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young female doctor examines x-ray

High-Value, Cost-Conscious Care: Iterative Systems-Based Interventions to Reduce Unnecessary Laboratory Testing

Inappropriate testing contributes to soaring healthcare costs within the United States, and teaching hospitals are vulnerable to providing care largely for academic development. Via its “Choosing Wisely” campaign, the American Board of Internal Medicine recommends avoiding repetitive testing for stable inpatients. We designed systems-based interventions to reduce laboratory orders for patients admitted to the wards […]

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Delayed Transient Cortical Blindness from Hypoxic Ischemic Encephalopathy

To the Editor: An 85-year-old woman with no significant past medical history presented after a mechanical fall complicated by multiple fractures. She received intravenous pain medications with resultant decreased level of consciousness and respiratory distress. Intubation was difficult because of bilateral mandibular fractures, and she consequently experienced 10 minutes of hypoxia before secure airway control […]

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The Coronary (Cardiac) Care Unit at 50 Years: A Major Advance in the Practice of Hospital Medicine

This year, 2017, marks the 50th anniversary commemorating the publication of an article describing the results from the classic study by Killip and Kimball showing a reduction in mortality from acute myocardial infarction in patients sequestered in a specialized hospital unit1 at New York Hospital in New York City. Also described in the article was the […]

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elder woman sick in bed with husband looking on

Death and Dignity: Exploring Physicians’ Responsibilities After a Patient’s Death

Literature focused on care at the end of life is flourishing. The scope of this work has been broad, including how to best communicate bad news1, 2 or discuss patient wishes at the end of life,3, 4 as well as detailing where patients are dying and how it impacts their care5 and the value of palliative and hospice care during […]

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Choosing Wisely? Measuring the Burden of Medications in Older Adults near the End of Life: Nationwide, Longitudinal Cohort Study

The burden of medications near the end of life has recently come under scrutiny, because several studies suggested that people with life-limiting illness receive potentially futile treatments. Methods We identified 511,843 older adults (>65 years) who died in Sweden between 2007 and 2013 and reconstructed their drug prescription history for each of the last 12 […]

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