Background: More than two million people are evaluated for syncope each year in the United States, and approximately 30-40% of these patients are hospitalized for further costly investigation. Total annual cost of syncope related hospital evaluation is estimated to be over 2 billion dollars. The most common cause of syncope is reflex mediated. It does […]

Background: Continuous infusions of unfractionated heparin (UFH) are still commonly used in the initial treatment of venous thromboembolism (VTE). As a result of UFH's high‐risk profile and common usage, weight‐based UFH nomograms were developed more than 2 decades ago to standardize its dosing. Since that time, there has been scant literature on improving UFH administration. […]

Background: Venous thromboembolism (VTE) is a common inpatient condition, managed with high‐risk anticoagulants. VTE management is often suboptimal. Inpatient anticoagulation teams improve anticoagulation processes and outcomes, but many centers (including ours) lack this resource. Diverse health care systems would benefit from alternative methods to optimize VTE management in the absence of an anticoagulation team. Methods: […]

Background: The approach to managing and admitting patients with syncope in an emergency setting lacks standardization. Our study aims to investigate how regional variation in management of emergency department (ED) patients presenting with syncope impacts outcomes and resource utilization in this patient population. Methods: We used the 2006 to 2014 Nationwide Emergency Department Sample to […]

Background: Syncope scores San Francisco Syncope Rule (SFSR) and Evaluation of Guidelines in Syncope Study (EGSYS)(1) are used as screening tools for predicting adverse outcomes among patient with syncope(1, 2). Surprisingly for scoring systems used for risk stratification of same clinical condition, differ significantly based on variables of importance used in calculating individual scores. An […]

Background: Reduction of the spread of nosocomial and community‐acquired methicillin‐resistant Staphylococcus aureus (MRSA) has become a health priority for hospitals and public health officials because of the increasing rate of MRSA infections and the difficulty in treating these severe infections. Efforts to address the increasing trend of MRSA cases involve routine prevention practices, including active […]

Background: The ability to effectively practice consultative medicine is increasingly important. The increase in medical specialization, as well as an increasing number of providers responsible for patient care, makes this particularly evident in inpatient settings. Indeed, a dedicated consultation rotation is required of every internal medicine residency program. Few formal curricula for teaching consultative medicine […]

Background: Syncope is usually an isolated occurrence in younger patients whereas it is multi factorial with many predisposing factors in the elderly. Medication use, co-morbidities and functional decline further complicate syncope evaluation in the elderly. Hence, elderly patients presenting with syncope must be risk stratified uniquely. San Francisco Syncope Rule (SFSR) and Evaluation of Guidelines […]

Background: Unnecessary hospitalizations and testing for syncope remain common (1), and physician attitudes continue to favor overuse for syncope (2). Structured protocols, specialized units, and decision support algorithms may reduce health service use, but lack of data precludes the ability to advocate for use of a specific decision support algorithm (3). Purpose: Our primary aim […]

Case Presentation: A 48‐year‐old woman with systemic sclerosis and secondary interstitial lung disease on 4–6 L/minute oxygen per nasal cannula at baseline presented to the emergency department with 2 days of new onset nonproductive cough, pleuritic chest pain, worsening shortness of breath and subjective fever. Patient's home medications included prednisone 10 mg daily and dapsone […]