Southern Medical Journal最新文献

{"title":"Performance of Chat Generative Pre-Trained Transformer on Personal Review of Learning in Obstetrics and Gynecology.","authors":"Adam Cohen, Jersey Burns, Martina Gabra, Alex Gordon, Nicholas Deebel, Ryan Terlecki, Katherine L Woodburn","doi":"10.14423/SMJ.0000000000001783","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001783","url":null,"abstract":"<p><strong>Objectives: </strong>Chat Generative Pre-Trained Transformer (ChatGPT) is a popular natural-language processor that is able to analyze and respond to a variety of prompts, providing eloquent answers based on a collection of Internet data. ChatGPT has been considered an avenue for the education of resident physicians in the form of board preparation in the contemporary literature, where it has been applied against board study material across multiple medical specialties. The purpose of our study was to evaluate the performance of ChatGPT on the Personal Review of Learning in Obstetrics and Gynecology (PROLOG) assessments and gauge its specialty specific knowledge for educational applications.</p><p><strong>Methods: </strong>PROLOG assessments were administered to ChatGPT version 3.5, and the percentage of correct responses was recorded. Questions were categorized by question stem order and used to measure ChatGPT performance. Performance was compared using descriptive statistics.</p><p><strong>Results: </strong>There were 848 questions without visual components; ChatGPT answered 57.8% correct (N = 490). ChatGPT performed worse on higher-order questions compared with first-order questions, 56.8% vs 60.5%, respectively. There were 65 questions containing visual data, and ChatGPT answered 16.9% correctly.</p><p><strong>Conclusions: </strong>The passing score for the PROLOG assessments is 80%; therefore ChatGPT 3.5 did not perform satisfactorily. Given this, it is unlikely that the tested version of ChatGPT has sufficient specialty-specific knowledge or logical capability to serve as a reliable tool for trainee education.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"102-105"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Firearm Shootings: A Serious Public Health Issue.","authors":"Steven Lippmann","doi":"10.14423/SMJ.0000000000001781","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001781","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"140"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Communication about Fall Risk and Prevention between Internal Medicine Residents and Older Adults.","authors":"Mary L Thomas, Yulu Pan, Christopher D Jackson","doi":"10.14423/SMJ.0000000000001786","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001786","url":null,"abstract":"<p><strong>Objectives: </strong>More than one in four older adults fall yearly, but fewer than half inform their doctors. As such, medical trainees must gain experience assessing fall risk in older adults. Studies exploring how often residents initiate these assessments and which interventions effectively increase this frequency are needed. The objective of our study was to determine whether a reminder survey increases the frequency and proportion of resident-initiated fall risk and prevention discussions between Internal Medicine residents and older adults.</p><p><strong>Methods: </strong>This quantitative pre- and postintervention study used an anonymous survey distributed to residents within one urban Internal Medicine resident clinic. For 1 week, residents were exposed to Stopping Elderly Accidents, Deaths, and Injuries fall risk assessments completed by patients 65 years and older to stimulate fall risk and prevention discussions. Residents completed the same survey 3 months after intervention withdrawal.</p><p><strong>Results: </strong>Postintervention, there was a statistically significant increase in the proportion of resident-initiated fall risk and prevention discussions (43% vs 81%, <i>P</i> = 0.03). Although not statistically significant, residents reported initiating fall risk (14% vs 19%, <i>P</i> = 1) and fall prevention (3.6% vs 19%, <i>P</i> = 0.25) discussions more frequently, and fewer residents reported forgetfulness as a barrier to having these discussions (57% vs 44%, <i>P</i> = 0.59).</p><p><strong>Conclusions: </strong>Exposure to the Stopping Elderly Accidents, Deaths, and Injuries fall risk tool is a promising reminder intervention to increase the frequency and proportion of resident-initiated fall risk and prevention discussions; however, larger multisite studies are needed to assess the statistical significance of these findings.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"114-117"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Medical Education for the Care of Patients with Intellectual and Developmental Disabilities: The Role of Specialized Training and Early Exposure.","authors":"Alice Hamilton, Caroline Sachse, Elisa Sottile, Rafik Jacob","doi":"10.14423/SMJ.0000000000001782","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001782","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"111-113"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alpelisib-Induced Hyperglycemia in <i>PIK3CA</i>⁺ Breast Cancer Patients.","authors":"Anika Annoor, Mariya Rahman Marzan, Raisa Binte Iqbal, Aysha Ferdausi, Arowa Yasmeen, Parisa Tarannum, Preethi John","doi":"10.14423/SMJ.0000000000001791","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001791","url":null,"abstract":"<p><p>Alpelisib is a phosphatidylinositol 3-kinase inhibitor approved by the US Food and Drug Administration for the treatment of hormone receptor-positive metastatic breast cancer with <i>PIK3CA</i> (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit α) mutation. In recent years a number of adverse effects have been observed to be associated with this therapy, the most notable of which is hyperglycemia. A literature search was conducted to include case studies, case series, systematic reviews, and meta-analyses within the last 10 years that evaluated patients with <i>PIK3CA-</i>mutated hormone receptor-positive, human epidermal growth factor receptor 2 negative metastatic breast cancer. Hyperglycemia was a notable adverse effect that was found in the majority of patients without preexisting diabetes mellitus. Patients with hyperglycemia were in the high-risk groups of advanced age, prediabetes mellitus or history of insulin resistance, increased body mass index, increased blood monocyte count, and increased hemoglobin A1c (glycated hemoglobin). Hyperglycemia was manageable with antihyperglycemic agents and dose modification/discontinuation of alpelisib with no severe progression. Other notable adverse effects were rash, stomatitis, diarrhea, pneumonitis, reduced appetite, elevated liver enzymes, nausea, fatigue, and rare reports of diabetic ketoacidosis. This literature review aims to highlight the incidence and risk factors of alpelisib-induced hyperglycemia in greater depth.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"97-101"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medications That May be Contributing to Your Patient's Weight Gain.","authors":"Jason Powell, James Taylor","doi":"10.14423/SMJ.0000000000001792","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001792","url":null,"abstract":"<p><p>Nearly 42% of adults in the United States are considered obese. Although there are a number of contributing factors to obesity, one sometimes overlooked contributor to weight gain is medications. Within many classes of medications that may affect weight, the degree of weight gain varies. Although factors such as efficacy, cost, interactions, and adverse effects play a role in selecting a medication, the effects on weight also should be considered in those who are overweight or obese. This article reviews some of the classes of medications used in the outpatient setting that may affect weight to provide a guide to clinicians.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"122-127"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of COVID-19 on Emergency Department Visits for Suicidal Ideation and Suicide Attempts among South Carolina Youth.","authors":"Radhika J Kothadia, Kaustubh G Joshi, Richard L Frierson, Coleton King","doi":"10.14423/SMJ.0000000000001789","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001789","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence suggests that the coronavirus disease 2019 pandemic negatively affected children's mental health (MH). The emergency department (ED) is often the first point of contact with a physician for youth who are experiencing suicidal thoughts and behaviors. Population-level reports of ED utilization in South Carolina for suicidal ideation (SI) and suicide attempts (SAs) during the pandemic are lacking. This study compares trends in ED visits for SI and SAs among youth in South Carolina ages 5 to 24 years, before (ie, March-December 2019) and during (ie, March-December 2020) the coronavirus disease 2019 pandemic.</p><p><strong>Methods: </strong>We examined 16,906 deidentified patient records from the South Carolina Revenue and Fiscal Affairs Office. Dispositional outcomes, type of insurance, ED utilization, and mortality also were reviewed.</p><p><strong>Results: </strong>The total number of ED visits for SI or an SA decreased during the pandemic, but the percentage of MH-related and total ED visits attributed to SI and SAs relative to other conditions increased. The pandemic negatively affected youth with preexisting utilization of EDs for MH reasons, SI, and SAs, but also those without prior ED visits for these reasons. Many youths who presented to an ED during the pandemic for SI or SAs had subsequent ED visits for MH concerns, SI, or an SA.</p><p><strong>Conclusions: </strong>The percentage of MH- and SI/SA-related visits increased during the pandemic. These data underscore the need for adequate MH services in EDs and increased access to outpatient MH resources to reduce the strain on EDs during public health emergencies.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"85-90"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undervaluation of Perioperative Work for ACL Reconstruction by Relative Value Scale Update Committee Methodology in a Single Surgeon's Practice.","authors":"Shelby Cate Hodges, Juan J Gordillo, Mathew Hargreaves, Maxwell Harrell, Clay Rahaman, Eugene Brabston, Thomas Evely, Aaron Casp, Amit M Momaya","doi":"10.14423/SMJ.0000000000001787","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001787","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to determine the accuracy of the Relative Value Update Committee (RUC) and Centers for Medicare & Medicaid Services current times and work relative value units (wRVUs) for the perioperative work involved in anterior cruciate ligament (ACL) reconstruction by directly timing perioperative tasks as they occur in real time.</p><p><strong>Methods: </strong>The RUC was contacted to obtain a list of perioperative tasks and the corresponding times allotted for the tasks involved in arthroscopically aided ACL reconstruction (Current Procedural Terminology code 29888). The tasks that occurred both inside and outside the operating room were timed by the attending physician as the event occurred. The time for each task was then multiplied by its respective Centers for Medicare & Medicaid Services-assigned intensity coefficient to calculate the wRVU. Calculated and allotted wRVUs were compared for accuracy.</p><p><strong>Results: </strong>The tasks timed in this study were allotted 100 minutes by the RUC and a total wRVU value of 2.026. Our study found that these tasks took 132.1 minutes and had a total wRVU value of 2.713. The overall time it takes to perform perioperative tasks in arthroscopically aided ACL surgeries is underestimated by 32.1 minutes, which results in an undervaluation of the total wRVU value by 0.687.</p><p><strong>Conclusions: </strong>The perioperative wRVU assigned by the RUC underestimates the amount of time assigned to perform the required tasks. The RUC should consider using prospective times collected by physicians to calculate a more accurate wRVU. In addition, the RUC should consider how modern patient care practices and requirements have increased the intensity of work for physicians.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"118-121"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU-Broncho-Aspiration Protocols Monitoring at an Academic Health Network System.","authors":"Araceli Cuaranta, Michael Abdelmasseh, Calyb King, Alex Ashley, Jeremy Eckles, Juan Hernandez-Pelcastre, Tania Nguyen, Nic Tate, Chase Gillispie, Joshua Keefer, Levi Nolan, Errington Thompson, Robert Finley, Barbara Payne, Alexei Gorka, Jonathan Willis, Vineela Kadiyala, Juan Sanabria","doi":"10.14423/SMJ.0000000000001790","DOIUrl":"10.14423/SMJ.0000000000001790","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives were to determine intensive care unit (ICU) incidence of broncho-aspiration (BA) and the effect of monitoring BA prevention protocols.</p><p><strong>Methods: </strong>The Health Network Warehouse was interrogated for the diagnosis of BA in patients older than 18 years in the surgical ICU (SICU) from January 2010 to December 2020. A BA prevention bundle protocol was prospectively monitored during all consecutive SICU admissions from August 2021 to November 2021 until discharge/death (n = 159). Experimental subjects were matched for age, sex, body mass index, and comorbidities with historical controls (BA^- and BA⁺) as a propensity score analysis study. The BA prevention bundle protocol consisted of head-of-bed elevation at 30°, acid-suppressive medication, and daily administration of mouthwash. Univariate/multivariate analyses were conducted (<i>P</i> < 0.05).</p><p><strong>Results: </strong>The BA incidence over a 10-year period was 5.6%. Before study initiation, random monitoring showed a mean bundle protocol compliance of 29% (18%-39%). After the introduction of protocol monitoring, compliance increased to 92% despite an upsurge in temporary nurses serving in the ICU. There was a total of 795 daily entries, with a mean head-of-bed elevation of 29.8° ± 13°, and a 10-fold decrease in BA (from 5.6% to 0.6%, <i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Implementation and monitoring of a BA prevention protocol significantly reduced the rate of BA in the SICU.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"128-133"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and Infant Outcomes in a Subset of Patients with Sickle Cell Disease in South Carolina.","authors":"Christina M Abrams, Caroline B Foster, Natalia Davila, Marcelaine Reneau, Earleisha Felder, Martina Mueller, Caroline Davila","doi":"10.14423/SMJ.0000000000001784","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001784","url":null,"abstract":"<p><strong>Objectives: </strong>Sickle cell disease (SCD), which disproportionately affects minorities, increases complications during pregnancy. Severe maternal mortality is increased in women with SCD, including morbidity related to the disease and other nondisease-related complications. It also can have devastating complications for fetuses, with increases in premature birth and low birth weight. This study aimed to describe the characteristics of women with SCD in South Carolina, with a specific focus on fetal and maternal outcomes and complications. The secondary aim of this study was to identify the effect of maternal characteristics on birth outcomes, including social determinants of health.</p><p><strong>Methods: </strong>A secondary analysis of women from a single institution, the Medical University of South Carolina, which was part of the registry from the multi-institutional Sickle Cell Disease Implementation Consortium, was conducted. Patient demographics, self-reported pregnancy history, hydroxyurea use, and maternal and fetal outcomes were collected from patient-reported survey data. In addition, the number of vaso-occlusive episodes surrounding their pregnancies was collected for analysis.</p><p><strong>Results: </strong>Fifty-nine percent (116/195) of the female participants reported ever being pregnant. Seventy-two percent had live births, 15.8% had miscarriages, 1.8% had stillbirths, and 6.1% had an abortion. The mean age was 22.3 ± 4 years, with no difference in markers of severity between the groups. Most women were HbSS genotype with high rates of pain in the last year. No difference was found in age, education, employment, or income between these groups of women. Women in the nonlive birth cohort had higher body weights (78.7 versus 72.1 kg, <i>P</i> = 0.045). The Distressed Community Index was used as a marker for social determinants of health and was similar between the two groups, with a majority of both cohorts (61.7% and 52%) living in \"at risk\" and \"distressed\" communities. Complications related to SCD were high, including 43% of women experiencing pain during pregnancy, 5.2% developing acute chest syndrome, and 22.4% requiring transfusion. An additional 11% experienced preeclampsia. Unfavorable infant outcomes included 49% of the infants being premature and 40% having babies weighing less than 5.5 lb at birth.</p><p><strong>Conclusions: </strong>High rates of complications to both mother and infant were found in the women with SCD. Although few statistically significant predictors were found, by identifying and addressing specific needs of pregnant women with SCD, we can work toward reducing fetal and maternal mortality in an already vulnerable population.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"91-96"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}