Background: Overnight vital sign assessment can disrupt sleep in the hospital and may be unnecessary in clinically stable patients. However, providers may not feel comfortable determining which patients can safely forego overnight vitals. We studied the effect of a clinical decision support (CDS) tool embedded in the electronic health record (EHR) that automatically identified clinically […]

Background: Postmyocardial Infarction Syndrome (PMIS), also called Dressler syndrome or Post-pericardiotomy Syndrome, refers to a heterogeneous group of autoimmune-mediated conditions of pericardial, epicardial and myocardial inflammation following myocardial infarction. Generally considered to be rare in the reperfusion era, the features and risk factors of PMIS are less well characterized in the contemporary era. This study […]

Background: Interventions to improve inpatient sleep rely on the ability to objectively quantify sleep; however existing methods of measurement (wrist actigraphy and patient survey) are resource intensive and impose a burden on patients. To overcome these barriers, we developed “sleep opportunity” (SLOP), a surrogate metric for sleep derived solely from the electronic health record (EHR). […]

Background: Rest is critical to healing, yet a child’s sleep during an inpatient hospital admission is often disrupted. One such disruption is oral medication administration, which is commonly scheduled around the clock (q6h, q8h, q12h) by default, despite comparable efficacy during waking hours. Previous studies suggest that flexible medication times help inpatients sleep longer and […]

Background: Obstructive sleep apnea (OSA) is defined as a sleep disorder marked by pauses in breathing of 10 seconds or more causing unrestful sleep and accompanied by loud or abnormal snoring, daytime sleepiness, irritability, and depression. According to the National Sleep Foundation, more than 18 million Americans have OSA, 80% of whom are undiagnosed. The […]

Background: Overnight disruptions in sleep during acute care hospitalizations contribute to lower patient satisfaction, higher risk of delirium, and potentially, increased length of stay. One primary offender of quality sleep is high frequency collection of vital signs during overnight hours. Protocols for reduction in collection of overnight vital signs have been successfully implemented at other […]

Case Presentation: A 32 year-old African American man with a history of Kikuchi-Fujimoto’s Disease (KFD), presented with 2 weeks of fever, cervical lymphadenopathy and cough. Laboratory tests showed pancytopenia, elevated ESR, positive double stranded DNA and ANA titer. Complement 3 and 4 levels were low. His fever persisted despite broad spectrum antibiotics. Computed tomography (CT) […]

Case Presentation: We report a case of 24-year-old male with past medical history significant for bicuspid aortic valve, epistaxis who comes to emergency department because of feeling lightheaded, generalized weakness and episode of syncope 2 weeks ago. The patient delayed seeking medical care as he had an exam the next day after he had syncope. […]

Case Presentation: A 57-year old man was found down at home one day prior to admission. Three days prior, he experienced intermittent “stabbing” chest pain and dizziness. Past medical history was significant only for multiple sclerosis treated with Copaxone. On admission, he was afebrile, heart rate 113bpm, blood pressure 104/71 mmHg, respiratory rate 19 breaths […]

Case Presentation: 51-year-old Hispanic male with past medical history significant for SLE treated with Plaquenil for the past four years and Idiopathic thrombocytopenia (ITP) requiring splenectomy presented with one-week history of hematuria and worsening bilateral flank and abdominal pain. Physical examination revealed petechiae on bilateral lower extremities and edema. Laboratory data was significant for a […]