Bundled de-implementation of recurring hospital orders with a novel electronic medical record order set.

Introduction: High-frequency recurring orders placed through the electronic medical record (EMR) may contribute to unnecessary care in hospitalised patients. This quality initiative sought to develop and pilot test a hospital order set for bundled review and de-implementation of common recurring orders.

Methods: A voluntary-use EMR order set was developed to display low-frequency order alternatives for common hospital care components.

Choosing Daily Labs Wisely in the Hospital: A Novel Tool for Assessing Laboratory Testing Appropriateness.

Background: The Minnesota Lab Appropriateness (MLAB) criteria were developed for assessing appropriateness of complete blood counts (CBCs) and serum electrolyte panels (SEPs) ordered for adult inpatients.

Methods: Two independent raters used the MLAB criteria to rate appropriateness of labs ordered during 50 hospitalizations through retrospective medical record review.

Results: Evaluation of 208 CBCs and 253 SEPs on a 2-category scale (appropriate/inappropriate) resulted in an inappropriate lab rate of 24% and 25% for CBCs and SEPs, respectively.

Women's Health Policy in the United States: An American College of Physicians Position Paper.

In this position paper, the American College of Physicians (ACP) examines the challenges women face in the U.S. health care system across their lifespans, including access to care; sex- and gender-specific health issues; variation in health outcomes compared with men; underrepresentation in research studies; and public policies that affect women, their families, and society.

Achieving Gender Equity in Physician Compensation and Career Advancement: A Position Paper of the American College of Physicians.

Women comprise more than one third of the active physician workforce, an estimated 46% of all physicians-in-training, and more than half of all medical students in the United States. Although progress has been made toward gender diversity in the physician workforce, disparities in compensation exist and inequities have contributed to a disproportionately low number of female physicians achieving academic advancement and serving in leadership positions. Women in medicine face other challenges, including a lack of mentors, discrimination, gender bias, cultural environment of the workplace, imposter syndrome, and the need for better work-life integration.

Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper.

Social determinants of health are nonmedical factors that can affect a person's overall health and health outcomes. Where a person is born and the social conditions they are born into can affect their risk factors for premature death and their life expectancy. In this position paper, the American College of Physicians acknowledges the role of social determinants in health, examines the complexities associated with them, and offers recommendations on better integration of social determinants into the health care system while highlighting the need to address systemic issues hindering health equity.

Demographics and Epidemiology of Sudden Deaths in Young Competitive Athletes: From the United States National Registry.

Background: Sudden deaths in young competitive athletes are tragic events, with high public visibility. The importance of race and gender with respect to sport and the diagnosis and causes of sudden death in athletes has generated substantial interest.

Methods: The US National Registry of Sudden Death in Athletes, 1980-2011, was accessed to define the epidemiology and causes of sudden deaths in competitive athletes.

Those eyes don't lie: a case of osmotic demyelination syndrome in a patient with hepatic encephalopathy.

Osmotic demyelination syndrome (ODS), previously known as central pontine myelinolysis, is a rare neurological condition characterized by demyelination of the pons or extrapontine areas including the midbrain, thalamus, basal nuclei, and cerebellum, resulting in upper motor neuron dysfunction and pseudobulbar palsy. We report a case of a 45-year-old woman with a history of alcohol dependence and end stage liver disease complicated by hepatic encephalopathy who developed symptoms suspicious of recurrent hepatic encephalopathy and experienced a generalized seizure during an inpatient stay. After 10 days of treatment with no improvement, it was noted that the patient had locked-in syndrome and that her sodium levels had rapidly risen 2 days prior.

The role of novel anticoagulants in the management of venous thromboembolism.

Venous thromboembolism (VTE) is a common health condition with a high mortality and morbidity as well as significant health cost. Traditional treatment with parenteral heparin followed by vitamin K antagonist (VKA) has helped to decrease both morbidity and mortality over years. However, difficulties with warfarin such as INR monitoring, drug-drug interactions, and dietary restrictions has led to research for new anticoagulants.

Strategies for assessing the prevalence of cardiovascular sudden deaths in young competitive athletes.

Background/objectives: Prevalence/incidence of sudden death due to cardiovascular disease in young competitive athletes has become an important part of the debate over the most effective and practical preparticipation screening strategies for this population. Since event reporting is not mandatory, identification of cases has been achieved largely through publicly available data and internet searches. The accuracy of this methodology has not been studied and deserves scrutiny.

Incidence and causes of sudden death in U.S. college athletes.

Objectives: The goal of this study was to reliably define the incidence and causes of sudden death in college student-athletes.

Background: The frequency with which cardiovascular-related sudden death occurs in competitive athletes importantly influences considerations for pre-participation screening strategies.

Methods: We assessed databases (including autopsy reports) from both the U.