Background: Spontaneous bacterial peritonitis (SBP) is a commonly encountered complication of end stage liver disease that carries a high morbidity and mortality. Risk factors for SBP are defined by the American Association for the Study of Liver Diseases (AASLD) as a prior history of SBP, active gastrointestinal bleeding, and low ascites total protein (< 1.5 […]

Case Presentation: A 58‐year‐old African American man presented to our hospital with confusion, diffuse morbiliform rash, facial edema, fever to 41.1°C, leukocytosis with eosinophilia, acute kidney injury, transaminitis, and elevated creatinine kinase. Extensive evaluation for possible infection, including urine, blood, and CSF cultures, was negative. Six weeks prior to admission the patient had been started […]

Background: It has been reported that vaccination rates with pneumococcal vaccine are low in elderly persons in Japan. The primary aim of this study was to examine whether introduction of a vaccination status checkbox in electronic medical records increased the vaccination rates. Methods: Subjects were inpatients and outpatients in the Department of General Medicine at […]

Case Presentation: A 47‐year‐old female smoker presented to the emergency department for right rib pain for 4 days. She had nausea, nonbloody and nonbilious emesis, nonproductive cough, and sore throat. She denied fever, headaches, dizziness, chest pain, palpitations, shortness of breath, or dysuria. In the emergency department, a computed tomography scan showed consolidation in the […]

Case Presentation: An 88‐year‐old man with a medical history of atrial fibrillation presented with dyspnea for 1 week. He endorsed bilateral leg edema, orthopnea, and productive cough of pinkish sputum. He denied fevers, chest pain, and palpitations and had no recent travel history, prolonged period of immobility, or reported history of congestive heart failure. He […]

Background: Physicians increasingly utilize electronic health records (EHR) to deliver healthcare, and the EHR has been identified as leading source of physician burnout and frustration [Shanafelt et al]. Studies report up to 52.6% of hospitalists exhibit symptoms of burnout [Roberts et al]. However, there is no data to inform how hospital medicine physicians spend their […]

Case Presentation: A 64‐year‐old man with coronary artery disease, type 2 diabetes, and stage 3 chronic kidney disease (baseline creatinine, 1.7) was admitted for worsening renal failure noted routinely (creatinine 6.2, BUN 70). His only symptoms were malaise and lethargy. He denied urinary changes, new medications, or exposures. Chronic medications were omeprazole, allopurinol, amlodipine, lisinopril, […]

Background: New Mexico has the highest number of alcohol-related deaths in the country, a title held since 1981. Nationally 1 in 10 deaths in working-aged adults are alcohol-associated whereas in New Mexico the ratio is 1 in 6 deaths. About 130,000 New Mexicans report alcohol dependence or abuse within the past year, but only 3% […]

Case Presentation: A 47‐year‐old Hispanic man with active intravenous heroin abuse presented with 2–3 weeks of severe (“11”/10) chest discomfort. The pain was described as constant, though the severity waxed and waned, and located substernally with intermittent radiation to the left arm. The patient's symptoms were exacerbated by movement, and there was no relationship to […]

Background: As inpatient medical care has increased in complexity and fragmentation, rounding has become siloed away from patients and by discipline, resulting in disjointed and inefficient care models. In response, hospitalist groups across the country have been implementing unit-based rounding programs to centralize communication and align work-flow of health care team members. At UC San […]