Southern Medical Journal最新文献

{"title":"A Qualitative Study of Transportation-Related Barriers to HIV Care in South Carolina.","authors":"Sarah J Miller, Mariajosé Paton, Divya Ahuja, Sharon Weissman, Tammeka Evans, Cassidy A Gutner, Sayward E Harrison","doi":"10.14423/SMJ.0000000000001742","DOIUrl":"10.14423/SMJ.0000000000001742","url":null,"abstract":"<p><strong>Objectives: </strong>Addressing structural barriers to care for people living with human immunodeficiency virus (HIV) in the southern United States is critical to increase rates of viral suppression and to reduce existing HIV disparities. This qualitative study aimed to describe transportation-related barriers experienced by people living with HIV in South Carolina, understand perceived effects of transportation vulnerability on HIV care, and explore strategies used by individuals to overcome transportation-related challenges.</p><p><strong>Methods: </strong>We conducted semistructured interviews with 20 people living with HIV from South Carolina who were either reengaging in HIV care after a prolonged absence (>9 months) or in care but with a detectable viral load (ie, >200 copies/mL). All people living with HIV reported transportation vulnerability. A deductive/inductive approach was used to identify transportation-related barriers perceived to negatively affect HIV care. We also identified strategies and resources described by people living with HIV as helpful in addressing transportation challenges.</p><p><strong>Results: </strong>Participants described a range of transportation-related barriers to HIV care, including lack of access to reliable, safe, and affordable transportation, as well as stigma due to HIV and socioeconomic statuses. These barriers were reported to negatively affect engagement in care and worsen both physical and mental health. Participants indicated flexible clinic policies and instrumental support from family and friends were useful in overcoming barriers.</p><p><strong>Conclusions: </strong>This study offers insight for the development of transportation interventions to improve equitable access to HIV care for people living with HIV in South Carolina. It also calls attention to the ways in which transportation vulnerability, HIV-related stigma, and disability status intersect to create unique challenges for some people living with HIV.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"617-622"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376050","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":"More Technology, Fewer Boundaries, and Physician Burnout in Academic Primary Care Physicians.","authors":"Laura Porterfield, Ashley Collazo, Karen E Schlag, José E Rodríguez, Kendall M Campbell","doi":"10.14423/SMJ.0000000000001735","DOIUrl":"10.14423/SMJ.0000000000001735","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"587-590"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376067","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":"Exploring Bias in Health Care: Using Art to Facilitate a Narrative Medicine Approach among Third-Year Medical Students.","authors":"Erij Elkamel, Daniela Guerra, Marquita Samuels, Sarah E Stumbar","doi":"10.14423/SMJ.0000000000001740","DOIUrl":"10.14423/SMJ.0000000000001740","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Teaching medical students about biases in health care poses challenges due to the complexity of modifying preexisting beliefs and the possibility of triggering strong emotional reactions. Narrative medicine fosters reflection and discussion among healthcare providers, and visual thinking strategies (VTS) enable providers to improve diagnostic ability through close and methodical examination of art. This study investigated the effectiveness of a session integrating narrative medicine and VTS to enhance third-year medical students' understanding of bias in health care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 90-minute \"Narrative Medicine Rounds\" session was implemented in the Family Medicine clerkship for all third-year medical students in the Florida International University Herbert Wertheim College of Medicine class of 2024. The session included a faculty-facilitated discussion of Robert Colescott's painting &lt;i&gt;Emergency Room&lt;/i&gt;, an overview of narrative medicine principles, and a sharing of student narratives related to bias experienced in the healthcare setting. After the session, students wrote and submitted their narrative essays. Students also completed an anonymous, optional, computer-based evaluation with Likert-type and free-response questions. Likert questions were analyzed using descriptive statistics. For the short-answer questions, teams of two researchers (D.G. and S.E.S., E.E. and M.S.) analyzed responses for themes and subthemes, met to reach consensus on a codebook through discussion, and recoded data as needed until frequencies of themes were mutually determined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 101 students, 87 (86%) provided responses to the Likert questions. Seventy percent of respondents agreed that Robert Colescott's &lt;i&gt;Emergency Room&lt;/i&gt; was a useful tool for discussing bias in medicine, whereas 25% were neutral. Fifty-one percent of respondents agreed that the session enhanced their understanding of bias in patient care, with 33% being neutral. Forty-seven percent of respondents agreed that the session made them more familiar with narrative medicine as a tool that they can use in patient care, with 28% being neutral. Students identified five themes for recognizing bias: empathy (16%), self-reflection (60%), active listening (17%), communication (13%), and education (7%). When addressing bias, students outlined five strategies: drawing from personal experiences (1%), self-reflection (64%), communication (29%), education (15%), and advocacy (26%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Combining narrative medicine and VTS in a single session offers a promising approach for discussing bias in healthcare education. Through reflective experiences and art interpretation, students demonstrated an awareness of often interconnected strategies to identify and mitigate bias while caring for patients. Future next steps for this study involve exploring longitudinal impacts and integrating narrative medicine st","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"612-616"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376052","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":"Intimate Partner Violence: Physicians Must Address Physical and Mental Health Harms.","authors":"Donna Ewy","doi":"10.14423/SMJ.0000000000001724","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001724","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"521-523"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126769","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":"Quantifying Efficacy of Video Interventions about Adverse Events in Medical Student Education.","authors":"Eric Wahlstedt, Brittany Levy, William Cranford, Adam Dugan, Justin Ziemba, Andrew Harris","doi":"10.14423/SMJ.0000000000001733","DOIUrl":"10.14423/SMJ.0000000000001733","url":null,"abstract":"<p><strong>Objectives: </strong>The coronavirus disease 2019 pandemic catalyzed a rapid shift toward remote learning in medicine. This study hypothesized that using videos on adverse events and patient safety event reporting systems could enhance education and motivation among healthcare professionals, leading to improved performance on quizzes compared with those exposed to standard, in-person lectures.</p><p><strong>Methods: </strong>Participants were randomly assigned to a group both watching the video and attending an in-person lecture or a group that received only the in-person lecture in this study performed in 2022. Surveys gathered demographic information, tested knowledge, and identified barriers to reporting adverse events.</p><p><strong>Results: </strong>A total of 83 unique participants responded to the survey out of the 130 students enrolled (64%; 83/130). Among the students completing all of the surveys, the group who watched the Osmosis video had a higher average quiz score (6.46/7) than the lecture group (6.31/7) following the first intervention. Only 25% of respondents agreed or strongly agreed that they knew what to include in a patient safety report and only 10% agreed or strongly agreed that they knew how to access the reporting system.</p><p><strong>Conclusions: </strong>This study suggests virtual preclass video learning can be a beneficial tool to complement traditional lecture-based learning in medical education. Further research is needed to determine the efficacy of long-term video interventions in adverse events.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"551-555"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126772","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 Enduring Value of the VA in Health Professions Education: Medical Student Perspectives.","authors":"Drupad Annapureddy, Joelle Abdallah, Zuhair Hawa, Hyemi Chong, Reuben J Arasaratnam","doi":"10.14423/SMJ.0000000000001726","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001726","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"562-564"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126774","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":"Why Is US Health Care Failing? Some Reasons Are Obvious, but Fixes Are Harder.","authors":"Steven Lippmann","doi":"10.14423/SMJ.0000000000001725","DOIUrl":"10.14423/SMJ.0000000000001725","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"549-550"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126776","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":"Characteristics of Admissions from the Pediatric Emergency Department Observation Unit.","authors":"Shabana Yusuf, Elizabeth A Camp, Aderonke O Adekunle-Ojo","doi":"10.14423/SMJ.0000000000001734","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001734","url":null,"abstract":"<p><strong>Objective: </strong>Emergency department observation units (EDOUs) are used to manage common pediatric illnesses and reduce the admission rate to the hospital. Most of these patients require a short duration of observation before a determination can be made whether they need to be admitted to the hospital or safely discharged home. The purpose of this study was to determine the characteristics of admissions from a pediatric EDOU for the top 10 diagnoses admitted to the unit. This will help standardize the disposition of such types of patients from the ED, hence improving the efficiency of the unit.</p><p><strong>Methods: </strong>We did a retrospective surveillance study of admitted patients from 0 to 18 years of age from the EDOU for the top 10 diagnoses. Descriptive data were reported using percentages and medians with interquartile ranges. Pearson χ² tests were used to determine significant differences (<i>P</i> < 0.05) between the reason for admission and medical history.</p><p><strong>Results: </strong>In total, 520 patients were admitted from the EDOU during the study period. The median patient age was 3.39 years, with most being Hispanic and female. The top three primary diagnoses of all admitted patients were cellulitis and abscess, gastroenteritis, and bronchiolitis. Sixty-three percent of all admitted patients had secondary diagnoses. Most of these patients were admitted to the inpatient unit due to progression of the primary condition.</p><p><strong>Conclusions: </strong>The characteristics of admissions from the EDOU may help us to understand historical experience regarding diagnoses, timing, and indications of deterioration, resource utilization, and other metrics that resulted in transfers of EDOU patients to the intensive care unit/operating room/inpatient units.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"543-548"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126766","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":"Diagnosis of Gout as a Correlative Risk for Acute Myocardial Infarction in the Absence of Traditional Cardiovascular Risk Factors.","authors":"Rezwan F Munshi, James R Pellegrini, Samuel Olson, Andrej M Sodoma, Prachi Anand, Ofek Hai, Roman Zeltser, Amgad N Makaryus","doi":"10.14423/SMJ.0000000000001730","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001730","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to study the impact of gout as a correlative risk factor in the incidence of acute myocardial infarction (AMI) among patients without known MI risk factors. Our study population was obtained from the National Inpatient Sample (NIS) 2011-2018 using the <i>International Classification of Diseases, Ninth</i> and <i>Tenth Revisions</i>.</p><p><strong>Methods: </strong>This study included patients without cardiovascular disease (CVD), and various outcomes were compared among patients with and without gout. Cohorts were weighted using an algorithm provided by the NIS, which allows for national estimates. Our primary endpoint was the odds of developing an MI, and secondary endpoints were adverse hospital events and length of stay. In total, 117,261,842 patients without CVD risk factors were included in this study, 187,619 (0.16%) of whom had a diagnosis of gout.</p><p><strong>Results: </strong>Patients without CVD risk factors who had gout were older and more likely to be male compared with patients without gout. Among patients without CVD risk factors, the odds of having an AMI were significantly higher in those with gout compared with those without, even after adjusting for chronic nonsteroidal anti-inflammatory drug and oral steroid use. Moreover, patients without CVD risk factors and with gout were more likely to develop acute renal failure, acute thromboembolic event, shock, acute gastrointestinal bleed, and arrhythmia compared with those without gout. Furthermore, patients without CVD risk factors who were admitted with gout had higher mortality compared with those without gout.</p><p><strong>Conclusions: </strong>In our study, we found that patients without risk factors for AMI who had gout were more likely to develop AMI compared with those without gout. Furthermore, the same patients were more likely to develop other adverse outcomes. Even with proper management, these individuals should be monitored closely for coronary events.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"539-542"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126767","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":"Seeking the \"Why\": Moral Education in Medical Training.","authors":"Benjamin Frush","doi":"10.14423/SMJ.0000000000001723","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001723","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"565-566"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126773","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}