Background: Skin, soft tissue, and joint infections are common in pediatric patients and can require invasive procedures to drain purulent fluid. Atypical pathogens (fungal and acid-fast bacilli [AFB]) are important but rare causes of these infections with reported case rates as low as 0.6-1.6 cases/100,000 a year. Despite the rarity of these infections, costly atypical […]

Background: Skin, soft tissue, and joint infections are common in pediatric patients and can require invasive procedures to drain purulent fluid. Atypical pathogens (fungal and acid-fast bacilli [AFB]) are important but rare causes of these infections with reported case rates as low as 0.6-1.6 cases/100,000 a year. Despite the rarity of these infections, costly atypical […]

Background: Assessing vitals at regular intervals can be disruptive to a patient’s rest and unnecessary if the patient is clinically stable. These interruptions may lead to impaired sleep, parental fatigue and anxiety, delayed discharge, and increased cost of care. Moreover, alarm fatigue has been described with over-monitoring of patients, as has the overuse of staff […]

Background: Assessing vitals at regular intervals can be disruptive to a patient’s rest and unnecessary if the patient is clinically stable. These interruptions may lead to impaired sleep, parental fatigue and anxiety, delayed discharge, and increased cost of care. Moreover, alarm fatigue has been described with over-monitoring of patients, as has the overuse of staff […]

Background: Thoughtful laboratory testing is a key component of high-value and cost-effective patient care. Studies estimate that nearly half of laboratory tests may be unnecessary in certain patient populations. The drivers of observed variation in laboratory testing are not clearly established; our study aims to examine whether testing varies by hospitalist years of experience. Methods: […]

Background: Failure and delay in identifying clinical deterioration in hospitalized ward patients can result in adverse outcomes. Although many hospitals have instituted rapid response teams to quickly treat and triage unstable patients, early and reliable identification of high‐risk patients remains a challenge. Objective, vital sign–based risk prediction scores, such as the Modified Early Warning Score […]

Case Presentation: A 56‐year‐old woman presented with worsening bilateral ankle and knee swelling for 10 months, causing difficulty walking. She reported a 20‐pound weight loss over the same time. She denied family history of arthritis, autoimmune disorders, or malignancy, but did endorse a 45‐year smoking history. She was afebrile on presentation. Lung exam showed diffuse […]

Background: Computed tomography (CT) can provide critical information for diagnosis and is a prevalent and easy-to-use imaging test, but overtesting becomes a big probleｍ. The previous report showed 30-40% of abdominal CT scans were medically unnecessary. Therefore, head CT is a research topic in overtesting, and clinical predictive scores have been developed to avoid overtesting […]

Case Presentation: A 29‐year‐old woman with a medical history of “heart murmur” and remote anxiety diagnosis presented to the ER with a 10‐day history of fever/chills (103°F–104°F), fatigue, and shortness of breath. The patient denied cough, nausea, vomiting, diarrhea, abdominal pain, chest pain, IV drug use, skin lesions, or travel. She reported a 1‐year history […]

Background: In the US, hospitalist system has been introduced with improvement of quality and safety of care, education and value. Japan now face rapidly declining birthrate and aging population. Organ-based subspecialty system has difficulty in managing patients with multiple diseases. Patient-centered general medical care is required for inpatient management. However, in Japan, there are only […]