Southern medical journal
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Southern medical journal · Nov 2010
Why do physicians prescribe stress ulcer prophylaxis to general medicine patients?
Little is known about why physicians prescribe inappropriate stress ulcer prophylaxis (SUP) among nonintensive care unit (ICU) hospitalized patients without supporting evidence. This study seeks to understand which factors influence physician prescribing behavior regarding SUP. ⋯ Fear of legal repercussions and ignorance of the side effects of acid suppressive therapy were strongly associated with inappropriate prescribing of SUP. Educating physicians about the adverse effects of acid suppression therapy and about existing national guidelines might reduce inappropriate prescribing.
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Chronic myocardial ischemia often presents with a fairly typical history, but patients can present with atypical chest pain or pain referred to a less-typical location like the jaw, stomach, or back. Sometimes patients describe symptoms usually not attributed to heart disease, like indigestion or feeling cold and clammy, in the presence or absence of chest pain. ⋯ This paper describes two unusual presentations of myocardial ischemia in patients whose main symptom was hiccups, the first intractable hiccups over months and the second effort-induced hiccups. Both also described atypical chest pain.
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To detect the readmission rates of a hospitalist group at a community hospital, to identify probable causes of rehospitalizations, and to propose solutions to decrease the rate of readmissions. ⋯ Our readmission rate (1.6%) is significantly lower than that of previous studies (23.2%), as we included the readmissions only due to the same diagnosis. Patient education, family involvement in discharge process, and scheduling follow-up appointments could potentially reduce readmissions, despite multiple unmodifiable factors. We suspect all-cause readmissions have room for more improvement, which should be the focus of intervention.
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Colonoscopy is a routine procedure done tens of thousands of times per year for screening purposes. The vast majority of these procedures are uneventful. There are, however, complications that can arise from this procedure, including hollow viscus perforation and hemorrhage. ⋯ We present a case of a 67-year-old female who underwent a routine screening colonoscopy at our institution and presented to the emergency department several hours later complaining of abdominal pain. Ultimately, abdominal computed tomography showed a large splenic laceration, which was treated operatively. The diagnosis of splenic laceration should be considered for patients with continued abdominal pain post-colonoscopy when other etiologies have been evaluated and ruled out.