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: We have previously showed how implementing the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to inform peripherally inserted central catheter (PICC) use can lead to more appropriate device use. In this analysis, we assessed the association between appropriateness and PICC-related complications. We hypothesized that improved PICC appropriateness is associated with reduced major PICC complications […]

Background: ACGME Milestones and Entrustable Professional Activities (EPA) have emerged as benchmarks for the professional development of house staff. Residents must demonstrate expertise in these patient care activities in order to progress in training, and thus, programs will require tools for direct observation in order to evaluate these skills. These tools must evaluate milestone‐specific performance […]

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 […]

Case Presentation: A 38‐year‐old man presented with complaints of yellowish discoloration of skin, severe fatigue, polyuria, and polydipsia for 5 months. He had a history of alcoholism for 20 years. He was diagnosed with chronic alcoholic liver disease with cirrhosis. Admission labs showed serum sodium 130 meq/L, potassium 2.2 mEq/L, chloride 106 meq/L, bicarbonate 12 […]

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 […]

Case Presentation: A 61‐year‐old man developed acute renal failure and difficulty ambulating 2 days after radical perineal prostatectomy. He complained of bilateral lower leg pain, numbness, tingling in his toes, and shooting pains in his anterior thighs. He denied any upper‐extremity complaints. He noted normal urine output. His medical history was notable for chronic kidney […]

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 […]

Case Presentation: A 25‐year‐old man, diagnosed with systemic lupus erythematous (SLE) 6 months prior and undergoing a workup for LUPUS NEPHRITIS, was brought to the emergency department by his family for weakness and altered mental status, for 1 day. Per the family, the patient complained of generalized body weakness on the morning of admission. Subsequently, […]