Elevated Troponins and Diagnosis of Non-ST-Elevation Myocardial Infarction in the Emergency Department.

Background In the emergency department (ED), the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is primarily based on the presence or absence of elevated cardiac troponin levels, ECG changes, and clinical presentation. However, limited data exist regarding the incidence, clinical characteristics, and predictive value of different cardiac diagnostic tests and outcomes in patients with non-acute coronary syndrome (ACS)-related troponin elevation. Our study aimed to determine the percentage of patients with elevated troponin levels who had true ACS and identify various risk factors associated with true ACS in these patients.

Predictors of prolonged length of stay in adult patients with respiratory syncytial virus infections - a multi-center historical cohort study.

Objectives: Several studies have reported risk factors for severe disease and mortality in hospitalized adults with RSV infections. There is limited information available regarding the factors that affect the duration of a patient's hospital length of stay (LOS).

Methods: This was a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV in Southeast Michigan between January 2017 and December 2021.

Determining if the prognostic nutritional index can predict outcomes in community acquired bacterial pneumonia.

Background: The Prognostic Nutritional Index (PNI) uses albumin levels and total lymphocyte count to predict the relationship between immune-nutritional state and prognosis in a variety of diseases, however it has not been studied in community acquired bacterial pneumonia (CABP). We conducted a historical cohort study to determine if there was an association between PNI and clinical outcomes in patients with CABP.

Methods: We reviewed 204 adult patients with confirmed CABP, and calculated admission PNI and Neutrophil-to-Lymphocyte Ratio (NLR).

Using the Electronic Medical Record to Address Code Status Documentation: A Quality Improvement Project.

Code status (CS) is often overlooked while admitting patients to the hospital. This is important for patients with end-stage disease. This quality improvement project investigated whether a CS pop-up alert in the electronic medical record, combined with provider education, improved addressing CS.

Epidemiology, clinical features and outcomes of hospitalized patients with COVID-19 by vaccination status: a multicenter historical cohort study.

Introduction: COVID-19 disease resulted in over six million deaths worldwide. Although vaccines against SARS-CoV-2 demonstrated efficacy, breakthrough infections became increasingly common. There is still a lack of data regarding the severity and outcomes of COVID-19 among vaccinated compared to unvaccinated individuals.

Clinical predictors and outcomes for Legionnaire's disease versus bacteremic pneumococcal pneumonia.

Background: Legionnaires' disease (LD) is a serious sometimes fatal pneumonia caused by Legionella pneumophila. The clinical manifestations of LD may be similar to those by caused by Streptococcus pneumoniae. As both conditions can be serious illnesses but requiring different antimicrobial therapies, factors that can help differentiate these types of pneumonias can be helpful in the clinical management of hospitalized patients with bacterial pneumonia.

Tocilizumab: A retrospective multi-center cohort study of critically ill patients with COVID-19.

Background: Coronavirus disease 19 (COVID-19) can have a severe presentation characterized by a dysregulated immune response requiring admission to the intensive care unit (ICU). Immunomodulatory treatments like tocilizumab were found to improve inflammatory markers and lung injury over time. We aim to evaluate the effectiveness of tocilizumab treatment on critically ill patients with severe COVID-19.

A comparison of coronavirus disease 2019 (COVID-19) versus influenza during the pandemic: Can we distinguish COVID-19 from flu?

We conducted a retrospective chart review examining the demographics, clinical history, physical findings, and comorbidities of patients with influenza and patients with coronavirus disease 2019 (COVID-19). Older patients, male patients, patients reporting fever, and patients with higher body mass indexes (BMIs) were more likely to have COVID-19 than influenza.

Predicting QT interval prolongation in patients diagnosed with the 2019 novel coronavirus infection.

Introduction: 2019 novel coronavirus (COVID-19) patients frequently develop QT interval prolongation that predisposes them to Torsades de Pointes and sudden cardiac death. Continuous cardiac monitoring has been recommended for any COVID-19 patient with a Tisdale Score of seven or more. This recommendation, however, has not been validated.

Cisplatin-induced nephrotoxicity in an outpatient setting.

Background: The use of cisplatin is limited by the development of nephrotoxicity, with an incidence approaching 30%. It is unclear if a risk prediction score can effectively predict the development of nephrotoxicity throughout all cycles of cisplatin therapy among outpatients.

Methods: Retrospective, observational study evaluating adult patients receiving cisplatin in outpatient infusion centers from January 2009 to November 2019 (n = 186).

Pre-Operative Predictors of Concurrent Choledocholithiasis in Patients With Acute Calculus Cholecystitis: An External Validity Analysis.

Introduction Patients that are presented with acute calculus cholecystitis (AC) and elevated liver enzymes markers (LEM), often require evaluation for concurrent choledocholithiasis (CDL). Currently, evaluation guidelines follow the American Society of Gastroenterology Endoscopy (ASGE) recommendations. Objectives The aim of the study was to externally validate both ASGE and the Chisholm predictors in a community hospital patient cohort.

A 90-second magnetocardiogram using a novel analysis system to assess for coronary artery stenosis in Emergency department observation unit chest pain patients.

Background: Magnetocardiography (MCG) has been shown to non-invasively detect coronary artery stenosis (CAS). Emergency department (ED) patients with possible acute coronary syndrome (ACS) are commonly placed in an observation unit (OU) for further evaluation. Our objective was to compare a novel MCG analysis system with stress testing (ST) and/or coronary angiography (CA) in non-high risk EDOU chest pain patients.

Efficacy and Safety of Lumen-Apposing Stents for Management of Pancreatic Fluid Collections in a Community Hospital Setting.

Background/aims: Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital.

Methods: We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal.

The association of psychiatric medication use with adherence in patients with HIV.

Over two million new cases of HIV infection will occur annually, worldwide. Triple drug anti-retroviral therapy (ART) decreases the viral load in patients with HIV, helping to stop progression of HIV infection to AIDs. Our study assessed how pharmacologic treatment for mental health issues affects medication adherence and viral load in patients with HIV.

Training Internal Medicine Residents to Provide Care and Treatment for Human Immunodeficiency Virus-1-Infected Patients.

Background: Human immunodeficiency virus (HIV) infection is now considered a chronic infection manageable on antiretroviral therapy. If trained in HIV care, primary care physicians would be well suited to work in consultation with infectious disease specialists to provide care for HIV patients.

Methods: Human immunodeficiency virus training was incorporated into our internal medicine residency program.

Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest.

Background: In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis.

Are Blacks at Higher Risk for Vancomycin-Related Acute Kidney Injury?

Background: Black individuals have a higher lifetime risk of acute kidney injury (AKI) and chronic kidney disease than whites. Vancomycin has a potential for nephrotoxicity. The objective of this study was to determine whether the incidence of AKI among patients being treated with vancomycin differs by race.

Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals.

We compared interventions to improve urinary catheter care and urine culturing in adult intensive care units of 2 teaching hospitals. Compared to hospital A, hospital B had lower catheter utilization, more compliance with appropriate indications and maintenance, but higher urine culture use and more positive urine cultures per 1,000 patient days.

Radiation Exposure in Pediatric Intensive Care Unit Patients: How Much Is Too Much?

We aimed to determine median cumulative radiation exposure in pediatric intensive care unit (PICU) patients, proportion of patients with high radiation exposure (above annual average radiation per person of 6.2 mSv), and determine risk factors for high exposure. This was a retrospective chart review of PICU patients up to 18 years of age admitted to a large community hospital over 2 years.

Yield of Echocardiogram and Predictors of Positive Yield in Pediatric Patients: A Study in an Urban, Community-Based Outpatient Pediatric Cardiology Clinic.

The yield of outpatient echocardiograms varies based on the indication for the echocardiogram and the age of the patient. The purpose of this study was to determine the cumulative yield of outpatient echocardiograms by age group and reason for the test. A secondary aim was to determine the predictors of a positive echocardiogram in an outpatient cardiology clinic at a large community teaching hospital.

Lack of effect of antibiotics on biopsy culture results in vertebral osteomyelitis.

We report a retrospective study of 173 patients with vertebral osteomyelitis evaluating the effect of antibiotics administered prior to percutaneous and open biopsy cultures. Antibiotics given prior to these biopsies did not have a significant effect on the yield of cultures.

Long-term outcomes of patients with diabetes mellitus undergoing percutaneous intervention for popliteal and infrapopliteal peripheral arterial disease.

Objectives: To evaluate the association of diabetes mellitus (DM) with clinical and angiographic characteristics and outcomes of patients with popliteal and infrapopliteal peripheral arterial disease (PAD) undergoing peripheral vascular intervention (PVI).

Background: Clinical features and outcomes in patients with DM and popliteal or infrapopliteal PAD undergoing PVI are not well described.

Methods: Using the data from the laser in popliteal and infrapopliteal stenosis study, we retrospectively examined the association of diabetes with clinical and angiographic characteristics and risk adjusted short- and intermediate term outcomes (all cause death, major adverse events (MAE) [composite of death, ipsilateral major amputation, or repeat revascularization]) in patients with popliteal and infrapopliteal PAD undergoing PVI for critical limb ischemia treated either with laser-assisted balloon angioplasty or balloon angioplasty alone.

The association of race with quality of health in peripheral artery disease following peripheral vascular intervention: The Q-PAD Study.

Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients.