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Partial anomalous pulmonary venous return mimics arterial positioning after central line placement for plasmapheresis
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-04)
the left internal jugular vein. A chest x-ray showed a line that terminated to the left of the midline and raised concern for arterial placement (Figure 1). Blood gases from the line were: pH 7.72, pCO2 21 mmHg, pO2 369 mmHg, bicarbonate 28.4 mmol/L....
Nighttime resident supervision and education: results of a national survey of internal medicine residency program directors
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-04)
Over the past several years, the Accreditation Council for Graduate Medical Education (ACGME) has issued new restrictions on resident duty hours while calling for increased supervision to ensure patient safety. To meet these requirements, some...
Perceptions Towards the Discharge Process in a Community Teaching Hospital
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-04)
.4[percent] of nurses favored multidisciplinary round versus 4.2[percent] who did not. This was 54.5[percent] vs. 27.2[percent] for case managers and 44.1[percent] vs. 30.2[percent] for the residents (P-value = 0.002). Conclusion: Discharge process...
Rothman Index as a predictor of 30-day hospital readmission
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2021-04)
Introduction: The Centers for Medicare and Medicaid services financially penalize hospitals for elevated 30-day readmission rates. Identifying patients at high risk for short-term readmission would allow health systems to strategically allocate...
Incidental Portal Vein Aneurysm Found in a Patient with a Diaphragmatic Hernia and Evolving Gastric Volvulus
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-04)
large diaphragmatic hernia. Computed tomography (CT) revealed displacement of abdominal contents and 37 mm aneurysm of the main portal vein (image 1,2). Because of the large size of our patients' malformation (37 mm), surgery was pursued in the form...
Mandating vaccination -- is it justified?
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2021-04)
"The answer is yes…and no. It depends... Personal and Public Obligations: Freedom from oppression, the right to choose, and self-determination are bedrock values upon which our country was founded. They are also central ...
Disseminated cysticercosis
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2021-04)
on neurological and general physical examination were normal. Laboratory findings were notable for peripheral eosinophilia and thrombocytopenia present for a few months, which resolved in subsequent evaluations. Human immunodeficiency virus 1/2 Antigen...
Acute chest syndrome: a narrative review to guide inpatient management
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-04)
better outcome for patients, and the evidence behind using antibiotics, steroids, bronchodilators, nitric oxide, incentive spirometry, as well as the current management of patients with concomitant ACS and SARS-CoV2....
The Failing Right Ventricle : An Internist's Guide to the Diagnosis and Management of Pulmonary Hypertension
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-04)
Pulmonary hypertension represents a complex and multifactorial disease with significant implications on patients' morbidity, mortality, and quality of life. The number of patients hospitalized with pulmonary hypertension is increasing. Elevated...
Persistent meningeal signs despite previous treatment for cryptococcal meningitis -- a case report
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-07)
Cryptococcal meningitis continues to be a life-threatening fungal infection in patients with HIV. Treatment involves a year of antifungal therapy, and persistent meningeal signs months after treatment initiation are uncommon. ...