Effectiveness and Safety of a Clinical Decision Rule to Reduce Repeat Ionized Calcium Testing: A Pre/Post Test Intervention.

The American Recovery and Reinvestment Act authorizes the Centers for Medicare and Medicaid Services to reimburse hospitals that demonstrate meaningful use of certified electronic health record technology. We sought to demonstrate meaningful use by developing and implementing one clinical decision support rule in the computerized physician order entry system that targets clinician-ordered repeat ionized calcium measurement at the University of Connecticut Health Center. The rule consists of a pop-up computer reminder that is triggered by ordering a second ionized calcium test within 72 hours after an initial normal test, with no clear indication for repeat testing. We implemented the rule on December 14, 2010, and have reviewed all data collected through December 2014. We found that the number of repeat tests decreased from 46% to 14% with no significant increase in the number of serious adverse events. We conclude that computerized reminders can decrease unnecessary repeat testing in the inpatient setting.

Fibromuscular Dysplasia Presenting as Acute Unilateral Renal Infarction: A Case Report and Review of Two Diseases.

Fibromuscular dysplasia (FMD) is a rare systemic vascular disease that has been found to present as a renal infarction (RI) in only a handful of cases.  We present a case of a 53-year-old Vietnamese patient presenting for sharp, severe left-sided abdominal pain of two-day duration associated with a migraine headache. On presentation, she was afebrile, and her vital signs were stable. Laboratory investigations were significant for mildly elevated leukocytosis but were otherwise normal. CT abdomen and pelvis with contrast revealed a left-sided renal infarct. The patient was then admitted to the hospital and started on therapeutic anticoagulation. A transthoracic echocardiogram was obtained and revealed no vegetation. CT angiography of the abdomen was pursued and was significant for mild beading within the mid-right and left renal arteries, consistent with fibromuscular dysplasia. Our patient was diagnosed with renal infarction in the setting of fibromuscular dysplasia, a combination that has been reported only a few times. Interestingly, our patient also had mild FMD based on imaging, making it even more of an unusual cause of renal infarction. This case highlights the connection between these two diseases and the need for more studies to characterize the association between them.