6 kg (3%) and her admit weight was 2.47 kg (3 Standard deviations [...]
Case Presentation: An 80–year–old female presented with a 2 day history of intermittent left lateral rib and chest pain. She denied any acute or chronic headache or visual changes. Overall, she appeared well. Vital sign [...]
Case Presentation: A 57–year–old man presented acutely after being awoken from sleep with shortness of breath. He had no associated or prodromal symptoms, and no gastrointestinal complaints. Review of systems revealed significant weight loss, with [...]
Case Presentation: A 26–year–old Hispanic female without significant past medical history presented with new–onset diabetic ketoacidosis. She was admitted, and blood sugars and metabolic derangements quickly normalized with insulin and intravenous fluids. Physical examination on [...]
Case Presentation: A 53–year–old female presented with complaints of watery bowel movements every 30 minutes for several days. Although previously plagued with chronic diarrhea, it had resolved 1 month prior with cessation of alcohol abuse. [...]
Case Presentation: A 5–year–old white female presented to the ED with 3 day history of vomiting. She has had two week history of upper respiratory symptoms prior to the onset of vomiting. The emesis was [...]
Case Presentation: A 60–year–old male with sarcoidosis and cryptogenic cirrhosis presented with increasing dyspnea and abdominal distention. He underwent a therapeutic and diagnostic paracentesis. The cell count was consistent with spontaneous bacterial peritonitis (cloudy fluid [...]
Case Presentation: An 85–year–old man received the last of twelve treatments of intravesical Bacillus Calmette–Guérin (BCG) for transitional cell carcinoma of the bladder. Urinary catheter placement was difficult and complicated by hematuria. Over the next [...]
Case Presentation: A 59–year–old Caucasian male with bipolar disorder presented to an outside hospital with altered mental status, generalized weakness, and lower extremity paralysis after a day of significant physical exertion. Physical exam revealed an [...]
Case Presentation: BG was a 35 week preemie via C/S to a 23–year–oldo G2P1 mom due to preterm labor. Pregnancy was complicated by a progressively dilated loop of bowel without haustrations and only very occasional [...]
Case Presentation: A 42–year–old man with no past medical history presented with right sided abdominal pain of 8 hours duration. He denied dysuria, frequency, or urinary urgency. He was afebrile and his blood pressure was [...]
Case Presentation: A 78–year–old man with metastatic follicular thyroid cancer status post thyroidectomy and radioactive iodine ablation in 2008 was admitted to the hospital for atypical chest pain and back pain for 2 weeks. He [...]
Case Presentation: 74–year–old man presents with blue–gray discoloration of the face, neck and upper thorax. The patient had a history of esophageal adenocarcinoma, completing definitive chemo radiation in 2006. His presenting complaint was of weight [...]
Case Presentation: A 69–year–old lady with metastatic breast cancer presents with 2 months of leg edema and abdominal swelling. Initially diagnosed and treated 13 years earlier, she had recurrence of invasive ductal carcinoma 3 years [...]
Case Presentation: An 82–year–old female with a medical history notable for dementia, type 2 diabetes mellitus, hypertension, hyperlipidemia, cerebrovascular accident, gastroesophageal reflux, and gastric ulcers secondary to Stevens Johnson syndrome was brought into the emergency [...]
Case Presentation: A 29–year–old woman presented to the hospital with fever, chills, and bilateral neck swelling for 1 week. There was no history of recent travel, sick contacts or exposure to tuberculosis. On presentation vital [...]
Case Presentation: A 52–year–old gentleman with human immunodeficiency disease (HIV) and CD4 count greater than 500 cells per cubic millimeter of blood presented with 2 days of diarrhea, lethargy, myalgias, arthralgias, and a rash. He [...]
Case Presentation: A 34–year–old Caucasian female recently diagnosed with hypertension presented to our hospital with an episode of syncope. She was started on hydrochlorothiazide by her primary care physician 1 week prior to admission. Two [...]
Case Presentation: An 80–year–old woman presented to the hospital with syncope and several weeks of headache, nausea, dizziness, generalized weakness and anorexia. Vital signs were stable and physical exam was unremarkable except bilateral maxillary sinus [...]
Case Presentation: A 20–year–old man with no past medical history was brought to the hospital with complaints of two witnessed episodes of generalized tonic–clonic seizures. He also complained of headaches which were diffuse, but denied [...]
Case Presentation: A 66–year–old woman presented to the hospital for vomiting, diarrhea and abdominal pain since 10 days but persistent for many years. She had been diagnosed as Irritable Bowel Syndrome. Physical exam was unremarkable [...]
Case Presentation: A 73–year–old man with atrial fibrillation, and multiple myeloma was admitted with severe back pain secondary to multiple lumbar osteoporotic vertebral compression fractures (VCF). Four kyphoplasties (KP) were performed, providing significant pain relief. [...]
Case Presentation: 45–year–old previously healthy male presented to the ED with progressively worsening headache of 5 days associated with dizziness and a questionable seizure activity per family members. There were no fever, motor, sensory or [...]
Case Presentation: An 80–years–old Korean man with a history of liver fluke infection treated 26 years ago presented with 2 weeks history of fever and abdominal pain Pt had a non diagnostic CT scan of [...]
Case Presentation: A 73–year–old man, with a past history of coronary artery disease, s/p CABG, end stage renal disease on hemodialysis and aortic stenosis status post bioprosthetic aortic valve replacement 3 years prior. Presented to [...]
Case Presentation: A 47–year–old Caucasian male with a history of diabetes, hypertension and depression sustained a fall in the woods and had a fracture of the right ankle a week prior to admission. He had [...]
Case Presentation: A 29–year–old African American male with no prior medical history was admitted to the hospital with substernal chest pain and cough with minimal expectoration for the past 3 months. He reported a 25 [...]
Case Presentation: A 94–year–old African American female patient admitted to the hospital with altered mental status and slurring of speech. Patient daughter had home blood sugar measured as 22 mg/dl. She had been suffering from [...]
Case Presentation: 61–year–old female with a medical history of asthma, fibromyalgia, hypertension, osteoarthritis, insomnia and anxiety was admitted to the hospital for persistent low–grade fever, cough and myalgias for 12 weeks. Extensive outpatient workup including [...]
Case Presentation: A 50–year–old woman with left breast cancer and a 10–pack–year smoking history presented to the emergency department with pleuritic right–sided chest pain and dyspnea. Six days earlier, she had undergone bilateral total mastectomy. [...]
Case Presentation: A 71–year–old man with chronic lymphocytic leukemia (CLL) and chronic obstructive pulmonary disease presented with fatigue, fever, and right knee pain and swelling. He denied right knee trauma. He also reported dyspnea and [...]
Case Presentation: An 8–year–old boy presented with 1 day of agitation, hypertension, and encephalopathy. Prior to presentation, he was babbling incoherently with some extremity shaking, incontinent of urine and became somnolent. He had a history [...]
Case Presentation: A 65–year–old female with metastatic breast cancer, glioblastoma multiforme, bilateral pulmonary emboli diagnosed 4 days prior to admission started on enoxaparin, presented with syncope. On the day of admission the patient collapsed on [...]
Case Presentation: A 37–year–old Caucasian female with a history of hypothyroidism presented with acute, diffuse, cramping abdominal pain, bloody diarrhea and green mucous discharge. The patient was admitted to our institution for acute gastroenteritis. Physical [...]
Case Presentation: A 51–year–old man with a past medical history significant for obesity, cirrhosis and COPD presented to an outside emergency department for evaluation of progressive edema. The patient was diagnosed with alcoholic cirrhosis 15 [...]
Case Presentation: A 63–year–old man with type 2 Diabetes and recent diagnosis of high grade Myelodysplastic Syndrome, presented with one week of progressive left eyelid swelling and erythema. He had an associated clear discharge and [...]
Case Presentation: A 25–year–old Asian Indian male studying in Poland presented with pain, swelling and drainage from the right clavicular area of 15 days duration limiting his activity. Four months ago, he was diagnosed with [...]
Case Presentation: A 55–year–old male with hypertension and polysubstance abuse presented after 3 days of bilateral flank and epigastric abdominal pain and chills. He was afebrile and exam revealed clear lungs, regular rhythm, no heart [...]
Case Presentation: A 42–year–old Hispanic male, butcher by occupation with a history of alcohol abuse, presented with a 6–day history of epigastric abdominal pain, diarrhea and fevers. Vital signs showed fever and mild tachycardia. Laboratory [...]
Case Presentation: A 35–year–old bisexual African–American male presented with complaints of a rapidly progressing rash over 2 weeks associated with fatigue. The rash began on his palms, but later appeared on his soles. He denied [...]
Case Presentation: A 34–year–old man with history of myocardial infarction, polysubstance use, hepatitis C, and lumbar disc disease presented with severe back pain and extremity weakness. The patient is a martial arts fighter who was [...]
Case Presentation: A 31–year–old man with no past medical history presented to the emergency department with 3 weeks of shortness of breath and yellowing of the skin. The symptoms acutely worsened 4 days prior to [...]
Case Presentation: A 72–year–old male admitted for progressive shortness of breath with pleuritic chest pain for 2 days. He noted weight loss of 25 lbs in the past 6 months. Past medical history includes hypertension [...]
Case Presentation: A 55–year–old male with a 20 pack year smoking history was diagnosed with stage IIIA (T2N2M0) non small (non squamous) cell carcinoma of the upper lobe of the left lung after presenting with [...]
Case Presentation: A 28–year–old African American male, recently diagnosed with HIV (CD4 count 12 cells/mm3) was admitted with a history of fever of 2 weeks duration. On exam, he had high grade fever of 38.50 [...]
Case Presentation: A 41–year–old Caucasian male with past medical history significant for morbid obesity, OSA and two recent admissions for pneumonia presented with dyspnea and expectoration of brownish yellow "sea creatures" for 2 weeks. Patient [...]
Case Presentation: A 54–year–old Haitian Woman with chronic back pain and an implanted neurostimulator placed years ago, presented in the spring with a frontal headache and subjective fevers for 8 days. She noted a nonpuritic [...]
Case Presentation: A 32–year–old Asian woman with a variant of multiple sclerosis (MS) was admitted with pyelonephritis and sepsis. She was started on ciprofloxacin (Cipro) 400 mg IV Q12 hours and continued on her home [...]
Case Presentation: This is a 72–year–old African American woman who presented to the hospital with abdominal pain and failure to thrive which began 1 month prior to presentation. Notably, she was diagnosed with hydralazine–induced lupus [...]
Case Presentation: A previously healthy 43–year–old white man was hospitalized because of recurrent episodes of fever, hepatosplenomegaly, abdominal pain and pancytopenia over the past 6 months. Previous extensive workup was unrevealing in causation. The patient [...]
Case Presentation: A 34–year–old female presented with a 1–week history of dysarthria, ataxia and postural instability. The week prior to her presentation she was admitted to a local hospital with significant vomiting and dehydration. She [...]
Case Presentation: A 45–year–old black female presented with 2 weeks history of worsening fatigue, malaise, shortness of breath upon exertion and dizziness. She also reported irregular menstrual periods. Laboratory analysis showed: Leukocyte count 2.36 × [...]
Case Presentation: A change in previously controlled hypertension (HTN) should prompt consideration of a secondary workup. An 81–year–old obese female, with history of HTN, hyperlipidemia, and anxiety, presented with refractory HTN. Her blood pressure (BP) [...]
Case Presentation: A 24–year–old man presented with 2 weeks of fever, malaise, diarrhea, and cough followed by right upper quadrant pain, leg edema, and dyspnea on exertion. He denied previous illnesses or high–risk behavior, took [...]
Case Presentation: A 52–year–old previously healthy woman was admitted to our institution with a chief complaint of dyspnea, dry cough, and fever worsening over 4 days. Her past medical history was positive for lung adenocarcinoma [...]
Case Presentation: This patient is a 5–week–old male with no significant past medical history who presented with lack of expected weight gain. Patient was born at 39 5/7 weeks gestation to a 23–year–old G2 P2 [...]
Case Presentation: This is an 80–year–old Caucasian man who was admitted to the hospital with complaints of bilateral upper neck swelling, mainly in the pre–auricular and infra–auricular region, worsened over the last 5 days. The [...]
Case Presentation: A 23–year–old African American Midwestern gentleman with history of subaortic stenosis repair had presented to the Emergency Department (ED) with complaints of pain and swelling in the left ankle, left chest wall and [...]
Case Presentation: A 78–year–old man presented with a 3–week history of suprapubic post–prandial abdominal pain, fevers, and anorexia. Two weeks prior he was admitted for acute mental status changes, fatigue, and anorexia, with diagnosis of [...]
Case Presentation: A previously healthy 27–year–old Caucasian male presented with acute onset of right sided flank pain, nausea, vomiting and mild fever for approximately 5 days. He denied any abnormal urinary symptoms and has no [...]
Case Presentation: A 23–year–old gentleman presented with a 2–week history of cough, epistaxis, hemoptysis and shortness of breath on exertion, loss of appetite, fatigue, nausea and dysgeusia. He denied rash or arthralgias and reported normal [...]
Case Presentation: A 43–year–old man with recently diagnosed HIV/AIDS on HAART presented for further evaluation of worsening jaundice, abdominal pain and weight loss. He developed immune reconstitution syndrome following the initiation of HAART, and had [...]
Case Presentation: A 50–year–old Caucasian female with no prior respiratory ailments presented with worsening non productive cough and exertional dyspnea for 4 months. She denied fevers, weight loss or lower extremity swelling. She reported an [...]
Case Presentation: A 27–year–old female with a h/o headaches presented to the ED with complaint of thunderclap headache that was the worst of her life. It was nine of 10 in severity and was located [...]
Case Presentation: A previously asymptomatic 46–year–old male presented with acute onset of sharp right upper quadrant (RUQ) pain. Patient denied nausea, vomiting, fever or similar symptoms before. The patient is Lebanese and had moved to [...]
Case Presentation: A previously healthy 19–year–old female, presented with 1 day of fever, severe occipital headaches, nausea, vomiting, diarrhea, severe myalgias and polyarthralgias. She is attending her spring semester in college while living in a [...]
Case Presentation: A 51–year–old female with history of anxiety, depression, and tobacco abuse was admitted to the ICU due to severe respiratory distress, hypoxia, productive cough, fever and chills. Her symptoms began 8 days prior [...]
Case Presentation: A previously healthy 37–year–old male patient presented with 4 days of fever, nausea, myalgias and headaches. Patient had returned from a 3–week vacation trip to Malawi 2 weeks before this episode. He did [...]
Case Presentation: 71 female with multidrug resistant HIV, stable on antiretroviral therapy for 4 years on a regimen containing tenofovir, with CD4 count of 140 cells/ml and non detectable HIV viral load, presented to the [...]
Case Presentation: A previously healthy 35–year–old male patient presented with 2 weeks history of fatigue and a maculopapular rash over his back, torso, extremities and face. He had flu–like symptoms and rinorrhea just before the [...]
Case Presentation: A 20–year–old African American Female was admitted with diffuse skin thickening and intractable pain in these skin lesions. Her past medical history was significant for recurrent kidney stones for which she had undergone [...]
Case Presentation: A 41–year–old African–American woman traveling in Ghana experienced progressive edema, diffuse joint pain and night sweats over a 9–day period. Three days before her presentation she noted dyspnea, dry cough and inability to [...]
Case Presentation: A 58–year–old woman presented with a severe headache with onset 3 hours after taking prophylactic amoxicillin for a routine dental cleaning. She described a constant bifrontal headache with mild photophobia, multiple episodes of [...]
Case Presentation: A 49–year–old male with diabetes mellitus presented with jaw pain and an absolute neutrophil count (ANC) of 200 cells/mm3. He denied drug use. A periodontal abscess seen on computerized tomogram was treated by [...]
Case Presentation: A 50–year–old male presented to the emergency department with aphasia and weakness. He had been in his usual state of health until 7 hours prior, when he acutely developed right hand weakness and [...]
Case Presentation: A 77–year–old Caucasian female with a history of morbid obesity, breast cancer status post bilateral mastectomy with reconstruction, deep venous thrombosis, and hypertension presented with a 5–day history of abdominal pain, nausea and [...]
Case Presentation: A 52–year–old female with end–stage liver disease and no recent travel history sustained head trauma 3 weeks prior to presentation that required laceration repair. She was transferred to our medicine service from an [...]
Case Presentation: A 41–year–old female with a history of substance abuse presented to the Emergency Department with 1 month of bilateral lower extremity rash and severe pain. On arrival patient had altered mental status, met [...]
Case Presentation: A 32–year–old African American woman with history of Sickle Cell Disease (SCD) with various complications, depression, and frequent visits to the Emergency Department (ED) presents with a chief complaint of pain crisis. Multiple [...]
Case Presentation: A 17–year–old male presented with a three–day history of shortness of breath, non–productive dry cough, pleuritic chest pain, and fatigue. He had recently recovered from infectious mononucleosis. He was hypoxic with an oxygen [...]
Case Presentation: An 85–year–old woman with hypertension, coronary artery disease (angioplasty and stent in 1998), peripheral vascular disease presented to the emergency room after a mechanical fall at home. The patient had a sudden fall [...]
Case Presentation: A 60–year–old man presents to the hospital with 4 days of rash accompanied by severe pain and pruritus. The rash began on the patient's hands bilaterally, then, began to spread centrally. He denied [...]
Case Presentation: A 71–year–old man with hypothyroidism presented with atypical left–sided pain to the emergency room. The patient developed acute left–sided pain about 2 months prior to presentation to ER. The pain started in the [...]
Case Presentation: A 42–year–old male with no medical history was brought to the emergency room unconscious after he had a generalized tonic clonic seizure. As per his wife, he had fatigue and headache for several [...]
Case Presentation: A 72–year–old male with a remote history of splenectomy secondary to Hodgkin's lymphoma presented with high–grade fever and confusion for 3 days. Nine months prior to this admission, he was diagnosed with pneumococcal [...]
Case Presentation: A 58–year–old female presented with severe respiratory distress, diaphoresis, hypertension and tachycardia. Vital signs: BP 215/106, HR 139, RR 38, SaO2 48% on room air. She was intubated due to hypoxia. Her medical [...]
Case Presentation: A 15–year–old primigravida with no prenatal care at 32 weeks of gestation presented with preterm contractions, abdominal pain, elevated BP and headache. An elevated sodium of 153 mEq/L was initially believed to be [...]
Case Presentation: A 41–year–old Caucasian male presented to the physician's office with 1–week history of dysphasia along with transient left posterior jaw pain and chewing difficulty. He also felt that the food clogged on his [...]
Case Presentation: A 52–year–old man with a history of obesity suffered a syncopal event immediately after arising from a seated position. Shortly thereafter, he developed epigastric pain, nausea and vomiting. Initial evaluation revealed orthostatic hypotension, [...]
Case Presentation: A 67 year–old previously healthy woman with HIV (CD4 count 1233/mm3) was admitted for 1 month of progressive odynophagia and dysphagia that began with solids and progressed to liquids. She reported food "getting [...]
Case Presentation: #1:69–year–old female Chinese immigrant with rheumatoid arthritis on prednisone and methotrexate presented with weakness, abdominal discomfort, cough, fever and chills. She developed sepsis with bilateral lung opacities. Endoscopic biopsy revealed Strongyloides stercoralis. #2:72–year–old [...]
Case Presentation: Mrs. AS is a 76–year–old female with PMH of CHF, PVOD, T2DM, atrial fibrillation, osteomyelitis, and CKD who was admitted with recurrence of intermittent mental status changes. She was functioning at her normal [...]
Case Presentation: Ms. MM is a 78–year–old female former smoker with history of MAI, OSA, HTN, and anxiety admitted with hypercalcemia and FTT. Primary complaints were progressive weakness, malaise, weight loss, and decreased appetite. Exam [...]
Case Presentation: A 50–year–old Asian woman presented with 4 days of abdominal discomfort and progressive distention. She had no significant past medical history and did not consume alcohol. Her physical examination was remarkable for normal [...]
Case Presentation: A 19–year–old woman with a history of migraines, depression and a bony cyst in her jaw presented with abdominal pain. Three days prior, she acutely developed sharp, non–radiating epigastric pain which was worse [...]
Case Presentation: A 44–year–old woman with a past medical history of reflux presented with jaundice. Ten days prior to presentation, she noticed dark urine but did not seek medical attention. Five days prior, she developed [...]
Case Presentation: A 20–year–old woman with a history of Crohn's disease and a Mallory Weiss tear presented with hematemesis. One month prior to presentation she was admitted to another institution with black, tarry stools. She [...]
Case Presentation: A 61–year–old African American man with long history of diabetes and hypertension as well as end stage renal disease presented with progressive weakness of both legs for 3 months. It started as difficulty [...]
Case Presentation: A 23–year–old Mexican male with no known medical history presented to the emergency department with headache, fever, nausea, vomiting and photophobia. He stated that he was well 1 week prior to admission. On [...]
Case Presentation: This is a 76–year–old white female with a history of mastocytosis, who was admitted with acute diastolic heart failure and new–onset atrial fibrillation. Intravenous furosemide was initiated for diuresis, Verapamil was utilized to [...]
Case Presentation: A 31–year–old African American male with no medical history presented to the hospital from prison with worsening fatigue, nausea and abdominal discomfort for several weeks. He also reported lightheadedness and unintentional weight loss [...]
Case Presentation: A 23–year–old man with no previous medical history presented to the Emergency department complaining of a 2–week history of intermittent right thigh swelling and pain. He denied any preceding trauma, insect bites, or [...]
Case Presentation: A 54–year–old Caucasian male with medical history of alcohol dependence presented to our hospital with 3 weeks of worsening gait, behavioral changes and slurred speech, as observed by his friends. Exam revealed normal [...]
Case Presentation: A 37–year–old male with benign past medical history presented with worsening bilateral conjunctival injection, progressive hearing impairment and disequilibrium for approximately 1 month. He had earlier been on erythromycin eye drops for suspected [...]
Case Presentation: A 44–year–old male with history of obstuctive uropathy presented with dyspnea, left sided chest pain, flank pain and hypoxia a day after an urologic procedure. His percutaneous nephrostomy tube was removed 1 day [...]
Case Presentation: A 75–year–old female with a history of schizophrenia and diabetes mellitus was transferred to our hospital for sepsis and worsening rash. The rash first appeared on the flexor surfaces of her upper extremities, [...]
Case Presentation: This is an 81–year–old woman with rate controlled atrial fibrillation, hypothyroidism and invasive ductal carcinoma, which was diagnosed in 2008, and treated with breast sparing surgery and radiation. At her first ER visit, [...]
Case Presentation: A 61–year–old man was admitted with a three–week history of productive cough, fever, chills, night sweats and fatigability. He experienced progressive pleuritic chest pain and dyspnea. His past medical history was significant for [...]
Case Presentation: A 51–year–old man with liver cirrhosis secondary to alcoholism and hepatitis C complicated with refractory, paracentesis–dependent ascites was found unresponsive in his apartment. His medications were furosemide, spironolactone, thiamine and folic acid. On [...]
Case Presentation: A 67–year–old male presented to our emergency department complaining of typical chest pain few minutes after smoking cocaine. Pain was retrosternal and radiating to left shoulder associated with diaphoresis and nausea but no [...]
Case Presentation: A 62–year–old man presented with a 3–day history of fever, chills, night sweats, fatigue, and arthralgias, associated with generalized non–pruritic painless skin rash. He has past medical history significant for hypertension, ulcerative colitis [...]
Case Presentation: A 58–year–old male patient, who had worked as a welder for 30 years, complained of 3 months history of progressively worsening hemoptysis. He underwent thoracotomy and right upper lobectomy 5 years ago for [...]
Case Presentation: A 56–year–old male presented with generalized body aches, chills and fever for 8 days. Symptoms were associated with palpitation, sweating, headache, and dry cough. He denied any IV drug abuse. Physical exam showed [...]
Case Presentation: A 60–year–old woman with no past medical history presented with sudden onset of confusion, mutism, agitation, and behavioral changes that were precipitated by a stressful family event. On initial presentation, she had no [...]
Case Presentation: A 44–year–old man with no significant past medical history was admitted to the hospital for further evaluation of intermittent chest pain. He had no similar episodes in the past. He denied symptoms of [...]
Case Presentation: A 50–year–old male with a history of dyslipidemia was evaluated at an outside hospital for abdominal pain, constipation, and intractable nausea and vomiting for five days prior to admission. The pain was crampy [...]
Case Presentation: A 54–year–old AAM with HIV/AIDS and G6PD deficiency presented with severe weakness and a diffuse rash with alopecia that began 3 months ago. His weakness progressed gradually and he now required assistance to [...]
Case Presentation: A 59–year–old Caucasian male presented with progressive shortness of breath and productive cough for 2 weeks along with low–grade fever. He denied any chest pain. Past history was significant for type 2 diabetes [...]
Case Presentation: An 8–year–old female with past medical history significant for bipolar disorder and ADHD presented to an emergency department for evaluation of four days of vomiting and diffuse abdominal pain. The patient had been [...]
Case Presentation: 62–year–old man with AIDS presented with a history of photophobia and blurry vision in his left eye. He denied any pain, discharge, redness or floaters. There was no associated change in mental status, [...]
Case Presentation: A 36–year–old Hispanic female immigrant presented with two days of headache and neck pain. She had presented on a prior occasion with similar complaints, and was diagnosed with migraine headaches. She was admitted [...]
Case Presentation: A 21–year–old woman presented with two days of a petechial rash on her upper extremities and chest. She noted no additional symptoms; she had no history of easy bruising or bleeding, or risk [...]
Case Presentation: A 31–year–old man with no past medical history presented with three days of progressively worsening abdominal pain radiating to the epigastrum. The pain was dull in character, and associated with nausea and vomiting. [...]
Case Presentation: A 63–year–old man presented with ten days of dyspnea on exertion, occurring with minimal exertion and resolving after rest. He reported associated palpitations, fevers, chills, and increasing abdominal girth, but denied chest pain, [...]
Case Presentation: A 42–year–old woman presented with three days of worsening left flank pain radiating to her groin. She experienced similar pain over the past year, but it had never been this severe. She now [...]
Case Presentation: A 35–year–old man presented with new onset seizures. He reported progressively worsening bilateral occipital headache that suddenly resulted in a "white–out" of his vision. He lost consciousness, and was taken to an outside [...]
Case Presentation: A 73–year–old woman presented with one week of bilateral hand weakness and increasing confusion. She had a baseline Alzheimer's dementia, but her family reported that her confusion markedly increased in the prior week, [...]
Case Presentation: A 67–year–old woman presented with 3 h of sharp, intermittent chest pain and palpations. The episodes lasted for several minutes at a time and were associated with shortness of breath, nausea, diaphoresis, and [...]
Case Presentation: A 35–year–old man presented with 6 h of epistaxis. He had a lifelong history of von Willebrand disease (vWD) type IIB, but denied previous hospitalizations or transfusions. He reported prior epistaxis episodes that [...]
Case Presentation: A 48–year–old man with AIDS and a CD4 count of 68 presented with two weeks of fevers, night sweats, nausea and decreased appetite. He had been well until two months earlier when he [...]
Case Presentation: A 29–year–old woman with a history of HIV nephropathy and end–stage renal disease presented one day of headaches, nausea, and vomiting. She noted no trauma, and no new neurologic abnormalities. She did note [...]
Case Presentation: An 81–year–old man presented with sharp pain in his left foot of 4 h. His left foot was cold with cyanosis of the great toe and distal tips of the second and third [...]
Case Presentation: A 49–year–old T4 paraplegic man presented after being found down in his yard for one day. He was oriented only to self and had several large stage–three decubitus ulcers. His left foot was [...]
Case Presentation: A 64–year–old man presented with fatigue, fever, and bilateral lower extremity pain. He had a history of Laennec's cirrhosis and was awaiting liver transplant. He noted no recent travel, ill contacts or occupational [...]
Case Presentation: A 76–year–old women presented with two days of hemoptysis, dyspnea on exertion, and fatigue stating she coughed up two cups of blood per day. She had no previous history or exposure to tuberculosis, [...]
Case Presentation: A 46–year–old man presented with three days of fever and nonspecific flu–like symptoms. He denied any prior medical history, or additional associated complaints. He noted an upper respiratory infection two weeks earlier, but [...]
Case Presentation: A 62–year–old man presented with three weeks of abdominal distension and bilateral pitting edema of the lower extremities. He noted no shortness of breath or chest pain. His urine output was normal, and [...]
Case Presentation: A 48–year–old woman presented with six weeks of worsening right upper quadrant pain and lower extremity edema. Associated symptoms included nonbloody diarrhea. She also noted one week of dyspnea while lying flat. Her [...]
Case Presentation: A 25–year–old Caucasian man with no past medical history complained of 3 days of severe bilateral "gnawing" pain in his calves and forearms. It began in his right calf, preceded by 2 h [...]
Case Presentation: A 52–year–old woman with history of systemic lupus erythematosus and end–stage renal disease status post cadaveric renal transplant (2008) presented with three days of a progressive vesicular rash. The rash began in her [...]
Case Presentation: A 22–year–old man, on military deployment, presents to a remote clinic in Central Africa with 2 days of worsening dyspnea on exertion, fever, and fatigue; he denied a cough. His symptoms worsened despite [...]
Case Presentation: A 30–year–old woman presented with 7 days of intermittent fevers, sweats, and flank pain. She noted nausea, vomiting, and dysuria, and severe headaches for the prior five days, a history of uncomplicated urinary [...]
Case Presentation: Patient is a 4–year–old male with inadvertent intravenous administration of an oral liquid acetaminophen pharmaceutical preparation. He initially presented to an outside emergency center for evaluation of a closed head injury after a [...]
Case Presentation: A three–year–old male was transferred to our tertiary care facility with a one week history of vomiting and decreased activity and ongoing worsening mental status after admission to a community hospital for dehydration. [...]
Case Presentation: A 48 y/o Cambodian woman with history of immigrating to the US thirty years pta and "cryptogenic cirrhosis" was transferred to our facility with abdominal pain, nausea, and anorexia. PE revealed jaundice, tachypnea, [...]
Case Presentation: A 46–year–old woman presented with a 4 day history of progressive throat pain and low grade fever. She went to an urgent care clinic 3 days prior to admission and was discharged on [...]
Case Presentation: A 45–year–old man presented with encephalopathy after experiencing multiple seizures. The patient's fiancée observed the patient's body stiffen, then he had full–body jerking for 10 min. He lost bladder function, and afterwards was [...]
Case Presentation: This is a 37–year–old African American man with history of type 2 diabetes mellitus, scleroderma complicated by esophageal dysmotility requiring total parental nutrition and Raynaud's phenomenon, who was admitted to the hospital for [...]
Case Presentation: A 56–year–old Caucasian female with a history of asthma since age 14 presented with dyspnea on exertion and productive cough for the past three days. One month prior she was hospitalized for similar [...]
Case Presentation: A previously healthy 70yo female presented to the emergency department after a syncopal episode. The patient had been feeling progressively fatigued for 2 months prior to presentation, yet had not seen a physician [...]
Case Presentation: This is a 52–year–old man with a history of Stage 1A Hodgkin lymphoma diagnosed at age 18 successfully treated with mantle radiation. He recurred at age 48 and underwent chemotherapy and autologous stem [...]
Case Presentation: An 85–year–old Hispanic female with history of hypertension presented with abdominal pain, diarrhea and increased abdominal distension for 4 days. She also had increased fatigue, dysphagia and edematous legs for 4 months. She [...]
Case Presentation: This is a 59–year–old man with diabetes and heart failure who was admitted for surgical treatment of recurrent foot infection. He received two weeks of vancomycin and piperacillin–tazobactum before a muscle flap repair. [...]
Case Presentation: A 21–year–old male with no significant past medical history presents with two episodes of acute pericarditis in a one month period. The first episode was complicated by cardiac tamponade requiring pericardial drain. Work [...]
Case Presentation: A 54–year–old female with metastatic ovarian cancer was admitted to the gynecologic oncology service with increasing abdominal girth, nausea, and vomiting. Her past medical history was significant for papillary serous adenocarcinoma with malignant [...]
Case Presentation: A 25–year–old lady presented with abdominal pain, bloating, nausea, vomiting and diarrhea since one year and 15 pound weight loss since two months. Patient had consulted several physicians before with no avail. Physical [...]
Case Presentation: A 47–year–old lady was sent to our institution by her PMD for evaluation of ataxia, gradually worsening bilateral leg weakness and numbness for 3 years. She also reported low back pain, paraesthesia of [...]
Case Presentation: A 24–year–old Caucasian woman presented with diffuse left sided chest pain and shortness of breath. The pain was sharp, nonradiating, pleuritic, and began acutely while sitting at her computer. Patient reported a chronic [...]
Case Presentation: A 69–year–old man with a basal ganglia hemorrhage was found on his 9th hospital day to have multiple right upper and middle lobe pulmonary artery emboli (PE). Because of his recent hemorrhagic stroke, [...]
Case Presentation: A 27–year–old African American woman without prior medical history reported 12 h of left lower extremity swelling associated with dull, throbbing pain. Her only daily medication was an oral contraceptive. She had no [...]
Case Presentation: A 76–year–old bed–bound woman with rheumatoid arthritis presented with one week of abdominal pain. Three days earlier she had developed mouth sores, painful swallowing and decreased oral intake. She was hypotensive and had [...]
Case Presentation: A 24–year–old Caucasian male with no past medical history presented with 3–4 days of nausea/vomiting, weakness, sore throat, right lower quadrant pain, and subjective fever. The physical exam showed a fever of 101.8 [...]
Case Presentation: A 34–year–old Caucasian male was brought into the emergency room as he was found unresponsive. Patient received three doses of naloxone without any improvement. Patient had a temperature of 93.3 F, blood pressure [...]
Case Presentation: A 62–year–old male, previously healthy, not immunocompromised, presented with low grade fever, chills, and worsening redness, pain and swelling of the right shoulder, strenoclavicular area and neck. He was recently hospitalized and treated [...]
Case Presentation: This is a 76–year–old female with a past medical history of hypertension, hypothyroidism, and hyperlipidemia who was referred by her primary care physician for evaluation of rash and syncope. One week prior to [...]
Case Presentation: A 45–year–old female with type 2 diabetes was admitted to the orthopedic surgery service with a painful right thigh mass and hyperglycemia. Her pain had progressed over the past month and was now [...]
Case Presentation: A 52–year–old male with a past medical history of right sided nephrectomy for clear cell renal carcinoma was admitted for evaluation of a 6 month history of occasional parasthesias and acute onset of [...]
Case Presentation: The patient is a previously healthy two–year–old female. While eating in a restaurant with her family, she had a temper tantrum. She then became limp with her eyes rolling back. She recovered in [...]
Case Presentation: A 61–year–old man with HIV, not currently on highly active antiretroviral therapy, hypertension, and monoclonal gammopathy of unknown significance, presented to the hospital with a worsening erythematous macular rash for six days. The [...]
Case Presentation: A 69–year–old Hispanic male, with a past history of diabetes and coronary artery disease, was admitted for fever, diarrhea and confusion of 4 weeks' duration. Physical examination showed a disoriented patient with multiple [...]
Case Presentation: A 7–month–old Caucasian male was admitted to a hospital in central California due to complaints of poor feeding. There was remote history of choking on a plastic bead which was removed by mother. [...]
Case Presentation: A 55–year–old woman presented to Emergency Department (ED) complaining of two weeks history of progressive shortness of breath, lethargy and decreased appetite. She was diagnosed with small cell lung cancer 5 months ago [...]
Case Presentation: 47–year–old male with past medical history of chronic back pain presented to emergency room complaining of exacerbation of symptoms. Patient reported three months history of sharp excruciating pain that was located on the [...]
Case Presentation: A 40–year–old male went to his primary medical doctor complaining of headache. He reported a 9/10 dull and achy pain on the right side of his head affecting frontal and temporal regions. He [...]
Case Presentation: A 27–year–old male with unremarkable past medical history presented to the hospital with severe headache for two days. He had associated sinus pressure, nasal congestion with purulent discharge, proptosis, and tearful eyes for [...]
Case Presentation: A 48–year–old woman in generally good health presented with two months of profuse, large volume watery diarrhea. She was initially diagnosed with Clostridium difficile colitis and symptoms resolved with oral metronidazole. Five days [...]
Case Presentation: This was a 42–year–old Caucasian female with history of alcohol–induced cirrhosis, Roux–en–Y gastric bypass surgery who presented to the hospital for generalized weakness and severe rash. She developed symmetrical weakness in her lower [...]
Case Presentation: A 50–year–old female presented to the hematology clinic for evaluation of pancytopenia. Past medical history significant for bariatric surgery performed one year ago. Complete blood counts were normal prior to surgery. Examination was [...]
Case Presentation: A 23–year–old male presented to the Emergency Room with symptoms of substernal chest pain radiating to his neck. The pain began spontaneously one day prior to arrival and progressed through the day. Subsequently [...]
Case Presentation: A 72–year–old man with a history of resected multicentric ileal carcinoid tumor underwent evaluation for small bowel obstruction (SBO). A newly elevated urinary 5–hydroxyindoleacetic acid level prompted a single–photon emission computed tomography/computed tomography [...]
Case Presentation: 63–year–old male with history of hypertension and dyslipidemia presented to the hospital with a 5 month history of fatigue, 40 lbs. weight loss, diaphoresis, insomnia, short–term memory loss, and hyponatremia secondary to presumed [...]
Case Presentation: A 41–year–old female with a history of substance abuse presented to the Emergency Department with one month of bilateral lower extremity rash and severe pain. On arrival patient was noted to have altered [...]
Case Presentation: A 52–year–old man presented for open reduction and internal fixation (ORIF) of an uncomplicated distal radius fracture after a helmeted skiing accident. One year prior to presentation he underwent shoulder rotator cuff repair [...]
Case Presentation: Introduction: Albeit a frequent complication in cancer patients, stroke has rarely been reported as an initial manifestation of an occult malignancy. We report a patient presenting with multifocal cerebral infarction who was later [...]
Case Presentation: A 31–year–old man with a history of human immunodeficiency virus (HIV) presents with shortness of breath, headache, vomiting, diarrhea and tingling in lower extremities. He had been hospitalized eight months prior due to [...]
Case Presentation: A 22–year–old Caucasian gentleman was referred for the evaluation of a 5–day history of non traumatic lower backache and fever. Backache was acute in onset, non radiating, dull in character and of 4/10 [...]
Case Presentation: A 66–year–old Caucasian woman presented to outpatient clinic with the complaints of generalized weakness, nausea, headaches and hiccups of three weeks duration. One day before the onset of her symptoms she was outside [...]
Case Presentation: 57–year–old male came with 4 weeks of constant 6/10 diffuse abdominal pain which was aggravated by meals. He had worsening constipation with loss of appetite, early satiety and a 15 lb. weight loss. [...]
Case Presentation: A 35–year–old male presented to the emergency department (ED) complaining of intractable nausea and vomiting. This was a reoccurrence of a long standing affliction dating back 7 years in which he had chronic [...]
Case Presentation: Henoch–Schönlein purpura (HSP), an IgA mediated systemic vasculitis, presents with a tetrad of lower extremity purpuric rash, bowel angina, acute nephritis and arthritis. HSP is mostly seen in the pediatric population, but rarely [...]
Case Presentation: A 39–year–old female presented to the hospital with 2 weeks of fevers, diffuse pain, headaches, neck stiffness, photophobia, nausea and vomiting. Her past medical history includes hypothyroidism, diverticulitis, GERD and gluten intolerance. She [...]
Case Presentation: Pulmonary infiltrates with eosinophilia (PIE syndrome) is characterized by eosinophilic pulmonary infiltrates and peripheral blood eosinophilia. We describe clinical,radiological and histological presentation of a patient with chronic eosinophilic pneumonia.55–year–old lady with a h/O [...]
Case Presentation: A 50–year–old Caucasian woman presented to the emergency department with worsening left breast redness and nipple discharge for 3 days. Examination was significant for erythema encompassing most of the left breast with yellow [...]
Case Presentation: An 80–year–old man was admitted for low back pain and bilateral lower extremity weakness and gait instability for 6 months. He also had weight loss of 40 pounds and fatigue over the last [...]
Case Presentation: A 27–year–old female with a past medical history of polycystic ovarian syndrome presented to the hospital with nausea and intractable vomiting starting 2 weeks after intrauterine insemination. Her physical examination was normal. At [...]
Case Presentation: A 32–year–old woman presented with non bloody vomitus and generalized weakness for 3 days. Medical history was significant for diabetes mellitus type 1 and diabetic ketoacidosis (DKA) in 2006. She was not compliant [...]
Case Presentation: A 58–year–old male with uncontrolled hypertension presented to the emergency department complaining of worsening dyspnea on exertion, orthopnea and bilateral lower extremity edema of several months duration. On physical exam he appeared flushed, [...]
Case Presentation: This is a 65–year–old male with diabetes and hypertension who presented to the emergency room with a complaint of right shoulder pain. He was also found to be febrile to 101.5 F with [...]
Case Presentation: The patient is a 62–year–old man with significant PMH of Type II diabetes mellitus, hypertension, and gout, who presented with lightheadedness, and shortness of breath. Laboratory analysis was significant for anemia with a [...]
Case Presentation: A 51–year–old female with end stage renal disease, cirrhosis, tricuspid regurgitation, and portal hypertension undergoes hemodialysis three times per week and receives periodic therapeutic paracenteses. She routinely has 10L or more removed per [...]
Case Presentation: A 50–year–old man presented to his dermatologist with a 2–week history of a rash over his extremities. The nodules were painful, raised and violaceous (Fig. 1). He was empirically treated with oral Prednisone [...]
Case Presentation: A 28–year–old woman, gravida2 para2, presented to the ER for abdominal pain and distention 2 weeks after cesarean section with total abdominal hysterectomy for placenta accreta. She was diagnosed with retrovesicular abscess which [...]
Case Presentation: A 58–year–old female presented with progressively worsening shortness of breath over years with rapid worsening over the previous weeks. Her medical history is notable for progressive pulmonary disease secondary to M. kansasii diagnosed [...]
Case Presentation: A 53–year–old female presented to the orthopedic clinic with complaints of left hip pain, back pain, and motor and sensory deficits. Imaging demonstrated multiple lytic bone metastasis and thoracic spinal cord compression. She [...]
Case Presentation: A 63–year–old man with a history of end stage renal disease status post deceased donor renal transplant and small bowel carcinoid status post excision presented with fevers. Infectious work–up was negative, and a [...]
Case Presentation: A 75–year–old male presented for inpatient treatment of major depression. A medicine consult was requested for evaluation of a pruritic facial rash that had been present for 2 weeks. Review of the systems [...]
Case Presentation: A 27–year–old African American male inmate with a history of occupational exposure to silica and fiberglass dust presented with an acute onset of dyspnea associated with left–sided pleuritic chest pain. He reported a [...]
Case Presentation: A 42–year–old man presented with persistent dyspnea for 10 months that had worsened over the last month. He has had multiple hospital admissions for congestive heart failure and anemia of chronic disease. An [...]
Case Presentation: A 28–year–old nonsmoker female with a history of migraines and OCP use presented to the hospital with acute onset confusion, disorientation and right–sided focal neurologic deficits. The patient had migraines since age 12 [...]
Case Presentation: DG is a 50–year–old female with no significant past medical history who presented to the emergency department (ED) two weeks after a near–syncopal episode. She complained of "flu–like" symptoms and ED physicians noted [...]
Case Presentation: A 38–year–old Mexican man presented with one day of sudden onset left shin pain, with generalized weakness and dyspnea. His temperature was 99.0, pulse 90, blood pressure 108/72, respiratory rate 24. On exam [...]
Case Presentation: A 60–year–old female bookkeeper with a past medical history significant for a 40 pack year smoking history presented to her primary care physician with a complaint of a persistent sweet taste in her [...]
Case Presentation: We report a case of a 68–year–old female with hypertension and osteoarthritis who presented with altered mental status and bilateral lower extremity cellulitis. Shortly after initial evaluation, the patient became non–responsive and exhibited [...]
Case Presentation: A 59–year–old male presented with abdominal pain for 5 days. His past medical history was significant for hypertension, dyslipidemia and a stable 5 cm abdominal aortic aneurysm (AAA) detected 4 years ago. The [...]
Case Presentation: A 59–year–old male with a history of asthma presented to our emergency department with severe wheezing associated with shortness of breath. His asthma had been stable, requiring albuterol inhalation one to two times [...]
Case Presentation: A 71–year–old man with a past history of long standing asthma presented with productive cough for 1 week and nausea, vomiting, diarrhea, fevers, headache, and generalized weakness for 1 day. In the last [...]
Case Presentation: A 61–year–old male with worsening back pain and right leg weakness secondary to lumbar spinal stenosis underwent an elective L2–S1 laminectomy with L4–L5 fusion. His past medical history included essential hypertension with medication [...]
Case Presentation: A 60 year old male presented with acute dyspnea and pleuritic retrosternal chest pain. His past medical history was significant for Wegener's granulomatosis (WG) in remission for four years. His history was negative [...]
Case Presentation: This is a 21–year–old male presenting with a 3–month history of worsening colicky periumbilical abdominal pain. The patient has had fevers, night sweats, diarrhea and hematochezia associated with this pain. He has a [...]
Case Presentation: A 75–year–old African American woman was admitted following two weeks history of fatigue, jaundice, anorexia, intermittent nausea and vomiting. Her physical exam was unremarkable except for profound icterus. She was previously maintained on [...]
Case Presentation: A 71–year–old woman with a history of inverse psoriasis (occurs on skin folds versus extensor surfances), breast cancer status post right lumpectomy and radiation, last treated 3 months ago, presents to the hospital [...]
Case Presentation: A previously healthy 28–year–old female medical student presented with four days of high fevers (up to 39.9 C) and epigastric pain. In the past month, she completed an infectious disease rotation, then went [...]
Case Presentation: A 44–year–old woman with 30–pack year smoking history, diabetes and non–alcoholic fatty liver disease presented with shortness of breath since two months and recurrent right sided pleural effusion on chest radiographs. Prior to [...]
Case Presentation: An 81–year–old man with a history of chronic obstructive pulmonary disease, congestive heart failure and chronic kidney disease presented to our hospital with 6–day history of increasing shortness of breath, fever (self recorded [...]
Case Presentation: A 68–year–old man with stable lupus nephritis diagnosed in 1999, presented with progressive difficulty with swallowing and speaking since May 2009 requiring percutaneous endoscopic gastrostomy tube placement in August 2010. Muscle atrophy, twitching [...]
Case Presentation: A 57–year–old man with a known history of ischemic cardiomyopathy, high cholesterol, hypertension and diabetes presented with 2–month history of seven daily episodes of watery stools. He lost eleven kg over this period. [...]
Case Presentation: A 22–year–old woman with a history of systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome on chronic immunosuppression and anticoagulation presented with one week of post–prandial upper abdominal pain and fevers. Her vital [...]
Case Presentation: A 50–year–old HIV–positive, African American male presented with fever and rash of 3 months duration. He first noticed an "elevated, itchy, red spot that enlarged and oozed when scratched" on his left hand. [...]
Case Presentation: A 44–year–old female with a past medical history of HIV presented to the emergency room with bilateral leg pain, edema and erythema that was progressively worsening over several weeks. The patient first began [...]
Case Presentation: A 63–year–old male with a history of prostate cancer status post open prostatectomy in 2000 presented in July 2010 to the emergency department with fevers. He reported 6 months of terminal dysuria and [...]
Case Presentation: This is a 64–year–old Caucasian male with past medical history significant for non–ischemic cardiomyopathy with recent EF of 19% who presented to the hospital with chief complaint of right upper quadrant pain and [...]
Case Presentation: A 77–year–old man from Putnam County, New York, was hospitalized on December 5, 2010 for one week history of fever, dysuria and confusion. He was treated for a urinary tract infection without improvement. [...]
Case Presentation: A 57–year–old Caucasian female started having painless bleeding per rectum. She denied any constipation or pain during bowel movements. She noticed small lump at anal margin. Her other co–morbidities were hypertension, hyperlipidemia, stress [...]
Case Presentation: A 38–year–old Caucasian male with a history of gout presented with odynophagia and epigastric pain following a hiking trip. He was diagnosed with gastro esophageal reflux disease likely secondary to NSAID use. Esophogastroduodenoscopy [...]