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Principles and Practice
of Hospital Medicine
NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are required. The authors and the publisher
o this work have checked with sources believed to be reliable in their e orts to provide in orma-
tion that is complete and generally in accord with the standards accepted at the time o publica-
tion. However, in view o the possibility o human error or changes in medical sciences, neither
the authors nor the publisher nor any other party who has been involved in the preparation or
publication o this work warrants that the in ormation contained herein is in every respect accu-
rate or complete, and they disclaim all responsibility or any errors or omissions or or the results
obtained rom use o the in ormation contained in this work. Readers are encouraged to con irm
the in ormation contained herein with other sources. For example, and in particular, readers are
advised to check the product in ormation sheet included in the package o each drug they plan to
administer to be certain that the in ormation contained in this work is accurate and that changes
have not been made in the recommended dose or in the contraindications or administration. This
recommendation is o particular importance in connection with new or in requently used drugs.
Principles and Practice
of Hospital Medicine
Second Edition
Editors
Sylvia C. McKean, MD, SFHM, FACP
Deputy Editor or Editorial Projects, UpToDate
Formerly:
Leave o absence:
Associate Pro essor o Medicine,
Harvard Medical School
Hospitalist
Brigham and Women’s Hospital
Boston, Massachusetts
John J. Ross, MD, CM, FIDSA

Assistant Pro essor o Medicine
Hospitalist Service
Daniel D. Dressler, MD, MSc, SFHM, FACP

Pro essor o Medicine
Director, Internal Medicine Teaching Services
Emory University Hospital
Associate Program Director
J. Willis Hurst Internal Medicine Residency Program
Co-Director, Semmelweis Society
Emory University School o Medicine
Atlanta, Georgia
Danielle B. Scheurer, MD, MSCR, SFHM

Chie Quality O icer and Hospitalist
Associate Pro essor o Medicine
Medical University o South Carolina
Charleston, South Carolina
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
Principles and Practice o Hospital Medicine, Second Edition
Copyright © 2017 by McGraw-Hill Education. All rights reserved. Printed in the United States
o America. Except as permitted under the United States Copyright Act o 1976, no part o this
publication may be reproduced or distributed in any orm or by any means, or stored in a data
base or retrieval system, without the prior written permission o the publisher. Previous edition
copyright © 2012 by The McGraw-Hill Companies, Inc.
1 2 3 4 5 6 7 8 9 DOW 21 20 19 18 17 16
ISBN 978-0-07-184313-3
MHID 0-07-184313-2
This book was set in Myriad pro by Cenveo Publisher Services.

The editors were Amanda Fielding and Kim J. Davis.
The production supervisor was Richard Ruzycka.
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Library o Congress Cataloging-in-Publication Data
Names: McKean, Sylvia C., editor. | Ross, John J. (John James), 1966-editor.
| Dressler, Daniel D., editor. | Scheurer, Danielle, editor.
Title: Principles and practice o hospital medicine / editors, Sylvia C.
McKean, John J. Ross, Daniel D. Dressler, Danielle B. Scheurer.
Description: Second edition. | New York : McGraw-Hill Education Medical, [2017]
| Includes bibliographical re erences and index.
Identi iers: LCCN 2016022668 (print) | LCCN 2016023825 (ebook)
| ISBN 9780071843133 (hardcover : alk. paper) | ISBN 0071843132 (hardcover :
alk. paper) | ISBN 9780071843140 (ebook)
Subjects: | MESH: Hospital Medicine—methods | Hospitalization | Inpatients |
Hospitalists Classi ication: LCC RA972 (print) | LCC RA972 (ebook) | NLM WX 21 |
DDC 362.11—dc23
LC record available at https://lccn.loc.gov/2016022668
McGraw-Hill Education books are available at special quantity discounts to use as premiums
and sales promotions, or or use in corporate training programs. To contact a representative,
please visit the Contact Us pages at www.mhpro essional.com.
CONTENTS
Editors ...............................................................................................................xi 18 Standardization and Reliability . . . . . . . . . . . . . . . . . . . . . . . 113
Contributors ................................................................................................. xiii 19 Tools to Identify Problems and Reduce Risks . . . . . . . . . . 118
Section Reviewers ..................................................................................xxxix 20 Preventing and Managing Adverse Patient
C
Foreword ......................................................................................................... xli Events: Patient Safety and the Hospitalist . . . . . . . . . . . . . 124
O
N
Preface ...........................................................................................................xliii 21 Principles and Models of Quality Improvement:
T
Plan-Do-Study-Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
E
Acknowledgments ..................................................................................... xlv
N
22 The Role of Information Technology in
T
S
Hospital Quality and Safety . . . . . . . . . . . . . . . . . . . . . . . . . . 134
PART I: THE SPECIALTY OF HOSPITAL

MEDICINE AND SYSTEMS OF CARE SECTION 5 Practice Management
23 Building, Growing and Managing a

The Value and Values of Hospitalist Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
SECTION 1 Hospital Medicine
24 Best Practices in Physician Recruitment
1 The Face of Health Care: Emerging Issues and Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
for Hospitalists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 25 Teamwork in Leadership and Practice-Based
2 Value-Based Health Care for Hospitalists . . . . . . . . . . . . . . . 10 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
3 Racial/Ethnic Disparities in Hospital Care . . . . . . . . . . . . . . . 18 26 Negotiation and Conflict Resolution . . . . . . . . . . . . . . . . . . 164
4 Comanagement of Orthopedic Patients ............... 23
5 Professionalism in Hospital Medicine . . . . . . . . . . . . . . . . . . 29 Billing, Coding, and Clinical
SECTION 6 Documentation
6 Principles of Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
27 Professional Coding and Billing Guidelines
Critical Decision Making at the for Clinical Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . 173
SECTION 2 Point of Care 28 Consultation, Comanagement, Time-Based,
and Palliative Care Billing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
7 Principles of Evidence-Based Medicine and
Quality of Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 29 Billing for Procedures and Use of Modifiers
in Inpatient Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
8 Diagnostic Reasoning and Decision Making . . . . . . . . . . . . 45
30 Billing in the Teaching Setting and Billing
9 Principles of Evidence-Based Prescribing . . . . . . . . . . . . . . . 56 with Advanced Practice Providers . . . . . . . . . . . . . . . . . . . . 198
10 Summary Literature: Practice Guidelines 31 Hospital-Driven Documentation ..................... 204
and Systematic Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
32 Taming the ICD-10 Monster ......................... 210
11 Practical Considerations of Incorporating
Evidence into Clinical Practice . . . . . . . . . . . . . . . . . . . . . . . . 70
Principles of Medical Ethics and
SECTION 7 Medical-Legal Concepts
SECTION 3 Transitions of Care
33 Common Indications for Ethics Consultation .......... 217
12 Care Transitions into the Hospital: Health Care
Centers, Emergency Department, Outside 34 Medical-Legal Concepts: Advance Directives
Hospital Transfers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 and Surrogate Decision Making . . . . . . . . . . . . . . . . . . . . . . 224
13 Care Transitions within the Hospital: The Hand-Off ..... 84 35 Medical Malpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
14 Care Transitions at Hospital Discharge . . . . . . . . . . . . . . . . . 90
SECTION 8 Professional Development
Patient Safety and Quality
SECTION 4 36 Principles of Adult Learning and Continuing
Improvement
Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
15 Principles of Patient Safety: Intentional 37 Cultural Competence ............................... 246
Design and Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
38 Career Design and Development in Academic
16 Patient-Centered Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 and Community Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
17 Harnessing Data to Make Quality Improvement 39 Mentorship of Peers and Trainees . . . . . . . . . . . . . . . . . . . . 257
Decisions: Measurement and Measures . . . . . . . . . . . . . . . 110
40 Research in the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
v
41 For Individuals and Practices: Career 65 Management of Common Perioperative
Sustainability and Avoiding Burnout ................. 273 Complications in Orthopedic Surgery. . . . . . . . . . . . . . . . . 437
66 Transplant Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
67 Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
PART II: MEDICAL CONSULTATION
SECTION 1 Surgery PART III: REHABILITATION AND SKILLED

42 Physiologic Response to Surgery . . . . . . . . . . . . . . . . . . . . . 283 NURSING CARE
68 Postacute Care Rehabilitation Options . . . . . . . . . . . . . . . . 463
43 Perioperative Hemostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
C
69 Physical Therapy and Rehabilitation . . . . . . . . . . . . . . . . . . 469
O
44 Postoperative Complications ........................ 292
N
70 The Role of Speech/Language Pathologists in
45 Surgical Tubes and Drains . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
T
Dysphagia Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476
E
N
46 Surgical Critical Care ................................ 300
71 Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482
T
S
72 Pressure Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491
SECTION 2 Anesthesia
73 Patient Safety and Quality Improvement
47 Anesthesia: Choices and Complications . . . . . . . . . . . . . . . 309 in Postacute Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497
48 Perioperative Pain Management ..................... 313 74 Hospice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Perioperative Risk Assessment and

SECTION 3 Management PART IV: APPROACH TO THE PATIENT AT
THE BEDSIDE
49 Role of the Medical Consultant . . . . . . . . . . . . . . . . . . . . . . . 325
75 Acute Abdominal Pain .............................. 513
50 Preoperative Cardiac Risk Assessment and
Perioperative Management . . . . . . . . . . . . . . . . . . . . . . . . . . 329 76 Acute Back Pain .................................... 522
51 Perioperative Pulmonary Risk Assessment and 77 Evaluation of Anemia ............................... 533

Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336 78 Bleeding and Coagulopathy . . . . . . . . . . . . . . . . . . . . . . . . . 539
52 Perioperative Risk Assessment and Management 79 Chest Pain ......................................... 547
of the Diabetic Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
80 Constipation ....................................... 556
53 Preoperative Evaluation of Liver Disease . . . . . . . . . . . . . . 348 81 Delirium ........................................... 563
54 Preoperative Assessment of Patients with 82 Diarrhea ........................................... 572
Hematologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352
83 Disorders of the Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579
Prevention, Assessment, and 84 Dizziness and Vertigo ............................... 587

SECTION 4 Management of Common 85 Dyspnea ........................................... 595
Complications in Noncardiac Surgery
86 Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 604
55 Antimicrobial Prophylaxis in Surgery ................. 361 87 Falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
56 Venous Thromboembolism (VTE) Prophylaxis for 88 Fever and Rash ..................................... 620
Nonorthopedic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
89 Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
57 Postoperative Blood Transfusion . . . . . . . . . . . . . . . . . . . . . 373
90 Hemoptysis ........................................ 636
58 Nutrition and Metabolic Support . . . . . . . . . . . . . . . . . . . . . 377
91 Hypertensive Urgencies and Emergencies ............ 641
59 Cardiac Complications after Noncardiac Surgery. . . . . . . 385
92 Hyperthermia and Fever. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 647
60 Management of Postoperative Pulmonary
93 Hypotension ....................................... 657
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
94 Hypothermia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 665
61 Assessment and Management of Patients with
Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397 95 Hypoxia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669
62 Postoperative Neurologic and Psychiatric 96 Sleep Disturbance in the Hospitalized Patient . . . . . . . . . 676
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412 97 Nausea and Vomiting ............................... 689
98 Numbness: A Localization-Based Approach ........... 694
Specialty Consultation—What the
SECTION 5 99 Pain ............................................... 701
Consulting Hospitalist Needs to Know
100 Suspected Intoxication and Overdose ................ 709
63 Surgical Management of Obesity . . . . . . . . . . . . . . . . . . . . . 421 101 Syncope ........................................... 714
64 Common Postoperative Complications 102 Tachycardia ........................................ 729
in Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
103 The Geriatric History and Physical Examination . . . . . . . . 740
vi
104 The Neurologic Examination . . . . . . . . . . . . . . . . . . . . . . . . . 747 136 Pacemakers, Defibrillators, and Cardiac
105 Using Prognosis to Guide Treatment ................. 754 Resynchronization Devices in Hospital Medicine . . . . . 1025
106 Weakness: How to Localize the Problem . . . . . . . . . . . . . . 763

SECTION 2 Critical Care
137 Inpatient Cardiac Arrest and Cardiopulmonary

PART V: DIAGNOSTIC TESTING AND Resuscitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1037
PROCEDURES 138 Acute Respiratory Failure . . . . . . . . . . . . . . . . . . . . . . . . . . 1047
139 Pain, Agitation and Delirium in the Critical
SECTION 1 Interpretation of Common Tests Care Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1055
C
140 Mechanical Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1065
O
107 Basic Diagnostic Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 771
N
108 The Resting Electrocardiogram . . . . . . . . . . . . . . . . . . . . . . . 776 141 Sepsis and Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1074
T
E
142 Acute Respiratory Distress Syndrome . . . . . . . . . . . . . . . 1085
N
109 Elevated Liver Biochemical and Function Tests . . . . . . . . 796
T
143 Prevention in the Intensive Care Unit Setting . . . . . . . . 1094
S
110 Pulmonary Function Testing . . . . . . . . . . . . . . . . . . . . . . . . . 805
111 Urinalysis and Urine Electrolytes ..................... 814
SECTION 3 Dermatology
SECTION 2 Radiology 144 Flushing and Urticaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1105

145 Adverse Cutaneous Drug Reactions ................ 1114
112 Introduction to Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 825
146 Psoriasis and Other Papulosquamous Disorders ..... 1125
113 Patient Safety Issues in Radiology . . . . . . . . . . . . . . . . . . . . 831
147 Diabetic Foot Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 1131
114 Basic Chest Radiography (CXR) . . . . . . . . . . . . . . . . . . . . . . . 838
148 Venous Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1138
115 Advanced Cardiothoracic Imaging ................... 853 149 Dermatologic Findings in Systemic Disease ......... 1145
116 Basic Abdominal Imaging ........................... 864
117 Advanced Abdominal Imaging . . . . . . . . . . . . . . . . . . . . . . . 870 SECTION 4 Endocrinology
118 Neurologic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 876
150 Glycemic Emergencies ............................ 1171
119 Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 884 151 Inpatient Management of Diabetes and
Hyperglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1178
SECTION 3 Procedures 152 Thyroid Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1184
120 Vascular Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 891 153 Adrenal Insufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1191
121 Intubation and Airway Support ...................... 895 154 Pituitary Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1198
122 Arterial Blood Gas and Placement of A-line . . . . . . . . . . . . 901

SECTION 5 Gastroenterology
123 Feeding Tube Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 905
124 Thoracentesis ...................................... 909 155 GERD and Esophagitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1209
125 Lumbar Puncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 914 156 Upper Gastrointestinal Bleeding ................... 1217
157 Acute Pancreatitis ................................ 1227
126 Paracentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 918
158 Jaundice, Obstruction, and Acute Cholangitis ....... 1232
127 Arthrocentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 921
159 Acute Liver Disease ............................... 1239
160 Cirrhosis and Its Complications .................... 1253
PART VI: CLINICAL CONDITIONS IN THE 161 Acute Lower Gastrointestinal Bleeding ............. 1269
INPATIENT SETTING 162 Small Bowel Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1279
163 Large Bowel Disorders ............................ 1290
SECTION 1 Cardiovascular Medicine 164 Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . 1308
128 Acute Coronary Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . 929
129 Heart Failure ....................................... 941 SECTION 6 Geriatrics
130 Myocarditis, Pericardial Disease, and 165 Principles of Geriatric Care . . . . . . . . . . . . . . . . . . . . . . . . . 1323
Cardiac Tamponade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 954
166 Agitation in Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . 1330
131 Valvular Heart Disease .............................. 965
167 Elder Mistreatment ............................... 1336
132 Supraventricular Tachyarrhythmias . . . . . . . . . . . . . . . . . . . 980
168 Malnutrition and Weight Loss in Hospitalized
133 Bradycardia ........................................ 996 Older Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1346
134 Ventricular Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . 1003
135 Cardioversion .................................... 1015
vii
SECTION 7 Hematology SECTION 10 Neurology
169 Abnormalities in Red Blood Cells . . . . . . . . . . . . . . . . . . . 1353 207 Coma and Disorders of Consciousness . . . . . . . . . . . . . . 1667
170 Disorders of the White Cell ........................ 1373 208 Intracranial Hemorrhage and Related Conditions ... 1674
171 Quantitative Abnormalities of Platelets: 209 Transient Ischemic Attack and Stroke . . . . . . . . . . . . . . . 1681
Thrombocytopenia and Thrombocytosis . . . . . . . . . . . . 1381 210 Parkinson’s Disease and Related Disorders . . . . . . . . . . 1690
172 Approach to Patients with Bleeding Disorders . . . . . . . 1392 211 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1700
173 Hypercoagulable States . . . . . . . . . . . . . . . . . . . . . . . . . . . 1399 212 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1712
174 Hematologic Malignancies ........................ 1405 213 Peripheral Neuropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1719
C
O
SECTION 8 Oncology
N
SECTION 11 Palliative Care
T
E
175 Overview of Cancer and Treatment . . . . . . . . . . . . . . . . . 1431
N
214 Principles of Palliative Care ........................ 1727
T
176 Oncologic Emergencies ........................... 1436
S
215 Communication Skills for End-of-Life Care .......... 1733
177 Approach to the Patient with 216 Domains of Care: Physical Aspects of Care .......... 1740
Suspected Malignancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1443
217 Care of the Dying Patient ......................... 1756
178 Breast, Ovary, and Cervical Cancer. . . . . . . . . . . . . . . . . . 1454
179 Men’s Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1458 SECTION 12 Pregnancy
180 Cancers of the Kidney, Renal Pelvis, and Ureter . . . . . . 1463
181 Oncologic Issues of the Aerodigestive Tract . . . . . . . . . 1468 218 Overview of Physiologic Changes of Pregnancy ..... 1767
182 Gastrointestinal Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . 1474 219 Medication Management ......................... 1771
183 Immune-Related Adverse Events (irAEs) 220 Critical Care of the Pregnant Patient . . . . . . . . . . . . . . . . 1781
in Cancer Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1477 221 Common Medical Problems in Pregnancy. . . . . . . . . . . 1786
222 Postpartum Consultation for Common Complaints .. 1807
SECTION 9 Infectious Disease
SECTION 13 Psychiatry
184 Fundamentals of Antibiotics . . . . . . . . . . . . . . . . . . . . . . . 1489
185 Antibiotic Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1498 223 Mood and Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . 1813
186 Community-Acquired Pneumonia . . . . . . . . . . . . . . . . . . 1503 224 Combat Stress and Related Disorders . . . . . . . . . . . . . . . 1827
187 Health Care and Hospital-Acquired 225 Assessment and Management of Psychosis ......... 1833
Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1514 226 Eating Disorders ................................. 1841
188 Intravascular Catheter-Related Infections: 227 The Suicidal Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1848
Management and Prevention . . . . . . . . . . . . . . . . . . . . . . 1519 228 The Difficult Patient .............................. 1853
189 Infective Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1528 229 Approach to the Patient with Multiple Unexplained
190 Clostridium difficile–Associated Somatic Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1861
Disease (CDAD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1537
191 Peritonitis and Intra-Abdominal Abscess . . . . . . . . . . . . 1542 SECTION 14 Pulmonary and Allergy Immunology
192 Meningitis and Encephalitis. . . . . . . . . . . . . . . . . . . . . . . . 1549
230 Allergy and Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . 1871
193 Osteomyelitis and Septic Arthritis . . . . . . . . . . . . . . . . . . 1557
231 Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1876
194 Prosthetic Joint Infections . . . . . . . . . . . . . . . . . . . . . . . . . 1564
232 Chronic Obstructive Pulmonary Disease ............ 1887
195 Sexually Transmitted Infections . . . . . . . . . . . . . . . . . . . . 1574
233 Interstitial Lung Diseases/Diffuse Parenchymal
196 Skin and Soft Tissue Infections . . . . . . . . . . . . . . . . . . . . . 1582 Lung Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1898
197 Urinary Tract Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1589 234 Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1905
198 Viral Infections ................................... 1596 235 Sleep Apnea and Obesity Hypoventilation
199 Tickborne Infections .............................. 1604 Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1915
200 Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1612 236 Pleural Diseases .................................. 1923
201 Candida and Aspergillus ........................... 1618 237 Pulmonary Hypertension ......................... 1932
202 Histoplasmosis, Blastomycosis, Coccidioidomycosis,
and Other Dimorphic Fungi. . . . . . . . . . . . . . . . . . . . . . . . 1625 SECTION 15 Renal
203 The Hospitalized Patient with HIV . . . . . . . . . . . . . . . . . . 1634
238 Acid-Base Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1943
204 Infections of the Immunocompromised Host ....... 1646
239 Acute Kidney Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1952
205 Fever in the Returning Traveler .................... 1653
240 Calcium Disorders ................................ 1961
206 Undiagnosed Fever in Hospitalized Patients ........ 1659
viii
241 Potassium and Magnesium Disorders . . . . . . . . . . . . . . . 1972 SECTION18 Vascular Medicine
242 Disorders of Sodium and Water Balance ............ 1982
252 Venous Thromboembolism Prophylaxis for
243 Kidney Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1993
Hospitalized Medical Patients . . . . . . . . . . . . . . . . . . . . . . 2077
244 Secondary Hypertension .......................... 2000
253 Diagnosis and Treatment of Venous
245 Chronic Kidney Disease and Dialysis . . . . . . . . . . . . . . . . 2008
Thromboembolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2081
254 Anticoagulant Therapy ........................... 2093
SECTION 16 Rheumatology
255 Diseases of the Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2107
246 Rheumatologic Emergencies. . . . . . . . . . . . . . . . . . . . . . . 2017 256 Acute and Chronic Lower Limb Ischemia . . . . . . . . . . . . 2115
247 Gout, Pseudogout, and Osteoarthritis 2023
C
.............. 257 Vasculitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2121
O
248 Systemic Lupus Erythematosus .................... 2033
N
T
249 Rheumatoid Arthritis and Other Inflammatory Online Chapters
E
N
Arthritides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2046
T
e1 Global Health and Hospital Medicine
S
SECTION 17 Toxicology and Addiction e2 The Economics of Hospital Care
e3 Principles of Medical Ethics
250 Drug Overdose and Withdrawal . . . . . . . . . . . . . . . . . . . . 2057 e4 The Core Competencies in Hospital Medicine
251 Addiction of Prescription and e5 Bioterrorism
Nonprescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2070
Index ................................................. 2129
ix
EDITORS
Sylvia C. McKean, MD, SFHM, FACP
Daniel D. Dressler, MD, MSc, SFHM, FACP
xi
CONTRIBUTORS
Numbers in brackets refer to the chapters written or co-written by the contributor.
Samer Abdel-Aziz, MD Daniel A. Anaya, MD

Pain Medicine Fellowship Associate Pro essor o Surgery
Medical College o Wisconsin Division o Surgical Oncology
C
Milwaukee, Wisconsin [99] Michael E. DeBakey Department o Surgery
O
N
Research Scientist
Meredith C. B. Adams, MD, MS
T
The Houston Center or Quality o Care &Utilization Studies
R
Assistant Pro essor o Anesthesiology and Pain Medicine
I
Director
B
Director
U
Liver Tumor Program, Michael E. DeBakey VAMC
T
Pain Medicine Fellowship Baylor College o Medicine
O
Medical College o Wisconsin Houston, Texas [55]
R
S
Milwaukee, Wisconsin [99]
Douglas S. Ander, MD
Aaron W. Aday, MD Pro essor o Emergency Medicine
Division o Cardiovascular Medicine Emory University School o Medicine
Department o Medicine Atlanta, Georgia [121]
Boston, Massachusetts [255] Eddy Ang, MD
Instructor in Medicine
Bhavin Adhyaru, MD Harvard Medical School
Emory University School o Medicine Division o Gerontology
Atlanta, Georgia [10] Beth Israel Deaconess Medical Center
Kush Agrawal, MD Boston, Massachusetts
Advanced Endovascular and Structural Interventional Fellow Department o Medicine, Hebrew SeniorLi e
VIVA Physicians Roslindale, Massachusetts [68]
El Camino Hospital Kelly Armstrong, PhD
Mountain View, Cali ornia [101] Senior Clinical Ethicist
Mikhail Akbashev, MD Memorial Health System
Assistant Pro essor o Medicine Adjunct Assistant Pro essor
Emory University School o Medicine Department o Medical Humanities
Atlanta, Georgia [11] SIU School o Medicine
Spring eld, Illinois [34]
A saneh Alavi, MD, MSc, FRCPC
Department o Medicine (Dermatology) Vineet M. Arora, MD, MAPP
University o Toronto Associate Pro essor and Assistant Dean or Scholarship and
Toronto, Ontario, Canada [148] Discovery
Director
G. Caleb Alexander, MD, MS GME Clinical Learning Environment Innovation
Associate Pro essor o Epidemiology and Medicine Pritzker School o Medicine
Bloomberg School o Public Health University o Chicago
Johns Hopkins University Chicago, Illinois [13]
Baltimore, Maryland [e3]
Cameron Ashbaugh, MD
Anne E. Allan, MD Assistant Pro essor
Miraca Li e Sciences Harvard Medical School
Irving, Texas [146] Division o In ectious Diseases
Ashwin Ananthakrishnan, MD Boston, Massachusetts [196]
Attending Physician
Massachusetts General Hospital Saima Aslam, MD, MS
Instructor in Medicine, Harvard Medical School Assistant Pro essor
Boston, Massachusetts [183] Director
Solid Organ Transplant In ectious Diseases service
Division o In ectious Diseases
University o Cali ornia, San Diego
San Diego, Cali ornia [188]
xiii
Mark J. Ault, MD Robert B. Baron, MD, MS
Pro essor o Medicine Pro essor o Medicine
University o Cali ornia Associate Dean or Graduate and Continuing Medical Education
Los Angeles School o Medicine Vice Chie , Division o General Internal Medicine
Department o Medicine University o Cali ornia
Cedars-Sinai Medical Center San Francisco School o Medicine
Los Angeles, Cali ornia [125] San Francisco, Cali ornia [36]
Patrick Avila, MD, MPhil, MPH Tom Baudendistel, MD, FACP

Internal Medicine Resident Physician Internal Medicine Residency Program Director
Brigham and Women’s Hospital Kaiser Permanente
C
Boston, Massachusetts [160] Oakland, Cali ornia [39]
O
N
Vasilis C. Babaliaros, MD Mihaela H. Bazalakova, MD, PhD
T
Pro essor o Medicine and Surgery Assistant Pro essor
R
I
B
Co-Director Department o Neurology
U
Emory Structural Heart and Valve Center Center or Sleep Medicine and Sleep Research
T
O
Emory University Hospital University o Wisconsin-Madison
R
Atlanta, Georgia [131] Madison, Wisconsin [96]
S
Lindsey R. Baden, MD Joshua A. Beckman, MD, MSc
Associate Pro essor Section o Vascular Medicine
Harvard Medical School Cardiovascular Division
In ectious Diseases Division Vanderbilt University Medical Center
Brigham and Women’s Hospital and Dana-Farber Cancer Institute Nashville, Tennessee [255]
Boston, Massachusetts [204]
Nicole M. Bedi, RD, CNSC
Meridale V. Baggett, MD Birmingham, Michigan [58]
Harvard Medical School Laurence Beer, MD, SFHM
Inpatient Clinician Educator Service Emory University School o Medicine
Department o Medicine Atlanta, Georgia [8]
Massachusetts General Hospital Michael Belkin, MD
Boston, Massachusetts [78] Division o Vascular Surgery
James L. Bailey, MD Brigham and Women’s Hospital
Pro essor Boston, Massachusetts [256]
Emory University School o Medicine Elie F. Berbari, MD
Atlanta, Georgia [241] Pro essor o Medicine
Stephen J. Balevic, MD Mayo Clinic College o Medicine
Adult and Pediatric Rheumatology Fellow Rochester, Minnesota [194]
Duke University Medical Center Colm Bergin, MD, FRCPI, FRCP, FIDSA
Durham, North Carolina [248] Clinical Pro essor o Medicine
Peter A. Banks, MD Trinity College Dublin
Pro essor o Medicine Consultant Physician in In ectious Diseases
Harvard Medical School Associate Director
Director o the Center or Pancreatic Disease Wellcome-Health Research Board Clinical Research Facility
Division o Gastroenterology, Hepatology and Endoscopy St. James’s Hospital
Department o Medicine Dublin, Ireland [195]
Brigham and Women’s Hospital Aaron L. Berkowitz, MD, PhD
Boston, Massachusetts [157] Department o Neurology
Aditya Bardia, MD, MPH Brigham and Women’s Hospital
Assistant Pro essor Harvard Medical School
Harvard Medical School Boston, Massachusetts [98]
Attending Physician Rachelle E. Bernacki, MD, MS
Massachusetts General Hospital Cancer Center Assistant Pro essor o Medicine
Boston, Massachusetts [177, 183] Harvard Medical School
Maria F. Barile, MD Director o Quality Initiatives
Clinical Instructor in Radiology Palliative Care
Harvard Medical School Dana-Farber Cancer Institute
Thoracic Radiologist, Brigham and Women’s Hospital
Brigham and Women’s Hospital Ariadne Labs
Boston, Massachusetts [114, 115] Boston, Massachusetts [105, 214]
xiv
Robert A. Bessler, MD Ghada Bourjeily, MD
CEO Associate Pro essor o Medicine
Sound Physicians The Warren Alpert Medical School o Brown University
Tacoma, Washington [23, 25] The Miriam Hospital
Pulmonary, Critical Care, Obstetric Medicine
John P. Bilezikian, MD Department o Medicine
Dorothy L. and Daniel H. Silberberg Pro essor o Medicine Providence, Rhode Island [220]
Pro essor o Pharmacology
Columbia University Medical College John M. Braver, MD
Chie , Division o Endocrinology Assistant Pro essor
Director Harvard Medical School
C
Metabolic Bone Diseases Program Director
O
Columbia University Medical Center Gastrointestinal Radiology
N
New York, New York [240] Brigham and Women’s Hospital
T
R
Boston, Massachusetts [116, 117]
I
Courtney Bilodeau, MD, FACP
B
U
Assistant Pro essor Ursula C. Brewster, MD
T
O
The Warren Alpert Medical School o Brown University Associate Pro essor o Medicine
R
Department o Obstetric Medicine, Women’s Medicine Section o Nephrology
S
Collaborative Yale University School o Medicine
Miriam Hospital New Haven, Connecticut [245]
Providence, Rhode Island [222]
Joseph Brito, MD
Kenneth D. Bishop, MD, PhD Division o Urology
Assistant Pro essor o Medicine The Warren Alpert Medical School o Brown University
Division o Hematology/Oncology Providence, Rhode Island [180]
Rhode Island Hospital
The Warren Alpert Medical School o Brown University Jared R. Brosch, MD, MS
Providence, Rhode Island [176] Assistant Pro essor o Neurology
Indiana University School o Medicine
Ioannis A. Bliziotis, MD, PhD, MSc Indianapolis, Indiana [192]
Internal Medicine and In ectious Diseases Specialist
Senior Researcher Katherine L. Brown, MD, MPH
Al a Institute o Biomedical Sciences Suncoast Dermatology
Athens, Greece [184] Orlando, Florida [148]
Arline D. Bohannon, MD Tod A. Brown, MD

Associate Pro essor o Internal Medicine Assistant Pro essor
Virginia Commonwealth University Anesthesia and Perioperative Medicine
Richmond, Virginia [103] Medical University o South Carolina
Charleston, South Carolina [62]
Peter A. Boling, MD
Pro essor o Internal Medicine Avery L. Buchholz, MD, MPH
Virginia Commonwealth University Health System Department o Neurosurgery
Richmond, Virginia [103] Medical University o South Carolina
Marcy B. Bolster, MD
Associate Pro essor Tina Budnitz, MPH, MHM
Harvard Medical School Senior Advisor
Director Society Hospital Medicine
Rheumatology Fellowship Training Program Philadelphia, Pennsylvania [e4]
Massachusetts General Hospital Robert Burakof , MD, MPH
Boston, Massachusetts [248, 249] Associate Pro essor o Medicine
Diego F. Bonilla Arcos, MD Division o Gastroenterology, Hepatology, and Endoscopy
Pulmonary Critical Care Brigham and Women’s Hospital
Boston University Harvard Medical School
Pulmonary Center Boston, Massachusetts [155]
Boston Medical Center T. Karl Byrne, MD, FACS
Boston, Massachusetts [237] Pro essor o Surgery
Joanna M. Bonsall, MD, PhD Director
Assistant Pro essor o Medicine Bariatric Surgery Program
Division o Hospital Medicine Medical University o South Carolina
Emory University School o Medicine Charleston, South Carolina [63]
Atlanta, Georgia [12]
xv
Amanda Caissie, MD, PhD, FRCPC Olga S. Chajewski, MD
Department o Radiation Oncology Department o Pathology and Laboratory Medicine
Dalhousie University Medical University o South Carolina
Saint John Regional Hospital Charleston, South Carolina [57]
Saint John, New Brunswick, Canada [215]
Walter W. Chan, MD, MPH
Evelyn Cantillo, MD, MPH Assistant Pro essor o Medicine
Clinical Instructor o Obstetrics and Gynecology Division o Gastroenterology, Hepatology, and Endoscopy
Program in Women’s Oncology Harvard Medical School
Women &In ants’Hospital o Rhode Island Brigham and Women’s Hospital
The Warren Alpert Medical School o Brown University Boston, Massachusetts [155]
C
O
Arjun S. Chanmugam, MD, MBA
N
Stephanie M. Cantu, MD Associate Pro essor o Emergency Medicine
T
Department o Medicine Johns Hopkins University School o Medicine
R
I
B
Brigham and Women’s Hospital Baltimore, Maryland [79]
U
T
Helen Chen, MD
O
Mitchell S. Cappell, MD, PhD Assistant Pro essor o Medicine
R
S
Pro essor o Medicine Harvard Medical School
Oakland University William Beaumont School o Medicine Division o Gerontology
Chie , Division o Gastroenterology and Hepatology Beth Israel Deaconess Medical Center
Department o Medicine Chie Medical O cer
William Beaumont Hospital Hebrew SeniorLi e
Royal Oak, Michigan [163] Boston, Massachusetts [73]
Alexander R. Carbo, MD, FACP, SFHM Kenneth K. Chen, MD, FRACP

Assistant Pro essor o Medicine Assistant Pro essor o Medicine and OB/GYN
Harvard Medical School Division o Obstetric and Consultative Medicine
Hospitalist The Warren Alpert Medical School o Brown University
Beth Israel Deaconess Medical Center Providence, Rhode Island [221]
Steven T. Chen, MD, MPH
Teresa L. Carman, MD Instructor in Dermatology
Assistant Pro essor o Medicine Harvard Medical School
Case Western Reserve University School o Medicine Massachusetts General Hospital
Director Boston, Massachusetts [145]
Vascular Medicine
University Hospitals Case Medical Center Xi Chen, MD, PhD
Cleveland, Ohio [86] Neurology Department
Atrius Health
Patrick J. Cawley, MD, MHM Boston, Massachusetts [96]
CEO
MUSC Health Nishay Chitkara, MD
Vice President or Health A airs Assistant Pro essor o Medicine
Medical University o South Carolina NYU Langone Medical Center/Bellevue Hospital
Charleston, South Carolina [1] Department o Medicine
Division o Pulmonary
Laura K. Certain, MD, PhD Critical Care and Sleep Medicine
Instructor in Medicine New York, New York [143]
Division o In ectious Diseases Louisa W. Chiu, MD
Massachusetts General Hospital Assistant Pro essor o Surgery
Boston, Massachusetts [193] Michael E. DeBakey Department o Surgery
Baylor College o Medicine
Matthew E. Certain, MD Houston, Texas [55]
Interventional and Peripheral Cardiologist
Southeast Georgia Health Systems Elbert B. Chun, MD
Brunswick, Georgia [130] Assistant Pro essor
Division o Hospital Medicine
Sukit Chaiyachati, MD Department o Internal Medicine
Assistant Pro essor o Medicine Emory University School o Medicine
Division o Hospital Medicine Emory University Hospital
Emory University School o Medicine Atlanta, Georgia [132]
xvi
Roger P. Clark, DO Frank E. Corrigan, III, MD
Assistant Pro essor o Medicine Cardiology Fellow
Division o Geographic Medicine and In ectious Diseases Emory University School o Medicine
Tu ts Medical Center Atlanta, Georgia [101]
Consultant, In ectious Diseases
Brigham and Women’s Faulkner Hospital Dominique L. Cosco, MD, FACP
Boston, Massachusetts [199] Assistant Pro essor o Medicine
Associate Program Director
John O. Clarke, MD Grady Memorial Hospital
Associate Pro essor o Medicine J. Willis Hurst Internal Medicine Residency Program
Division o Gastroenterology &Hepatology Emory University School o Medicine
C
Johns Hopkins University Atlanta, Georgia [230]
O
Baltimore, Maryland [97]
N
Douglas B. Coursin, MD, FCCP
T
Stephen D. Clements, Jr., MD Pro essor o Anesthesiology and Medicine
R
I
B
Pro essor o Medicine (Cardiology) University o Wisconsin School o Medicine and Public Health
U
R. Harold Harrison Chair in Cardiology Madison, Wisconsin [153]
T
O
Division o Cardiology
Lisa Criscione -Schreiber, MD, MEd
R
Department o Medicine
S
Emory University School o Medicine Associate Pro essor o Medicine
Atlanta, Georgia [130] Rheumatology Training Program Director
Duke University Medical Center
Steven L. Cohn, MD, FACP, SFHM Duke University School o Medicine
Pro essor o Clinical Medicine Durham, North Carolina [248, 249]
University o Miami Miller School o Medicine
Medical Director Yvette M. Cua, MD
UHealth Preoperative Assessment Center Associate Pro essor o Medicine
Director Department o Medicine
Medical Consultation Services Associate Vice Chair or Clinical A airs
University o Miami Hospital and Jackson Memorial Hospital Department o Medicine
Miami, Florida [49, 50] University o Louisville
Louisville, Kentucky [28-30, 32]
Lauren Colbert, MD
Fellow Randall Czajkowski, MS, RRA, RT(R)(CT)
Radiation Oncology Lead Clinical CT Technologist
MD Anderson Cancer Center Brigham and Women’s Hospital
Houston, Texas [182] Boston, Massachusetts [119]
Alexandra Columbus, MD Sonye K. Danof , MD, PhD

Resident Associate Pro essor o Medicine
General Surgery Department o Medicine
Brigham and Women’s Hospital Division o Pulmonary and Critical Care Medicine
Boston, Massachusetts [45] Johns Hopkins University School o Medicine
Jose F. Condado, MD, MS
Cardiology Research Fellow Jatin K. Dave, MD, MPH
Structural Heart and Valve Center Part-Time Instructor, Harvard Medical School
Division o Cardiology Division o Aging, Brigham and Women’s Hospital
Emory University School o Medicine Boston, Massachusetts
Atlanta, Georgia [131] Medical Director
Geriatrics and Senior Care Options
Nicholas J. Connors, MD Tu ts Health Plan
Assistant Pro essor o Medicine Watertown, Massachusetts [68, 73]
Division o Emergency Medicine David B. De Lurgio, MD
Section o Medical Toxicology Pro essor
Charleston, South Carolina [100] Clinical Cardiac Electrophysiology
Emory Saint Joseph’s Hospital
Darin J. Correll, MD Atlanta, Georgia [136]
Assistant Pro essor o Anesthesia
Harvard Medical School Steven B. Deitelzweig, MD, MMM, SFHM, FACP
Director Ochsner Health System
Postoperative Pain Management Service Medical Director o Regional Business Development
Department o Anesthesiology, Perioperative, and Pain Medicine System Chairman, Hospital Medicine
Chair, Acute Pain Committee Associate Pro essor o Medicine-Ochsner Clinical School [24]
xvii
Paul F. Dellaripa, MD Daniel D. Dressler, MD, MSc, SFHM, FACP
Associate Pro essor Pro essor o Medicine
Harvard Medical School Director
Division o Rheumatology Internal Medicine Teaching Services
Brigham and Women’s Hospital Emory University Hospital
Boston, Massachusetts [246] Associate Program Director
J. Willis Hurst Internal Medicine Residency Program
E. Patchen Dellinger, MD Co-Director
Pro essor and Vice Chair Semmelweis Society
Department o Surgery Emory University School o Medicine
University o Washington Atlanta, Georgia [101]
C
Seattle, Washington [55]
O
Jacob M. Drew, MD
N
Harry A. Demos, MD Assistant Pro essor
T
Associate Pro essor
R
Department o Orthopedics
I
B
Department o Orthopedics Medical University o South Carolina
U
T
O
R
Catherine E. DuBeau, MD
S
Rebecca Dezube, MD Pro essor o Medicine
Postdoctoral Fellow Family Medicine and Community Health, and Obstetrics and
Johns Hopkins University Gynecology
Pulmonary and Critical Care Medicine Clinical Chie o Geriatrics
Baltimore, Maryland [95] University o Massachusetts Medical School
Lorenzo Di Francesco, MD, FACP, FHM Worcester, Massachusetts [71]
Pro essor o Medicine Jenni er Duf , MD
Division o General Medicine &Geriatrics Assistant Pro essor o Medicine
Program Director Division o Hematology and Oncology
J. Willis Hurst Internal Medicine Residency Program Department o Medicine
Assistant Chie o Medicine, Grady Memorial Hospital University o Florida College o Medicine
Emory University School o Medicine Hematology and Oncology Section
Atlanta, Georgia [93] NF/SG Veterans A airs Medical Center
Shira Doron, MD, FIDSA Gainesville, Florida [175]
Antimicrobial Steward Liam Durcan, MD, FRCPC
Associate Hospital Epidemiologist Assistant Pro essor
Division o Geographic Medicine and In ectious Diseases Department o Neurology and Neurosurgery
Tu ts Medical Center McGill University
Boston, Massachusetts [191] Consultant Neurologist
Michael Dougan, MD, PhD McGill University Health Centre
Gastroenterology Fellow Montreal, Quebec, Canada [207]
Massachusetts General Hospital Kent Russell Edwards, Jr., MD
Boston, Massachusetts [183] Urology Research Assistant
James D. Douketis, MD, FRCP(C), FACP, FCCP University o South Carolina School o Medicine
Pro essor o Medicine Columbia, South Carolina [67]
McMaster University Mikhael F. El-Chami, MD, FACC, FHRS
Hospitalist Service Associate Pro essor o Medicine
St. Joseph’s Healthcare Hamilton Division o Cardiology-Section o Electrophysiology
Hamilton, Ontario, Canada [56, 252] Emory University
Aeron A. D. Doyle, MD, CM, FRCPC Atlanta, Georgia [134]
Assistant Pro essor o Anesthesiology Elwaleed A. Elhassan, MD, FACP, FASN
University o British Columbia Assistant Pro essor o Medicine
Department o Anesthesiology, Perioperative Medicine, and Pain Division o Nephrology and Hypertension
Management Wayne State University School o Medicine
Providence Health Care Detroit, Michigan [242]
Vancouver, British Columbia, Canada [47]
William J. Elliott, MD, PhD
Tracy J. Doyle, MD, MPH Chair
Instructor in Medicine Department o Biomedical Sciences
Harvard Medical School Chie , Division o Pharmacology
Pulmonary and Critical Care Medicine Pro essor o Preventative Medicine, Internal Medicine, Pharmacology
Brigham and Women’s Hospital Paci c Northwest University o Health Sciences
Boston, Massachusetts [85] Yakima, Washington [244]
xviii
John M. Embil, MD, FRCPC, FACP James C. Fang, MD, FACC, FAHA
Pro essor o Internal Medicine and Medical Microbiology Chie
University o Manitoba Cardiovascular Division
Director Pro essor o Medicine
In ection Prevention and Control Unit, Health Sciences Centre John and June B. Hartman Presidential Endowed Chair
Winnipeg, Manitoba, Canada [147, 202] Executive Director
Cardiovascular Service Line
Scott F. Enderby, DO, MMM, SFHM, FACP University o Utah Health Sciences Center
CEO/Medical Director Salt Lake City, Utah [129]
Bay Area Hospitalist Associates, Inc.
San Francisco, Cali ornia [25] John Fanikos, RPh, MBA
C
Department o Pharmacy Services
O
Jeannine Z. Engel, MD Brigham and Women’s Hospital
N
Associate Pro essor o Medicine Boston, Massachusetts [254]
T
Internal Medicine, Huntsman Cancer Hospital
R
I
Harrison W. Farber, MD
B
Physician Advisor, Billing Compliance
U
Compliance Services Pro essor o Medicine
T
O
University o Utah Health Sciences Boston University School o Medicine
R
Salt Lake City, Utah [31] Director
S
Pulmonary Hypertension Center
Joseph C. English, III, MD Boston Medical Center
Pro essor o Dermatology Boston, Massachusetts [237]
University o Pittsburgh Department o Dermatology
Pittsburgh, Pennsylvania [144] Claire E. Farel, MD, MPH
Clinical Assistant Pro essor o Medicine
Mary Eno, MD, MPH University o North Carolina School o Medicine
Regional Chie o Addiction Medicine Medical Director
Southern Cali ornia Permanente Medical Group UNC In ectious Diseases Clinic
Los Angeles, Cali ornia [251] UNC Institute or Global Health and In ectious Diseases
Andrew S. Epstein, MD Chapel Hill, North Carolina [203]
Assistant Attending Dimitrios Farmakiotis, MD
Memorial Sloan Kettering Cancer Center Assistant Pro essor o Medicine
Gastrointestinal Oncology Service New York University School o Medicine
New York, New York [182] Division o In ectious Diseases and Immunology, NYU Langone
Evert A. Eriksson, MD, FACS, FCCP Medical Center
Associate Pro essor o Surgery New York, New York [201]
Department o Surgery Jeanne M. Farnan, MD, MHPE
Medical University o South Carolina Associate Pro essor
Charleston, South Carolina [46] Section o Hospital Medicine
Samir M. Fakhry, MD, FACS Assistant Dean, Curricular Development and Evaluation
Charles F. Crews Pro essor o Surgery Pritzker School o Medicine
Chie , Division o General Surgery University o Chicago
Department o Surgery Chicago, Illinois [13]
Medical University o South Carolina Grace Farris, MD
Charleston, South Carolina [46] Beth Israel Deaconess Medical Center
Matthew E. Falagas, MD, MSc, DSc Boston, Massachusetts [168]
Adjunct Associate Pro essor o Medicine Kevin Felner, MD
Tu ts University School o Medicine Associate Pro essor
Boston, Massachusetts Division o Pulmonary and Critical Care
Director New York University School o Medicine
Al a Institute o Biomedical Sciences Harbor VA Medical Center
Director New York, New York [141]
Department o Internal Medicine and In ectious Diseases
Iaso General Hospital Andrew Z. Fenves, MD, FACP, FASN
Athens, Greece [184] Associate Pro essor o Medicine
Kenneth R. Falchuk, MD Clinician Educator Service
Associate Clinical Pro essor o Medicine Massachusetts General Hospital
Co-Director
Inf ammatory Bowel Disease Center
Department o Medicine, Division o Gastroenterology
Beth Israel Deaconess Medical Center
xix
Joseph D. Feuerstein, MD Michael Gardam, MD, MSc, FRCPC
Assistant Pro essor o Medicine Associate Pro essor o Medicine
Harvard Medical School University o Toronto
Attending in Gastroenterology Director
Center or Inf ammatory Bowel Disease In ection Prevention and Control
Beth Israel Deaconess Medical Center University Health Network
Boston, Massachusetts [164] Medical Director
Tuberculosis Clinic
Joseph J. Fins, MD, MACP Toronto Western Hospital
The E. William Davis, Jr., MD Pro essor o Medical Ethics and Toronto, Ontario, Canada [200]
C
Weill Cornell Medical College Brian T. Garibaldi, MD
O
Director Assistant Pro essor o Medicine
N
Medical Ethics and Attending Physician Johns Hopkins University School o Medicine
T
R
New York Presbyterian Hospital-Weill Cornell Medical Center Department o Medicine
I
B
New York, New York [33] Division o Pulmonary and Critical Care Medicine
U
T
O
Leslie A. Flores, MHA, SFHM
R
Nelson Flores Hospital Medicine Consultants Steven Garlow, MD, PhD
S
La Quinta, Cali ornia [26] Associate Pro essor
Chie o Psychiatry
John A. Flynn, MD, MBA, MEd, FACP, FACR Emory University Hospital
Medical Director Atlanta, Georgia [223]
Spondyloarthritis Program
Associate Dean and Executive Director Germán E. Giese, MD
Clinical Practice Association Assistant Pro essor o Medicine
Vice President, O ce o Johns Hopkins Physicians University o Miami Miller School o Medicine
Johns Hopkins University Attending, Division o Hospital Medicine
Baltimore, Maryland [76] University o Miami Hospital
Miami, Florida [37]
Ryan M. Ford, MD
Assistant Pro essor o Medicine Richard S. Gitomer, MD, MBA, FACP
Director o Viral Hepatitis Assistant Pro essor
Emory Transplant Center Emory University School o Medicine
Transplant Hepatologist President and Chie Quality O cer
Emory University Hospital Emory Healthcare Network
Atlanta, Georgia [159] Atlanta, Georgia [18]
Vance G. Fowler Jr., MD, MHS Jef rey J. Glasheen, MD, SFHM
Division o In ectious Diseases Chie Quality O cer
Duke University Medical Center University o Colorado Hospital
Durham, North Carolina [189] Associate Dean or Clinical A airs, Quality and Sa ety Education
Director
Gil Freitas, MD Institute or Healthcare Quality, Sa ety and E ciency
Division o Trauma, Burn, and Surgical Critical Care Pro essor
Harvard Medical School Division o General Internal Medicine
Fellow, Metabolic Support Service University o Colorado School o Medicine
Brigham and Women’s Hospital Aurora, Colorado [59]
Dragan Golijanin, MD
Joseph M. Furman, MD, PhD Associate Pro essor o Surgery
Pro essor Director
Departments o Otolaryngology Genitourinary Oncology
Neurology, Bioengineering and Physical Therapy The Warren Alpert Medical School o Brown University
University o Pittsburgh School o Medicine Providence, Rhode Island [180]
Director
Divisions o Balance Disorders Lucas Golub, MD
Pittsburgh, Pennsylvania [84] Emory University School o Medicine
Julia M. Gallagher, MD
Medical Director Steven M. Gorbatkin, MD, PhD
MGH Home Based Palliative Care Program Associate Pro essor
Division o Palliative Care Emory University School o Medicine
Massachusetts General Hospital Nephrologist, Atlanta VA Medical Center
Boston, Massachusetts [74] Decatur, Georgia [241]
xx
Norman D. Grace, MD Caroline N. Harada, MD
Lecturer on Medicine Associate Pro essor o Medicine
Harvard Medical School Assistant Dean or Community-Engaged Scholarship
Pro essor o Medicine University o Alabama School o Medicine
Tu ts University School o Medicine Division o Gerontology, Geriatrics, and Palliative Care
Sta Physician Birmingham, Alabama [166]
Division o Gastroenterology, Hepatology, and Endoscopy
Department o Medicine Nikroo Hashemi, MD, MPH
Brigham and Women’s Hospital Instructor o Medicine
Boston, Massachusetts [53, 160] Harvard Medical School
C
Yonatan H. Grad, MD, PhD Division o Gastroenterology and Hepatology
O
Assistant Pro essor Boston, Massachusetts [109]
N
Harvard T. H. Chan School o Public Health
T
Joaquim M. Havens, MD
R
Division o In ectious Diseases
I
B
Brigham and Women’s Hospital Assistant Pro essor o Surgery
U
T
O
Division o Trauma, Burn, and Surgical Critical Care
R
Charles S. Greenberg, MD Brigham and Women’s Hospital
S
Department o Medicine Boston, Massachusetts [45]
Division o Hematology/Oncology
Medical University o South Carolina Meghan Hayes, MD, FACP
Charleston, South Carolina [54] Department o Internal Medicine
Sutter Medical Group
Stephen B. Greenberg, MD, MACP Clinical Instructor
Distinguished Service Pro essor, Herman Brown Teaching University o Cali ornia
Pro essor Davis Medical Center
Baylor College o Medicine Sacramento, Cali ornia [218, 220]
Vice Chie o Sta , Chie o Medicine
Ben Taub Hospital Catherine P. M. Hayward, MD, PhD, FRCPC
Houston, Texas [198] Pro essor
Pathology and Molecular Medicine/Medicine McMaster University
Norton J. Greenberger, MD, MACP Head, Coagulation
Clinical Pro essor o Medicine Hamilton Regional Laboratory Medicine Program
Harvard Medical School West Hamilton, Ontario, Canada [172]
Senior Physician
Brigham and Women’s Hospital Galen V. Henderson, MD
Boston, Massachusetts [75] Director
Neurocritical Care and Neuroscience Intensive Care Unit
Anne F. Gross, MD Brigham and Women’s Hospital
Assistant Pro essor o Psychiatry Assistant Pro essor, Harvard Medical School
Associate Residency Training Director Boston, Massachusetts [209]
Oregon Health &Science University
Portland, Oregon [229] Kathie L. Hermayer, MD, MS, FACE, FACP
Angela S. Guarda, MD Medical Director or Diabetes Management Services at MUSC
Associate Pro essor o Psychiatry and Behavioral Sciences Division o Endocrinology, Diabetes, and Medical Genetics
Johns Hopkins School o Medicine Medical University o South Carolina
Director Chair, Diabetes Task Force
Eating Disorders Program Ralph H. Johnson Veteran’s A airs Medical Center
The Johns Hopkins Hospital Charleston, South Carolina [52]
Heather Herrington, MD
Navin R. Gupta, MD Associate Pro essor o Medicine
Department o Medicine Division o Gerontology, Geriatrics, and Palliative Care
Renal Division University o Alabama at Birmingham
Brigham and Women’s Hospital Birmingham, Alabama [166]
Stacy Higgins, MD, FACP
Sarah P. Hammond, MD Associate Pro essor o Medicine
Assistant Pro essor o Medicine Division o General Medicine and Geriatrics
Harvard Medical School Emory University School o Medicine
Division o In ectious Diseases Atlanta, Georgia [12]
xxi
Keiki Hinami, MD, MS Jef C. Huf man, MD
Collaborative Research Unit Associate Pro essor o Psychiatry
Cook County Health &Hospitals System Harvard Medical School
Chicago, Illinois [41] Medical Director
Inpatient Psychiatry
Ashley B. Hink, MD, MPH Massachusetts General Hospital
General Surgery Resident Boston, Massachusetts [229]
Department o General Surgery John T. Huggins, MD
Charleston, South Carolina [63] Associate Pro essor o Medicine
Division o Pulmonary and Critical Care
Kerstin Hogg, MD, MBChB, MSc
C
O
Assistant Pro essor Charleston, South Carolina [236]
N
T
McMaster University Daniel P. Hunt, MD
R
I
B
East Hamilton, Ontario, Canada [253] Pro essor o Medicine
U
Director
T
Fernando Holguin, MD, MPH
O
Emory Division o Hospital Medicine
Associate Pro essor o Medicine and Pediatrics
R
S
Asthma Institute Emory University School o Medicine
Division o Pulmonary Atlanta, Georgia [78]
Allergy and Critical Care Medicine
University o Pittsburgh William R. Hunt, MD
Pittsburgh, Pennsylvania [231] Assistant Pro essor o Medicine
Division o Pulmonary, Allergy, Critical Care, and Sleep Medicine
Anthony N. Hollenberg, MD Department o Medicine
Pro essor o Medicine Emory-Children’s Center or Cystic Fibrosis
Harvard Medical School McKelvey Lung Transplant Center
Chie , Division o Endocrinology, Diabetes, and Metabolism Emory University School o Medicine
Beth Israel Deaconess Medical Center Atlanta, Georgia [234]
Aubrey Ingraham, MD
Elizabeth H. Holt, MD, PhD Department o Internal Medicine
Associate Pro essor Kaiser Permanente
Yale School o Medicine Oakland, Cali ornia [39]
Yale Endocrinology
Yale Endocrine Oncology Program Bertrand L. Jaber, MD, MS
New Haven, Connecticut [240] Associate Pro essor o Medicine
Tu ts University School o Medicine
Michael H. Hoskins, MD Vice Chair or Clinical A airs
Assistant Pro essor Department o Medicine
Clinical Cardiac Electrophysiology Caritas St. Elizabeth’s Medical Center
Emory University Hospital Boston, Massachusetts [243]
Atlanta, Georgia [133, 136]
Claire S. Jacobs, MD, PhD
Susy Hota, MD, MSc, FRCPC Department o Neurology
Assistant Pro essor o Medicine Brigham and Women’s Hospital
University o Toronto Boston, Massachusetts [211]
Hospital Epidemiologist and In ectious Diseases Specialist
University Health Network Francine L. Jacobson, MD, MPH
Toronto, Ontario, Canada [200] Thoracic Radiologist at Brigham and Women’s Hospital
Assistant Pro essor
Liangge Hsu, MD Department o Radiology
Assistant Pro essor o Radiology Harvard Medical School
Division o Neuroradiology Boston, Massachusetts [107, 112-119]
Harvard Medical School Shilpa H. Jain, MD
Boston, Massachusetts [118] Clinical Assistant Pro essor (A liated)
Division o Endocrinology, Gerontology, and Metabolism
Margo S. Hudson, MD Stan ord University School o Medicine
Assistant Pro essor o Medicine Veterans A airs Palo Alto Health Care System
Harvard Medical School Palo Alto, Cali ornia [154]
Diabetes Management Service
xxii
Kunal Jajoo, MD Laurence Katznelson, MD
Assistant Pro essor Associate Dean o Graduate Medical Education
Harvard Medical School Pro essor o Neurosurgery and Medicine (Endocrinology and
Associate Physician Metabolism)
Brigham and Women’s Hospital Medical Director
Boston, Massachusetts [158] Pituitary Center
Stan ord University School o Medicine
Edward C. Jauch, MD, MS Stan ord, Cali ornia [154]
Pro essor
Director Clive Kearon, MB, MRCPI, FRCPC, PhD
Division o Emergency Medicine Jack Hirsh Pro essorship in Thromboembolism
C
Pro essor, Department o Neurosciences Department o Medicine
O
Vice Chair, Research, Department o Medicine McMaster University
N
Pro essor, Department o Bioengineering (Adjunct) Juravinski Hospital
T
R
Clemson University Hamilton, Ontario, Canada [253]
I
B
U
Robert T. Keenan, MD, MPH
T
O
R
Brent Jewett, MD Director
S
Clinical Instructor o Surgery Duke Gout and Crystal Arthropathy Clinic
Department o Surgery Duke University School o Medicine
Medical University o South Carolina Durham, North Carolina [247]
Corey D. Kershaw, MD
Danielle Jones, MD, FACP Associate Pro essor o Medicine
Associate Pro essor o Medicine Division o Pulmonary &Critical Care Medicine
Division o General Medicine and Geriatrics University o Texas Southwestern Medical Center
Emory University School o Medicine Medical Director, MICU
Atlanta, Georgia [93] William P. Clements Jr. University Hospital
Dallas, Texas [142]
J. Ryan Jordan, MD
Cardiovascular Disease and Clinical Cardiac Electrophysiology Adeel M. Khan, MD, MPH
South Denver Cardiology Associates, PC Taussig Cancer Institute
Littleton, Colorado [135] Cleveland Clinic Foundation
Cleveland, Ohio [181]
S. Andrew Josephson, MD
Vice President Claude Killu, MD
Neurohospitalist Society Intensive Care
Carmen Castro-Franceschi and Gladyne K. Mitchell Distinguished Los Angeles Medical Center
Neurohospitalist Pro essorship Los Angeles, Cali ornia [125]
Vice Chairman, Parnassus Programs Director, Neurohospitalist
Program Emmanuel S. King, MD, FHM, FACP
Department o Neurology Associate Pro essor o Clinical Medicine
University o Cali ornia, San Francisco Perelman School o Medicine
San Francisco, Cali ornia [104] University o Pennsylvania
Director o Clinical Operations
Brian W. Kaebnick, MD Section o Hospital Medicine
Structural Cardiology Fellow Division o General Internal Medicine
Department o Cardiology Hospital o the University o Pennsylvania
Emory University Hospital Philadelphia, Pennsylvania [21]
Joyce E. King, MD
Stephen P. Kalhorn, MD Assistant Pro essor
Assistant Pro essor Neurosurgery Georgetown University School o Medicine
Medical University o South Carolina Washington, DC
Charleston, South Carolina [64] Clinical Instructor
University o Maryland Medical School
Jameela Kari, MD Director Inpatient Medicine
Pediatric Nephrology Unit Family Medicine Residency
Department o Pediatrics Medstar Franklin Square Medical Center
King Abdulaziz University Baltimore, Maryland [228]
Jeddah, Kingdom o Saudi Arabia [239]
Emad Kishi, MD
Assistant Pro essor o Surgery
Division o Abdominal Transplant
Department o Surgery
xxiii
Joshua P. Klein, MD, PhD Mark S. Lachs, MD, MPH
Associate Pro essor o Neurology and Radiology Irene and Roy Psaty Distinguished Pro essor o Medicine
Harvard Medical School Co-Chie o Geriatrics and Palliative Medicine
Chie , Division o Hospital Neurology Weill Cornell Medicine
Department o Neurology Director o Geriatrics
Brigham and Women’s Hospital New York Presbyterian Health System
Boston, Massachusetts [106] New York, New York [167]
Michael Klompas, MD, MPH Victoria D. Lackey, MD

Associate Pro essor Duke University School o Medicine
Department o Population Medicine Division o Rheumatology and Immunology
C
Harvard Medical School Duke University Medical Center
O
Division o In ectious Diseases Durham, North Carolina [249]
N
T
Joshua R. Lakin, MD
R
I
B
U
Christopher Knudson, MD Dana-Farber Cancer Institute
T
O
Instructor o Medicine Boston, Massachusetts [105]
R
S
Emory University School o Medicine Albert Q. Lam, MD
Atlanta, Georgia [90] Associate Physician
Division o Renal Medicine
Serena Koenig, MD, MPH Brigham and Women’s Hospital
Assistant Pro essor Harvard Medical School
Division o Global Health Equity
Division o In ectious Diseases Lindy H. Landzaat, DO, FAAHPM
Brigham and Women’s Hospital Assistant Pro essor
Boston, Massachusetts [205] Division o Palliative Medicine
University o Kansas Medical Center
Sophia Koo, MD Kansas City, Kansas [217]
Harvard Medical School Vijay H. Lapsia, MD, MBBS
Division o In ectious Diseases Assistant Pro essor o Medicine
Brigham and Women’s Hospital Mount Sinai School o Medicine
Boston, Massachusetts [201] New York, New York [238]
Makeida B. Koyi, MD Lucia Larson, MD, FACP

Deputy Director o Adult Inpatient Consultation Service Associate Pro essor o Medicine
Clinical Instructor Director
Community Psychiatry Program Division o Obstetric Medicine
Department o Psychiatry and Behavioral Sciences Women’s Medicine Collaborative
Johns Hopkins Bayview Medical Center The Alpert Medical School o Brown University
Baltimore, Maryland [81] Providence, Rhode Island [218]
Svetlana Krasnokutsky, MD, MS Jodi Layton, MD

Assistant Pro essor o Medicine Assistant Pro essor o Medicine
Co-Director The Warren Alpert Medical School o Brown University
NYU Crystal Diseases Study Group Hematology and Oncology
New York University School o Medicine Rhode Island Hospital Comprehensive Cancer Center
New York, New York [247] Providence, Rhode Island [180]
Harold Kudler, MD Brian Leber, MDCM, FRCPC

Adjunct Associate Pro essor Pro essor o Medicine
Department o Psychiatry and Behavioral Sciences McMaster University
Duke University Medical Center Attending Physician
Durham, North Carolina [224] Hamilton Health Sciences/Juravinski Hospital and Cancer Centre
Hamilton, Ontario, Canada [170]
Carlos E. Kummer eldt, MD
Sta Pulmonologist Noah Lechtzin, MD, MHS, FCCP
TJ Samson Community Hospital Assistant Pro essor
Glasgow, Kentucky [236] Director
Johns Hopkins Adult Cystic Fibrosis Program
Pulmonary Director
Johns Hopkins Amyotrophic Lateral Sclerosis Clinic
Pulmonary and Critical Care Medicine
Johns Hopkins University
xxiv
Ji Yeon Lee, MD David J. Likosky, MD, SFHM, FAHA, FACP
Pulmonary/Critical Care Fellow President
Emory University School o Medicine Neurohospitalist Society
Division o Pulmonary, Allergy, Critical Care &Sleep Medicine Medical Director
Atlanta, Georgia [235] EvergreenHealth Neuroscience Institute
Clinical Assistant Pro essor
Linda A. Lee, MD University o Washington
Clinical Director EvergreenHealth
Division o Gastroenterology and Hepatology Kirkland, Washington [104]
Johns Hopkins University School o Medicine
Director o Endoscopy Ming Y. Lim, MB BChir
C
Johns Hopkins Hospital Department o Medicine
O
Director Division o Hematology/Oncology
N
Johns Hopkins Integrative Medicine &Digestive Center Medical University o South Carolina
T
R
Lutherville, Maryland [80] Charleston, South Carolina [54]
I
B
U
Linda S. Lee, MD Walter Limehouse, MD, MA, FACEP
T
O
Assistant Pro essor o Medicine Associate Pro essor o Emergency Medicine
R
Harvard Medical School Medical University o South Carolina
S
Director Charleston, South Carolina [33]
Endoscopic Education and Women’s Health in GI
Co-Director Lori-Ann Linkins, MD, MSc (Clin Epi), FRCPC
Pancreas Center Associate Pro essor
Brigham and Women’s Hospital Department o Medicine
Boston, Massachusetts [161] Division o Hematology &Thromboembolism
McMaster University
Blair J. N. Leonard, MD, PhD, FRCP Juravinski Thromboembolism Service
Senior Hematology Fellow MF1 Director/MF1 Hematology Subunit Planner
McMaster University Michael G. DeGroote School o Medicine
Hamilton, Ontario, Canada [170] Thrombosis &Atherosclerosis Research Institute
William I. Levin, MD
Associate Pro essor o Medicine Ra ael H. Llinas, MD
Division o General Internal Medicine Associate Pro essor o Medicine
University o Pittsburgh School o Medicine Associate Pro essor o Neurology
Pittsburgh, Pennsylvania [60] Chairman o Neurology
Johns Hopkins Bayview Medical Center
Katherine Lewis, MD, MSCR Baltimore, Maryland [89]
Assistant Pro essor o Medicine and Pediatrics
The Medical University o South Carolina Hermioni N. Lokko, MD, MPP
Charleston, South Carolina [52] Clinical Fellow o Psychiatry
Cindy Lien, MD Administrative Chie Resident
Assistant Pro essor o Medicine Massachusetts General Hospital
Palliative Care Physician
Internal Medicine Hospitalist Lenny López, MD, MPH, MDiv
Beth Israel Deaconess Medical Center Associate Pro essor o Medicine
Boston, Massachusetts [216] Chie o Hospital Medicine
San Francisco VA Medical Center
Elaine Chiewlin Liew, MD, FRCA University o Cali ornia
Assistant Pro essor o Anesthesiology San Francisco, Cali ornia [3]
Department o Anesthesiology and Perioperative Medicine
David Ge en School o Medicine David J. Lucier, Jr., MD, MBA, MPH
University o Cali ornia, Los Angeles (UCLA) Instructor o Medicine
Ronald Reagan UCLA Medical Center Harvard Medical School
Los Angeles, Cali ornia [153] Director o Quality and Patient Sa ety
Hospital Medicine Group
Assistant in Medicine
Division o General Internal Medicine
Massachusetts General Hospital
xxv
Courtney H. Lyder, ND, ScD(Hon), FAAN Merry Jenni er Markham, MD
Pro essor o Nursing, Geriatric Medicine, and Public Health Associate Pro essor o Medicine
Dean Emeritus Division o Hematology and Oncology
School o Nursing Department o Medicine
University o Cali ornia University o Florida College o Medicine
Los Angeles, Cali ornia [72] Gainesville, Florida [175]
William L. Lyons, MD Alayne D. Markland, DO, MSc

Pro essor Associate Pro essor o Medicine
Division o Geriatrics and Gerontology Division o Gerontology, Geriatrics, and Palliative Care
Department o Internal Medicine University o Alabama at Birmingham
C
University o Nebraska Medical Center Birmingham, Alabama [71]
O
Omaha, Nebraska [165]
N
Greg S. Martin, MD, MSc, FACP, FCCP, FCCM
T
Elizabeth H. Mack, MD, MS Pro essor and Associate Division Director or Critical Care
R
I
B
Pediatric Critical Care Division o Pulmonary, Allergy, and Critical Care
U
Medical University o South Carolina Emory University School o Medicine
T
O
Charleston, South Carolina [19] Director o Research
R
Emory Critical Care Center
S
James H. Maguire, MD, MPH Section Chie , Grady Memorial Hospital
Pro essor o Medicine Atlanta, Georgia [142]
Senior Physician R. Kirk Mathews, MBA
Division o In ectious Diseases Partner, Schmidt
Brigham and Women’s Hospital Mathews LLC
Boston, Massachusetts [205] Providing Executive Search and Leadership
Development Services [24]
Rahul Maheshwari, MD
Gastroenterology Fellow Melissa Mattison, MD, SFHM, FACP
Division o Digestive Diseases Assistant Pro essor o Medicine
Emory University School o Medicine Harvard Medical School
Atlanta, Georgia [159] Chie , Hospital Medicine Unit
Scott Manaker, MD, PhD Boston, Massachusetts [168]
Associate Pro essor o Medicine, Pulmonary, Allergy, and Critical
Care Division Saverio M. Maviglia, MD, MSc
Vice Chair or Regulatory A airs Assistant Pro essor o Medicine
Department o Medicine Harvard Medical School
Perelman School o Medicine, University o Pennsylvania Hospitalist Service
Philadelphia, Pennsylvania [27] Brigham and Women’s Hospital
E rén Manjarrez, MD, SFHM
Chie , Division o Hospital Medicine Laura K. Max, BA
Associate Pro essor o Clinical Medicine Clinical Research Assistant
Miller School o Medicine Johns Hopkins School o Medicine
University o Miami Anesthesiology and Critical Care Medicine
Miami, Florida [37] Johns Hopkins Hospital
Kimberly D. Manning, MD, FACP, FAAP
Associate Pro essor o Medicine Matthew W. McCarthy, MD
Director Assistant Pro essor o Medicine
Distinction in Teaching and Leadership Weill Cornell Medicine
J. Willis Hurst Internal Medicine Residency Program Assistant Attending Physician
Department o Medicine NewYork-Presbyterian Hospital
Division o General Medicine and Geriatrics New York, New York [33]
Atlanta, Georgia [5] Michael McDaniel, MD, FSCAI
Michael Manogue, MD Emory University School o Medicine
Fellow in Cardiovascular Disease Director
Emory University School o Medicine Cardiac Catheterization Lab
Atlanta, Georgia [133, 135] Grady Health Systems
Gary Margolias, MD
Assistant Pro essor o Anesthesiology
xxvi
Timothy B. McDonald, MD, JD Karina Meijer, MD, PhD
Pro essor, Anesthesiology and Pediatrics Division o Haemostasis and Thrombosis
Chie Sa ety and Risk O cer or Health A airs Department o Haematology
University o Illinois University Medical Centre Groningen
Chicago, Illinois [20] Groningen, The Netherlands [173]
Andrew McFarlane, MLT, ART, FCSMLS(D) David Meltzer, MD, PhD

Technical Specialist Fanny L. Pritzker Pro essor o Medicine
Molecular Hematology and Red Cell Disorders Economics and Public Policy Chie
Lecturer McMaster University Section o Hospital Medicine
Department o Medicine Director, Center or Health and The Social Science
C
McMaster University Medical Centre The University o Chicago
O
Hamilton, Ontario, Canada [169] Chicago, Illinois [e2]
N
T
John W. McGillicuddy, MD, FACS Peter A. Merkel, MD, MPH
R
I
B
Associate Pro essor o Surgery Chie , Division o Rheumatology
U
Medical University o South Carolina Pro essor o Medicine and Epidemiology
T
O
Charleston, South Carolina [66] University o Pennsylvania
R
Philadelphia, Pennsylvania [257]
S
Gerard Michael McGorisk, MD, FACC, MRCPI
Assistant Pro essor o Medicine Joseph J. Miaskiewicz, Jr., MD, FCCP, SFHM
Emory University Assistant Clinical Pro essor
Atlanta, Georgia [132] Tu ts Medical School
Chie o Utilization Review and Clinical Documentation
Sylvia C. McKean, MD, SFHM, FACP Hospitalist
Deputy Editor or Editorial Projects, UpToDate North Shore Medical Center
Boston, Massachusetts [107, 112, 116, 123, 124, e4] Salem, Massachusetts [110, 122]
Graham T. McMahon, MD, MMSc Chad S. Miller, MD, FACP, FHM
Adjunct Pro essor Associate Pro essor
Northwestern University Division Director
Feinberg School o Medicine General Internal Medicine
President and Chie Executive O cer Saint Louis University School o Medicine
Accreditation Council or Continuing Medical Education St. Louis, Missouri [92, 94]
Chicago, Illinois [150]
Tracey A. Milligan, MD, MS, FAAN
Julia McNabb-Baltar, MD Assistant Pro essor o Medicine
Instructor o Medicine Harvard Medical School
Harvard Medical School Vice Chair or Education
Center or Pancreatic Disease Department o Neurology
Division o Gastroenterology, Hepatology, and Endoscopy Brigham and Women’s Hospital
Department o Medicine Boston, Massachusetts [211]
Boston, Massachusetts [157] Elinor Mody, MD
Division o Rheumatology
Thomas E. McNalley, MD Brigham and Women’s Hospital
Associate Pro essor Boston, Massachusetts [127]
University o Washington School o Medicine
Department o Rehabilitation Medicine Daniel L. Molloy, Jr., MD
Seattle Children’s Hospital Division o Cardiology
University o Washington Medical Center Emory University
Seattle, Washington [69] Atlanta, Georgia [130]
Jakob I. McSparron, MD Paul A. Monach, MD, PhD

Instructor in Medicine Chie , Rheumatology Section
Harvard Medical School VA Boston Healthcare System
Division o Pulmonary, Critical Care, and Sleep Medicine Associate Pro essor
Beth Israel Deaconess Medical Center Section o Rheumatology
Boston, Massachusetts [85] Boston University School o Medicine
Niharika D. Mehta, MD
Assistant Pro essor o Medicine Carmen Monzon, MD
The Warren Alpert Medical School o Brown University Clinical Assistant Pro essor o Psychiatry and Human Behavior
Director o Ambulatory services The Warren Alpert Medical School o Brown University
Division o Obstetric and Consultative Medicine Women’s Behavioral Medicine, Women’s Medicine Collaborative
Women and In ants Hospital o Rhode Island Miriam Hospital
Providence, Rhode Island [221] Providence, Rhode Island [221]
xxvii
Luis Fernando Mora, MD Jenni er S. Myers, MD, FACP, FHM
The Arrhythmia Center o South Florida Associate Pro essor o Clinical Medicine
Delray Beach, Florida [134] Department o Medicine
Division o General Internal Medicine
CoLette Morgan, MD, FHM, CCDS, CDIP Section o Hospital Medicine
Assistant Pro essor Perelman School o Medicine
Division o Hospital Medicine University o Pennsylvania
Department o Medicine Philadelphia, Pennsylvania [21]
Atlanta, Georgia [32] Satish N. Nadig, MD, PhD, FACS
Assistant Pro essor
Christopher Moriates, MD
C
Surgery, Microbiology, and Immunology
O
Assistant Clinical Pro essor Medical University o South Carolina
N
Division o Hospital Medicine Transplant Surgery
T
University o Cali ornia at San Francisco
R
I
B
Director o Caring Wisely Program
U
UCSF Center or Healthcare Value Amulya Nagarur, MD
T
O
San Francisco, Cali ornia Instructor in Medicine
R
Director o Implementation Initiatives Harvard Medical School
S
Costs o Care, Inc. Hospital Medicine Group
Boston, Massachusetts [2] Massachusetts General Hospital
Ala Moshiri, MD, PhD
Assistant Pro essor o Ophthalmology Peter Najjar, MD
Eye Center Resident
University o Cali ornia, Davis Department o Surgery
Sacramento, Cali ornia [83] Brigham and Women’s Hospital
John E. Moss, MD Boston, Massachusetts [44]
Department o Critical Care Medicine Dale M. Needham, MD, PhD, FCPA
Mayo Clinic Florida Pro essor
Jacksonville, Florida [137] Division o Pulmonary &Critical Care Medicine
Department o Physical Medicine &Rehabilitation
Srinivasan Mukundan, MD, PhD School o Medicine, Johns Hopkins University
Associate Pro essor o Radiology Baltimore, Maryland [81]
Boston, Massachusetts [113] John Nelson, MD, MHM
Overlake Medical Center
L. Silvia Munoz-Price, MD, PhD Nelson Flores Hospital Medicine Consultants
Associate Pro essor o Clinical Medicine Bellevue, Washington [24]
Institute or Health and Society
Medical College o Wisconsin Karin J. Neu eld, MD, MPH
Enterprise Epidemiologist Clinical Director o Psychiatry
Froedtert Health System Johns Hopkins Bayview Medical Center
Milwaukee, Wisconsin [185] Associate Pro essor
Johns Hopkins University School o Medicine
Mandakolathur R. Murali, MD Department o Psychiatry and Behavioral Sciences
Director o Clinical Immunology Laboratory Baltimore, Maryland [81]
Harvard Medical School Tobenna Nwizu, MD
Boston, Massachusetts [230] Taussig Cancer Institute
Cleveland Clinic Foundation
Ernest Murray, MD Cleveland, Ohio [181]
Hospital Medicine Section
General Internal Medicine and Geriatrics Christopher D. Ochoa, MD
Medical University o South Carolina Fellow
Charleston, South Carolina [250] Pulmonary and Critical Care Medicine
Daniel M. Musher, MD Atlanta, Georgia [232]
Distinguished Service Pro essor o Medicine
Pro essor o Molecular Virology and Microbiology Victor M. Orellana, MD
Chie Emeritus, In ectious Disease Section Department o Medicine
Michael E. DeBakey VA Medical Center Rhode Island Hospital
Houston, Texas [186] Providence, Rhode Island [174]
xxviii
Karin Ouchida, MD Nicholas J. Pastis, MD
Assistant Pro essor o Medicine Assistant Pro essor o Medicine
Weill Cornell Medical College Division o Pulmonary and Critical Care
New York Presbyterian Hospital Medical University o South Carolina
New York, New York [167] Charleston, South Carolina [236]
Thomas A. Owens, MD Vihas Patel, MD

Vice President or Medical A airs Instructor
Chie Medical O cer Department o Surgery
Duke University Health System Director
Associate Pro essor o Medicine and Pediatrics Metabolic Support Service
C
Duke University School o Medicine Brigham and Women’s Hospital
O
Durham, North Carolina [189] Division o Trauma, Burn, and Surgical Critical Care
N
T
David A. Oxman, MD, FACP
R
I
B
U
Sidney Kimmel Medical College Timothy J. Patton, DO
T
O
Medical Intensive Care Unit Assistant Pro essor o Dermatology
R
Thomas Je erson University Hospital University o Pittsburgh
S
Philadelphia, Pennsylvania [206] Pittsburgh, Pennsylvania [144]
Menaka Pai, MD, MSc, FRCPC Jill M. Paulson, MD

Associate Pro essor Assistant Pro essor o Endocrinology
Department o Medicine George Washington University School o Medicine.
Associate Member, Department o Pathology and Molecular George Washington Medical Faculty Associates
Medicine Washington, DC [152]
McMaster University
Trans usion Medicine Quality Lead and Consultant Laboratory Allan B. Peetz, MD
Hematologist Instructor
Hamilton Regional Laboratory Medicine Program Department o Surgery
Hamilton, Ontario, Canada [56, 252] Brigham and Women’s Hospital
Division o Trauma, Burn, and Surgical Critical Care
Sumanta K. Pal, MD Harvard Medical School
Assistant Pro essor and Co-Director Boston, Massachusetts [42-45]
Kidney Cancer Program
Department o Medical Oncology &Experimental Therapeutics Vincent D. Pellegrini, Jr., MD
City o Hope Comprehensive Cancer Center John A. Siegling Pro essor and Chair
Duarte, Cali ornia [179] Department o Orthopedics
Robert M. Palmer, MD Charleston, South Carolina [65]
Director
Glennan Center or Geriatrics and Gerontology Jason Persof , MD, SFHM
Eastern Virginia Medical School University o Colorado School o Medicine
Nor olk, Virginia [87] Hospital Medicine Group
Aurora, Colorado [137]
Anand K. Pandurangi, MD, MBBS, DABPN
Pro essor o Psychiatry and Adjunct Pro essor o Radiology Brent G. Petty, MD
Vice Chair, Department o Psychiatry and Chair, Division o The Johns Hopkins Hospital
Inpatient Psychiatry Baltimore, Maryland [9]
Virginia Commonwealth University (VCU) Kurt P ei er, MD, FACP, FHM
Medical Director Pro essor o Medicine
Inpatient Psychiatry General Internal Medicine
VCU Health System Medical College o Wisconsin
Richmond, Virginia [225] Milwaukee, Wisconsin [51]
Jonathan B. Parr, MD, MPH Tania J. Phillips, MD
University o North Carolina School o Medicine Pro essor o Dermatology
Division o In ectious Disease Boston University School o Medicine
Chapel Hill, North Carolina [203] Boston, Massachusetts [148]
Jenni er C. Passini, MD Edward F. Pilkington, III, MD
Clinical Assistant Pro essor Instructor o Medicine
Hospital Medicine Hospitalist Service
University o Wisconsin Department o Medicine Brigham and Women’s Hospital
Madison, Wisconsin [153] Boston, Massachusetts [189]
xxix
Michael H. Pillinger, MD Amir A. Qamar, MD
Pro essor o Medicine and Biochemistry and Molecular Assistant Pro essor o Medicine
Pharmacology Tu ts University School o Medicine
Co-Director Boston, Massachusetts Senior Sta Hepatologist
NYU Crystal Diseases Study Group Lahey Hospital and Medical Center
New York University School o Medicine Burlington, Massachusetts [53]
Rheumatology Section Chie
VA New York Harbor Health Care System, New York Campus Susan Y. Quan, MD [97]
New York, New York [247] Clinical Assistant Pro essor (A liated)
Stan ord University School o Medicine
J. Richard Pittman, Jr., MD, FACP Division o Gastroenterology and Hepatology
C
Assistant Pro essor o Medicine Veterans A airs Palo Alto Healthcare System
O
Division o General Medicine and Geriatrics Palo Alto, Cali ornia
N
T
Timothy R. Quinn, MD, CM
R
I
B
Atlanta, Georgia [11, 101] Medical Director o Dermatopathology
U
Dermpath Diagnostics New England
T
O
Carol Pohlig, RN, BSN, CPC Marlborough, Massachusetts [146]
R
Senior Coding and Education Specialist
S
O ce o Clinical Documentation Talat H. Raja, MD
Department o Medicine Instructor
Hospital o the University o Pennsylvania Hospital Medicine
Philadelphia, Pennsylvania [27] Division o General Internal Medicine and Geriatrics
Timothy J. Poterucha, MD Charleston, South Carolina [82]
Resident Physician and Clinical Fellow
Harvard Medical School Graham W. Redgrave, MD
Department o Medicine Assistant Pro essor o Psychiatry and Behavioral Sciences
Brigham and Women’s Hospital Director or Residency Education
Boston, Massachusetts [108] Johns Hopkins School o Medicine
Assistant Director
Raymond O. Powrie, MD, FRCP, FACP Eating Disorders Program
Pro essor o Obstetrics, Gynecology, and Medicine The Johns Hopkins Hospital
Alpert School o Medicine o Brown University Baltimore, Maryland [226]
Chie Medical Quality O cer
Care New England John J. Reilly, Jr., MD
SVP or Population Health Vice Chancellor or Health A airs
Chie o Medicine Dean or School o Medicine
Women &In ants Hospital o Rhode Island University o Colorado School o Medicine
Providence, Rhode Island [219] Aurora, Colorado [60]
Michaella Maloney Prasad, MD Kerry Reynolds, MD

Assistant Pro essor o Urology and Pediatrics Instructor in Medicine
Medical University o South Carolina Harvard Medical School
Charleston, South Carolina [67] Attending Physician
Massachusetts General Hospital Cancer Center
Alicia Privette, MD Boston, Massachusetts [177, 183]
Assistant Pro essor o Surgery
Medical University o South Carolina Joseph Rhatigan, MD
Department o Surgery Associate Pro essor o Medicine
Charleston, South Carolina [46] Harvard Medical School
Division o Global Health Equity
Alberto Puig, MD, PhD, FACP Brigham and Women’s Hospital
Associate Pro essor o Medicine Boston, Massachusetts [e1]
Director Jessica Rimsans, PharmD, BCPS
Clinician Educator Service Senior Clinical Pharmacist
Massachusetts General Hospital Hemostatic and Antithrombotic Stewardship Pharmacist
Boston, Massachusetts [38] Brigham and Women’s Hospital
Rana C. Pullatt, MD, MS, MRCS, FACS, FASMBS
Diplomate in Obesity Medicine Tina Rizack, MD, MPH
Associate Pro essor o Surgery Assistant Pro essor o Medicine and Obstetrics and Gynecology
Director Robotic Surgery The Warren Alpert Medical School o Brown University
Director Bariatric Surgery VISN-7 Hematology/Oncology
Medical University o South Carolina Program in Women’s Oncology
Charleston, South Carolina [63] Women &In ants Hospital
xxx
Malcolm K. Robinson, MD Bradley T. Rosen, MD, MBA, FHM
Assistant Pro essor o Surgery Medical Director
Harvard Medical School ISP Hospitalist Service
Director Medical Director
Nutrition Support Service Supportive Care Medicine (Palliative Care)
Brigham and Women’s Hospital Director
Boston, Massachusetts [58] Care Transitions and Complex Medical Management
Associate Pro essor, Cedars-Sinai Medical Center
Katina Robison, MD Associate Pro essor, UCLA School o Medicine
Assistant Pro essor o Obstetrics and Gynecology Cedars-Sinai Health System
Program in Women’s Oncology Los Angeles, Cali ornia [120]
C
Department o Obstetrics and Gynecology, Women &
O
In ants’Hospital o Rhode Island Karen Rosene -Montella, MD, FACP
N
The Warren Alpert Medical School o Brown University Senior Vice President
T
R
Providence, Rhode Island [178] Vice Chair o Medicine or Quality/Outcomes
I
B
Division Chie Obstetric Medicine
U
Thomas P. Rocco, MD
T
Pro essor o Medicine and Obstetrics and Gynecology
O
Associate Pro essor o Medicine The Warren Alpert Medical School at Brown University
R
S
Providence, Rhode Island [219, 221, 222]
Clare Rock, MD, MS, MRCPI Assistant Pro essor o Medicine
Department o Medicine Harvard Medical School
Division o In ectious Diseases Hospitalist Service
Johns Hopkins University Brigham and Women’s Hospital
Baltimore, Maryland [195] Boston, Massachusetts [197, 201, 212]
Sarahi Rodríguez-Pérez, MD Stephen R. Rotman, MD
Director o Clinical Operations Gastroenterology Fellow
Assistant Pro essor o Clinical Medicine Brigham and Women’s Hospital
Miller School o Medicine Boston, Massachusetts [156]
University o Miami Hospital Joseph Rudolph, MD
Miami, Florida [37] Department o Neurology
Cleveland Clinic
Vinayak S. Rohan, MD Cleveland, Ohio [210]
Department o Surgery
Medical University o South Carolina Matthew L. Russell, MD, MSc
Charleston, South Carolina [66] Medical Director
Rehabilitation Service Units
Karen L. Roos, MD Hebrew Rehabilitation Center
John and Nancy Nelson Pro essor o Neurology Hebrew Senior Li e
Pro essor o Neurological Surgery Boston, Massachusetts [73]
Indiana University School o Medicine
Indianapolis, Indiana [192] Daniel F. Ruthven, MD
Clinical Associate o Psychiatry and Behavioral Sciences
Alexander E. Ropper, MD Johns Hopkins University School o Medicine
Assistant Pro essor Baltimore, Maryland [226]
Department o Neurosurgery
Baylor College o Medicine Arturo P. Saavedra, MD, PhD
Houston, Texas [208] Assistant Pro essor
Allan H. Ropper, MD, FRCP Medical Director
Pro essor o Neurology Medical Dermatology
Harvard Medical School Massachusetts General Hospital
Executive Vice Chair o Neurology Boston, Massachusetts [145]
Boston, Massachusetts [208, 212] Michel J. Sabbagh, MD
Assistant Pro essor
Anesthesia and Perioperative Medicine
Cheryl A. Sadow, MD
Assistant Pro essor o Radiology
Division o Abdominal Imaging and Intervention
xxxi
Bisan A. Salhi, MD, MA Jef rey L. Schnipper, MD, MPH, FHM
Assistant Pro essor o Emergency Medicine Associate Pro essor o Medicine
Emory University Harvard Medical School
Department o Emergency Medicine Director o Clinical Research, Hospitalist Service
Atlanta, Georgia [121] Brigham and Women’s Hospital
Boston, Massachusetts [40, 151]
John R. Saltzman, MD, FACP, FACG, FASGE, AGAF
Associate Pro essor o Medicine Robert W. Schrier, MD, MACP
Harvard Medical School Pro essor Emeritus o Medicine
Director o Endoscopy University o Colorado School o Medicine
Brigham and Women’s Hospital Division o Renal Diseases and Hypertension
C
Boston, Massachusetts [156, 162] University o Colorado Hospital
O
Aurora, Colorado [242]
N
Kenneth Sands, MD, MPH
T
Associate Pro essor o Medicine Allison R. Schulman, MD
R
I
B
Harvard Medical School Gastroenterology Fellow
U
Senior Vice President, Health Care Quality Brigham and Women’s Hospital
T
O
Beth Israel Deaconess Medical Center Boston, Massachusetts [158]
R
S
David A. Schulman, MD, MPH, FCCP
Milda Saunders, MD, MPH Associate Pro essor o Medicine
Assistant Pro essor Division o Pulmonary, Allergy Critical Care, and Sleep Medicine
Section o Hospital Medicine and MacLean Center or Clinical Emory University School o Medicine
Medical Ethics Atlanta, Georgia [235]
University o Chicago Sam Schulman, MD, PhD
Chicago, Illinois [e3] Thrombosis Service, McMaster Clinic
Hamilton Health Sciences-General Hospital
Marianne E. Savastano, MS, CCC-SLP Hamilton, Ontario, Canada [173]
Speech/Language Pathology Practice Leader
Stroke and Spinal Cord Injury Programs Richard M. Schwartzstein, MD
Spaulding Rehabilitation Hospital Gordon Pro essor o Medicine and Medical Education
Boston, Massachusetts [70] Harvard Medical School
Associate Chie , Division o Pulmonary, Critical Care, and
Paul E. Sax, MD Sleep Medicine
Pro essor o Medicine Beth Israel Deaconess Medical Center
Division o In ectious Diseases Julian L. Sei ter, MD
Boston, Massachusetts [203] Harvard Medical School
Senior Nephrologist and the James Haidas Family Master Clinician
Adam C. Schaf er, MD Brigham and Women’s Hospital
Instructor in Medicine Boston, Massachusetts [61]
Hospital Medicine Unit Samir K. Shah, MD
Brigham and Women’s Hospital Division o Vascular Surgery
Boston, Massachusetts [35, 111] Brigham and Women’s Hospital
Chie Quality O cer and Hospitalist Daniel S. Shapiro, MD
Associate Pro essor o Medicine Pro essor o Internal Medicine
Medical University o South Carolina University o Nevada School o Medicine
Charleston, South Carolina [82, 190] Reno, Nevada [e5]
Lynn Schlanger, MD Ann M. Sheehy, MD, MS

Associate Pro essor Associate Pro essor and Division Head, Hospital Medicine
Emory University School o Medicine Department o Medicine
Atlanta, Georgia [241] University o Wisconsin
Madison, Wisconsin [153]
Robert K. Schneider, MD, FACP
Associate Pro essor Eugenie Shieh, MD
Departments o Psychiatry, Internal Medicine, and Family Medicine Clinical Fellow
Virginia Commonwealth University Johns Hopkins Medicine
Director o Mental Health and Primary Care Integration Division o Gastroenterology
McGuire VA Medical Center Baltimore, Maryland [80]
Richmond, Virginia [227]
xxxii
Deborah M. Siegal, MD, MSc, FRCPC Scot T. Smith, MD
Division o Hematology and Thromboembolism Chie Medical O cer
Department o Medicine Sound Physicians
McMaster University Denver, Colorado [25]
Diana L. Snow, MA, CCS, CPC, CHC
Eric M. Siegal, MD, SFHM Director o Revenue Integrity &Quality
Clinical Associate Pro essor o Medicine (Adjunct) University o Utah Healthcare
University o Wisconsin School o Medicine and Public Health University o Utah School o Medicine
Medical Director Salt Lake City, Utah [31]
Aurora Critical Care Service
David R. Snydman, MD, FACP, FIDSA
C
Aurora St Luke’s Medical Center
O
Milwaukee, Wisconsin [138] Pro essor
N
Tu ts University School o Medicine
T
Mark Siegler, MD Chie , Division o Geographic Medicine and In ectious Diseases
R
I
B
Lindy Bergman Distinguished Service Pro essor Hospital Epidemiologist
U
Pro essor, Departments o Medicine and Surgery Tu ts Medical Center
T
O
Director Boston, Massachusetts [191]
R
MacLean Center or Clinical Medical Ethics
S
University o Chicago Medical Center Society o Hospital Medicine Key Characteristics
Chicago, Illinois [e3] Workgroup [24]
Members o the Society o Hospital Medicine Key Characteristics
Ross D. Silverman, JD, MPH Workgroup are Patrick Cawley, MD, Steven Deitelzweig, MD, Leslie
Pro essor o Health Policy and Management Flores, MHA, Joseph Miller, MS, John Nelson, MD, Scott Rissmiller,
Indiana University Richard M. Fairbanks School o Public Health MD, Laurence Wellikson, MD, and Winthrop Whitcomb, MD
Pro essor o Public Health and Law
Indiana University Robert H. McKinney School o Law Aaron Sodickson, MD, PhD
Indianapolis, Indiana [34] Associate Pro essor o Radiology
Christian T. Sinclair, MD, FAAHPM Section Chie o Emergency Radiology
Assistant Pro essor Medical Director o CT
Division o Palliative Medicine Brigham and Women’s Hospital
University o Kansas Medical Center Boston, Massachusetts [113]
Kansas City, Kansas [217]
Lauge Sokol-Hessner, MD
Ajay K. Singh, MBBS, MBA, FRCP Instructor in Medicine
Renal Division Harvard Medical School
Brigham and Women’s Hospital Associate Director o Inpatient Quality
Boston, Massachusetts [239] Attending Hospitalist
Beth Israel Deaconess Medical Center
Anika T. Singh Boston, Massachusetts [16]
Renal Division
Brigham and Women’s Hospital Margarita Sotelo, MD
Boston, Massachusetts [239] Associate Clinical Pro essor
Divisions o Geriatrics and Hospital Medicine
Mousumi Sircar, MD San Francisco General Hospital
Geriatrics Fellow
San Francisco, Cali ornia [165]
Department o Gerontology Geof rey L. Southmayd, MD
Beth Israel Deaconess Medical Center Instructor o Medicine
Boston, Massachusetts [73] Emory University School o Medicine
Chie Medical Resident, Emory University Hospital
Gerald W. Smetana, MD, FACP J. Willis Hurst Internal Medicine Residency Program
Division o General Medicine and Primary Care Nathan Spell, MD
Beth Israel Deaconess Medical Center Associate Pro essor o Medicine
Boston, Massachusetts [51] Emory University School o Medicine
Chie Quality O cer
Dustin T. Smith, MD Emory University Hospital
Atlanta, Georgia [8, 10]
Kelly Cunningham Sponsler, MD, SFHM
Robert L. Smith, MD Assistant Pro essor o Medicine
Associate Pro essor
Section o Hospital Medicine
Division o Pulmonary and Critical Care
Vanderbilt University Medical Center
New York University School o Medicine
Nashville, Tennessee [14]
Harbor VA Medical Center
New York, New York [141]
xxxiii
Jerry E. Squires, MD, PhD Ashley Stuckey, MD
Department o Pathology and Laboratory Medicine Assistant Pro essor o Obstetrics and Gynecology
Medical University o South Carolina Program in Women’s Oncology
Charleston, South Carolina [57] The Warren Alpert Medical School o Brown University
Department o Obstetrics and Gynecology
Christopher J. Standaert, MD Women &In ants’Hospital o Rhode Island
Clinical Associate Pro essor Providence, Rhode Island [178]
Rehabilitation Medicine, Neurological Surgery, and Orthopedics
and Sports Medicine Prem S. Subramanian, MD, PhD
University o Washington School o Medicine Pro essor o Ophthalmology, Neurology, and Neurosurgery
University o Washington Medicine Sports and Spine Physicians Vice Chair or Academic A airs, Department o Ophthalmology
C
Clinic University o Colorado School o Medicine
O
Harborview Medical Center Aurora, Colorado [83]
N
Seattle, Washington [69]
T
Ram M. Subramanian, MD
R
I
Gerald W. Staton, MD
B
Associate Pro essor o Medicine and Surgery
U
Pro essor o Medicine Hepatology and Critical Care
T
O
Division o Pulmonary and Emory University School o Medicine
R
Critical Care Medicine Atlanta, Georgia [159]
S
Emory University School o Medicine Katelyn W. Sylvester, PharmD, BCPS, CACP
Atlanta, Georgia [232] Pharmacy Manager
Clinical Pharmacy Specialist
Arlene Stecenko, MD Brigham and Women’s Hospital
Associate Pro essor o Pediatrics and Medicine Boston, Massachusetts [254]
Chie , Division o Pulmonary, Allergy and Immunology,
Cystic Fibrosis and Sleep Jef rey A. Tabas, MD
Department o Pediatrics Pro essor o Emergency Medicine
Director Director o Outcomes and Innovations
Emory-Children’s Center or Cystic Fibrosis O ce o Continuing Medical Education
Associate Director University o Cali ornia
Emory-Children’s Center or Cystic Fibrosis and Airways San Francisco School o Medicine
Disease Research San Francisco, Cali ornia [36]
Emory University School o Medicine Jenni er K. Tan, MD
Atlanta, Georgia [234] Associate Physician
Daniel I. Steinberg, MD Northstar Dermatology
Mount Sinai Beth Israel Fort Worth, Texas [149]
New York, New York [7] Todd A. Taylor, MD
Michael Sterling, MD Assistant Pro essor o Emergency Medicine
Assistant Pro essor o Medicine Emory University
Division o Pulmonary, Allergy and Critical Care Medicine Atlanta, Georgia [121]
Emory University School o Medicine Tracy J. Tipton, MD
Atlanta, Georgia [139] Urology Resident
Theodore A. Stern, MD Medical University o South Carolina
Ned H. Cassem Pro essor o Psychiatry in the eld o Charleston, South Carolina [67]
Psychosomatic Medicine/Consultation Catherine Dawson Tobin, MD
Harvard Medical School Assistant Pro essor
Chie , Avery D. Weisman Psychiatry Consultation Service Anesthesia and Perioperative Medicine
Massachusetts General Hospital Medical University o South Carolina
Director Charleston, South Carolina [62]
O ce or Clinical Careers
Massachusetts General Hospital Derrick J. Todd, MD, PhD
Boston, Massachusetts [229] Instructor in Medicine
Melissa B. Stevens, MD Division o Rheumatology
Assistant Pro essor o Medicine Brigham and Women’s Hospital
Division o Hospital Medicine Boston, Massachusetts [246]
Atlanta, Georgia David Tong, MD, MPH
Atlanta VA Medical Center Assistant Pro essor o Hospital Medicine
Decatur, Georgia [12] Department o Medicine
xxxiv
Anne C. Travis, MD, MSc Madeleine Verhovsek, MD, FRCPC
Department o Medicine Assistant Pro essor
Division o Gastroenterology, Hepatology and Endoscopy Division o Hematology and Thromboembolism
Brigham and Women’s Hospital McMaster University
Boston, Massachusetts [162] Consultant Laboratory Hematologist, Red Cell Disorders Laboratory,
Hamilton Regional
Glenn J. Treisman, MD, PhD Laboratory Medicine Program
Eugene Meyer, III Pro essor o Psychiatry and Medicine Hamilton, Ontario, Canada [77, 169]
Departments o Psychiatry and Behavioral Sciences and
Internal Medicine Donald C. Vinh, MD, FRCPC, FACP
Johns Hopkins University School o Medicine Assistant Pro essor
C
Baltimore, Maryland [228] Faculty o Medicine
O
McGill University
N
Elly Trepman, MD Division o In ectious Diseases, Department o Medicine
T
Department o Medical Microbiology
R
McGill University Health Centre
I
B
University o Manitoba Montreal, Quebec, Canada [202]
U
Winnipeg, Manitoba, Canada [147]
T
O
Kittane S. Vishnupriya, MBBS
Geof rey Tsaras, MB, ChB, MPH
R
S
Clinical Assistant Pro essor o Medicine Johns Hopkins University School o Medicine
University o Illinois College o Medicine at Rock ord Baltimore, Maryland [79]
Rock ord, Illinois [194]
Ruth Ann Vleugels, MD, MPH
Jef rey Turner, MD Associate Pro essor o Medicine
Assistant Pro essor o Medicine Harvard Medical School
Section o Nephrology Director
Yale University School o Medicine Autoimmune Skin Disease Program
New Haven, Connecticut [245] Department o Dermatology
Amit Uppal, MD Brigham and Women’s Hospital
Assistant Program Director Boston, Massachusetts [149]
Director o MICU Megan Ann Waldrop, MD
Bellevue Hospital Pediatric Neurology Fellow
Division o Pulmonary, Critical Care, and Sleep Medicine University o Cali ornia, Irvine
New York University Medical Center Children’s Hospital o Orange County
New York, New York [140] Orange, Cali ornia [213]
W. Alexander Vandergri t, III, MD Ruth H. Walker, MB, ChB, PhD
Associate Pro essor Neurosurgery Departments o Neurology
Medical University o South Carolina James J. Peters Veterans A airs Medical Center, Bronx, NY
Charleston, South Carolina [64] Mount Sinai School o Medicine
Joseph Varon, MD, FACP, FCCP, FCCM, FRSM New York, New York [210]
Chie o Critical Care Services Leon Walthall, MD
University General Hospital Hospital Medicine Section
Pro essor General Internal Medicine and Geriatrics
Department o Acute and Continuing Care Medical University o South Carolina
University o Texas Health Science Center at Houston Charleston, South Carolina [250]
Clinical Pro essor o Medicine
University o Texas Medical Branch at Galveston David A. Walton, MD, MPH
Pro essor o Medicine and Surgery UDEM, UNE, UABC, UAT, Division o Global Health
Anahuac, UACH, USON, UPAEP – Mexico [91] Brigham and Women’s Hospital
Boston, Massachusetts [e1]
Alvaro Velasquez, MD
Assistant Pro essor o Medicine John Scott Walton, MD
Division o Critical Care and Respiratory Medicine Associate Pro essor
Emory University School o Medicine Anesthesia and Perioperative Medicine
Atlanta, Georgia [90] Medical University o South Carolina
Nicole F. Velez, MD
Westmoreland Dermatology Associates
University o Pittsburgh Medical Center East
Pittsburgh, Pennsylvania [145]
xxxv
Annabel Kim Wang, MD Tosha B. Wetterneck, MD, MS
Associate Pro essor (Neurology) Department o Medicine
University o Cali ornia, Irvine School o Medicine and Public Health
Orange, Cali ornia Center or Quality and Productivity Improvement
Sta Neurologist University o Wisconsin Madison
VA Long Beach Healthcare System Madison, Wisconsin [41]
Long Beach, Cali ornia [213]
Omar Wever-Pinzon, MD
Sally Wang, MD Assistant Pro essor o Medicine
Instructor University o Utah School o Medicine
Harvard Medical School Department o Medicine, Cardiology Division,
C
Hospitalist Heart Failure Section
O
Brigham and Women’s Hospital University o Utah Health Science Center
N
Boston, Massachusetts [126] Salt Lake City, Utah [129]
T
R
I
Martha C. Ward, MD Christopher M. Whinney, MD, FACP, FHM
B
U
Assistant Pro essor Clinical Assistant Pro essor o Medicine
T
O
Department o Psychiatry and Behavioral Sciences Cleveland Clinic Lerner College o Medicine
R
Department o Medicine Chairman, Department o Hospital Medicine
S
Society Advisor, Osler Society Cleveland Clinic
Assistant Course Director Cleveland, Ohio [4]
Essentials o Patient Care Course
Emory University School o Medicine I. David Wiener, MD
Atlanta, Georgia [223] Pro essor o Medicine and Physiology and Functional Genomics
University o Florida College o Medicine
Theodore E. Warkentin, MD, FRCP(C), FACP, FRCP(Edin) Chie , Nephrology and Hypertension Section
Pro essor Gainesville VA Medical Center
Department o Pathology and Molecular Medicine and Department Gainesville, Florida [238]
o Medicine Michael G. DeGroote School o Medicine
McMaster University Jef rey G. Wiese, MD, FACP, FSM, SFHM
Trans usion Medicine, Hamilton Regional Laboratory Medicine Pro essor o Medicine
Program Tulane University
Service o Clinical Hematology, Associate Chairman, Department o Medicine
Hamilton General Hospital Senior Associate Dean or Graduate Medical Education
Hamilton, Ontario, Canada [171] Director
Tulane Internal Medicine Program
Kathryn Webert, MD, MSc, FRCPC Tulane University Health Sciences Center
Associate Pro essor New Orleans, Louisiana [92, 94]
Department o Pathology and Molecular Medicine
McMaster University B. Robinson Williams, III, MD
Medical Director, Utilization Assistant Pro essor o Medicine
Canadian Blood Services Program Director
Hamilton, Ontario, Canada [172] Cardiovascular Disease Fellowship
Steven Weinberger, MD, FACP Atlanta, Georgia [135]
Executive Vice President and CEO
American College o Physicians Neil H. Winawer, MD, SFHM
Adjunct Pro essor o Medicine Pro essor o Medicine
University o Pennsylvania Emory University School o Medicine
Philadelphia, Pennsylvania Director
Senior Lecturer on Medicine Hospital Medicine Unit
Harvard Medical School Grady Memorial Hospital
Boston, Massachusetts [6] Atlanta, Georgia [230]
Saul N. Weingart, MD, PhD Eric S. Winer, MD

Chie Medical O cer and Senior VP Medical A airs Division o Hematology/Oncology
Tu ts Medical Center Rhode Island Hospital
Pro essor o Medicine Providence, Rhode Island [174]
Tu ts University School o Medicine Kristin R. Wise, MD, FHM
Boston, Massachusetts [15] Assistant Pro essor o Medicine
Stacy Westerman, MD, MPH Hospital Medicine Section, General Internal Medicine and Geriatrics
Fellow, Cardiovascular Disease Medical University o South Carolina
Department o Medicine, Division o Cardiology Charleston, South Carolina [250]
xxxvi
Karl D. Wittnebel, MD, MPH Brian K. Yorkgitis, DO
Medical Director Assistant Pro essor
Pre-Operative Pain Program Department o Surgery
Department o Medicine University o Florida College o Medicine-Jacksonville
Cedars-Sinai Medical Center Jacksonville, Florida [43]
Hospitalist
Division o General Internal Medicine Bishoy Zakhary, MD
Cedars-Sinai Medical Center Pulmonary and Critical Care Fellow
Los Angeles, Cali ornia [120] Department o Pulmonary, Critical Care, and Sleep Medicine
New York University Medical Center
Brian D. Wol e, MD New York, New York [140]
C
O
Hospital Medicine Section Shanta M. Zimmer, MD
N
University o Colorado Denver Associate Pro essor o Medicine
T
University o Pittsburgh
R
University o Colorado Hospital
I
B
Aurora, Colorado [59] Director
U
Internal Medicine Residency Training Program
T
O
Kenneth E. Wood, DO, FCCP University o Pittsburgh Medical Center
R
Chie Medical O cer Pittsburgh, Pennsylvania [88]
S
Geisinger Medical Center
Director Camilla Zimmermann, MD, PhD, FRCPC
Center or Systems Re-engineering in Healthcare, Geisinger Head, Palliative Care Program
Health System University Health Network
Clinical Pro essor o Medicine Director o Research
Temple University School o Medicine Lederman Palliative Care Centre
Geisinger Medical Center Princess Margaret Hospital
Danville, Pennsylvania [153] Associate Pro essor o Medicine
University o Toronto
Rollin Wright, MD Toronto, Ontario, Canada [215]
Division o Geriatric Medicine and Gerontology
University o Pittsburgh
Pittsburgh, Pennsylvania [87]
Irene M. Yeh, MD, MPH

Division o Adult Palliative Care
Dana-Farber Cancer Institute
xxxvii
SECTION REVIEWERS
Joanna M. Bonsall, MD, PhD Don S. Dizon, MD, FACP
Assistant Pro essor o Medicine Associate Pro essor o Medicine
Division o Hospital Medicine Harvard Medical School
Emory University School o Medicine Clinical Co-Director, Gynecologic Oncology
S
E
Atlanta, Georgia Director
C
Part I, Section 3 The Oncology Sexual Health Clinic
T
I
Massachusetts General Hospital Cancer Center
O
Yvette M. Cua, MD
N
Associate Pro essor o Medicine Part VI, Section 7
R
E
V
Associate Vice Chair or Clinical A airs Francine L. Jacobson, MD, MPH
I
E
Department o Medicine Thoracic Radiologist at Brigham and Women’s Hospital
W
University o Louisville Assistant Pro essor
E
R
Louisville, Kentucky Department o Radiology
S
Part I, Section 6 Harvard Medical School
Jatin K. Dave, MD, MPH Part V, Section 2
Part-Time Instructor
Harvard Medical School Tina Rizack, MD, MPH
Division o Aging, Brigham and Women’s Hospital Assistant Pro essor o Medicine and Obstetrics and Gynecology
Boston, Massachusetts The Warren Alpert Medical School o Brown University
Medical Director Hematology/Oncology
Geriatrics and Senior Care Options Program in Women’s Oncology
Tu ts Health Plan Women &In ants Hospital
Watertown, Massachusetts Providence, Rhode Island
Part III Part VI, Section 7
Steven B. Deitelzweig, MD, MMM, SFHM, FACP Karen Rosene -Montella, MD, FACP
Ochsner Health System Senior Vice President
Medical Director o Regional Business Development Women’s Services and Clinical Integration, Li espan
System Chairman, Hospital Medicine Vice Chair o Medicine or Quality/Outcomes
Associate Pro essor o Medicine-Ochsner Clinical School Division Chie Obstetric Medicine
Part I, Section 5 Pro essor o Medicine and Obstetrics and Gynecology
The Warren Alpert Medical School at Brown University
Providence, Rhode Island
Part VI, Section 12
Dustin T. Smith, MD
Atlanta, Georgia
Part I, Section 2
xxxix
FOREWORD
I well remember reading the landmark article by Wachter and important topics in both clinical and nonclinical areas, ranging rom
Goldman entitled “The emerging role o ‘hospitalists’ in the value-based medicine to transplant surgery consultation. The sec-
American health care system,” published in the New England Journal tion on billing, coding, and clinical documentation has been greatly
of Medicine in 1996.1 In this article, the authors recognized the need expanded, as has coverage o a wide host o malignancies. Because
F
or “a new breed o physicians … specialists in inpatient medicine” o the importance o the recovery period and transitions to a variety
O
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and coined the term “hospitalist” to re er to this new type o physi- o settings a ter hospital discharge, a welcome new section on reha-
E
cian specialist. Since then, the specialty o hospital medicine has bilitation and skilled nursing care has also been added.
W
become an increasingly popular and success ul career pathway, The editors and authors are to be congratulated on again having
O
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and has expanded beyond its roots in internal medicine to other made a major contribution to the care o hospitalized patients and
D
disciplines, such as pediatrics, amily practice, and obstetrics. The to those physicians, whether or not they ormally identi y them-
Society o Hospital Medicine estimated there were approximately selves as hospitalists, who care or these patients. Given the breadth
44,000 hospitalists in the United States in 2014, and predicted that and the depth o this text, there are ew questions that clinicians
number will continue to grow.2 will not be able to answer or guidance that they will not be able to
When hospital medicine started, the expertise o hospitalists was obtain about how to provide the best care or the wide spectrum o
ocused on the clinical issues surrounding care o the hospitalized their hospitalized patients.
patient. More recently, there has been increasing emphasis on the Steven E. Weinberger, MD, MACP, FRCP
hospitalist’s role in designing and improving the systems o care Executive Vice President and Chie Executive O cer
in the hospital. These added responsibilities have necessitated an American College o Physicians
expansion o the hospitalist’s skills set beyond just a clinical knowl- Adjunct Pro essor o Medicine
edge base to an understanding o such topics as teamwork, transi- Perelman School o Medicine at the University o Pennsylvania
tions o care, quality metrics and improvement, and patient sa ety, Senior Lecturer on Medicine
among many others. A consequence o this proli eration o speci c Harvard Medical School
competencies has been the creation o an optional pathway or
internal medicine hospitalists to maintain their certi cation with the
American Board o Internal Medicine, o cially re erred to as Focused
Practice in Hospital Medicine. REFERENCES
In the rst edition o Principles and Practice of Hospital Medicine,
1. Wachter RM, Goldman L. The emerging role o “hospitalists” in
McKean and her co-editors took on the herculean task o assem-
the American health care system. N Engl J Med. 1996;335:514-517.
bling an outstanding group o contributing authors and putting
together a superb, comprehensive textbook o hospital medicine 2. Bureau o Labor Statistics. http://www.bls.gov/careeroutlook/
that was published in 2012. In this second edition, the editors 2015/youre-a-what/hospitalist.htm . Accessed April 12, 2016.
have not only updated content but have also added a number o
xli
PREFACE
Since its initial publication in 2012, Principles and Practice of Hospital concentrates on what the consulting hospitalist needs to know
Medicine has become established as a leading resource or the when consulting on patients undergoing bariatric surgery, neuro-
specialty o hospital medicine. More than 200 renowned generalists surgery, orthopedic surgery, transplant surgery and urologic proce-
and specialists contributed to make this book comprehensive and dures. All chapters ocus on problems commonly encountered in
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authoritative, but as practical as possible. Clinical chapters presented the hospital setting, such as assessment and management o the
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questions that commonly arise in the course o practice and empha- diabetic patient, risk assessment and risk reduction or patients with
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sized core concepts with well-illustrated subject matter, radiology, end-stage liver disease, and preoperative assessment o patients
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clinical images and quick-view decision trees. The scope o content with hematologic disorders.
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de ned most o the eld o hospital medicine as it existed in 2012, Part III: Rehabilitation and Skilled Nursing Care. This new part,
and the ormat o the text itsel was enhanced both with an online written primarily by experts in rehabilitation medicine, provides
edition available through the widely used AccessMedicine.com, and key in ormation that hospitalists need to consider as they work to
an app version or use on iPad. ensure sa e transitions rom the inpatient setting to extended care
Since the publication o the rst edition, the eld o hospital acilities. Individual chapters address rehabilitation options, physi-
medicine has continued to evolve into areas beyond evidence- cal and occupation therapy, common issues such as bowel and
based general medical care into the practice o co-management bladder incontinence, dysphagia, pressure ulcers, care o surgical
o surgical and medical subspecialties, rehabilitation medicine, and wounds and pressure ulcers. The chapter on patient sa ety and quality
palliative care. Driven by quality improvement e orts, as well as improvement emphasizes core concepts embraced by hospitalists—
reimbursement models such as bundled payments, the last ew the multidisciplinary approach, prevention o complications, and
years have seen an increased emphasis on coordination o care patient-centered communication in the transition o patients to
between acute care hospitals and other settings, including skilled and rom the post-acute setting. The chapter on hospice ocuses on
nursing acilities, rehabilitation acilities, and long-term acute care common issues that clinicians need to address as they shi t toward
acilities. The rapid growth o the eld has been accompanied by an palliative care and consider the best setting or their patients.
emerging cadre o outstanding clinicians and leaders, both at the Part IV: Approach to the Patient at the Bedside. These chap-
local, national, and international level, and this book is the product ters provide detailed guidance or the initial inpatient evaluation,
o their collective e orts. diagnostic testing, and management o patients with common
The second edition o Principles and Practice of Hospital Medicine presenting complaints that may be encountered at the time o
provides tools to address the unique set o challenges hospitalists admission or in the middle o the night. Each disorder is addressed
ace in a healthcare system that ought to be sa er and more e ec- rom the perspective o hospital care, which in many cases di ers
tive. It comprehensively covers topics not included in any other signi cantly rom initial outpatient care or the same complaint.
print or online textbook. For example, this edition has new sections Even experienced clinicians will nd value in reviewing an initial,
and chapters on the value and values o hospital medicine; practi- sometimes algorithmic, approach to common problems such as
cal, specialty in ormation relating to what consulting hospitalists anemia, alls, delirium, dizziness and vertigo, insomnia, numbness,
need to know as they co-manage patients rom other services; key and weakness (how to localize the problem). Many o the chapters
in ormation in rehabilitation and skilled nursing care pertinent to re er to subsequent chapters in Part VI, which covers the diagnosis
patient sa ety and quality; expanded content on the approach to and management o speci c diagnoses.
the patient at the bedside and clinical conditions in the inpatient Part V: Diagnostic Testing and Procedures. E ciency o care,
setting. Using the basic ormat o the rst edition, all content has reduced cost, especially length o stay, coupled with high quality
been updated to incorporate new medical knowledge relevant to begins with clinical problem solving at the time o admission. This
the practice o hospital medicine. part explains how to interpret common admission tests, such as liver
The second edition has six major parts, covering issues o impor- biochemical tests or arterial blood gas reports, and how to avoid
tance to hospitalists everywhere: waste ul, unnecessary medical tests and treatments. The radiology
Part I: The Specialty of Hospital Medicine and Systems of Care. section reviews indications o radiology studies typically ordered in
The authors o this section represent some o the most knowledge- the hospital setting, a general approach to interpretation, patient
able and orward-thinking people in the areas o value based medi- sa ety issues in imaging and procedures per ormed by interven-
cine, critical decision making at the point o care, transitions o care, tional radiologists. A comprehensive textbook in hospital medicine
patient sa ety and quality improvement, practice management, would not be complete without a section on procedures. The
ethics and pro essional development. This part emphasizes the mul- procedures’ section provides some standardization o procedure
tidisciplinary approach, teamwork, prevention o hospital-acquired per ormance, highlights indications, initial assessment, prevention
complications, and patient-centered communication to ensure sa e o complications, and interpretation o results with links to video
and e cient care transitions and hando s. online resources that provide additional instruction, not possible
Part II: Medical Consultation. This part explains the traditional in a text ormat. This section includes the core set o procedures
role o the medical consultant and updates preoperative cardiac most likely to be per ormed or supervised by hospitalists and
and pulmonary risk assessment and risk reduction. Chapters that acknowledges local and regional variations in the role o hospitalists
ref ect the evolving role o hospitalists in co-management o surgi- per orming or supervising these procedures.
cal patients include general principles o surgery and anesthesia, Part VI: Clinical Conditions in the Inpatient Setting. Updated
perioperative pain management, and management o common clinical content across the breadth o hospital medicine includes major
complications in noncardiac surgery. The surgical specialties section disciplines in internal medicine such as cardiology, gastroenterology,
xliii
and in ectious diseases as well as sections with special relevance to hospital medicine has evolved and the skills required o hospitalists
hospital medicine, such as geriatrics, palliative care, psychiatry, toxi- so that they can provide exceptional patient care and clinical care
cology, and addiction. In response to the evolving role o hospitalists leadership. We thank the American College o Physicians or its col-
on oncology inpatient services, the section covering hematology laborative publishing arrangement with McGraw-Hill that included
and oncology has been substantially expanded. input into the editors, contributors, and overall scope or this new
Electronic chapters (available on AccessMedicine.com) cover edition. Through its engagement in this book, the college advances
hospital medicine aspects o global health and hospital medicine, it mission to enhance the quality and e ectiveness o health care.
the core competencies o hospital medicine, the economics o
health care, principles o medical ethics, and bioterrorism. Sylvia C. McKean, MD, FACP, SFHM
In summary, the second edition o Principles and Practice of
Hospital Medicine takes into account how the eld and practice o
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South America, but the best disposed to receive the evangelical law,
most constant after having embraced it, and the best adapted to
honour Christianity. These people lived divided into various villages,
of which the most populous had the name of the nation. It is not
known what were the number of those villages, which the Jesuits
reduced to seven; and on this account were denominated reduçōes,
or reductions, also missions. The names of these seven celebrated
missions, are the following, with the number of inhabitants in each at
the period of their conquest by the Portuguese in 1801:—
INHABITANTS.
St. Francisco de Borja 1,300
St. Miguel 1,900
St. Joam 1,600
St. Angelo 1,960
St. Nicolau 3,940
St. Lourenço 960
St. Luiz 2,350
St. Francisco de Borja, which is the most southern, is two miles
distant from the Uruguay, and five leagues from the confluence of
Ibicui. It suffered much by an invasion from the Minuanos, a little
before changing its dominion. It has many white people.
St. Miguel, situated twenty-five leagues distant from the Uruguay,
and thirty east-north-east from St. Borja, is the most easterly, and is
considered the capital of the province. A great portion of it was
consumed by fire, which its inhabitants set to it in 1756, when they
saw the combined armies arriving in order to deliver the province up
to the Portuguese crown.
St. Joam is three leagues north of St. Miguel. Its mother church is
in the centre of a vast square. In the time of its prosperity it had forty
streets.
St. Angelo, which is the most northerly, is six leagues to the north
of St. Joam.
St. Nicolau, formerly capital of the various reductions upon the
right bank of the Uruguay, is situated near that river and a small
brook which falls into the Paratini.
St. Lourenço is six leagues to the west of St. Miguel.
St. Luiz is upon the road which goes from St. Lourenço to St.
Nicolau, nine leagues to the east of the latter place, and ten to the
west of the former. All these reductions, otherwise missions, and
which we ought to call towns, as they have a senate, took the name
of the patron of their mother churches. The whole were and yet are
upon the same plan, the houses of earth, with straight streets, and
verandas on the sides, which protect them against the rain and heat,
similar to the missions of the Paranna, with which in equal steps they
reached a flourishing condition, and fell with them into a state of
decay.
Each place has its peculiar Guaranitic dialect, differing little from
the others. Many of these Indians understand the Spanish and
Portuguese, and express themselves tolerably well in both
languages. They exercise almost all the requisite manual
occupations and various mechanical arts with intelligence; likewise
manufacture coarse woollens and cottons. Matte is the only article of
exportation.
In each mission, when governed by the Jesuits, there was a
school for reading, writing, and speaking the Spanish language by
royal order. There were many Indians who could read Spanish books
which they did not understand, as the masters or curates artfully
refrained from uttering a word to them, but in Guaranitic. In
consequence of which, these crafty preceptors were charged to fulfil
the royal determination, by a decree of 1743, but which decree had
not the desired effect.
CHAP. VIII.
PROVINCE OF ST. CATHARINA.
Boundaries—Colonization—Productions—Mountains—Mineralogy—
Phytology—Zoology—Rivers, Lakes, and Ports—Towns,
Parishes, &c.—Agricultural Establishments—Population—Islands
—Delightful Climate.
This province, which is a dismemberment of that of St. Paulo,
subsequent to the latter receiving the addition of a part of St. Amaro
and of St. Vincente, comprehends the island which gives it the
name, and a territory of sixty leagues from north to south on the
neighbouring continent, reckoning from the Sahy, which separates it
from St. Paulo on the north, to the Mampituba, which divides it from
the province of Rio Grande on the south; on the west it has the same
provinces, the heads of the cordillera, running parallel with the sea,
constituting a boundary on that side. Its greatest width does not
exceed twenty leagues, occupying the Beira-Mar, or sea-coast, of
the greatest portion of the ci-devant capitania of St. Amaro; and lying
between 25° 50′, and 29° 20′ south latitude.
A period of one hundred and twenty years elapsed without the
donatories establishing any colonists in the island of St. Catharina,
which, for some time had the name of Isle of Patos. King John IV.
gave it, in the year 1654, to Francisco Dias Velho, who was
assassinated by an English pirate at the time the establishment
began. In consequence of this disaster, the island long remained in
its primitive state. Eventually, various colonists from the Azores were
established in it, at the cost of the crown.
The climate is delightfully temperate and salubrious, with the
exception of certain marshy situations. The face of the country is
mountainous, watered by numerous rivers, and overspread with
woods. The soil is fertile and well adapted to the culture of
mandioca, Indian corn, rice, sugar, coffee, flax, and vegetables.
Wheat and barley are likewise grown in some districts. All the
hortulans of the south of Europe prosper here, particularly onions.
Mountains.—Camberella, which is upon the southern entrance
of the port of the capital, is the highest mountain seen from Santo to
the Torres[18] or Towers. The mountain of Bahul is a land-mark for
navigators.
Mineralogy.—Calcareous stones, granite, pedras d’amolar, or
whetstone. It is said there are indications of gold and other metals.
Phytology.—The oak tree is here more diversified than in the
mother country, and excellent for building. The sassafras, cedar,
loiro, pau d’arco, and those called guarabu and grapecique, are
trees of precious wood, well adapted for cabinet work; likewise the
tree denominated here pau d’oleo, having the grain close and nicely
waved. The Brazilian pine is numerous in various districts. There are
a diversity of medicinal plants; likewise the plant that nurtures the
cochineal, which has been fully described by many writers. It is an
insect, and feeds upon the leaves of the opuncia; its size is so
diminutive at first, that it scarcely can be seen, but it soon moves and
fixes upon a part of the plant, from which it does not remove, and
becomes gradually covered with a white skin, so that the body, which
is scarlet, is no longer seen. In three months it arrives at maturity,
and is not larger than a small pea; there are various modes of
cultivating it, and great care is required to keep off other insects
which destroy it. This is an article of considerable commerce and
might be cultivated to a great extent in the Brazil.
Zoology.—Cattle do not abound in consequence of the
mountainous nature of the country. Amongst other wild quadrupeds,
are well known the deer, the tamandua, the monkey, the boar, the
ounce, the anta, the paca, and the quaty. Amongst numerous
species of birds are remarked the parrot, the macuco partridge, the
rola, or turtle, the guara, and various sorts of the humming bird
called colibri, or beija-flor. The lakes abound with wild ducks and
geese. An infinite variety of beautiful butterflies are seen in this
province, to delight the eye, and engage the research of the
naturalist. The air appears filled with floating flowers.
Rivers, Lakes, and Ports.—The first are generally of a short
extent. About three miles north-north-east of the Towers is the mouth
of the Mampituba, about one hundred fathoms wide, which was
called for some time the Martim Affonso. It is not more than seven
leagues long, being formed of various streams that descend from the
cordillera; its current is violent, but sumacas, or smacks, ascend with
the tide twelve miles to the port of Forquilhas. By its northern margin
it receives the waters of a lake, which is about five leagues long, and
one broad, extending parallel with the sea-coast as far as the
Campos das Lagoinhas, from thence it has another outlet to the sea,
by a channel called Arroyo Grande.
Near the situation denominated the Conventos, there is a serro of
rock moderately elevated, and terminating in a platform near the
beach, about six leagues distant from the Mambituba. Six miles
further, the river Ararangua enters the sea, and is navigable for the
space of five leagues to the Tres Portos, where it is one hundred
fathoms wide, and deeper than at the bar, having a rapid current
from the month of June to September. Three leagues beyond the
preceding, the river Urussanga disembogues, being more extensive,
and much more rapid when its waters are high; no vessel can enter
its mouth, in consequence of the sea breaking with great violence
upon a bank which crosses it. Higher up it is wider, and has four
fathoms of depth in some places. This river communicates with a
large and deep lake, where the boto and other large fish are seen,
which come up from the ocean; it lies northward of the river. Five
leagues further is the rock of St. Martha, where the coast changes its
direction to the north. Three leagues to the north of the Morro, or
rock of St. Martha, is the spacious bay of Laguna, formerly the river
Da Lagoa, (of the Lake) which is the mouth of the river Tubarao, and
together the outlet of various lakes, prolonged in a chain parallel with
the ocean, and at no considerable distance from it. This river rises in
the serra that bounds this province, and its current is rapid from April
to September. Canoes proceed up it a distance of eight or nine
leagues to Porto da Guarda; but sumacas do not pass the mouth of
the river Capibary, which joins it by the left bank, and is navigable for
a space of eight leagues to Pouzo Alto. On the northern margin of
the Tubarao is the outlet of the great lake Laguna, which is five
leagues long from north to south, near two at the greatest width, and
is of sufficient depth for sumacas, as far as its northern extremity. On
the southern bank of the Tubarao, in front of the outlet of the
Laguna, is that of the lake of St. Martha, which lake is a quarter of a
league square. On its southern side the lake Garopaba discharges
itself, is about the same size, and one league distant. Into the latter
the outlet of the lake Jaguaruna disembogues, which is two leagues
further to the southward, and a little larger. The three together afford
a passage to large canoes, as far as the river Congonhas, which is
not considerable, and empties itself into the western margin of the
latter lake. They are comprehended under the name of the lakes of
Camacho, and abound in fish.
On the western side of the Laguna, and near its northern
extremity, the river Una discharges itself, and affords navigation to
canoes for some leagues, as far as the rock of St. Joam. An arm of
this river extends a league and a half to the north, is deep, and
terminates in a morass.
In front of the embouchure of the Laguna is the small island of
Lobos. Four leagues to the north is the point and port of the
Embituba, and two farther is the mouth of the river Piraquera, which
is the outlet of the lake of the same name, otherwise Encantada, four
miles long and one wide.
Continuing onward, the river Embahu is met with, which at its
mouth is only eight fathoms wide, but it gradually increases to more
than eighty fathoms; canoes can proceed up during a day’s voyage.
Two miles farther to the north is the point of Pinheira, which is
followed by the gulf of the same name, being the southern entrance
to the channel of the island of St. Catharina; its southern extremity is
a league to the north of the said point.
Near six miles to the north of Point Pinheira, the Massambu
disembogues, being thirty fathoms wide, and of considerable depth,
but of short extent: Rio Dom Rodrigo was its first designation. After it
follows a small bay, called Brito, and a little farther is the entrance of
the river Cubatao, sixty fathoms wide, up which larger canoes
proceed during two days’ voyage. In the proximity of this river there
are various fountains of hot water, having different degrees of heat:
the most distant one, situated five leagues up the river, possesses
one hundred and two degrees.
After passing various small rivers, the river Maruhy is met with,
as large as the preceding one, and navigable to the place
denominated Guarda. Near this river is the bay of St. Joze. A little to
the north is a straight, which divides the channel into two almost
equal parts; and a little farther is the entrance of the river Biguassu,
fifty fathoms in width, and up which canoes proceed for many
leagues. The first discoverers called it the river of Patos, in
consequence of its constituting a limit between the Indians of that
name, who extended themselves as far as the St. Pedro, and the
Carijos to the north as far as Cannanea.
The large bay of St. Miguel follows; afterwards, the point of
Armacao; and, farther on, that of Ganchos, which lies east and west
of the extremity of the island of St. Catharina, and is to the
southward of the spacious bay of Tejucas, at the farther end of which
the river of the same name discharges itself, being fifty fathoms
wide, and affording two days’ navigation. The surrounding country of
the bay of Tejucas is a morass or marshy plain in the winter, when its
passage is attended with great labour and inconvenience.
To the north of the preceding is the bay of Guaroupas, open to
the north-east, not so large, but sufficiently sheltered and capacious
for the reception of a squadron of ships; the river Bupeba runs into it,
as well as the two Pireques. The intervening land of those two bays
is a peninsula, which extends to the sea, terminating in three points,
and forming two small bays.
Proceeding northward, the next river is the Cambory-Guassu,
rapid at its entrance into the sea, and being twenty fathoms in width.
Nearly three leagues farther is the embouchure of the great river
Tajahy, which is little less than sixty fathoms in width at the passage
a short distance from the beach. It is the only river met with on the
road from Portalegre to St. Paulo that flows towards the east; the
sumacas proceed up only three miles, launches and large canoes
navigate freely as far as the first fall. About one hundred and twenty
yards above it becomes navigable for the space of three days, by
towing, and as many more with the oar, to the next cataract. It rises
between the river Negro and the Correntes, (which run to westward.)
In its neighbourhood there are many small mountains. The principal
confluents which enlarge it are the Rio de Luiz Alves (which comes
from the north-west, runs near the mountain of Bahul, seen from the
sea at a great distance, and is navigable for small canoes) and the
Tajahy Mirim, which runs from the south-west, navigable for canoes
about ten leagues. The whole flow through countries of great fertility.
Five miles farther to the north is the river Gravata, otherwise Iriri-
Guassu, thirty fathoms wide, and navigable for canoes. It is followed
by the spacious bay of Itapacoroya, where there is an establishment
for whale fishing. Proceeding onwards, the Iriri Mirim and the
Camboriu are met with, up which canoes also navigate with the aid
of the tide. Near to the latter is the Tajuba, a river of a similar class.
Three leagues to the north of the Itapacoroya the river Itapicu
disembogues, being fifty fathoms wide, and of considerable depth.
Its origin is far back in the province, and affords navigation to small
canoes for many leagues, without the interruption of more than one
cataract, which is situated ten miles above the mouth. The agitated
state of the sea at the mouth of this river does not permit the
entrance of any description of vessel. Immediately beyond the bar it
forms a lake, called Lagoa da Cruz, two leagues long from north to
south, parallel with the beach, and very narrow. Among the rivers
which enlarge it are remarked the Piranga, which is received by the
left bank, and is navigable by canoes for a space of five leagues; the
Upitanga, which joins it by the right margin, and is only navigable for
six miles; the Itapicu Mirim, that comes from the north-west and
admits of navigation for about fifteen miles; the Jaragua, which flows
from the south-west, and appears capable of allowing small vessels
to proceed as far as a situation about four leagues above its mouth;
and the Braço, which descends from the north-west, and admits of
canoes for the space of six miles. All these rivers run by winding
courses among mountains and uncultivated territories, thickly
wooded, demonstrating the natural fertility of the soil. The Itapicu is
supposed to be the river of Dragons, which the discoverers placed to
the south of the river St. Francisco in this district.
Five miles to the north of Itapicu is the island of St. Francisco, six
leagues long, and in the form of a bow, the right line of which is
nearest the coast; the channel which separates it from the continent
is improperly called the river of St. Francisco. The southern entrance
is denominated Aracary, is two hundred fathoms wide, has only
depth for large boats, and on its outside are the three islands of
Remedios and two of Tamboretes. The northern bar, called
Babitonga, is fifteen hundred fathoms wide and deep enough for
large sumacas.[19] At the end of the sixteenth century it was not
known that the land between the bar of Aracary and Babitonga was
an island; they were thought to be two mighty rivers, the southern
called the St. Francisco and the northern the Alagado. The channel,
or the pretended river St. Francisco, of a semicircular form, enlarges
considerably from both mouths to the middle, where it is three miles
wide, and contains a cluster of more than twenty islands. A great
number of rivers empty themselves here. The nearest to the bar of
Aracary is the Piraque, having a course of five leagues, five fathoms
in width at the mouth, and affords navigation to canoes for three
miles; next to it is the Pinheiros, still smaller; then the Paraty, which
is thirty fathoms wide at the bar, two and a half in depth, and
navigable for about a league. The little river Areas, narrow and deep,
is navigable for two miles. The great river Areas, up which canoes
proceed with the tide for some distance. The river Parannagua,
whose origin approximates to that of the Pirango, an arm of the
Itapicu: coasting vessels proceed up it a short way, large boats about
two miles, and canoes nearly five miles. Next follow the Saguaçu;
the two Erirys; the Cubatao Grande, twenty fathoms wide, three
deep, and navigable for ten leagues to the high rock of Tromba; the
Antonio Felis; the Ribeyrao; the Biguaçu; the Pyrabyréba; the
Cavalinhos, by which canoes proceed for a space of ten miles; the
Tres-Barras, so called in consequence of being the common
embouchure of the three rivers of Furtaenchente, St. Joam, and Tres
Barras, the second only being considerable, (its principal confluents
are the Maria Bachaara and the Farinhas, which come from the
serra of Curytiba, and afford navigation to canoes;) the Barrancos,
Bacuhy, Lamen, Batuby, Fornos, Fernandes, Barboza, and the two
Jaugarunas, the smaller of which is nearest to the northern point of
the bar of Babitonga. The nine last, and several of the others are
small, being only of any note during the spring tides. The whole of
these rivers generally run tamely between low banks, of a marshy
nature, abounding with considerable numbers of the beautiful scarlet
guara bird, which delight the eye of the navigators. In some of these
rivers are found seed pearls of various colours, also large pearls of
an imperfect kind.
The island of St. Francisco is low, watered with various small
rivers, and inhabited; on its eastern side there is a narrow lake, ten
miles long from north to south, denominated the river Acarahy; and
near it another small one. Two leagues north of the bar of Babitonga
is the river Sahy Mirim, and the same distance farther the Sahy
Grande, both inconsiderable, uniting in one stream a little above their
embouchures.
The greatest part of the population of this province is descended
from families who came from the Azore Islands, for the purpose of
colonizing it. Negroes are not numerous, and mesticos still less so.
The aboriginal Patos, whose name the island at first had, penetrated
into the continent. The Carijos were the first tribe understood by the
Vincentistas, and hence their name was given in common to all
domesticated Indians, of whatever nation.
This province has three towns, viz.
Nosso Senhora do Desterro, in the island of St. Catharina,
Laguna, on the continent,
St. Francisco, in the island of the same name;
and seven parishes, namely,

St. Joze
St. Miguel
on the continent;
Nosso Senhora do Rozario
Santa Anna
Nosso Senhora da Conceiçao

Nosso Senhora da Lapa in the island of St. Catharina.
Nosso Senhora das Necessidades
The hermitages are equal in number to the parishes.

In 1796, this province was computed to have
4,216 fogos, or houses.
23,865 adult inhabitants, exclusive of paid troops.
3 sugar engenhos, or works.
192 distilleries of rum.
4 engenhos for pounding rice.
297 wind and horse mills.
884 bolandeiras for grinding mandioca.
32 tan-pits.
In the year 1812, the population amounted to 31,530.
Islands.—The only considerable islands are that which gives the
name to the province and that of St. Francisco. The island of St.
Catharina, upwards of thirty miles long from north to south, and from
four to eight in width, is mountainous, abounding with water, yet in
parts covered with woods, and does not want for stone or potters’
earth. Between its mountains there are some cultivated plains, of
greater or less extent, and also many marshy situations. There are
many bays, and they abound with shells. On the eastern side there
is a lake two leagues long from north to south, deep in some places,
and at a certain part so contracted that it appears like two, united by
a neck fifty fathoms wide, having a large bridge. When in the winter it
begins to inundate the adjacent low grounds, the inhabitants in the
vicinity open a channel to discharge the overflowing water into a bay,
situated at a little distance, and which is immediately filled up again
by the flowing of the tide, when the current ceases, during which a
great quantity of fish enter from the ocean. It consequently affords at
all times an abundant supply. At its northern extremity, there is a
small river called Vermelho, near which the best water-melons of the
province are produced. To the south of the preceding, there are three
other lakes: the Lagoinha Grande, the Pantano, and the Lagoinha de
Leste. The whole are stored with the same fish as the first. Mandioca
and flax are the principal articles of agriculture, which is generally
exercised by white men, who also cultivate Indian corn, rice, coffee,
vegetables, sugar, and some cotton, which is not of good quality.
Some fruit trees from the south of Europe are here naturalized.
Water-melons, pine-apples, and oranges are very abundant. The
principal streams in this island are the Vermelho, the Ratones, which
enters the sea two leagues north of the capital, and the Tavares,
three miles south-east of the capital. The country, watered by the last
river, produces the best melons in the province.
The channel which separates this island from the continent is far
from being of uniform width, forming two large ports, almost equal in
size, and separated by a straight of two hundred fathoms between
two points. The northern and larger port, ten miles wide, having
depth for ships of war, is one of the best in South America, and the
key to the southern ocean. The wind prevails from the south during
the winter, which commences generally in May and ends in October.
Thunder-storms are frequent in the summer; all the afternoons here
are refreshed by strong sea breezes, rendering the climate of this
island equal to any in the world.
Near to the southern point of St. Catharina are six small islands.
The three western ones are called the Papagúos, and the eastern
the Tres Ismaos. The islands of Moleques, Campeche, Xavier,
Aranhas, and Badejo are situated upon the eastern coast of the
island of St. Catharina. Near its northern point are three, called the
Moleques. Five miles north of the same point are the islands of
Arvoredo and Galle. Within the principal port, amongst others, are
the islands of Tomarim, near the coast of the continent, and the
Ratones, almost in front of the river of the same name, both fortified.
In the southern port are the islands of Cardos and Maruhy.
The town of Nosso Senhora do Desterro, the capital of the
province, is considerable, populous, and situated on the western
side of the island of St. Catharina, upon a bay a little to the east-
south-east of the straight, on unequal land between two rocks,
traversed by three small rivers, which are passed by various stone
bridges. The streets are almost generally irregular, and the houses
either of stone or wood. Besides a church, it has the chapels of
Menino Deos, Our Lady of Rozario, a Terceira order of St. Francisco
d’Assis, and a hospital of charity. The quarters of the troops are
good. The senate is presided by a Juiz de Fora, and the youth are
instructed by royal masters in the primitive letters and Latin, for
whose benefit there is a tribute in rum. Potteries afford a branch of
industry and commerce. Coarse cloths of linen and cotton, also a
mixture of both, are manufactured.
The parish of Nosso Senhora das Necessidades, better known
by the name of St. Antonio, is five miles north of the capital, and
small, but its situation is particularly pleasant. The inhabitants
cultivate sugar, mandioca, Indian corn, some flax, and various
hortulans. A little more than three miles to the north is the bay Das
Canavieiras (of canes or reeds.) Here the Spaniards disembarked in
1777, and took possession of the island without the least resistance.
The parish of Nosso Senhora da Conceiçao is situated about a
league to the east of the capital, upon a steep, a little distant from
the large lake, enjoying an extensive view of the ocean. Its
parishioners cultivate sugar and mandioca, with the other provisions
of the country. In this district there is an establishment for whale
fishing.
Two leagues to the south of the capital is the parish of Nosso
Senhora da Lapa, situated near the mouth of a small river, in the
recess of a semicircular bay, and in front of an island. It is commonly
called Robeira, has abundance of fish, and the provisions of the
country.
Laguna is a middling town, advantageously situated upon the
eastern margin of the lake from which it derives the name. It is two
miles from the bar, near a small hill, from whence descend excellent
waters. The form of this place is quadrilateral, with three parallel
streets, crossed by others, and a square at one side, in which the
municipal house is situated. It has only one church, dedicated to St.
Antonio dos Anjos, and a great part of the houses are of stone, some
one story high, and whitened with the lime of shells. The inhabitants
cultivate the usual productions of the country. The lake is stored with
fish, and in the months of November and December a prodigious
quantity of bagre (a long fish with a forked tail) enter it, supplying a
lucrative branch of commerce. This town is sixty miles south of the
capital. From its port, which receives coasting vessels, is exported
farinha, rice, Indian corn, timber, and salt fish.
About fifteen miles north of Laguna, and near fifty south of the
capital, is the parish of St. Anna, commonly known by the name of
Villa Nova, a small place, pleasantly situated upon an elevation near
the northern extremity of the same lake, with two ports, one called
Porto da Embituba, sheltered on the south and east by a headland of
the same name, where there is a small whale fishery, subject to the
administration of that of Garopaba. The houses are generally of
wood, although there is abundance of stone. Its inhabitants, amongst
whom there are many macilentos, (meagre or spare,) cultivate the
productions common to the country, and a large quantity of flax,
having, consequently, more weavers of that article than any other
place in the province. Onions are of an extraordinary size, and other
hortulans of a fine quality.
The parish of Nosso Senhora do Rozario, which is upon the bay
of Brito, between two small brooks, thirty-five miles north of St. Anna,
and ten south of the capital, is yet small, and its parishioners
cultivate mandioca, Indian corn, and sugar, and also are fishermen.
In its district there are hot springs.
Four miles to the south-east of the capital, and one distant from
the left bank of the Maruhy, is the parish of St. Joze, upon a bay of
the same name, with a pottery of glazed earthenware. The
inhabitants grow the same articles as the preceding.
Eight miles north-west of the capital is the pleasant parish of St.
Miguel, upon a bay so called, which forms a good roadstead. Its
inhabitants cultivate and export a large quantity of rice and farinha,
with some sugar. Near this place is the principal establishment for
whale fishing.
The town of St. Francisco is of middling size, well supplied with
fish and the provisions of the country, with houses mostly built of
earth, and a handsome church of stone, dedicated to Our Lady da
Graca. It is upon the western beach of the island of that name, about
ten miles within the bar of Babitonga, upon level ground, and in a
situation well calculated for commerce. Only two streets are paved.
The inhabitants, generally whites, are very pale, and almost all
farmers of mandioca. The cultivation of Indian corn, rice, sugar,
coffee, and tobacco, which might be considerable, is at present very
trifling. There are few persons who do not possess at least one
canoe. Vessels are built here of good burden. Timber and cordage of
imbe are the most important exportations next to farinha (flour of
mandioca.)
This province, which makes a part of the bishopric of Rio de
Janeiro, was till recently under the jurisdiction of the ouvidor of
Portalegre, but is now governed by Senhor Alexandre Eloi Portelli.
CHAP. IX.
PROVINCE OF ST. PAULO.
Boundaries—First Settlement—Mountains—Mineralogy—Rivers and

Ports—Islands—Phytology—Zoology—Bugre Indians, Dwellings
and Customs—Character of the Paulistas—Division into
Comarcas—Comarca of Curytiba—Towns and Productions—
Comarcas of St. Paulo and Hitu—Towns and Productions.
This province, formed by the union of a part of the capitania of St.
Amaro, with one half of that of St. Vincente, took the name which
designates it in the year 1710, when John V. incorporating them with
the crown lands by purchase, nominated a governor, with the title of
captain-general, in the person of Antonio de Albuquerque Coelho,
and the city of St. Paulo for his residence. It is confined on the north
by the province of Minas Geraes, from which the serra of
Mantiqueira separates it, and by that of Goyaz, from which it is
divided by the river Grande; on the south by Rio Grande do Sul, of
which the river Pellotas forms the division; on the west by the river
Paranna, which separates it from the provinces of Goyaz and Matto
Grosso; and on the east by the ocean, and the provinces of Rio de
Janeiro on the northern part, and St. Catherina on the southern. Its
territory is almost all within the temperate zone, between 20° 30′ and
28° south latitude, comprising four hundred and fifty miles from north
to south, and three hundred and forty miles of medium width from
east to west; and possessing much variety in the climate, soil, and
aspect of the country.
John III. determining to divide the Brazilian coast into capitanias,
at the period that Martim Affonso de Souza was in this new region,
presented him, in 1532, with one comprising a hundred leagues of
coast, and his brother Pedro Lopez de Souza, who had
accompanied him, with another of fifty; but the letter of donation to
Martim Affonso was not signed till the 20th of January, 1535, at the
time when he had already taken his departure for India. It specified
that this captaincy, which afterwards took the name of St. Vincente,
should extend from the river Maccahe as far as twelve leagues to the
southward of the island of Cannanea, where the bar of Paranagua is
situated, excepting a certain portion of ten leagues, computed from
the river Curupace, now called Jiquiriquere, to that of St. Vincente.
The capitania of Pedro Lopez de Souza, which was denominated St.
Amaro, included the said ten leagues. That of St. Vincente had
scarcely existed forty years, when it was deprived of half its territory,
for the purpose of creating the new one of Rio de Janeiro.
With the change of possessors, the southern limits of both
capitanias disappeared, and the jurisdiction of the governors began
to extend by degrees over the countries which now constitute the
provinces of Minas Geraes, Goyaz, Matto Grosso, St. Catharina, and
Rio Grande do Sul, where, through the adventures of the Paulistas,
colonies were first planted.
The authority of Herrera would warrant the conclusion that there
was a factory at St. Vincente in the year 1527. At all events, the
licence which Martim Affonso conceded to Pedro Goes, on the 3d of
March, 1533, for the purpose of exporting seventeen captive Indians,
free of all duties which it was customary to pay, amply demonstrates
that such an establishment had existed for some time previous to the
latter year. Martim Affonso found here, as has been already
observed, two Europeans, Antonio Rodrigues, and John Ramalho,
whom Herrera imagined had escaped from some shipwreck upon
the coast; but it would seem improbable that they could of
themselves have constituted a factory; as establishments of that
kind, formed amongst barbarians, necessarily require a considerable
number of persons.
Mountains.—This province is not mountainous, if we except the
eastern part, in the whole extent of which there is a general
cordillera, running parallel to the coast, which occasionally receives
the name of Cubatam. This serra is not universally of the same
altitude, neither does it run uniformly at an equal distance from the
sea. It has many broken parts, by some of which torrents descend to
the ocean, and others wind into the interior. It abounds in verdant
woods, being generally high towards the sea, and is the most
elevated land of the province, with the exception of some dispersed
mountains in the interior; besides, the largest rivers which irrigate
this district have their origin in it, and run westward.
The serra Araassoiava, by corruption Guarassoiava, which
signifies the eclipsing of the sun, alluding to the great extent of land
obscured by its shade, previously to the sun’s departure. This
mountain, which is ten miles in length, and of proportionate width,
consists entirely of a pure mineral of iron, and is situated in the
district of the town of Sorocaba.
The mount of Araquara, from which are frequent exhalations, and
which is reputed to contain gold, is situated upon the right margin of
the Tiete, thirty miles below the embouchure of the Piracicaba. This
mountain must not be confounded with a serra of the same name,
which exists more in the centre of the province.
Near the head of the Jaguariquatu, is the elevated mount of
Pirapirapuan, which is discovered at a great distance, and
possesses gold. The mountain of Thaho, upon the margin of the
Thajahi, is also high, and yields the same metal.
The serra Dourada is situated in the campo of Guarapuaba, to
the west of the Tibagi. The serra of Apucaranna, is also in the plains
of Guarapuaba.
In the vicinity of the sea is to be remarked Mount Cardozo, on the
left of the entrance to the bay of Cannanea. Mount Jurea, by
corruption Judea, receives this name in consequence of its
appearing like Judea to the travellers, who cannot pass the road
leading over the summit without much fatigue. It is a few leagues to
the north of the river Iguape, is high, commands an extensive view,
and precipitates various torrents, amongst which the river Yerde is
conspicuous, forming several cascades.
The serra of Jaguary, which is between the rivers Itanhaen and
Una, near the beach, is in great part composed of stone, with trees
of more than ordinary magnitude.
Mineralogy.—There are mines of gold, silver, brass, iron,
brimstone, pumice-stone, flint, magnet, calcareous stone, granite,

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Principles and Practice of Hospital

Medicine 2nd Edition Edition Sylvia C.

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Davidson’s Principles and Practice of Medicine, 24th

Davidson's Principles and Practice of Medicine, 24th

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Principles and Practice of Physics, 2nd Edition Eric

The Harriet Lane Handbook: The Johns Hopkins Hospital

John J. Ross, MD, CM, FIDSA

Daniel D. Dressler, MD, MSc, SFHM, FACP

Danielle B. Scheurer, MD, MSCR, SFHM

This book was set in Myriad pro by Cenveo Publisher Services.

RR Donnelley was printer and binder.

Library o Congress Cataloging-in-Publication Data

PART I: THE SPECIALTY OF HOSPITAL

23 Building, Growing and Managing a

SECTION 1 Surgery PART III: REHABILITATION AND SKILLED

Perioperative Risk Assessment and

51 Perioperative Pulmonary Risk Assessment and 77 Evaluation of Anemia ............................... 533

Prevention, Assessment, and 84 Dizziness and Vertigo ............................... 587

106 Weakness: How to Localize the Problem . . . . . . . . . . . . . . 763

137 Inpatient Cardiac Arrest and Cardiopulmonary

SECTION 2 Radiology 144 Flushing and Urticaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1105

122 Arterial Blood Gas and Placement of A-line . . . . . . . . . . . . 901

John J. Ross, MD, CM, FIDSA

Daniel D. Dressler, MD, MSc, SFHM, FACP

Danielle B. Scheurer, MD, MSCR, SFHM

Samer Abdel-Aziz, MD Daniel A. Anaya, MD

Patrick Avila, MD, MPhil, MPH Tom Baudendistel, MD, FACP

Arline D. Bohannon, MD Tod A. Brown, MD

Alexander R. Carbo, MD, FACP, SFHM Kenneth K. Chen, MD, FRACP

Alexandra Columbus, MD Sonye K. Danof , MD, PhD

Michael Klompas, MD, MPH Victoria D. Lackey, MD

Makeida B. Koyi, MD Lucia Larson, MD, FACP

Svetlana Krasnokutsky, MD, MS Jodi Layton, MD

Harold Kudler, MD Brian Leber, MDCM, FRCPC

William L. Lyons, MD Alayne D. Markland, DO, MSc

Andrew McFarlane, MLT, ART, FCSMLS(D) David Meltzer, MD, PhD

Jakob I. McSparron, MD Paul A. Monach, MD, PhD

Thomas A. Owens, MD Vihas Patel, MD

Menaka Pai, MD, MSc, FRCPC Jill M. Paulson, MD

Michaella Maloney Prasad, MD Kerry Reynolds, MD

Lynn Schlanger, MD Ann M. Sheehy, MD, MS

Saul N. Weingart, MD, PhD Eric S. Winer, MD

Irene M. Yeh, MD, MPH

and seven parishes, namely,

Nosso Senhora da Conceiçao

The hermitages are equal in number to the parishes.

Boundaries—First Settlement—Mountains—Mineralogy—Rivers and

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