Southern Medical Journal最新文献

{"title":"Developing the Good Physician: The Influence of Role Models in the Development of Virtues and Flourishing in Medical Students.","authors":"Ross A Oakes Mueller, Aaron B Franzen, Joel T Sagawa, G Michael Leffel, Farr A Curlin, John D Yoon","doi":"10.14423/SMJ.0000000000001804","DOIUrl":"10.14423/SMJ.0000000000001804","url":null,"abstract":"<p><strong>Objectives: </strong>A virtues-based model of character development for training future physicians may lead to increased flourishing in medical students through the influence of exemplary role models. This study aimed to analyze the association between caring virtues and measures of flourishing and to identify facilitators of physician flourishing.</p><p><strong>Methods: </strong>The authors used data from a 2011 nationally representative sample of 605 US medical students in which caring virtues (mindfulness, empathic compassion, and generosity) were measured using scales at two time points during the students' clinical years. Hypothesizing a mediated influence of role models in students' generosity and flourishing, the authors explored the interrelationship between measures of mindfulness, empathic compassion, and generosity, using latent variables within a structural equation model. Built into the model were paths to determine mechanisms by which virtues and flourishing are facilitated and/or inhibited.</p><p><strong>Results: </strong>Analyses supported the interrelationship between physician-specific measures of mindfulness, empathic compassion, and generosity. Findings were generally consistent with the hypothesized direction of relationships between these virtues of medical care and the effect of role models on student generosity and sense of calling. Experiences of positive character feedback from a supervisor did not directly predict the generous behavior of medical students as hypothesized, but there appeared to be an indirect effect on generosity through increased vocational satisfaction. When moral elevation was added to the structural model, data offered further support for mentors inspiring caring behavior. Findings from this study provide continued evidence in support of a virtues-based model of character education in medicine that theorizes the influence of role modeling on virtues development and flourishing, including evidence for moral elevation as a potential psychological mechanism.</p><p><strong>Conclusions: </strong>Medical schools may consider adopting a virtues-based model of character education in which supervisors are selected based on their capacity to exemplify virtuous care in their professional life.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"141-149"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543352","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 Cost-Effectiveness of Hospital at Home in Patients with COVID-19.","authors":"David W Walsh, Anthony Daniels, Stephen Looney, Christy Ledford, Thad Wilkins","doi":"10.14423/SMJ.0000000000001797","DOIUrl":"10.14423/SMJ.0000000000001797","url":null,"abstract":"<p><strong>Objectives: </strong>The coronavirus disease 2019 (COVID-19) pandemic significantly affected the capacity of health systems across the United States. Although not widely used before the pandemic, the hospital-at-home (HaH) model emerged as a potential strategy to alleviate hospital burden by providing hospital-level care in the home setting. This study aims to evaluate the safety, clinical effectiveness, and cost-efficiency of a HaH program for patients with COVID-19, comparing these outcomes with those of traditional in-hospital care.</p><p><strong>Methods: </strong>A retrospective matched case-control study was conducted at a major academic medical center in the southeastern United States. The study included 200 patients with confirmed COVID-19, 100 of whom were enrolled in the HaH program between February 1, 2021 and January 31, 2022, and 100 served as matched controls who received conventional hospital care. Matching criteria included age, sex, and admission to the intensive care unit. The primary outcomes assessed were 30-day readmission rates and inpatient length of stay (iLOS). Secondary outcomes included total length of stay (tLOS), emergency department visits within 30 days, and detailed cost analysis, including fixed and variable costs.</p><p><strong>Results: </strong>The analysis included 200 patients (mean age 50.4 years, standard deviation 14.2; 55% female). There were no significant differences between the HaH and control groups in terms of age, sex, or intensive care unit admission rates. The study found no statistically significant differences in 30-day readmissions (11% vs 14%, <i>P</i> = 0.48), days to readmission (9.0 vs 11.8, <i>P</i> = 0.32), or 30-day emergency department visits (18% vs 20%, <i>P</i> = 0.72) between the HaH and control groups. The HaH group had a significantly shorter iLOS (5.7 vs 9.4 days, <i>P</i> = 0.04), however, although tLOS was longer (13.0 vs 9.4 days, <i>P</i> < 0.001). The HaH program also demonstrated cost benefits, with significantly lower inpatient fixed costs ($675,668 vs $1,469,098, <i>P</i> = 0.02) and total inpatient costs ($1,268,944 vs $2,995,512, <i>P</i> = 0.01).</p><p><strong>Conclusions: </strong>The HaH program for COVID-19 patients offered a safe alternative to traditional hospitalization, with similar clinical outcomes and significant reductions in inpatient costs. The shorter iLOS suggests potential benefits in hospital resource management during surge periods, while the longer tLOS highlights the need for optimized patient selection and care strategies in the home setting. Further research is warranted to explore the long-term economic implications and patient outcomes of HaH programs, particularly during heightened demand, on healthcare systems.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"177-180"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543522","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":"Relationship between Systolic Ejection Time and Inflammation in End-Stage Heart Failure.","authors":"Joel Gutovitz, Jonathan Kutcher, David Z Cherney, Yael Schiller, Itzhak Gabizon, Eran Keshet, Jordan Rimon, David Koren, Vivek Rao, Liza Grosman-Rimon","doi":"10.14423/SMJ.0000000000001801","DOIUrl":"10.14423/SMJ.0000000000001801","url":null,"abstract":"<p><strong>Objectives: </strong>Systolic ejection time (SET) and systemic inflammation are two essential indicators of heart failure (HF) progression. We aimed to evaluate the associations between SET and inflammatory mediators in end-stage HF.</p><p><strong>Methods: </strong>Participants included 16 patients with end-stage HF recruited from the Heart Failure Clinic at Toronto General Hospital and 16 healthy individuals free of any known cardiovascular disease. SET, end systolic pressure, and levels of inflammatory mediators were documented for each patient, and a Spearman rank correlation coefficient was performed to examine differences between patients with end-stage HF and healthy controls.</p><p><strong>Results: </strong>The mean SET in patients with HF was shorter than in the healthy controls (283.5 ± 34.3 ms vs 330.1 ± 19.0 ms, <i>P</i> < 0.001). C-reactive protein (<i>P</i> = 0.001), macrophage inflammatory protein-1β (<i>P</i> = 0.041), macrophage-derived chemokine (<i>P</i> = 0.007), and cyclic guanosine monophosphate (<i>P</i> < 0.001) levels were negatively correlated with SET. The levels of other inflammatory mediators-granulocyte-stimulating factor, granulocyte-macrophage colony-stimulating factor, interleukin-8, macrophage inflammatory protein-1, macrophage inflammatory protein-1α, and tumor necrosis factor α-were not significantly correlated with SET.</p><p><strong>Conclusions: </strong>We found that SET was significantly lower in patients with end-stage HF compared with healthy controls and that reduced SET correlated with increased levels of several inflammatory mediators in patients with HF. By better understanding the relationship between SET and inflammation in HF, a more thorough evaluation could lead to improved risk stratification among patients with HF. Future work should investigate the roles of SET and inflammation in HF.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"167-170"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543500","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":"Implementation of a Longitudinal Personal Finance Curriculum into Resident Medical Education.","authors":"Arohi Saxena, Rakhee K Bhayani, Fahd A Ahmad","doi":"10.14423/SMJ.0000000000001802","DOIUrl":"10.14423/SMJ.0000000000001802","url":null,"abstract":"<p><strong>Objective: </strong>Residents frequently graduate medical school with a significant amount of debt and low financial literacy. Historically, there has been a lack of standardized, longitudinal financial education curriculum to educate residents about important financial principles. Our objective was to design and implement a longitudinal curriculum to cover a variety of personal and professional finance topics relevant to Pediatrics and Internal Medicine residents.</p><p><strong>Methods: </strong>Beginning in 2016, we integrated four lectures per year on personal and professional finance into the noontime curriculum for Internal Medicine and Pediatrics residents at Washington University School of Medicine with topics repeating over a 3-year cycle. We distributed surveys to residents to evaluate the program during its first 4 years; however, we halted collection in 2020 with the transition to a virtual/hybrid model during the coronavirus disease 2019 pandemic. The knowledge and behavior survey contained both Likert scale questions (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree) and dichotomous yes/no questions assessing certain behaviors and knowledge.</p><p><strong>Results: </strong>A mean of 80 out of 240 (33%) total residents (standard deviation 17) attended each lecture yearly between 2016 and 2020. The mean postlecture survey response rate was 16% (standard deviation 8.1%). Analysis of first-year survey data showed significant improvements in knowledge domains related to employment contracts, negotiation, and physician practice structures. The qualitative feedback was overall positive, and several trainees commented on the relevancy of the physician-led sessions.</p><p><strong>Conclusions: </strong>We successfully integrated a longitudinal personal finance curriculum into resident medical education to support personal and professional development throughout the stages of their career.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"150-154"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543479","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":"Exploration of the Intersection between Infant Feeding and Postpartum Contraception in Western North Carolina: Perspectives of Postpartum Individuals and Providers.","authors":"Liane M Ventura, Melissa White, Rebecca Strasser, Kate E Beatty","doi":"10.14423/SMJ.0000000000001798","DOIUrl":"10.14423/SMJ.0000000000001798","url":null,"abstract":"<p><strong>Objectives: </strong>Short interpregnancy intervals are associated with preterm births. Increasing access to postpartum contraception is a preventive intervention. Best practice recommendations suggest that postpartum individuals exclusively breastfeed for up to 6 months. Conversations about these two topics tend to occur simultaneously throughout the perinatal period. This study explores the intersection between infant feeding and postpartum contraception.</p><p><strong>Methods: </strong>Semistructured key informant interviews were conducted with postpartum individuals and providers from throughout western North Carolina. Interviews were audio recorded and transcribed. The \"Sort and Sift, Think and Shift\" method was applied. Emergent themes were identified by systematically generating summaries, memoranda, and quotation diagrams independently by two coders.</p><p><strong>Results: </strong>Key themes included the need to prioritize individual decision-making autonomy and to provide prenatal patient education about infant feeding and postpartum contraception. Participants also discussed the types of social support needed for successful breastfeeding efforts and the impact of infant feeding on mental health. Contextual factors related to infant feeding and postpartum contraceptive decision-making encompassed cultural influences (eg, the historical context of reproductive rights and breastfeeding in public), the inherent challenges of rurality (eg, lack of transportation and the closure of labor and delivery units), and family leave and workplace policies.</p><p><strong>Conclusions: </strong>Infant feeding method and postpartum contraception are highly individualized decisions, which are supported through patient education and shared decision making, particularly during the prenatal period. Findings suggest the importance of incorporating infant feeding within the sexual and reproductive health literature.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"189-195"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543356","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":"α-Galactose Syndrome Cases within the Prisma Health System, South Carolina.","authors":"Hanna Waltz, Lilianne Kaminski, Kyndall Dye-Braumuller, Matthew Haldeman, Emily Owens Pickle, Melissa S Nolan","doi":"10.14423/SMJ.0000000000001799","DOIUrl":"10.14423/SMJ.0000000000001799","url":null,"abstract":"<p><strong>Objectives: </strong>Humans can develop a vector-associated allergy to galactose-α-1,3-galactose (α-gal) a polysaccharide found in mammalian meats and by-products, resulting in α-gal syndrome (AGS). <i>Amblyomma americanum</i> tick bites have been implicated in AGS development in the United States, but the AGS clinical burden in South Carolina is not well understood. Because <i>A. americanum</i> is the predominant tick species in the state and large AGS cohorts exist in neighboring states, the potential for AGS clinical cases in South Carolina exists. Increased understanding of high-incidence geographical clusters is critical for clinical and public education given the potential for severe anaphylaxis.</p><p><strong>Methods: </strong>We conducted a 5-year retrospective chart abstraction of AGS patient cases serologically confirmed within the state's largest healthcare system to characterize this condition in South Carolina's Upstate and Midlands regions.</p><p><strong>Results: </strong>From October 2017 to February 2023, 50 patients were serologically diagnosed as having AGS within the Prisma Health system. Cohort demographics were mostly older, White males, and Black patients were significantly underrepresented in the AGS caseload (<i>P</i> = 0.0004). Immunosuppressing comorbidities and cooccurring allergies were common.</p><p><strong>Conclusions: </strong>This article presents the first clinical AGS case series in South Carolina, warranting further clinical and public education and a need for continued clinical research on this emerging tick-associated condition.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"161-166"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543538","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":"Performance of Chat Generative Pre-Trained Transformer on Personal Review of Learning in Obstetrics and Gynecology.","authors":"Adam Cohen, Jersey Burns, Martina Gabra, Alex Gordon, Nicholas Deebel, Ryan Terlecki, Katherine L Woodburn","doi":"10.14423/SMJ.0000000000001783","DOIUrl":"10.14423/SMJ.0000000000001783","url":null,"abstract":"<p><strong>Objectives: </strong>Chat Generative Pre-Trained Transformer (ChatGPT) is a popular natural-language processor that is able to analyze and respond to a variety of prompts, providing eloquent answers based on a collection of Internet data. ChatGPT has been considered an avenue for the education of resident physicians in the form of board preparation in the contemporary literature, where it has been applied against board study material across multiple medical specialties. The purpose of our study was to evaluate the performance of ChatGPT on the Personal Review of Learning in Obstetrics and Gynecology (PROLOG) assessments and gauge its specialty specific knowledge for educational applications.</p><p><strong>Methods: </strong>PROLOG assessments were administered to ChatGPT version 3.5, and the percentage of correct responses was recorded. Questions were categorized by question stem order and used to measure ChatGPT performance. Performance was compared using descriptive statistics.</p><p><strong>Results: </strong>There were 848 questions without visual components; ChatGPT answered 57.8% correct (N = 490). ChatGPT performed worse on higher-order questions compared with first-order questions, 56.8% vs 60.5%, respectively. There were 65 questions containing visual data, and ChatGPT answered 16.9% correctly.</p><p><strong>Conclusions: </strong>The passing score for the PROLOG assessments is 80%; therefore ChatGPT 3.5 did not perform satisfactorily. Given this, it is unlikely that the tested version of ChatGPT has sufficient specialty-specific knowledge or logical capability to serve as a reliable tool for trainee education.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"102-105"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068043","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":"Firearm Shootings: A Serious Public Health Issue.","authors":"Steven Lippmann","doi":"10.14423/SMJ.0000000000001781","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001781","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"140"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068038","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":"Increasing Communication about Fall Risk and Prevention between Internal Medicine Residents and Older Adults.","authors":"Mary L Thomas, Yulu Pan, Christopher D Jackson","doi":"10.14423/SMJ.0000000000001786","DOIUrl":"10.14423/SMJ.0000000000001786","url":null,"abstract":"<p><strong>Objectives: </strong>More than one in four older adults fall yearly, but fewer than half inform their doctors. As such, medical trainees must gain experience assessing fall risk in older adults. Studies exploring how often residents initiate these assessments and which interventions effectively increase this frequency are needed. The objective of our study was to determine whether a reminder survey increases the frequency and proportion of resident-initiated fall risk and prevention discussions between Internal Medicine residents and older adults.</p><p><strong>Methods: </strong>This quantitative pre- and postintervention study used an anonymous survey distributed to residents within one urban Internal Medicine resident clinic. For 1 week, residents were exposed to Stopping Elderly Accidents, Deaths, and Injuries fall risk assessments completed by patients 65 years and older to stimulate fall risk and prevention discussions. Residents completed the same survey 3 months after intervention withdrawal.</p><p><strong>Results: </strong>Postintervention, there was a statistically significant increase in the proportion of resident-initiated fall risk and prevention discussions (43% vs 81%, <i>P</i> = 0.03). Although not statistically significant, residents reported initiating fall risk (14% vs 19%, <i>P</i> = 1) and fall prevention (3.6% vs 19%, <i>P</i> = 0.25) discussions more frequently, and fewer residents reported forgetfulness as a barrier to having these discussions (57% vs 44%, <i>P</i> = 0.59).</p><p><strong>Conclusions: </strong>Exposure to the Stopping Elderly Accidents, Deaths, and Injuries fall risk tool is a promising reminder intervention to increase the frequency and proportion of resident-initiated fall risk and prevention discussions; however, larger multisite studies are needed to assess the statistical significance of these findings.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"114-117"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068040","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 Medical Education for the Care of Patients with Intellectual and Developmental Disabilities: The Role of Specialized Training and Early Exposure.","authors":"Alice Hamilton, Caroline Sachse, Elisa Sottile, Rafik Jacob","doi":"10.14423/SMJ.0000000000001782","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001782","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"111-113"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068036","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}