Southern Medical Journal最新文献

{"title":"Preexposure Prophylaxis Provided in the Emergency Department: Clinician Perspectives.","authors":"Sarah M Guess, Ava Roth, Mirinda Ann Gormley, Prerana Roth, Jessica Hobbs, Alain H Litwin, Moonseong Heo, Phillip Moschella","doi":"10.14423/SMJ.0000000000001861","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001861","url":null,"abstract":"<p><strong>Objectives: </strong>The southern United States is facing a burden of human immunodeficiency virus (HIV) diagnoses, with 52% of new diagnoses made in the region. The emergency department (ED) is an important access point for patient care, especially given nationwide shortages in primary care appointments. The objective of our study was to assess ED (ED) clinician knowledge regarding preexposure prophylaxis (PrEP), the perceived barriers to initiation of PrEP, and clinician willingness to initiate it in the ED.</p><p><strong>Methods: </strong>An institutional review board-approved survey was distributed using an internal e-mail listserv to all ED physicians and advanced practice clinicians within a southern academic level I trauma center ED. The survey was available throughout August 2023. Descriptive statistics described survey responses.</p><p><strong>Results: </strong>Fifty-six Emergency Medicine clinicians participated, for a response rate of 25.0%. Nearly one-fourth of clinicians reported not prescribing PrEP because they believed they lacked knowledge of or familiarity with the medication. Whereas 52 believed that PrEP could be integrated in the ED, 54 mentioned a potential barrier to implementation. The most common barrier to integrating PrEP into the ED was lack of information/training; additional barriers included time and staff constraints. More than half expressed a lack of confidence (58.9%) assessing PrEP eligibility. When asked how likely they would be to discuss linkage to PrEP, 52.8% answered confident or very confident and 52.8% were not confident or slightly not confident.</p><p><strong>Conclusions: </strong>Despite recognition of the utility of prescribing PrEP in the ED, clinicians identified multiple barriers to providing this essential component of health care. Findings indicate, however, that Emergency Medicine clinicians would be willing to prescribe PrEP with appropriate education and connection to care.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 8","pages":"556-560"},"PeriodicalIF":0.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765524","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":"Awareness and Indications of 5-α-Reductase Inhibitors for Benign Prostatic Hyperplasia in the Primary Care Setting.","authors":"Daniel S Alicea, Mustufa Babar, Justin Loloi, Jainam Shah, Umair Azhar, Kevin Labagnara, Azizou Salami, Kevin Tang, Juan Robles, Pedro Maria","doi":"10.14423/SMJ.0000000000001859","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001859","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the study was to investigate primary care physicians' (PCPs') level of awareness and indications for urology referral in patients treated with 5-α-reductase inhibitors (5-ARIs).</p><p><strong>Methods: </strong>An anonymous 14-question survey was e-mailed to PCPs in the specialties of Family Medicine and Internal Medicine at an academic institution. Questions focused on residency graduation year, patient volume, medical practice characteristics, knowledge of 5-ARIs and their effects on prostate-specific antigen (PSA) kinetics, role of 5-ARIs in prostate cancer (PC) prevention, and indications for prostate biopsy referral.</p><p><strong>Results: </strong>In total, 221 PCPs were e-mailed, 85 of whom responded (38.5% response rate). Approximately 39% of the PCPs surveyed were not aware of the suppressive effects of 5-ARIs on PSA, 63.5% were not sure or incorrectly answered when asked about calculating the corrected PSA of a patient who is taking 5-ARIs, 77.6% were not sure or would not refer for a prostate biopsy a patient who is taking 5-ARIs but has an elevated corrected PSA that needs to be calculated, 63.5% were not sure or believed that 5-ARIs may decrease the risk of high-grade PC, and 49.4% were not sure or believed that 5-ARIs are approved for the prevention of PC. There were no differences in responses between PCPs who were Family Medicine physicians and internists (<i>P</i> > 0.05 for all).</p><p><strong>Conclusions: </strong>There is a general lack of awareness among PCPs about 5-ARIs and indications for biopsy referral in patients taking 5-ARIs. An educational opportunity exists to optimize usage of 5-ARIs and avoid delaying PC detection.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 8","pages":"552-555"},"PeriodicalIF":0.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765516","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":"Aligning Competency Committee and Observing Faculty Needs in Pursuit of Useful Written Evaluations of Residents.","authors":"Dheepa R Sekar, Anjali J Das, Megan E Hamm, Thomas Grau, Andrea Carter","doi":"10.14423/SMJ.0000000000001853","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001853","url":null,"abstract":"<p><strong>Objectives: </strong>End-of-rotation narrative evaluations by faculty of Internal Medicine residents provide feedback to residents directly and to the program leadership to assess resident competency; however, observing faculty often lack an understanding of what information is useful to the program leadership. Faculty also face barriers in completing evaluations and formulating high-quality evaluations. We sought to qualitatively evaluate the interplay of the needs of the program leadership and barriers faculty face in providing high-quality evaluations.</p><p><strong>Methods: </strong>We conducted a descriptive qualitative study through semistructured interviews with six faculty with program leadership positions and six observing clinical faculty at a single large Internal Medicine residency program.</p><p><strong>Results: </strong>Interview themes elucidated a multifaceted process that observing faculty must navigate in writing narrative evaluations and the important features of a useful narrative evaluation itself. Faculty must navigate assessment committee needs and their own competing priorities and be skilled in observing residents and navigating emotional barriers with residents. Successfully navigating these factors allows them to produce useful narrative evaluations that ultimately inform assessment committee decisions.</p><p><strong>Conclusions: </strong>Understanding the complex dynamics of observing faculty factors and assessment committee needs can help guide future interventions to improve the quality and utility of written evaluations in assessing residents.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 8","pages":"570-575"},"PeriodicalIF":0.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765514","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":"Opioid Use Disorder and Pharmacological Treatment in Southwestern North Carolina: NC SID Database 2000-2020.","authors":"Beth Harmer, Brook Alemu, Aaron Brown, Hind A Beydoun","doi":"10.14423/SMJ.0000000000001862","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001862","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of the study were to provide a descriptive assessment of patient and hospital characteristics among individuals with an opioid use disorder (OUD) diagnosis in North Carolina and the seven western North Carolina counties and to identify rates of selected psychiatric/physical health outcomes associated with OUD and treatment gaps in medications for opioid use disorder (MOUD).</p><p><strong>Methods: </strong>Using the State Inpatient Database (SID), analyses were conducted to identify OUD and MOUD-related discharges between 2000 and 2020. Descriptive statistics and rates of OUD per 1000 discharges were calculated. Statistical significance for rates of OUD and non-OUD cases was determined using 95% confidence intervals. Variables indicating OUD diagnosis, MOUD participation, and comorbidities were identified.</p><p><strong>Results: </strong>The seven selected counties in North Carolina had a total of 396,183 hospitalizations between 2000 and 2020. Apart from Macon County, the overall county-level prevalence rates of OUD were consistently higher than that of the state. Compared with North Carolina, the median hospital length of stay and hospital charges for OUD patients in the seven counties were consistently higher than those for non-OUD discharges. Significant MOUD treatment gaps were observed in the seven counties.</p><p><strong>Conclusions: </strong>The impact of the opioid epidemic is still pervasive in North Carolina, particularly in the seven western countries. The high rates of OUD and comorbid conditions in tandem with treatment shortages pose serious public health threats in these rural communities. Policies, funding, and programmatic efforts should prioritize the expansion of MOUD and other treatment efforts, including crisis services, harm reduction services, and recovery programs. Public health needs assessment that involves both patients and stakeholders should be carried out to deliver targeted health services and deploy necessary resources in this medically underserved region.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 8","pages":"533-541"},"PeriodicalIF":0.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765521","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":"Healthcare Provider and Public Health Challenges: Decreasing \"Us\" versus \"Them\".","authors":"Gail Price-Wise, Ella Caroline Duffy, Katerina Benson, Yanna Willett, John Dunn, Charles H Hennekens, Panagiota Kitsantas, Maria Carmenza Mejia","doi":"10.14423/SMJ.0000000000001854","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001854","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 8","pages":"576-577"},"PeriodicalIF":0.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765519","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 Awareness and Care: Addressing Military Sexual Trauma among Women Veterans.","authors":"Joyce A Akwe, Daniel P Hunt","doi":"10.14423/SMJ.0000000000001855","DOIUrl":"10.14423/SMJ.0000000000001855","url":null,"abstract":"<p><p>Military sexual trauma (MST) significantly impacts the health and well-being of women veterans in the US military, where women constitute 16.3% of active-duty service members. Despite policy advancements, MST remains prevalent, with profound implications for mental and physical health. MST encompasses sexual assault and harassment, affecting 38% of women and 4% of men in the military. It is linked to higher rates of posttraumatic stress disorder, depression, substance use disorders, and physical health issues such as cardiovascular disease and chronic pain. In addition, MST survivors face social functional impairments, including difficulties in family relationships, occupational performance, and educational achievements. The military environment, characterized by close living quarters and hierarchical power dynamics, exacerbates the risk and consequences of MST. Survivors often experience institutional betrayal and fear of retaliation, hindering reporting and access to support. Effective interventions must address these unique challenges, emphasizing trauma-informed care, social support, and systemic changes to promote gender equity and accountability. Leveraging technology, such as mobile applications and online interventions, can enhance access to care and support for MST survivors. Comprehensive prevention and intervention strategies, coupled with policy reforms and cultural shifts within the military, are crucial for mitigating the impacts of MST and supporting the recovery and well-being of women veterans. The objective of this narrative review is to examine the health impacts and systemic challenges of MST among women veterans, advocating for trauma-informed care and policy reform.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 8","pages":"517-521"},"PeriodicalIF":0.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765517","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 the Gap: Examining Physician Assistant Practice Patterns to Address Kentucky's Health Care Workforce.","authors":"Virginia Valentin, Daniel Potter","doi":"10.14423/SMJ.0000000000001847","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001847","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to provide a description of the physician assistant (PA) workforce in Kentucky and the perspective of current Kentucky PA students regarding factors to influence rural work. This study intends to provide insights into the practice patterns of Kentucky PAs and alumni and desires of current students to assist policy leaders in understanding the impact that PAs could have on this medically underserved part of the country.</p><p><strong>Methods: </strong>The Kentucky Board of Medical Licensure database of licensed PAs and physicians was used to locate all currently practicing PAs in Kentucky and PA graduates from a large public university in Kentucky, 2016-2022. These practice locations were used to demonstrate movement of PA alumni before school matriculation, current practice areas by Health Professional Shortage Area and Medically Underserved Areas/Populations by counties and area of specialty. A cross-sectional survey was given to PA students at a large public university in Kentucky aimed at assessing the perceptions and influential factors regarding the PA profession and personal employment opportunities among PA students.</p><p><strong>Results: </strong>There are 1649 PAs who have active licenses in Kentucky and practice in 92 counties with 28 counties with no PAs; 42.5% of Kentucky PAs serve primary care Health Professional Shortage Areas and 20.0% serve in Medically Underserved Areas/Populations. The most common areas of practice are emergency medicine (14.5%) and internal medicine (14.5%). PAs from rural areas had significantly higher odds of holding a rural license compared with those from metropolitan areas (odds ratio, 6.42; <i>Z</i> = 6.76; <i>P</i> < 0.00001). Students reported choosing the PA profession due to length of education, work-life balance, and career mobility.</p><p><strong>Conclusions: </strong>Addressing the critical healthcare access issue in the southern United States will require innovation and utilization of the entire healthcare team. With 34% of PAs working in rural counties in Kentucky, policy leaders need to focus on methods to incentivize the next generation of PA providers to rural counties. As the dependency on nonphysician providers increases, future policy decisions and research needs to center around PA practice patterns and understanding of the needs of the next generation of providers.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 7","pages":"400-405"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638138","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":"Access and Use of Green and Blue Spaces for Memory and Physical Health.","authors":"Julia Kay Wolf, Jeralynn S Cossman","doi":"10.14423/SMJ.0000000000001845","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001845","url":null,"abstract":"<p><strong>Objectives: </strong>The coronavirus disease 2019 pandemic exacerbated mental and physical health issues in the United States. Due to various lockdown procedures to curb the spread of the virus, indoor gatherings were severely restricted, intensifying stress and anxiety.</p><p><strong>Methods: </strong>We used nationally representative data from the 2021 Crime, Health, and Politics Survey sampled from the National Opinion Research Center's AmeriSpeak panel. To explore pandemic-safe options to relieve negative health outcomes, we studied how access to and use of green and blue spaces were related to self-rated physical and mental health (ie, memory) during the pandemic.</p><p><strong>Results: </strong>Most of the logistic regressions show no relationships between access to green or blue spaces and the health outcomes (except for access to blue spaces and physical health), but we find positive associations between use of green and blue spaces with overall physical health and memory.</p><p><strong>Conclusions: </strong>Access to green or blue spaces is not necessarily enough to create a relationship with overall physical health and memory-actually using these areas is a key component to their association with positive health outcomes.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 7","pages":"389-393"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638137","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":"Community Outreach: A Strategy to Increase Recruitment of Latinx Medical Students into Otolaryngology.","authors":"Pablo C Ochoa, Tissiana Vallecillo, Semirra Bayan","doi":"10.14423/SMJ.0000000000001843","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001843","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 7","pages":"406-407"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638139","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":"Role of hs-CRP in Post-MI Sequelae: Insights into Mechanisms and Clinical Significance.","authors":"Yash Vardhan Trivedi, Parth Munjal, Bhupinder Singh, Rhea Kanwar, Aachal Gupta, Rohit Jain","doi":"10.14423/SMJ.0000000000001848","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001848","url":null,"abstract":"<p><p>High-sensitivity C-reactive protein (hs-CRP) is a key marker of inflammation, predominantly produced by hepatocytes and various tissues, including intracardiac tissue, atherosclerotic plaques, and vascular smooth muscles. The biomarker serves as a crucial element of innate immunity and rises in response to various disease processes, including infections and cancers. This rise is triggered by the release of cytokines, primarily interleukin-6, tumor necrosis factor, and interleukin-1β. The utility of hs-CRP in clinical practice is being further explored, particularly regarding its role in cardiovascular disease, a leading cause of morbidity and mortality globally. Studies have demonstrated that elevated hs-CRP levels are associated with an increased risk of myocardial infarction (MI) and other cardiovascular events. hs-CRP has been suggested to play a role in the development of atrial and ventricular arrhythmias post-MI, although further research is needed to fully clarify this relationship. hs-CRP has been proposed as a potential biomarker for the early detection of post-MI events and be used for cardiovascular disease risk stratification, categorizing individuals into low-, intermediate-, and high-risk groups. In this study, we discuss the role of hsCRP in predicting adverse outcomes in various cardiovascular conditions, highlighting its potential as a valuable biomarker in clinical practice.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 7","pages":"382-386"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638145","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}