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 levels. To test this hypothesis, we examined the relationship between 25(OH) D and PAD as measured by Ankle–Brachial index (ABI) [...]

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. We hypothesize that many hospitalized patients with osteoporosis go undiagnosed. Methods: From 2007 –2010, 790 patients, >age 50, were identified [...]

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 is often used first line for symptomatic management of delirium due to its rapid onset and ease of administration. However, [...]

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 increasing literature suggests that team performance is more than just the sum of individual performance, and that the relationships among [...]

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 of being positive in these patients and its utility in clinical management has been questioned in previous studies. The objective [...]

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 with fidaxomicin (FDX) or vancomycin (VAN). Methods: Patients with toxin–positive CDI were randomized to receive FDX 400 mg/d or VAN [...]

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 13 and 64 should be offered HIV screening in all health care settings using an opt–out strategy. Clinician experiences with [...]

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 adoption has been slow due to an increased risk of bleeding. Identifying a high risk population such as older adults [...]

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 treatment, and concerns about quality. In addition, formulary constraints as well as an increase in providers who trained at institutions [...]

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 antibiotics, and are often leading to an associated increase in morbidity and mortality. ESBLs are considered an emerging threat and [...]