Background: An important duty of every hospitalist is to detect the earliest signs of imminent clinical deterioration. Breathing motion patterns can convey early warnings of respiratory instability (1). Normal breathing appears regular, effortless, well-coordinated and comfortable (2). In patients at high risk of respiratory deterioration, breathing appears labored (3). Well-established signs of labored breathing include: [...]

Background: While hospitals are primarily designed to provide acute care, a subset of patients have prolonged lengths of stay beyond medical necessity for months on general medicine wards[1]. These cases often occur in vulnerable patient populations, including those with mental health and substance use disorders[2], impaired decision-making capacity[3, 4], and housing insecurity[3]. However, few studies [...]

Background: Tebipenem pivoxil hydrobromide (TBP-PI-HBr) is an orally bioavailable prodrug that is rapidly converted in plasma to the carbapenem, tebipenem. Tebipenem has in vitro activity against select multidrug-resistant Gram-negative pathogens, including fluoroquinolone-resistant and extended-spectrum ß-lactamase (ESBL)-producing Enterobacterales. TBP-PI-HBr is being developed in the United States as the first oral carbapenem for treatment of cUTI and [...]

Background: Point-of-care ultrasound (POCUS) training was recently endorsed by the Alliance for Academic Internal Medicine (1) and the demand for training is increasing among internal medicine (IM) residency programs (2). Longitudinal POCUS training increases knowledge and skill retention compared to stand-alone workshops (3,4), but few programs currently provide longitudinal training due to institutional barriers, such [...]

Background: There has been a national push over the last few decades to integrate patient safety within clinical care delivery. Despite an increased focus by educators and accrediting bodies, successful involvement of learners in high fidelity event review resulting in systems-level improvement lags behind expectations. Specific areas for improvement include faculty skillset development, involving interprofessional [...]

Background: Cirrhosis is the result of advanced liver damage and causes significant morbidity, mortality, and burden on the U.S. healthcare system. In 2016, more than 40,000 Americans died because of complications related to cirrhosis, and this number continues to grow. A common complication of decompensated cirrhosis is refractory ascites, which is often managed through large-volume [...]

Background: Time spent on electronic medical record (EMR) documentation is one of the top dissatisfiers for providers. With burnout at an all-time high, reducing provider burden while maintaining high quality care is essential to moving healthcare forward in a sustainable way. “While electronic documentation provides a number of benefits as compared to paper-based documentation, including [...]

Background: Career exploration and professional identity formation (PIF) are critical in undergraduate medical education (UME). With its focus on management of acutely ill, hospitalized patients, Hospital Medicine (HM) is an opportune environment for pre-clinical students to gain valuable, diverse clinical experiences. While widely utilized in UME, shadowing on HM direct-care services (HM-DCS) (i.e., those without [...]

Case Presentation: A 39-year-old female with a history of primary sclerosing cholangitis status post-liver transplant in 1986 on cyclosporine, ankylosing spondylitis, Monoclonal gammopathies with undetermined significance, and migraines presents with progressive headaches, fevers (up to 101 F), and neck stiffness over the past 2 weeks. She was found to have photophobia, meningismus, and a positive [...]

Case Presentation: A 55-year-old man presented with bilateral upper back pain with radiation to the upper chest for the past 1 month. On examination, he had left upper back tenderness. A CT of the chest revealed septic pulmonary emboli. Blood cultures drawn on admission speciated to methicillin-resistant staphylococcus aureus (MRSA). Urine cultures speciated to MRSA [...]