Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered […]

Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they […]

Background: Delays in the discharge of the hospital ward patients cause a backlog for new admissions from the Emergency Department, and transfers from the Intensive Care Units and telemetry units. This bottleneck unnecessarily increases overall resource utilization and also negatively impacts patient care and satisfaction. Therefore, our Internal Medicine Residency Program aimed through this quality […]

Background: Chest pain and related symptoms are the number two reason patients visit emergency departments in the United States, often leading to routine hospitalization or observation. Improving utilization management of patients presenting to the emergency department with chest pain is an important goal for hospitals. Use of 5th generation troponins and risk stratifying tools can […]

Background: Staffing of inpatient medicine services with Advanced Practice Providers (APPs), including physician assistants and nurse practitioners, is becoming increasingly common at academic medical centers across the United States. The various roles filled by APPs have not been well-described in the literature. The purpose of this study is to better characterize how APPs are utilized […]

Background: Renal dysfunction is a complication in patients with decompensated cirrhosis. Due to the potential morbidity and mortality of these disorders in cirrhotic patients, it is important to ensure accurate clinical measurements of renal function. Standard creatinine-based estimated glomerular filtration rate (eGFR) equations have proven to be inaccurate in cirrhotic patients, as these patients have […]

Background: Unstable Angina (UA) is a common subset of Acute Coronary Syndrome (ACS) and presents as atypical chest pain without the presence of cardiac biomarkers. It accounts for nearly 550,000 hospital admissions each year in the United States [1]. Management of UA can vary depending on the physician and/or intensity of symptoms. Prior studies have […]

Background: Mitochondrial disease (MD) refers to a group of clinically heterogeneous disorders that result from dysfunctional oxidative phosphorylation and subsequent cellular incapability to meet energy demands. Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), myoclonus, epilepsy, ataxia with ragged red fibers (MERRFs), chronic progressive ophthalmoplegia, Kearns–Sayre syndrome, and sensory ataxia neuropathy dysarthria ophthalmoplegia are among […]

Background: In patients hospitalized with heart failure (HF) exacerbations, physicians routinely supplement potassium to maintain levels ≥4.0 mEq/L. The evidence basis for this practice is relatively weak. We aimed to evaluate the association between serum potassium levels and outcomes in patients hospitalized with HF. Methods: We identified patients admitted with acute HF exacerbations to hospitals […]

Background: We have presented our experience with a novel percutaneous approach for axillary artery implant of intra-aortic balloon pumps. The axillary approach permits up-right posture and ambulation, but such enhanced mobility may predispose to higher risk of IABP malposition with unique complications. We present a few complications here. Methods: We conducted a retrospective review of […]