Background: Anticoagulants are among the highest-risk medications in hospitalized patients. Studies have demonstrated that a majority of in-hospital anticoagulant adverse drug events are not only preventable, but are the result of excessive dosing. This is especially true for warfarin dosing, which is complicated by a lack of consensus among validated initial dosing nomograms. As part [...]

Background: Proton pump inhibitors (PPI) are the mainstay of treatment and symptomatic remission in GERD. Recently, PPI over-utilization has been a major concern due to associated increased risk of adverse events and unnecessary healthcare cost. Internal Medicine residents treat patients with GERD and prescribe a significant amount of PPI. However, very few studies have assessed [...]

Background: Geographic information science and technology (GIST) is an academic field that explains the importance of geospatial data and analysis. GIST is a powerful tool that has been successfully implemented to help address a number of significant health issues ranging from disease management to improved services. In this study, we have used GIST to help [...]

Background: Proton Pump Inhibitors are widely misused in both the outpatient and inpatient setting. Often, they are initiated and continued for reasons that do not follow best practice guidelines. Purpose: A Proton Pump Inhibitor Stewardship Committee was created to address this problem as part of a Quality Improvement project. The goal was to determine the [...]

Case Presentation: A 17 year-old male with a history of marijuana and nitrous oxide use presented with 4 days of paresthesia in his bilateral lower extremities, sudden onset-ataxia, gait instability, and genital numbness extending to his extremities. Comprehensive infectious and neurologic workup for Guillain-Barré syndrome, transverse myelitis, and other neuropathies all returned negative. Magnetic resonance [...]

Case Presentation: A 58-year-old woman with a past medical history notable for thyroid cancer status-post thyroidectomy complicated by hypoparathyrodism presented with muscle spasms in her hands and feet for two days. Four days prior to admission she reported bloating and heartburn for which she reports taking an unknown quantity of lansoprazole and an H2 blocker. [...]

Case Presentation: Discussion45-year-old male with history of HIV on Antiretroviral and treated syphilis presented with painful oral lesions and difficulty swallowing which started several days after being placed on Nitazoxanide, Doxycycline, Levaquin, and Omeprazole for diagnosis of Helicobacter Pylori via Endoscopy done for diarrhea. He was given fluconazole for presumed thrush during ER visit. His [...]

Background: In 2019, Banner Health innovated by launching Cultivating Happiness in Medicine (CHIM), which was Banner’s commitment to supporting physician and APP well-being and reducing burnout. The CHIM strategy is evidence-based, physician and APP driven, and holistic, supporting clinicians from individual wellness and organizational workplace environment perspectives. The six dimensions of the strategy include the [...]

Case Presentation: The patient is a 52 year old male with a history of GERD on omeprazole therapy. In the period of one month, the patient developed significant exertional symptoms without any evidence of concomitant illness. The patient sought out further work up and evaluation by a cardiologist. Due to the presenting symptoms, an echocardiogram [...]