Background: The volume of opioid prescriptions in the US has increased dramatically over the last two decades, and strong evidence suggests that this has perpetuated opioid misuse, addiction, overdose, and drug-related deaths. We aimed to learn if there are differences in opioid prescribing among generalist physicians, NPs, and PAs to Medicare beneficiaries. Methods: We performed [...]

Background: The economic burden of illness for patients with major depressive disorder (MDD) with suicidal ideation (SI) and suicide attempt (SA) can be attributed to the intensive level of care required, as these patients are frequently evaluated in the emergency department (ED) and admitted to the hospital. This study evaluated this burden of hospitalized patients [...]

Background: Patients hospitalized for major depressive disorder (MDD) with suicidal ideation (SI) or suicide attempt (SA) may have a high risk for hospital readmission. This study evaluated readmission/subsequent emergency department (ED) visit rates and the associated healthcare resource use and costs among patients who were hospitalized for MDD with SI or SA (SI/SA). Methods: Patients [...]

Background: Heart failure (HF) and atrial fibrillation (AF) share several risk factors including coronary artery disease, hypertension, smoking, obesity, diabetes, and renal disease, as well as common pathophysiologic pathway involving activation of the renin–angiotensin–aldosterone system, maladaptive atrial remodeling and subsequent impaired conduction system. Some studies have supported the role of angiotensin converting enzyme inhibitors (ACEIs) [...]

Background: Peripherally inserted central catheter (PICC) use in patients with chronic kidney disease (CKD) is associated with non-functioning arteriovenous fistulae. Existing guidelines recommend avoiding PICC placement in these patients but how often this occurs and how best to implement this recommendation is not known. Methods: Within 42-hospitals participating in the Michigan Hospital Medicine Safety Consortium [...]

Background: Pressure injuries are tissue damage caused by pressure and shear. Susceptible patients are the elderly, acute, critically ill and malnourished. Pressure injuries severely deplete hospital performance measures in the U.S. Currently, over 2.5 million patients develop pressure injuries at a national cost of about $25 billion each year and are implicated in 50,000 deaths. [...]

Background: Clinician prescribing practices are a contributing factor to and potential mitigator of the opioid epidemic in the United States. Several studies have identified the hospital setting as an important entry point into chronic opioid use. The Society for Hospital Medicine (SHM) and the Centers for Disease Control and Prevention (CDC) have made recommendations for [...]

Background: Diabetes is common, present in up to one third of hospitalized patients and up to 50% of critically ill patients. Studies have shown that hyperglycemia among hospitalized patients leads to worse clinical outcomes and increases readmission rates by over 30% relative to normo-glycemic patients. Insulin is the only medication recommended for treatment of diabetes [...]

Case Presentation: A 19 yo female presented to our hospital with the complaint of lower extremity weakness and paresthesias. She had a history of episodic abdominal pain with vomiting, headaches, and paresthesias. Prior evaluations for these symptoms had led to diagnoses of fibromyalgia, migraine headaches and cyclic vomiting with erosive esophagitis. She had experienced lower [...]

Case Presentation: A 24-year old woman presented to the emergency department with three days of decreased vision after she sustained blunt trauma to her face during a physical altercation. Social history was notable for methamphetamine use and unprotected sexual activity with multiple partners. Physical exam demonstrated right-sided periorbital swelling and tenderness, pupils were equal, round, [...]