Background: While medical school experience could be very rewarding, it is also known to be unusually stressful to many future physicians. Previous cross sectional studies have shown that symptoms of depression and burnout are higher among medical students compared to age matched general population. A meta-analysis reported overall pooled crude prevalence of depression, or depressive [...]

Background: Early development of clinical reasoning and problem-solving competencies are essential in generating individualized, outcome-based, and cost-effective patient care plans (Nat Acad Press 2015). However, few medical schools and residency programs have an explicit curriculum in clinical reasoning (Graber et al., 2012). A recent survey of internal medicine clerkship directors found medical students receive limited [...]

Background: The subset of admitted Major Depressive Disorder (MDD) patients with treatment-resistant depression (TRD) may be associated with incremental economic burden compared with other MDD patients. This study aimed to characterize and evaluate healthcare resource use, admission measures, and costs in these two groups. Methods: Patients aged ≥18 years with a diagnosis of MDD admitted [...]

Background: Peripherally inserted central catheters (PICCs) are associated with central vein stenosis and failure to establish a functioning arteriovenous fistula. Thus, guidelines recommend avoiding PICC placement when patients with chronic kidney disease (CKD) are likely to require hemodialysis. We sought to describe the current practice of PICC placement in hospitalized patients with an estimated glomerular [...]

Background: Elevated blood pressure (BP) is common among hospitalized patients, with prevalence estimates between 50-70%. Many factors may contribute to this, such as pain, nausea, anxiety, or volume overload. However, true hypertensive emergency requiring rapid reduction in BP is relatively rare. The easy availability of intravenous (IV) antihypertensives may lead to unnecessary treatment of asymptomatic [...]

Background: Electronic prescribing (eRx) at discharge enhances safety and quality of care transitions. It results in improved medication adherence and a decreased chance of readmission. Stage 3 Meaningful Use goals include discharge eRx rates of greater than 25%. As of September 2017, our large academic medical center had a year-to-date discharge eRx rate of 18.3%, [...]

Background: Opioids are widely prescribed for cancer and non-cancer related pain in hospitalized patients. The opioid usage increased roughly three times in the past two decades. Pain is a feeling of distress evoked by sensory stimuli with/without organ damage and an associated emotional experience. Considering the subjective nature of pain, the need for medication is [...]

Case Presentation: Teriflunomide is a pyrimidine synthesis inhibitor used in management of Relapsing Remitting Multiple Sclerosis (RRMS). Leflunomide is the active agent which has been used in rheumatoid arthritis. Chronic diarrhea has been associated with both of these. However, there is no evidence in literature to suggest clostridium difficile (C.Diff) diarrhea associated with these agents. [...]

Case Presentation: A 53 yo female presented with a subacute syndrome of intermittent fevers, fatigue, heliotrope rash, weight loss, fingertip necrosis, and nodular skin lesions. Skin biopsy was positive for septal and lobular granulomatous panniculitis. Serology was positive for antinuclear antibody (ANA) and anti-ribonucleoprotein (RNP), negative for other vasculitis and rheumatologic autoantibodies. She was diagnosed [...]

Case Presentation: A 37-year-old Hispanic female with no medical history presented to the hospital with bilateral lower extremity edema of 3-week duration. Concurrently, she also experienced dysphagia to solids associated with 30-lb weight loss and low-grade fever. Initial examination was significant for bilateral erythematous rash of lower extremities with 3+ pitting edema that extended from [...]