Background: Pneumonia (PNA) is the fourth most common diagnosis for hospital admissions in the United States. Although the Infectious Diseases Society of America (IDSA) defines PNA as requiring specific clinical features (cough, fever, sputum production and pleuritic chest pain) along with radiographic imaging confirmation, older adults can present with non-specific symptoms. Furthermore, in a landmark [...]

Background: In Japan, a “super-aged” society, the rate of end-stage dysphagia in the elderly is increasing. Artificial hydration and nutrition (AHN) can be used for such patients, although it may not improve mortality or quality of life. The many downsides of AHN are not always well explained to patients and their families, resulting in routine [...]

Background: In 2011, the Infectious Diseases Society of America (IDSA) published new guidelines on the management of community acquired pneumonia (CAP) in children and recommended use of narrow spectrum antibiotics such as ampicillin or amoxicillin over broader spectrum antibiotics such as ceftriaxone. Many studies have shown that these guidelines have been adopted with varying success [...]

Background: Ventilator associated pneumonia (VAP) is the leading cause of death from nosocomial infections in critically-ill patients. The CDC recommends maintaining Head-of-Bed (HOB) elevation at a target recumbency range of 30º-45º due to evidence that a semi-recumbent position significantly reduces VAP. Current methods for evaluating patient recumbency utilize “eyeballing” or built-in HOB protractors, which are [...]

Background: Most patients hospitalized with community-acquired pneumonia (CAP) can be safely treated with 5-days of antibiotic therapy. However, many are not. We aimed to determine whether a hospitalist-focused collaborative could reduce excessive antibiotic use in patients hospitalized with CAP through a combination of collaboration with antibiotic stewardship, data feedback, pay-for-performance, and sharing best practices. Methods: [...]

Background: Hospitalized patients are complex and often receive concurrent treatment for multiple diseases. Patients presenting with shortness of breath and infiltrates on chest x-ray may be treated for pneumonia, congestive heart failure (CHF) or both. Fluid and blood pressure management may be particularly challenging for these patients. Our goal was to define the impact of [...]

Case Presentation: A 14-year-old male with history of juvenile ankylosing spondylitis (JAS) and asthma presented to the hospitalist service with four weeks of fever, weight loss, dyspnea, wheezing and cough. He was admitted one week prior for treatment of bilateral pneumonia and was continued on antibiotics after discharge for a ten day course. He had [...]

Case Presentation: A 68-year-old female presented to the emergency department with altered mental status. A few weeks prior to presentation, she was found to have a viral influenza infection which was managed supportively. Approximately one week prior to presentation, she had started developing a productive cough associated with body aches and fatigue, and eventually developed [...]

Case Presentation: A 54 year-old previously healthy man presented to the ED with two weeks of cough productive of “grey-green” mucus and slowly worsening dyspnea on exertion. His symptoms were accompanied by low-grade fevers, fatigue, poor appetite, and lightheadedness upon standing. His spouse was recently ill with symptoms of an upper respiratory infection. Review of [...]

Case Presentation: A 66-year-old woman presented as a hospital transfer for further evaluation of 1 week of abdominal pain and jaundice and several months of a worsening dry cough and dyspnea. These were respectively attributed to acute cholecystitis status post unsuccessful ERCP and pulmonary edema. She had no fever, orthopnea, or edema. Her past medical [...]