The relationship between the follow-up to discharge ratio and length of stay.

Objectives: Average length of stay (ALOS) is used as a measure of the effectiveness of care delivery and therefore is an important operational measure when evaluating both the hospitalist group and individual hospitalist performance. No metric within the control of the individual hospitalist has been identified to support the individual hospitalist's contribution to the hospitalist group's ALOS goals. This study's objective was to evaluate the correlation between the follow-up to discharge ratio (F:D ratio) and ALOS and assess the relationship between F:D ratio and hospitalist experience.

Pharmacological thromboembolic prophylaxis for medical patients in a tertiary care, teaching community hospital: room for improvement.

Venous Thrombembolism (VTE) is a potentially lethal complication in hospitalized patients. Studies indicate that pharmacological prophylaxis may reduce the incidence of VTE. However, the use of VTE prophylaxis remains unclear.

The quantitative immunoturbidimetric D-dimer method to rule out venous thromboembolism (VTE).

D-dimer measurement is a technique that may improve the diagnostic strategy for venous thrombo-embolism (VTE). To evaluate D-dimer accuracy in the diagnosis of VTE, we identified 116 patients at Charleston Area Medical Center in Charleston, W.Va.

Using PDAs during the internal medicine clerkship.

In 2000, an Institute of Medicine Report stated that there are 99,000 deaths in hospitals each year due to medical errors. Many options have been tried to improve systems and practice patterns, but they have proven to be too cumbersome to be workable and were not accepted by physicians. We conducted a study of 19 third-year medical students (12 males, 7 females) at the West Virginia University School of Medicine, Charleston Division, during their eight-week clerkship in 2002 to determine whether providing them patient information at bedside with Personal Digital Assistants (PDAs) would be valuable.

Methadone-induced torsade de pointes in a patient with normal baseline QT interval.

Torsade de pointes (TdP) is a life threatening cardiac arrhythmia that is typically associated with prolongation of the QT interval. A wide variety of nonantiarrthymic medications may trigger TdP in patients with prolonged QT interval, only a few reports have described an association between TdP and methadone. We report a case of TdP caused by a large dose of methadone in a patient with presumably normal QT interval at baseline prior to his presentation at the hospital.

Subendocardial ischemia without coronary artery disease: is elevated left ventricular end diastolic pressure the culprit?

Background: The aim was to investigate the association between elevated left ventricular end diastolic pressure (LVEDP) and subendocardial ischemia.

Methods: A retrospective chart review was performed of 1846 consecutive patients admitted between January and September 2002 who had chest pain, stress testing and coronary angiography.

Results: 1592 patients were excluded due to a positive coronary angiogram for coronary artery disease (CAD), 254 patients had an angiogram compatible with non-significant CAD and an ejection fraction > 45%; of whom 210 (82.

Nanobacteria-caused mitral valve calciphylaxis in a man with diabetic renal failure.

We have found that nanobacteria, recently discovered Gram-negative atypical bacteria, can cause local calciphylaxis on the mitral valve in a setting of high-calcium X phosphorous product in the blood. We present the case of a 33-year-old man with diabetic renal failure on continuous ambulatory peritoneal dialysis who died as a result of multiple brain infarcts due to embolizations from mitral valve vegetations. Systemic calciphylaxis was not present.

Persistent candiduria complicating intraureteral stenting: a case report and review of literature.

Over the past 20 years, there has been a significant increase in the number of nosocomial infections. Nosocomial infections by fungal organisms, in particular Candida species, have shown the highest increase in incidence, currently being the leading pathogen in urinary tract infections and the fourth most common blood-born pathogen within hospitalized patients. This case report describes a patient with acute pancreatitis, complicated by acute renal failure, who developed nosocomial fungiuria and fungemia following bilateral ureteral stenting, and whose fungiuria persisted despite adequate antifungal treatment.

Single dose pharmacokinetics of syrup of ipecac.

Syrup of ipecac (SI) has been used medicinally since the 1500s; however, little is known about the pharmacokinetics in humans of SI's active ingredients, emetine and cephaeline. The objective of this study was to evaluate the rate of absorption and the rate of elimination of emetine and cephaeline. Ten healthy, adult, human volunteers between 18 and 45 years of age who were of ideal body weight (body mass index 20-25) completed this study.

Cardiac conduction manifestations of Reiter's syndrome.

This study shows that conduction abnormalities may occur frequently in Reiter's syndrome of new onset or short duration. Since these conduction defects may be initially life threatening or may progress to life-threatening abnormalities, anyone with RS should be followed up. Because of the strong association between RS and HIV infection, we suggest HIV testing for all patients with RS.