Case Presentation: A 40-year-old male with no significant history presented with acute dizziness, visual disturbances, and gait abnormality, preceded by a viral prodrome. He reported headache, neck stiffness, vertical diplopia, and neurological exam revealed bilateral CN 6 palsy, left CN 3 palsy, restricted extraocular movements, and bilateral dysmetria. Cardiovascular, respiratory, and abdominal exams were unremarkable. [...]

Background: Cocaine use disorders are a significant public health challenge, contributing to cardiovascular, neurological, and psychiatric complications. Chronic use exacerbates these risks and increases addiction rates. This study evaluates global, regional, and national trends in the burden of cocaine use disorders from 1990 to 2019 to inform targeted intervention strategies. Methods: Using the Global Burden [...]

Background: Patients admitted for nonsurgical management of small bowel obstruction (SBO) often receive intravenous (IV) opioids for pain relief. However, given the opioid crisis and the potential for opioids to hinder recovery and contribute to ileus, exploring alternative analgesics is crucial. This randomized controlled trial (RCT) evaluates the efficacy of IV acetaminophen for pain management [...]

Background: Self-directed discharge, also known as Against Medical Advice (AMA) discharges, comprise 1–2% of hospital discharges (1). The AMA process poses safety risks to patients and emotional strain on providers, potentially leading to implicit biases in documentation (2). While stigmatizing language in medical records has gained attention (3), its prevalence in AMA documentation remains underexplored. [...]

Background: Delirium is a common clinical syndrome, particularly among elderly patients in the inpatient hospital setting, and carries considerable associated morbidity. These patients can display symptoms of inattention, agitation, and restlessness, often necessitating the use of chemical or physical restraints to ensure the safety of the patient and staff. Unfortunately, these interventions are not without [...]

Background: Interhospital transfer (IHT) processes vary across institutions. The fragmented and complex nature of IHTs pose patient safety risks. The implementation of a standardized IHT process with a templated note for hospital medicine patients at our institution demonstrated promising patient safety outcomes and a significant increase in physician satisfaction. A second, iterative intervention expanded this [...]

Background: Hospital antibiotic stewardship programs (ASPs) play a critical role in minimizing unnecessary antibiotic use and combating antimicrobial resistance. Although various antibiotic stewardship interventions have been described, the feasibility and sustainability of these approaches remain uncertain. Furthermore, some interventions may be challenging for smaller hospitals to implement due to informatics resource limitations. Thus, we aimed [...]

Background: Self-directed discharges, also referred to as discharge “against medical advice” (AMA), refer to when patients leave the hospital prior to medical readiness. These discharges lead to worse health outcomes for patients, ethical dilemmas for clinicians, and increased readmission rates affecting healthcare systems. Research on self-directed discharges has emphasized patient characteristics affecting discharge, with less [...]

Background: Totally implantable venous access ports (“ports”) are a cornerstone of the treatment and survival of highly vulnerable patients, particularly those requiring chemotherapy for cancer. Because they are a lifeline for such patients, the ability to use ports for indications other than their primary use (e.g., chemotherapy) is often restricted. We sought to describe current [...]

Background: Self-directed discharges, also referred to as discharge “against medical advice” (AMA), comprise 1–2% of hospital discharges. Practice guidelines suggest avoiding the designation of “AMA” discharge as this is associated with adverse outcomes. The term “AMA discharge” persists, however, and characteristics of clinician documentation of self-directed discharges remain underexplored. We used retrospective chart review at [...]