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A Case of Reversible Osmotic Myelinolysis After Rapid Correction of Hyponatremia

Case Presentation: A 71‐year‐old woman on thiazide treatment for hypertension developed protracted vomiting and diarrhea for several days followed by confusion and lethargy. In the emergency department, serum sodium (SNa) was found to be 107 [...]

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Steroid Refractory Drug Reaction: Time to Readdress

Case Presentation: A 58‐year‐old African American man presented to our hospital with confusion, diffuse morbiliform rash, facial edema, fever to 41.1°C, leukocytosis with eosinophilia, acute kidney injury, transaminitis, and elevated creatinine kinase. Extensive evaluation for [...]

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Not Every Granuloma Is Tb

Case Presentation: A 35‐year‐old woman presented with moderate body aches, cough, dyspnea, chills, fever, nausea, and vomiting. Patient had a Groshong catheter in place for total parenteral nutrition because of short bowel syndrome following gastric [...]

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Why Can't I Move? A Case of Hypokalemic Paralysis As the Initial Presentation of SjÖgren's Syndrome

Case Presentation: A 51‐year‐old woman presented with worsening bilateral upper‐ and lower‐extremity weakness and difficulty walking for 2 weeks. She denied fevers, back pain, bowel and fecal incontinence, but reported oral and ocular dryness for [...]

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How Low Can You Go? Treating Anemia in the Setting of Hyperleukocytosis

Case Presentation: A 57‐year‐old man with previously untreated Rai stage IV chronic lymphocytic leukemia presented with severe dyspnea on exertion over the last 3 months. He also noted pulsatile tinnitus, lower leg pains with walking, [...]

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Primary Thoracic Ewing's Sarcoma — a Case Report with Unusual Presentation

Case Presentation: A 33‐year‐old otherwise healthy white man came to our clinic for evaluation of chronic sinus congestion, cough, and occasional chills. On review of symptoms he reported some diminished exercise tolerance over the past [...]

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A Unique Hospitalist/pain Management Collaboration to Improve Pain Outcomes

Background: Pain management is complex, and multiple variables may affect pain relief for patients. It is estimated that roughly 40% of hospitalized patients experience moderate to severe pain. Because hospitalists now care for an increasing [...]

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Stress Ulcer Prophylaxis: Pilot Project to Reduce Inappropriate Use in the Intensive Care Unit

Background: Stress ulcer prophylaxis (SUP) is overused in the intensive care setting. Acid suppression therapy has been associated with multiple adverse effects including increased risk of nosocomial pneumonia and Clostridium difficile colitis. Reduction in the [...]

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Transitions of Care from the Hospitalist to the “Snfist”: A Campaign to Improve Communication and Reduce Readmissions

Background: Patients discharged to a skilled nursing facility (SNF) are at significantly higher risk of readmission within 30 days. For hospitalists at the Cleveland Clinic, the rate in 2012 to date is 25.8%. The physician [...]

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A Multicenter Study of Physician Knowledge of Patient Fall Risk

Background: Falls are the leading cause of injury death among adults 65 or older. Physician knowledge of fall risk factors is crucial to reducing falls. Interventions targeting fall risk factors can reduce fall rates by [...]

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Comparison of Hcahps Patient Satisfaction Scores for Specialty and General Medical Hospital: Confounding Effect of Survey Response Rate

Background: Because of the low survey response rate of the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) patient satisfaction survey, currently administered by more than 4500 hospitals, patient satisfaction scores (PSSs) may not [...]

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Is Heparin‐Induced Thrombocytopenia Overdiagnosed in a Community Hospital?

Background: Heparin‐induced‐thrombocytopenia (HIT) is a life‐threatening immunologic reaction that develops as a result of the formation of platelet‐activating antibodies that recognize platelet factor 4 and heparin complexes (PF4/heparin). Subsequent thrombocytopenia and thrombus formation can lead [...]

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New Take on an Old Story: Revisiting the Heparin Nomogram

Background: Continuous infusions of unfractionated heparin (UFH) are still commonly used in the initial treatment of venous thromboembolism (VTE). As a result of UFH's high‐risk profile and common usage, weight‐based UFH nomograms were developed more [...]

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Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011

Background: Palliative care can improve outcomes and quality of life for people with serious illness and is a critical aspect of care for hospitalized patients. Despite calls for more palliative care consultation services (PCCS), little [...]

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Evaluation of Aha Recommendations for Cardiac Monitoring in a Noncritical Setting

Background: Cardiac monitoring is often overutilized. The 2004 American Heart Association (AHA) practice standards categorized indications for electrocardiographic monitoring in hospitalized patients based on the potential therapeutic benefit. This study sought to evaluate whether the [...]

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