Southern Medical Journal最新文献

{"title":"Comparison of Burnout and Fulfillment Rates between Physicians in Direct Primary Care and Other Practice Models.","authors":"Melissa E Boylan, Deborah M Hurley","doi":"10.14423/SMJ.0000000000001821","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001821","url":null,"abstract":"<p><strong>Objectives: </strong>Primary care internal medicine and family medicine physicians experience the second and sixth highest rates of burnout among all medical specialties. Direct primary care (DPC) is an understudied model of practice in which physicians are believed to have lower rates of burnout. In this study, we surveyed primary care physicians to assess burnout and fulfillment rates as well as quantify several burnout risk factors in DPC and non-DPC practicing physicians.</p><p><strong>Methods: </strong>The Stanford Professional Fulfillment Index was used to measure physician fulfillment and burnout in a select population of currently practicing primary care physicians in the southeastern United States. Physicians were classified by current practice model as DPC or non-DPC (self-identified). Data were analyzed to assess whether any differences existed in physician fulfillment, burnout, and other practice characteristics by medical practice/payment model.</p><p><strong>Results: </strong>DPC physicians had significantly lower burnout (<i>P</i> = 0.002) and higher fulfillment scores (<i>P</i> = 0.013) compared with non-DPC physicians despite working a similar number of hours per week (<i>P</i> = 0.923). DPC physicians had a higher rate of practice ownership (<i>P</i> < 0.001) and saw a lower number of patients per day (<i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Results show that compared with non-DPC physicians, physicians practicing the DPC model of care experience greater professional fulfillment and lower burnout. Given these significant results and the small sample size of this study, more research is warranted. A larger sample size and additional data collection would increase statistical power to better evaluate clinic and physician characteristics, allow for further exploration of the findings from this study, and increase the generalizability of results.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"275-280"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023788","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":"On \"Predictors of Blood Transfusion in Patients Undergoing Cytoreductive Surgeries for Ovarian Malignancy\".","authors":"Jana K Elsawwah, Patricia B Stopper, Zoltan H Nemeth","doi":"10.14423/SMJ.0000000000001819","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001819","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"251"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035507","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":"Teaching to Teach: A Scoping Review of Teaching Skill-Development Programs across Medical Education.","authors":"Alicia Darwin, Ashley Mason, Alyssa Faye Clare, Sarah Nestler, Antoinette Spoto-Cannons","doi":"10.14423/SMJ.0000000000001828","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001828","url":null,"abstract":"<p><strong>Objectives: </strong>Teaching is an integral part of the day-to-day responsibilities of physicians and physicians-in-training. We provide an overview across the medical education continuum of who is being trained how to teach, the methods of delivery used, and the effectiveness of the program in improving teacher confidence and teaching skills to improve the execution of teaching training programs.</p><p><strong>Methods: </strong>In October 2020, the authors conducted a scoping review, systematically searching six databases (PubMed, Embase, MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) for literature dating back to 2010 describing interventions aimed at teaching physicians or physicians-in-training how to teach effectively. Four authors screened the articles for inclusion based on title and key words. Four authors reviewed all of the articles selected to identify key features, including manuscript citation, study design, study institution, demographic information, course description, and efficacy, and entered the data into a Qualtrics survey. Two authors then analyzed the data extracted.</p><p><strong>Results: </strong>Of 23,409 potentially eligible studies, 163 were included. The populations studied included medical students (17%), residents (55%), fellows (13%), faculty/attendings (23%), and other (4%). The length of the training interventions ranged from half a day or less to longer than 1 year. Multiple instructional methods were used including lecture (71), observed teaching in action (71), case-based learning (34), learner feedback (24), modules (25), objective structured teaching exercises (19), essays/writing assignments (11), portfolio and/or personal teaching philosophy development (5), and tests/examinations (4). Evaluation methods varied, and efficacy was measured by an improvement in confidence in teaching abilities (61), in self-reported teaching abilities (59), objective structured teaching exercises scores (3), and an increased interest in academic medicine (33).</p><p><strong>Conclusions: </strong>Current programs designed to teach medical students, residents, and physicians how to teach vary widely. We propose that future research is needed to advance the instruction of physicians and physicians-in-training on how to be effective clinical educators.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"260-266"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047164","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":"Safety and Effectiveness in the Use of Clinical Artificial Intelligence.","authors":"Neil Nusbaum","doi":"10.14423/SMJ.0000000000001817","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001817","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"258-259"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042661","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":"Moral Distress in Training: A Disquieting Suggestion.","authors":"Benjamin Frush","doi":"10.14423/SMJ.0000000000001818","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001818","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"267-268"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052762","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":"Bridging Language Gaps in Health Care: Clinician Experiences and Challenges in Utilizing Medical Interpreters.","authors":"Tharani Ravi, Jasmine Rodriguez, Robert Wood, Anthony Pascullo, Etny Candelario, Daniela Estrada Gomez, Mario Hernandez, Carolina Sanchez, Fozia Ali","doi":"10.14423/SMJ.0000000000001826","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001826","url":null,"abstract":"<p><strong>Objectives: </strong>Providing high-quality care to patients from diverse ethnic and linguistic backgrounds demands effective communication using interpreters and the ability to build patient-physician relationships. This study aimed to explore clinician perceptions of healthcare quality when using interpreter services and identify barriers to effective interpreter use in a family medicine clinic.</p><p><strong>Methods: </strong>This was a multimethod study involving clinician and staff surveys and resident/faculty focus groups about experiences using interpreters. The study was conducted in a residency clinic in Bexar County, Texas, where 48% of the population speaks a foreign language.</p><p><strong>Results: </strong>Of the 70 clinicians and staff participants in the surveys, 87% were at least \"somewhat comfortable\" using qualified interpreters, and 76% believed that they could effectively overcome language barriers; however, only 39% were satisfied with the medical care they provided. More than 70% of clinicians felt capable of diagnosing and treating diseases (74% and 78%, respectively) using interpreters, but fewer than 50% were satisfied with their ability to empower patients (44%) or establish a personal connection (33%). Fifty-one percent of clinicians reported that they did not use interpreters at least once in the preceding 3 months, even when necessary, citing long wait times to connect to interpreter services, poor interpreter telephone connection, and patient request to use family/friend as interpreter. Focus groups identified other logistical challenges when using interpreters, as well as the impact of interpreter use on clinician-patient relationships.</p><p><strong>Conclusions: </strong>Clinicians and staff were comfortable using interpreter services and could fulfill their essential duties, yet they expressed dissatisfaction with both the medical care delivered and the relationships created with patients.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"252-257"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032365","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":"White Blood Counts of Hospitalized Patients Without Infection, Malignancy, or Immune Dysfunction.","authors":"Yazan Abu Omar, Erin Sullivan, Rebecca Schulte, Rayli Pichardo, Michael B Rothberg","doi":"10.14423/SMJ.0000000000001820","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001820","url":null,"abstract":"<p><strong>Objectives: </strong>An elevated white blood cell (WBC) count may indicate malignancy, infection, and immune dysfunction. In diagnosing these conditions, physicians generally evaluate laboratory results compared with reference ranges based on healthy populations. Reference ranges for hospitalized patients are lacking. This study aims to define a normal reference range for WBC count in hospitalized patients without malignancy, infection, or immune dysfunction.</p><p><strong>Methods: </strong>This was a retrospective cross-sectional study of nonsurgical patients hospitalized from 2017 to 2018 in the Cleveland Clinic Health System without malignancy, infection, or immunological dysfunction. WBC count, absolute neutrophil count, and absolute lymphocyte count were collected. We calculated means, standard deviations, and the reference range for each variable.</p><p><strong>Results: </strong>A total of 46,419 patients had WBC counts. Mean WBC count was 8.0 (standard deviation 3.31, reference range 1.6-14.5). In a multivariable linear regression, mean WBC count decreased with age, Black race relative to White race, and congestive heart failure. Body mass index, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and steroid use were associated with higher WBC count. In total, 13.5% of patients in this cohort had WBC counts above the \"normal\" threshold of 11.</p><p><strong>Conclusions: </strong>Among hospitalized patients without infection, malignancy, or immune dysfunction, the normal range for WBC count was 1.6 to 14.5 × 10⁹ WBCs/L. Age, race, body mass index, steroid use, and several comorbidities were associated with WBC count variation from the reference levels established based on healthy populations. Physicians should be cautious when interpreting WBC counts between 11 and 14.5 × 10⁹ WBCs/L, which appear to represent normal values in the hospital.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"287-292"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012948","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":"Periprocedural Complications in Adults with Mediastinal Masses.","authors":"Christina R Bellinger, Margo Lannan, Mitchell Butler Gigandet, Ben Morris","doi":"10.14423/SMJ.0000000000001824","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001824","url":null,"abstract":"<p><strong>Objectives: </strong>Respiratory and cardiovascular catastrophes are feared complications in patients with mediastinal masses undergoing anesthesia. Only a few of these events in the adult population have been noted in rare case reports, however. We aimed to investigate the complications related to surgical resection or biopsy involving mediastinal masses in clinical settings.</p><p><strong>Methods: </strong>We performed a retrospective review of patients undergoing procedures related to their mediastinal mass and report on the perioperative outcomes.</p><p><strong>Results: </strong>In a 10-year span, we identified 122 patients who underwent procedures for mediastinal masses. The majority of procedures (78.8%) were performed under general anesthesia. The median mass size was 5.5 cm, and 62.1% of patients exhibited various degrees of airway obstruction and/or compression of cardiovascular structures. Intraprocedural complications were 5.2% and included six hypoxic events. Postprocedural complications occurred in 7.0% of patients and included six cases of respiratory failure and three cases of circulatory shock; however, we found no incidence of airway or circulatory collapse during anesthesia induction or in patients undergoing bronchoscopy. There were no differences in complications based on body mass index, compression of mediastinal structures, or atelectasis. There were no deaths.</p><p><strong>Conclusions: </strong>We report a small number of complications in patients with mediastinal masses undergoing procedures despite the presence of structural compression and atelectasis. Large prospective studies are warranted to determine optimal patient management. Patients with mediastinal masses undergoing procedures require timely diagnosis and a multidisciplinary approach to periprocedural airway management.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"247-250"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054602","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":"Evaluation of Top-Ranked Search Engine Web-Based Osteoporosis Materials.","authors":"Kiersten L Bond, Lori W Turner","doi":"10.14423/SMJ.0000000000001822","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001822","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to examine the health literacy and quality of information on online Web sites about osteoporosis using the suitability assessment of materials (SAM) method.</p><p><strong>Methods: </strong>The search terms \"osteoporosis\" and \"weak bones\" were entered separately into three different search engines: Google, Bing, and Yahoo. Five Web sites were found on all three search engines for each search term, totaling 10 Web sites. Four different researchers graded the Web sites using the SAM scale and then averaged them.</p><p><strong>Results: </strong>For the osteoporosis search term Web sites, 60% were rated superior and 40% were rated adequate by the SAM method. The average reading grade level was 10.2, with 20% of Web sites rated superior and 40% rated adequate. Sixty percent of Web sites contained graphics, with only one Web site rated superior. In addition, 80% of Web sites were found to be unsuitable for having a summary. For the weak bones search term Web sites, 80% were rated adequate and only 20% were rated superior. The reading grade level was 9.8, with 40% of the Web sites rated adequate and 60% rated not suitable.</p><p><strong>Conclusions: </strong>Web sites about osteoporosis contain a higher reading grade level than the national average of 7th grade. Most Web sites lack an ending summary of key points and graphics to aid comprehension. Health information Web sites about osteoporosis need to contain a lower reading grade level, more graphics, and summaries to increase the comprehension of readers.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"293-298"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015148","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":"A Primary Care Approach to Visual Screening in Adults with Intellectual and Developmental Disabilities.","authors":"Alexander K Black, Alex C Weaver, Rafik Jacob","doi":"10.14423/SMJ.0000000000001827","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001827","url":null,"abstract":"<p><p>This article explores the unique challenges faced by adults with intellectual and developmental disabilities (IDDs) and proposes ways in which primary care physicians can improve ocular health in this patient population. The existing literature does not offer specific guidelines for vision screening in adults with IDDs in the primary care setting. Effectively screening for ocular issues and making timely referrals to specialists can improve ocular health. We recommend screening visual acuity at least annually, even in the absence of visual complaints in adults with IDDs to monitor for changes in visual acuity in this unique patient population that is prone to visual challenges and is vulnerable to underdiagnosis of related conditions.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 5","pages":"299-305"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018307","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}