Southern Medical Journal最新文献

{"title":"Linking Breastfeeding Support Training and Certification to Knowledge, Self-Efficacy, and Attitudes among Alabama Healthcare Professionals.","authors":"Xifan Yang, Jen Nickelson, Amy Lee, Lisa Pawloski","doi":"10.14423/SMJ.0000000000001966","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001966","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine whether healthcare professionals' breastfeeding-related training and certification are associated with breastfeeding support knowledge, self-efficacy, and attitudes.</p><p><strong>Methods: </strong>An online survey was created by modifying existing instruments. Items assessed Alabama healthcare professionals' certification in breastfeeding support, breastfeeding support-related training experience, knowledge, self-efficacy, and attitudes. Participants were healthcare providers and administrators serving infants and expectant or new mothers in Alabama, recruited by e-mailing through Alabama professional organization listservs and personal contacts. Multiple linear regression models were used to examine the relationship between breastfeeding support-related variables.</p><p><strong>Results: </strong>A total of 82 surveys were analyzed. Multiple linear regression showed that higher perceived training preparation was associated with higher self-efficacy (β=0.53, <i>P</i><0.001) and attitudes (β=0.27, <i>P</i>=0.040), but not higher knowledge (β=0.22, <i>P</i>=0.072), after controlling for sex and experience in breastfeeding their own infant. Certification status was associated with higher knowledge (β=0.34, <i>P</i>=0.005) and higher self-efficacy (β=0.32, <i>P</i>=0.003).</p><p><strong>Conclusions: </strong>Enhancing breastfeeding training for healthcare professionals in Alabama may help address the state's low breastfeeding rates and improve health equity for mothers and infants. Certification in breastfeeding support provides an additional level of training and should be encouraged. These findings underscore the need for targeted training interventions among healthcare professionals in Alabama.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"215-219"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821193","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":"The Evolution of Doula Care in Arkansas.","authors":"Pearl A McElfish, Anna B Cleek, Hannah McHardy, Bonnie Faitak, Nicolle Fletcher, Anna Strong, Molly Throgmorton, Krista Langston","doi":"10.14423/SMJ.0000000000001960","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001960","url":null,"abstract":"<p><strong>Objective: </strong>Arkansas has significant health disparities for maternal and infant outcomes, including high rates of low birth weight, preterm birth, severe maternal morbidity, and both maternal and infant mortality. Multiple studies have identified advantages of including doulas in maternal care teams. The purpose of this article was to describe the evolution of doulas in Arkansas.</p><p><strong>Methods: </strong>Leaders began training the workforce with only a hope of reimbursement, and doula organizations continued to evolve from informal dispersed networks into a formal statewide organization, the Doula Alliance of Arkansas. Collaborative efforts were key in driving policy change for doula reimbursement.</p><p><strong>Results: </strong>The University of Arkansas for Medical Sciences and stakeholders throughout Arkansas have collaborated to expand doula workforce capacity. In 2025, Arkansas legislators passed two bills focused on Medicaid reimbursements for doulas, which Governor Sarah Huckabee Sanders signed into law (HB 1252/Act 965 and HB 1427/Act 124).</p><p><strong>Conclusions: </strong>The article documents the results of persistent stakeholder collaboration focused on improving maternal health through expanded access to doula care. This article can serve to inform other states' policies and practices by documenting Arkansas's relatively rapid progression from establishing its first doula organization to expanding the doula workforce and ultimately passing legislation for Medicaid coverage.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"225-228"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821149","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":"Mood Stabilizers Are the First Line of Treatment for Bipolar Disorder.","authors":"Shaishav Shah, Kirolos Ibrahim, Ahmed Sadah, Rif S El-Mallakh","doi":"10.14423/SMJ.0000000000001959","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001959","url":null,"abstract":"<p><p>Although lithium and other mood stabilizers remain the preferred agents for bipolar disorder, their clinical use has been declining steadily while antipsychotic and antidepressant use has been increasing. We performed an integrative review of efficacy, mechanisms of disease, and drug effects. The most reproduced biologic abnormality during the ill phases of bipolar disorder is elevated intracellular sodium. This has been proposed to directly lead to the symptoms of the disease. Lithium and mood stabilizers directly reduce or normalize intracellular sodium concentrations. Dopamine D2 receptor blockade by antipsychotic agents indirectly increases sodium pump activity, thereby also reducing intracellular sodium. Antidepressants increase intracellular sodium, which is believed to contribute to the destabilization of the illness. Lithium and mood-stabilizing anticonvulsant drugs inhibit sodium entry in an activity-dependent fashion that may directly normalize documented biologic abnormalities in manic or depressed bipolar patients. This action makes them the preferred first-line pharmacologic agents. Antipsychotic medication indirectly lower intracellular sodium and would be reasonable adjunctive or second-line agents. Serotoninergic antidepressants increase intracellular sodium, which may explain why they destabilize the illness and should be avoided or used as third-line agents.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"274-278"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821174","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":"Erratum: Training with Artificial Intelligence: Are There Hidden Costs in Clinical Reasoning and Medical Education?","authors":"Maya Guhan, Chirayu Shah, Prathit A Kulkarni","doi":"10.14423/SMJ.0000000000001981","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001981","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.14423/SMJ.0000000000001927.].</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"279"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821208","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":"Practical Wisdom Through Narratives as Told by Medical Students and Physicians.","authors":"Jordan D Millhollin, Elaine Liang, Zachary Loveless, Sarah Kim, Laura Shinkunas, Tavinder K Ark, Lauris C Kaldjian, Fabrice Jotterand, John D Yoon","doi":"10.14423/SMJ.0000000000001967","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001967","url":null,"abstract":"<p><strong>Objective: </strong>Medicine, as both clinical and moral practice, is increasingly complex. As such, there is growing appreciation for the importance of practical wisdom (phronesis), a multidimensional capacity that clinicians develop as they navigate practice. Narrative serves as a mode by which clinical exemplars communicate wisdom and therefore provides a rich structure through which practical wisdom can be observed as manifest in lived experience. The purpose of this study was to analyze clinical phronesis narratives to uncover how participants understand practical wisdom through the real-life challenges of clinical encounters.</p><p><strong>Methods: </strong>This article describes a qualitative study using structured interviews of 62 participants (40 medical students and 22 physicians). Phronesis narratives describe a particular clinical situation involving an ethically or professionally challenging patient case in which respondents thought practical wisdom was demonstrated.</p><p><strong>Results: </strong>Narratives frequently identified practical wisdom as being needed in encounters involving patient advocacy, individualized patient care, and communication skills. Character traits associated with practical wisdom included empathy, patience, and emotional intelligence. Narratives most often revealed dimensions of practical wisdom such as person-centeredness, poise, or goal-directed decision making. Findings confirm the clinical relevance and multiple dimensions of practical wisdom in medicine \"in vivo\" that had previously been described theoretically \"in vitro.\" Analysis also revealed that clinical medical students appear able to observe practical wisdom in their supervising physicians, highlighting the need for role-modeling by wise exemplars.</p><p><strong>Conclusions: </strong>The moral content of clinical medicine can be illuminated by rich narratives that can assist in the formation of wise clinicians. Based on the richness of moral content found in these phronesis narratives, the inclusion of narrative-based practices in medical education may help cultivate practical wisdom in medicine.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"242-251"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821140","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":"When the Dog Bites: A 5-Year Retrospective on Canine Bite Encounters.","authors":"Sara Elisabeth Rowell, Michele Nichols, Charli Cohen, William King, Jennifer McCain, Kathy Monroe","doi":"10.14423/SMJ.0000000000001961","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001961","url":null,"abstract":"<p><strong>Objectives: </strong>This study addresses two objectives: to describe the epidemiology of dog bite-related emergency department (ED) visits and to evaluate changes in the rate of dog bite visits from 2019 to 2023.</p><p><strong>Methods: </strong>Dog bite visit data from the Children's Injury Database were analyzed. Descriptive statistical and epidemiologic analyses were conducted using Epi Info 7 version 7.2.4.0. ED visits cases containing code W54, \"bitten by dog,\" were retrieved and reviewed for inclusion.</p><p><strong>Results: </strong>Between 2019 and 2023, our ED treated 1403 dog bite-related visits. There were 1252 initial visits and 151 return visits for follow-up care related to the same injury. Even though there were 34% fewer visits in 2020 than in 2019, the rate of dog bite injury visits increased by 70%. Nearly 12% (n=165) of patients required admission, and the median length of stay for these patients was 40 hours. Injuries occurred to the head/neck/face (64%, n=805). Patients were most often male (57%, n=711), with an average age of 6.5 years old. Dog breeds were identified in 43% (n=596) of cases.</p><p><strong>Conclusions: </strong>Dog bites are commonly seen in a pediatric ED, with 12% of patients with this type of injury requiring admission. Frequently consulted specialties included facial surgery services and ophthalmology. Primary care physicians and parents share a crucial role in reducing this type of injury.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"220-224"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820774","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":"NET Rounding: A Standardized Rounding Intervention to Improve Rounding Efficiency and Optimize the Inpatient Experience for Internal Medicine Attendings and Residents.","authors":"Emily R Insetta, Peter Barish, Nathan Baskin, Rebeccah M Brusca, David Chia, Sandra Oreper, Shirley Chan, Molly A Kantor, Stephanie M Conner","doi":"10.14423/SMJ.0000000000001968","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001968","url":null,"abstract":"<p><strong>Objectives: </strong>There is a scarcity of published best practices for efficient and effective hospital rounds. We introduced a standardized rounding intervention (NET Rounding, or <i>Novel</i> Rounding Practices, Shared <i>Expectations</i>, and <i>Time</i> Management) with the primary aims of improving rounding efficiency, reducing resident work-hour violations, and positively affecting clinician experience. Secondary aims included identifying efficient rounding practices and describing the intervention's impact on the attending and resident experience.</p><p><strong>Methods: </strong>A standardized rounding intervention was implemented February-June 2022. Attendings and residents completed preintervention surveys October 2021-January 2022 and postintervention surveys immediately after their inpatient rotation during the intervention period. Survey data were compared using qualitative thematic analysis along with χ² and Fisher exact tests to assess intervention uptake, helpfulness of rounding strategies, and impact on education and efficiency.</p><p><strong>Results: </strong>A total of 171 attendings and 188 residents participated in the intervention. The survey response rates were 38% and 35%, respectively. Residents reported reduced rounding time and fewer work-hour violations with NET Rounding. There were perceived improvements in timeliness of patient care, shared expectations among team members, and overall inpatient clinician experience.</p><p><strong>Conclusions: </strong>A novel rounding intervention improved perceived rounding efficiency, resident work hours, and overall inpatient experience for attendings and residents.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"235-241"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821179","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":"Outcomes of Hepatitis C Virus Testing and Treatment at a Rural Safety Net Clinic in East Tennessee.","authors":"Patrick S M Means, Stacey W McKenzie","doi":"10.14423/SMJ.0000000000001963","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001963","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Hepatitis C virus (HCV) is the most common bloodborne infection in the United States and a leading cause of liver-related morbidity. Tennessee is among the top 10 states for a patient population living with HCV, and it is especially prevalent in the Appalachian counties. The purpose of this study was to report single-center findings for HCV during a 30-month period from January 2022 to August 2024 at a rural safety-net clinic in eastern Tennessee with a patient population notable for a high prevalence of previous incarceration, injection/intranasal drug use, and/or being unhoused. The aim of this project was to identify factors in the clinical pipeline for HCV testing and treatment that can be improved to increase completion of HCV curative treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients were offered confidential HCV antibody screening with OraSure rapid HCV antibody tests using a fingerstick blood sample at the clinic, followed by confirmatory HCV RNA and human immunodeficiency virus assay at the local health department. Hepatitis B virus status was established at the clinic before the initiation of treatment. Aspartate aminotransferase-to-platelet ratio (APRI) and Fibrosis-4 index (FIB-4) scores were used to assess the progression of liver disease in HCV patients. Patients with active infection were treated with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir for 8 or 12 weeks, respectively. Demographic data were collected on all patients. Antibody-positive patients were assessed for whether they received confirmatory RNA testing, followed up on their results, and if they tested positive, began treatment, completed therapy, and were cured posttherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 231 screening antibody tests performed, 30 (12.9%) of which were positive. Twenty-five patients received confirmatory testing, 18 of whom were RNA positive. Of the RNA-positive patients, 12 followed up on their results, 11 began therapy, and seven completed therapy, all of whom were confirmed cured. Thirty-eight percent of all RNA-positive patients were definitively cured. Twenty-seven patients had FIB-4 and APRI scores available; eight FIB-4 and eight APRI scores were predictive of cirrhosis. Previous hepatitis B virus infection was found in five antibody-positive patients, and no human immunodeficiency virus was found. Patients were demographically consistent with the county of testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The overall antibody-positivity rate was not significantly different from previous reports of safety-net clinics in eastern Tennessee. Rates of follow-up, therapy, completion of therapy, and confirmation of cure were high in those patients who received confirmatory testing; however, 10% of antibody-positive patients were lost to follow-up before confirmatory testing. This suggests that if confirmatory HCV laboratory values could be obtained at the time of the positive screening test, treatment and","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"259-262"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821117","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":"Therapeutic Approach to Heart Failure Management: Insight from Clinical Trials.","authors":"Ambrish Kumar, Rylee Fowler, Emily Ruggerio, John Monahan, Sean J Battle, James O Ampadu, Donald J DiPette, Jay D Potts","doi":"10.14423/SMJ.0000000000001965","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001965","url":null,"abstract":"<p><p>Heart failure (HF) is a global burden and, irrespective of age, sex, race, nationality, and geography, affects individuals across the world. Several reports mentioned that, globally, more than 64 million people, which accounts for 1% to 3% of the total global population, are living with HF. In the United States, approximately 6.7 million people older than 20 years have some form of HF, and it is expected to rise to 8.5 million (approximately 3% of the US population) by 2030. HF was linked to 85,037 deaths in 2021, which was 45.8% higher than in 2011. The direct and indirect healthcare costs to treat and manage HF keep increasing both in the United States and around the world. There are several different classes of therapeutic agents available to treat HF. The current recommended therapies include the following drug classes: renin-angiotensin-aldosterone system inhibitors, angiotensin receptor-neprilysin inhibitor, diuretics, β-blockers, and sodium-glucose cotransporter inhibitors. The present article reviews the pathophysiology of HF and focuses on the Food and Drug Administration-approved HF therapeutic agents and insights from corresponding clinical studies.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"252-258"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820642","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":"Micro- and Macroaggressions Experienced by Physicians and Trainees: A Nationwide Qualitative Study.","authors":"Cynthia Kay, Jennifer A Woodard, Natalie Yass, Sara Tesfatsion, Sarah Vepraskas","doi":"10.14423/SMJ.0000000000001962","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001962","url":null,"abstract":"<p><strong>Objectives: </strong>Most of the literature on micro- and macroaggressions from the perspectives of physicians and learners derives almost exclusively from surveys and focus groups. A more thorough understanding of individual perspectives is necessary to further advance this subject. The objective of this study was to explore physicians' and physician trainees' experiences with micro- and macroaggressions in the clinical setting and their thoughts on how to address such aggressions.</p><p><strong>Methods: </strong>This was a nationwide, qualitative study. Virtual one-to-one interviews were conducted between October 2021 and March 2022. A volunteer sample of 18 faculty physicians and trainees (medical students, residents, and fellows) representing all regions of the United States were interviewed. Grounded theory was used to analyze transcripts and create a code book. Codes were finalized through constant comparison and developed into themes and subthemes.</p><p><strong>Results: </strong>Thirteen participants identified as female. Eight were non-White. Eleven were faculty. All levels of learners were included. The average interview duration was 43 minutes. Participants described a wide range of aggressions, their resultant emotions and thoughts in response to an event, the complexity of addressing aggressions, and their self-reflection on what transpired and their roles within medicine and society.</p><p><strong>Conclusions: </strong>Most participants, regardless of level, felt responsible to respond to micro- and macroaggressions when individuals more junior to them were present. Most also admitted feeling unprepared and unsure of how to respond, however.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"229-234"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821198","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}