Case Presentation: A 14yo girl presented with syncope and 4 days of URI symptoms. She had no past medical or family history. On presentation, she was hypotensive with mildly elevated lactate, troponin, and BNP, and an unremarkable ECG and chest radiograph. Initial echocardiogram showed normal LV function. Cardiac MRI revealed a pericardial effusion and increased [...]

Creating a Best Practice for Discharges Against Medical Advice Background: Nationally, 1-2% of medical discharges from hospitals are against medical advice (AMA).  Patients that leave AMA are at higher risk for readmission and adverse health events.   At our facility, FY 2014 data revealed that 1% of discharges from the medical/surgical wards were AMA.  The 30 [...]

Background: Despite medical advancements for organic and structural diseases, effectively managing acute and chronic functional pain syndromes remains a daunting challenge for hospitalists. Standard inpatient treatments frequently fail to adequately control symptoms, often compelling hospitalists to shift from diagnostics to the contentious task of tapering opioids in patients with legitimate pain. This pivot can lead [...]

Background: Nationally, internal medicine (IM) residency programs have been struggling with the balance of protecting residents from exposure to COVID-19, ensuring they are sufficiently trained in general medicine while still teaching them about a new disease process and preparing them to help fight the pandemic (1). Anxiety is common amongst providers in a pandemic, especially [...]

Case Presentation: A 14yo girl presented with syncope and 4 days of URI symptoms. She had no past medical or family history. On presentation, she was hypotensive with mildly elevated lactate, troponin, and BNP, and an unremarkable ECG and chest radiograph. Initial echocardiogram showed normal LV function. Cardiac MRI revealed a pericardial effusion and increased [...]

Creating a Best Practice for Discharges Against Medical Advice Background: Nationally, 1-2% of medical discharges from hospitals are against medical advice (AMA).  Patients that leave AMA are at higher risk for readmission and adverse health events.   At our facility, FY 2014 data revealed that 1% of discharges from the medical/surgical wards were AMA.  The 30 [...]

Background: Although the national quality improvement campaigns are implemented to reduce Door-to-Balloon (DTB) time in the U.S.A., the community hospitals in Japan lack human resources and appear to be particularly challenging to implement these strategies such as 24/7 in-house cardiologists. Hospitalist is well positioned to be leaders and perform work improvement. Recently, there is increasing [...]

Background: Despite medical advancements for organic and structural diseases, effectively managing acute and chronic functional pain syndromes remains a daunting challenge for hospitalists. Standard inpatient treatments frequently fail to adequately control symptoms, often compelling hospitalists to shift from diagnostics to the contentious task of tapering opioids in patients with legitimate pain. This pivot can lead [...]

Background: Evidence-Based Medicine (EBM) improves physicians’ clinical decision-making through refining the skills of asking a clinical question, searching for and appraising the literature and then properly applying it to patient care. While EBM has been implemented as an essential module across medical schools worldwide, most graduates are not well versed in the fundamentals of effectively [...]

Case Presentation: A 31-year-old man with past medical history of secondary syphilis and HIV/AIDS (CD4 47) intermittently on ART presented with worsening rectal pain and recurrent rectal abscesses. He endorsed rectal pruritis, nausea, weight loss, and lower extremity pain. He denied fevers, night sweats, abdominal pain, or diarrhea. Last year, he had a prior rectal [...]