Background: It has been unclear about prevalence and in-hospital mortality of severe hypophosphatemia among hospitalized medical patients. Predictors for in-hospital mortality have not yet been determined in terms those may include serum nadir phosphate level, hemolytic complication from hypophosphatemia, or baseline disease as a cause of hypophosphatemia . Methods: A retrospective cohort study was conducted [...]

Background: It is estimated that nearly 20 million people are taking Statins (HMG-CoA Reductase Inhibitors) currently in the United States. The benefits of statins to treat and prevent cardiovascular disease are accepted universally. However, recent evidence indicates an increased risk of new onset diabetes mellitus (DM) in this population. A literature review was done to [...]

Background: Therapeutic duplication is the practice of prescribing multiple medications within the same class without a clear indication to use one over the other. Also referred to as “drug stacking”, this prescribing behavior is a violation of Joint Commission standards and leads to adverse opioid events such as increase risk of falls, respiratory failure, and [...]

Background: Widespread use of new oral anticoagulants (NOAG) for Atrial Fibrillation (A-Fib) has increased the annual incidence of gastrointestinal bleed (GIB) in recent years. These NOAG agents in our study include Rivaroxaban, Apixaban and Dabigatran. Convenience of use, quick onset, broad therapeutic window and eliminating need for frequent monitoring makes NOAGs attractive for A-Fib associated [...]

Background: Spontaneous Bacterial Peritonitis (SBP) is associated with high mortality.  A recent article[1] showed that, in the setting of SBP, delayed paracentesis was associated with increased mortality.  Because of the clinical ramifications of this association, we attempted to recreate this finding using our local patient population. Methods: Similar to the study that prompted this inquiry, [...]

Background: Oral anticoagulation is effective for reduction of risk for stroke and systemic embolism in patients with nonvalvular atrial fibrillation, but there may be uncertainty about how to manage anticoagulation in and following an emergency procedure or after treatment of hemorrhage. In case of an emergency, anticoagulation would ideally be immediately and completely reversed, bringing [...]

Background: Morbidity and Mortality (M&M) Conference is a traditional forum that provides residents with an opportunity to discuss medical errors, adverse events and near misses. Conventionally, most of the allotted time is spent on case presentation, unexpected outcomes and therapeutic debates. We demonstrate a unique approach to M&M, where we refocused the content by emphasizing [...]

Background: According to the most recent data released by the Centers for Disease Control, forty-six Americans die every day due to narcotic prescription drug overdose. Nationally, health care providers wrote two hundred and fifty-nine million prescriptions for narcotic analgesics in 2012, or roughly one bottle of narcotics per US adult. In an attempt to reduce [...]

Background: Catheter occlusion is often encountered when using peripherally inserted central catheters (PICCs). Patients who experience catheter occlusion are at risk of interruption of therapy, thrombolytic instillment, and complications such as VTE. Whether rates of PICC occlusion vary by flushing protocols, device type, or duration is not known. Methods: Using data from the Michigan Hospital [...]

Background: Crystalloid fluid solutions are one of the most common medications used in the inpatient setting. Although normally harmless, excessive administration of intravenous fluid (IVF) therapy can be a significant cause of patient morbidity in the hospital. This usually is a result of the liberal use, which based on anecdotal experience, is frequently due to [...]