Background: In 2010, the Patient Protection and Affordable Care Act (ACA) aimed to enhance health insurance access through subsidies and Medicaid expansion. The expansion was not adopted by all states, leading to variable coverage. The Centers for Medicare & Medicaid Services (CMS) releases a 3-year running average of 30-day risk-standardized mortality rates for Medicare patients [...]

Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]

Background: Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. Methods: We conducted a pooled cohort study using data from three acute heart failure trials (DOSE, ROSE, and ATHENA-HF). [...]

Background: Failure to thrive and malnutrition continues to be a common diagnosis in pediatrics contributing to a significant number of hospital admissions (1-5). There is no national practice guideline or consensus recommendation for diagnosis and treatment for patients hospitalized with failure to thrive, contributing to significant clinical practice variation. Unnecessary variability in practice has been [...]

Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered [...]

Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they [...]

Case Presentation: A five-year-old boy with autism presented to the hospital with two-months of fatigue, lower extremity pain, and a petechial rash. Review of systems was notable for a two-kilogram weight loss, intermittent gingival bleeding and refusal to walk for one week. On admission he was afebrile with a heart rate of 160 beats per [...]

Case Presentation: A 37-year-old-male with no significant past medical history who presents to the hospital with 2 months of progressive exertional dyspnea, palpitations and scrotal pain. He has also noticed some leg swelling and has a nonproductive cough. For the past 6 months, he has had ongoing diarrhea and unintentional weight loss of about 20 [...]

Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]

Background: In 2010, the Patient Protection and Affordable Care Act (ACA) aimed to enhance health insurance access through subsidies and Medicaid expansion. The expansion was not adopted by all states, leading to variable coverage. The Centers for Medicare & Medicaid Services (CMS) releases a 3-year running average of 30-day risk-standardized mortality rates for Medicare patients [...]