Southern Medical Journal最新文献

{"title":"Efficacy and Safety of Direct Oral Anticoagulants Compared to Warfarin in Patients with Cirrhosis and Splanchnic Vein Thrombosis.","authors":"Sean-Patrick Prince, Denisse Camille Dayto, Andrew Sephien, Marc Lozano, Robyn Tobillo, Natalie P Hurlock, Anil Ram, John Abernathy","doi":"10.14423/SMJ.0000000000001750","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001750","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of splanchnic vein thrombosis (SVT) is reported to be <25 times lower than that of deep vein thrombosis and pulmonary emboli, which occur in 70 to 270/100,000 cases in the general population. Current guidelines recommend initial treatment with therapeutic low-molecular-weight heparin followed by a transition to a vitamin K antagonist (VKA) or a direct oral anticoagulant (DOAC) in patients with cirrhosis who develop SVT without severe liver dysfunction. This, however, is based on observational data. This study aimed to evaluate the efficacy and safety of anticoagulant therapy in patients with cirrhosis who present with SVT and receive either a DOAC or a VKA.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study was conducted from December 2021 to November 2022. Patients between the ages of 18 and 75 years with cirrhosis and acute SVT who received either a VKA or a DOAC between July 2019 and July 2021 were eligible for inclusion. The primary outcome was the efficacy of treatment, defined as a new thrombotic event. The secondary outcome was the safety of treatment, defined as the development of major bleeding. Readmission data were followed up at 6 and 10 months. Bivariate analysis was conducted to assess the relationship between the medication groups and each outcome and summarized as odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was set at 5% for all of the comparisons.</p><p><strong>Results: </strong>A total of 80 patients from 50 hospitals were included in this study. Sixty-one patients (59.02% male) received DOACs and 19 (57.89% male) received a VKA. Of the patients who received DOACs, 41 (67.21%) received apixaban, one (1.64%) received dabigatran, and 19 (31.15%) received rivaroxaban. The results from the bivariate analysis revealed no significant differences between DOACs and warfarin for both the efficacy (OR 1.46, 95% CI 0.44-4.84, <i>P</i> = 0.53) and safety outcomes (OR 1.03, 95% CI 0.04-26.43, <i>P</i> = 1) at 10 months.</p><p><strong>Conclusions: </strong>The use of DOACs in patients with cirrhosis who present with SVT may be efficacious and safe compared with warfarin. The findings from our study may inform power analyses for well-conducted randomized trials to confirm these findings.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"662-665"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565121","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":"Neighborhood Ecologies, Cases, and Deaths during the Beginning of the COVID-19 Pandemic: Lessons for Current and Future Epidemics?","authors":"Peter T Baltrus, Chaohua Li, Megan Douglas, Robina Josiah Willock, Ashley Daniel, Dominic Mack, Anne H Gaglioti","doi":"10.14423/SMJ.0000000000001757","DOIUrl":"10.14423/SMJ.0000000000001757","url":null,"abstract":"<p><strong>Objectives: </strong>The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected Black and Latinx communities. Ecologic analyses have shown that counties with a higher percentage of Latinx and Black people have worse COVID-19 outcome rates. Few ecologic analyses have been published at the neighborhood (census tract) level. We sought to determine whether certain sociodemographic neighborhood ecologies were associated with COVID-19 case and death rates in metropolitan Atlanta, Georgia.</p><p><strong>Methods: </strong>We used census data and principal-component analysis to identify unique neighborhood ecologies. We then estimated correlation coefficients to determine whether the neighborhood profiles produced by a principal-component analysis were correlated with COVID-19 case and death rates. We conducted geographically weighted regression models to assess how correlation coefficients varied spatially for neighborhood ecologies and COVID-19 outcomes.</p><p><strong>Results: </strong>We identified two unique neighborhood profiles: (1) high percentage of residents, Hispanic ethnicity, without a high school diploma, without health insurance, living in crowded households, and lower percentage older than 65 years; and (2) high percentage of residents, Black race, living in poverty, unemployed, and households receiving Supplemental Nutrition Assistance Program benefits. Profile 1 was associated with COVID-19 case rate (Pearson <i>r</i> = 0.462, <i>P</i> < 0.001) and profile 2 was associated with COVID-19 death rate (Spearman <i>r</i> = 0.279, <i>P</i> < 0.001). Correlations between neighborhood profiles and COVID-19 outcomes varied spatially.</p><p><strong>Conclusions: </strong>Neighborhoods were differentially at risk of COVID-19 cases or deaths depending on their sociodemographic ecology at the beginning of the COVID-19 pandemic. Prevention methods and interventions may need to consider different social determinants of health when addressing potential cases and deaths during future emergent epidemics.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"640-645"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565181","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":"Improving Hypertension and Diabetes Mellitus Control with a Dedicated Patient Navigator.","authors":"Justin Marsden, Jingwen Zhang, Chloe Bays, Samuel O Schumann, Andrew D Schreiner, Afifah Khan, Patrick D Mauldin, Kimberly S Davis, William P Moran","doi":"10.14423/SMJ.0000000000001745","DOIUrl":"10.14423/SMJ.0000000000001745","url":null,"abstract":"<p><strong>Objectives: </strong>Hypertension and diabetes mellitus (DM) are the leading causes of cardiovascular, cerebrovascular, and chronic kidney diseases. They affect an estimated 47% and 11% of Americans, respectively. In this study, we assessed whether a dedicated patient navigator embedded within a patient-centered medical home (PCMH) using a structured panel management and patient outreach strategy could improve blood pressure and glycemic control in primary care patients with uncontrolled hypertension and DM.</p><p><strong>Methods: </strong>We performed a prospective study comparing blood pressure and glycemic control in primary care patients before and after implementation of a patient navigator executing a hypertension and DM-focused panel management plan.</p><p><strong>Results: </strong>From January 2014 to October 2019, inclusion criteria were met 5164 times, which comprised 1958 unique patients within a PCMH. Multivariate regression analysis reveals a significant decrease in uncontrolled systolic blood pressure (SBP) over time, with an actual decrease of roughly 40% of uncontrolled episodes of SBP becoming controlled by 12 months. Multivariate regression analysis reveals a significant decrease in uncontrolled hemoglobin A1c (HbA1c) over time for each plot (<i>P</i> < 0.0001), with an actual decrease of roughly 30% of uncontrolled episodes of HbA1c becoming controlled by 12 months.</p><p><strong>Conclusions: </strong>This study demonstrated the benefit of a dedicated patient navigator embedded within a PCMH on improving BP and glycemic control in primary care patients with uncontrolled hypertension and DM. Glycemic control was achieved, with 30% of episodes reaching an HbA1c of <8% and BP control achieved for 40% of episodes with SBP <140 mm Hg at 12 months. There were no differences by the social determinants of race and poverty.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"571-576"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376066","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":"Association of Socioeconomic Variables with Primary Cesarean Section.","authors":"Katrina B Wilson, Joshua Fogel, Allan J Jacobs","doi":"10.14423/SMJ.0000000000001744","DOIUrl":"10.14423/SMJ.0000000000001744","url":null,"abstract":"<p><strong>Objectives: </strong>Socioeconomic characteristics may be associated with cesarean section (CS) rates. We probe the relationship between socioeconomic variables and primary cesarean section (PCS) by studying indicators of socioeconomic status (SES) in a population-based study in New York City.</p><p><strong>Methods: </strong>This was a retrospective study of all 80,506 women in New York City who gave birth to a live child during 2018, and who met inclusion and exclusion criteria. Data were drawn from the New York City Department of Health and Mental Hygiene and the US Census. The main outcome measure was performance of PCS as compared with vaginal birth.</p><p><strong>Results: </strong>Approximately 21% of neonates were delivered by PCS. Multivariate multilevel mixed-effects logistic regression analysis showed higher odds for PCS for women with an upper-middle class median household income of US$108,500 to $380,499 (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07-1.76, <i>P</i> = 0.001), and the percentage enrolled in the Supplemental Nutrition Assistance Program (OR 1.01, 95% CI 1.001-1.012, <i>P</i> = 0.02). Lower odds for PCS occurred for all middle-class categories of per capita income: US$32,500 to $54,499 (OR 0.91, 95% CI 0.84-0.99, <i>P</i> = 0.02), US$54,500 to $108,499 (OR 0.76, 95% CI 0.66-0.88, <i>P</i> < 0.001), and US$108,500 to $380,499 (OR 0.80, 95% CI 0.66-0.96, <i>P</i> = 0.02). No significant association occurred for women receiving public assistance.</p><p><strong>Conclusions: </strong>Patient preferences in favor or against CS may be related to SES. There may be conflicts between obstetric care that is maximally beneficial and a patient's desire for delivery mode. Clinicians should be aware of the potential implications of this dilemma.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"591-598"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376051","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":"Numismedica II: Health Problems Caused by Coins.","authors":"Kenneth E Olive","doi":"10.14423/SMJ.0000000000001741","DOIUrl":"10.14423/SMJ.0000000000001741","url":null,"abstract":"<p><p>Coins occasionally cause health problems. These problems have a wide range of presentations and can affect multiple organ systems. This article updates a 2009 review of the medical literature addressing health problems caused by coins in several ways. The spectrum of clinical findings is expanded by describing new entities associated with coin ingestion, including laryngeal impaction in adults, gastric perforation, and pancreatic disease. Guidelines for differentiating swallowed coins from the potentially life-threatening mimic of swallowed button batteries are summarized. Multiple new case series better define outcomes and management approaches in coin ingestion. Metal toxicity from coins remains rarely reported. The evidence that systemic allergic reactions can result from ingested coins is strengthened by new case reports. Maintaining the perspective that coin ingestion can cause obscure symptoms may lead to both a diagnosis of the cause of such symptoms and the description of clinical findings not yet reported.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"582-586"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376068","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":"Skin Biopsies and Diagnostic Outcomes at a Multisite Family Medicine Residency Network.","authors":"Alice J Lin, Laura K Ferris, John Maier, Robin Maier","doi":"10.14423/SMJ.0000000000001739","DOIUrl":"10.14423/SMJ.0000000000001739","url":null,"abstract":"<p><strong>Objectives: </strong>Physicians other than dermatologists evaluate nearly 60% of all skin diseases, and 22% of these physicians are family physicians. Dermatology education is therefore an important aspect of Family Medicine training. Dermatologic procedural training in Family Medicine residency is not standardized, however, so family physicians graduate with highly variable skills. This study describes the scope and diagnostic outcomes of skin biopsies performed by residents at a multisite Family Medicine residency network in comparison with those performed by attendings at a Family Medicine faculty community practice.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients evaluated at eight Family Medicine residency training sites and one Family Medicine faculty community practice within a regional academic health system between January 2020 and October 2022. Patients with a skin finding who underwent at least one skin biopsy during their visit were included in the study.</p><p><strong>Results: </strong>Among all of the skin findings, the incidence of skin biopsy was 3.6% (258/7104) for residents and 1.8% (175/9917) for attendings (<i>P</i> < 0.001). Family Medicine residents performed fewer shave biopsies (57.8% vs 77.7%, <i>P</i> < 0.001) and more punch biopsies (25.6% vs 11.4%, <i>P</i> < 0.001) compared with attendings. Most biopsies performed by residents and attendings were benign, although residents biopsied significantly more benign (79.1% vs 64.6%, <i>P</i> < 0.001) and malignant lesions (11.2% vs 5.7%, <i>P</i> = 0.049). Attendings biopsied significantly more low-to-moderate-grade dysplastic (22.3% vs 5.0%, <i>P</i> < 0.001) and high-grade atypical lesions (4.0% vs 0.8%, <i>P</i> = 0.034).</p><p><strong>Conclusions: </strong>Family Medicine residents at this residency network receive training in a variety of skin biopsy types. Distinct skin biopsy practices and outcomes between residents and attendings may reflect differences in patient populations, clinical expertise, and dermatology referral patterns.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"609-611"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376071","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":"Validity of Endometrial Cavity Length on 3D Pelvic Ultrasound before Endometrial Ablation.","authors":"Kayla Shine, Rachael Cowherd, Alexandra Rowin, Raksha Soora, Michelle Meglin","doi":"10.14423/SMJ.0000000000001736","DOIUrl":"10.14423/SMJ.0000000000001736","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare endometrial cavity length measurements obtained by preoperative three-dimensional (3D) reconstruction of coronal images on pelvic ultrasound with intraoperative endometrial cavity measurements obtained in advance of Minerva endometrial ablation.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 41 individuals who underwent a Minerva endometrial ablation between August 1, 2018 and March 15, 2022 at a single academic medical center. Patients were excluded if they had an in-clinic ablation or no ultrasound with 3D uterine volume within 180 days before surgery. Physician sonologists measured the endometrial cavity length using 3D coronal reconstruction of the cavity. Two measurements were obtained by separate physicians who were blinded to intraoperative values. Intraoperative endometrial cavity lengths were obtained from operative reports. A Bland-Altman plot was used to evaluate the agreement of intraoperative and ultrasound measurements.</p><p><strong>Results: </strong>The mean intraoperative endometrial cavity length (50.7 ± 7.8 mm) was greater than the mean endometrial cavity length by 3D coronal reconstruction of pelvic ultrasound (36.1 ± 6.2 mm, <i>P</i> < 0.0001). The average difference between intraoperative and ultrasound measurements of cavity length was 14.6 ± 9.0 mm. The agreement between measurements was poor (Lin's concordance correlation coefficient 0.06). Using a Bland-Altman plot, the limits of agreement (-3.1 to 32 mm) exceeded the a priori acceptable limits of agreement (-10 to 10 mm).</p><p><strong>Conclusions: </strong>Our findings suggest that preoperative coronal endometrial cavity length measurements by ultrasound are not a valid substitute for intraoperative measurements before Minerva ablation.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"599-602"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376072","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":"Fit Testing Failure of Reprocessed \"Duckbill\"-Type N95 Masks.","authors":"Phillip Moschella, Wesley Liao, Alain H Litwin, Jonn Foulk, Jeff Anthony, Xiyan Tan, Christine Cole","doi":"10.14423/SMJ.0000000000001738","DOIUrl":"10.14423/SMJ.0000000000001738","url":null,"abstract":"<p><strong>Objectives: </strong>In response to worldwide shortages of N95 masks during the severe acute respiratory syndrome-coronavirus-2 pandemic, various strategies have been used. The Centers for Disease Control and Prevention recommend several strategies, including simple isolation to reprocessing methods using vaporized hydrogen peroxide to guide reuse of masks up to five times. National Institute for Occupational Safety and Health (NIOSH) quantitative fit testing was performed after five trials of donning and doffing in one cohort of new masks and two cohorts of repeatedly sterilized \"duckbill\"-type N95 masks.</p><p><strong>Methods: </strong>One cohort of new masks and two cohorts of sterilized masks were repeatedly subjected to 35% vaporized hydrogen peroxide for either five or 10 cycles. Then, they were subjected to five trials of donning and doffing, with NIOSH quantitative fit testing performed after each wear cycle to assess for any degradation on fit performance caused by sterilization and/or repeated donning and doffing up to the recommended Centers for Disease Control and Prevention limit of five times. All of the fit testing was performed on a single volunteer.</p><p><strong>Results: </strong>The means and 95% confidence intervals for each cohort and the individual results for each mask within each cohort were reported. A χ² analysis showed significant differences in percentages of masks that pass fit testing in both recycled mask cohorts.</p><p><strong>Conclusions: </strong>These data show the variability of NIOSH fit testing results of both new and sterilized masks. The mask recycling program of our partner health systems thus discarded these types of masks due to the variable failure rate. Health systems should consider individual evaluation to inform their overall policies on mask reuse and recycling.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"623-627"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376065","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":"Racial and Ethnic Disparities in Pediatric Atopic Dermatitis.","authors":"Urdur Jonsdottir, Emily S Craver, Tanvi R Patel","doi":"10.14423/SMJ.0000000000001743","DOIUrl":"10.14423/SMJ.0000000000001743","url":null,"abstract":"<p><strong>Objectives: </strong>Atopic dermatitis (AD) is one of the most common chronic childhood conditions. Disparities in treatment and access to care can result in poor disease control and decreased quality of life. The aim of this study was to determine whether race and ethnicity affect treatment and healthcare utilization for pediatric atopic dermatitis in central Florida.</p><p><strong>Methods: </strong>This study of 4008 children with AD compared healthcare utilization and management using the numbers of AD-related healthcare visits, prescriptions, testing, and subspecialty referrals. Multivariable models were used to compare racial and ethnic groups (Black, Hispanic, Asian, and Other) with the reference group of non-Hispanic White, while adjusting for common confounders.</p><p><strong>Results: </strong>The mean number of urgent care visits for the Hispanic group was 1.61 times that of the non-Hispanic White group, and the mean number of emergency department visits was 3.71 (<i>P <</i> 0.001) times the reference group. Black or African American patients had a mean number of emergency department visits that was 1.52 times that of non-Hispanic White patients (<i>P =</i> 0.021). The mean count of primary care visits was lower among Hispanic patients and higher among Asian patients (<i>P =</i> 0.012). Visits to subspecialty clinics and hospitalizations did not differ significantly. There were no consistent patterns in differences of AD-related prescriptions, testing, or subspecialty referrals.</p><p><strong>Conclusions: </strong>This study indicates that racial and ethnic disparities exist in healthcare utilization in pediatric AD. The underlying factors contributing to these disparities need to be further studied and addressed to reach health equity within pediatric AD.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"603-608"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376070","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":"Optimizing Dermatological Care Triage in a Safety-Net Hospital: Retrospective Analysis of Diagnoses and In-Person Referrals.","authors":"Allen Shih, Alexandria Riopelle, Aaron Ordan, Stephanie Sanchez, Jag Bhawan, Christina S Lam","doi":"10.14423/SMJ.0000000000001737","DOIUrl":"10.14423/SMJ.0000000000001737","url":null,"abstract":"<p><strong>Objectives: </strong>Teledermatology is a cost-effective and efficient approach to delivering care and is particularly beneficial for patients with limited access to specialized services. Considering the rapid expansion of telehealth, it is crucial to focus on optimization. The purpose of our study was to evaluate the triaging of dermatologic care in an electronic consultation (e-consultation) service in a safety-net hospital.</p><p><strong>Methods: </strong>This was a 2-year retrospective review of a dermatology asynchronous store-and-forward e-consultation service.</p><p><strong>Results: </strong>A total of 1425 patients completed 1502 e-consultation. Of these e-consultations, 46% of the patients had Medicaid and 44% were Black or African American. The top three diagnoses were dermatitis unspecified, neoplasm of uncertain behavior, and acne/rosacea. Most (68%) were managed via e-consultation and did not require an in-person appointment. Children and adolescents were more likely to require an in-person appointment (74%) compared with adults (30%, <i>P</i> < 0.0001). Patients with a chief complaint of hair loss or skin lesion were more likely to require in-person evaluation (58% and 41%, respectively) compared with rash (24%) and acne (18%) (<i>P</i> < 0.0001). There was no difference found in recommendations for in-person evaluation based on race, non-English-language preference, or insurance status.</p><p><strong>Conclusions: </strong>E-consultation services seem well suited for certain concerns, and underserved populations can be evaluated by teledermatology.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"577-581"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376069","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}