Southern Medical Journal最新文献

{"title":"Effect of COVID-19 on Emergency Department Visits for Suicidal Ideation and Suicide Attempts among South Carolina Youth.","authors":"Radhika J Kothadia, Kaustubh G Joshi, Richard L Frierson, Coleton King","doi":"10.14423/SMJ.0000000000001789","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001789","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence suggests that the coronavirus disease 2019 pandemic negatively affected children's mental health (MH). The emergency department (ED) is often the first point of contact with a physician for youth who are experiencing suicidal thoughts and behaviors. Population-level reports of ED utilization in South Carolina for suicidal ideation (SI) and suicide attempts (SAs) during the pandemic are lacking. This study compares trends in ED visits for SI and SAs among youth in South Carolina ages 5 to 24 years, before (ie, March-December 2019) and during (ie, March-December 2020) the coronavirus disease 2019 pandemic.</p><p><strong>Methods: </strong>We examined 16,906 deidentified patient records from the South Carolina Revenue and Fiscal Affairs Office. Dispositional outcomes, type of insurance, ED utilization, and mortality also were reviewed.</p><p><strong>Results: </strong>The total number of ED visits for SI or an SA decreased during the pandemic, but the percentage of MH-related and total ED visits attributed to SI and SAs relative to other conditions increased. The pandemic negatively affected youth with preexisting utilization of EDs for MH reasons, SI, and SAs, but also those without prior ED visits for these reasons. Many youths who presented to an ED during the pandemic for SI or SAs had subsequent ED visits for MH concerns, SI, or an SA.</p><p><strong>Conclusions: </strong>The percentage of MH- and SI/SA-related visits increased during the pandemic. These data underscore the need for adequate MH services in EDs and increased access to outpatient MH resources to reduce the strain on EDs during public health emergencies.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"85-90"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068035","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":"Undervaluation of Perioperative Work for ACL Reconstruction by Relative Value Scale Update Committee Methodology in a Single Surgeon's Practice.","authors":"Shelby Cate Hodges, Juan J Gordillo, Mathew Hargreaves, Maxwell Harrell, Clay Rahaman, Eugene Brabston, Thomas Evely, Aaron Casp, Amit M Momaya","doi":"10.14423/SMJ.0000000000001787","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001787","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to determine the accuracy of the Relative Value Update Committee (RUC) and Centers for Medicare & Medicaid Services current times and work relative value units (wRVUs) for the perioperative work involved in anterior cruciate ligament (ACL) reconstruction by directly timing perioperative tasks as they occur in real time.</p><p><strong>Methods: </strong>The RUC was contacted to obtain a list of perioperative tasks and the corresponding times allotted for the tasks involved in arthroscopically aided ACL reconstruction (Current Procedural Terminology code 29888). The tasks that occurred both inside and outside the operating room were timed by the attending physician as the event occurred. The time for each task was then multiplied by its respective Centers for Medicare & Medicaid Services-assigned intensity coefficient to calculate the wRVU. Calculated and allotted wRVUs were compared for accuracy.</p><p><strong>Results: </strong>The tasks timed in this study were allotted 100 minutes by the RUC and a total wRVU value of 2.026. Our study found that these tasks took 132.1 minutes and had a total wRVU value of 2.713. The overall time it takes to perform perioperative tasks in arthroscopically aided ACL surgeries is underestimated by 32.1 minutes, which results in an undervaluation of the total wRVU value by 0.687.</p><p><strong>Conclusions: </strong>The perioperative wRVU assigned by the RUC underestimates the amount of time assigned to perform the required tasks. The RUC should consider using prospective times collected by physicians to calculate a more accurate wRVU. In addition, the RUC should consider how modern patient care practices and requirements have increased the intensity of work for physicians.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"118-121"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068044","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":"ICU-Broncho-Aspiration Protocols Monitoring at an Academic Health Network System.","authors":"Araceli Cuaranta, Michael Abdelmasseh, Calyb King, Alex Ashley, Jeremy Eckles, Juan Hernandez-Pelcastre, Tania Nguyen, Nic Tate, Chase Gillispie, Joshua Keefer, Levi Nolan, Errington Thompson, Robert Finley, Barbara Payne, Alexei Gorka, Jonathan Willis, Vineela Kadiyala, Juan Sanabria","doi":"10.14423/SMJ.0000000000001790","DOIUrl":"10.14423/SMJ.0000000000001790","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives were to determine intensive care unit (ICU) incidence of broncho-aspiration (BA) and the effect of monitoring BA prevention protocols.</p><p><strong>Methods: </strong>The Health Network Warehouse was interrogated for the diagnosis of BA in patients older than 18 years in the surgical ICU (SICU) from January 2010 to December 2020. A BA prevention bundle protocol was prospectively monitored during all consecutive SICU admissions from August 2021 to November 2021 until discharge/death (n = 159). Experimental subjects were matched for age, sex, body mass index, and comorbidities with historical controls (BA^- and BA⁺) as a propensity score analysis study. The BA prevention bundle protocol consisted of head-of-bed elevation at 30°, acid-suppressive medication, and daily administration of mouthwash. Univariate/multivariate analyses were conducted (<i>P</i> < 0.05).</p><p><strong>Results: </strong>The BA incidence over a 10-year period was 5.6%. Before study initiation, random monitoring showed a mean bundle protocol compliance of 29% (18%-39%). After the introduction of protocol monitoring, compliance increased to 92% despite an upsurge in temporary nurses serving in the ICU. There was a total of 795 daily entries, with a mean head-of-bed elevation of 29.8° ± 13°, and a 10-fold decrease in BA (from 5.6% to 0.6%, <i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Implementation and monitoring of a BA prevention protocol significantly reduced the rate of BA in the SICU.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"128-133"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068039","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":"Maternal and Infant Outcomes in a Subset of Patients with Sickle Cell Disease in South Carolina.","authors":"Christina M Abrams, Caroline B Foster, Natalia Davila, Marcelaine Reneau, Earleisha Felder, Martina Mueller, Caroline Davila","doi":"10.14423/SMJ.0000000000001784","DOIUrl":"10.14423/SMJ.0000000000001784","url":null,"abstract":"<p><strong>Objectives: </strong>Sickle cell disease (SCD), which disproportionately affects minorities, increases complications during pregnancy. Severe maternal mortality is increased in women with SCD, including morbidity related to the disease and other nondisease-related complications. It also can have devastating complications for fetuses, with increases in premature birth and low birth weight. This study aimed to describe the characteristics of women with SCD in South Carolina, with a specific focus on fetal and maternal outcomes and complications. The secondary aim of this study was to identify the effect of maternal characteristics on birth outcomes, including social determinants of health.</p><p><strong>Methods: </strong>A secondary analysis of women from a single institution, the Medical University of South Carolina, which was part of the registry from the multi-institutional Sickle Cell Disease Implementation Consortium, was conducted. Patient demographics, self-reported pregnancy history, hydroxyurea use, and maternal and fetal outcomes were collected from patient-reported survey data. In addition, the number of vaso-occlusive episodes surrounding their pregnancies was collected for analysis.</p><p><strong>Results: </strong>Fifty-nine percent (116/195) of the female participants reported ever being pregnant. Seventy-two percent had live births, 15.8% had miscarriages, 1.8% had stillbirths, and 6.1% had an abortion. The mean age was 22.3 ± 4 years, with no difference in markers of severity between the groups. Most women were HbSS genotype with high rates of pain in the last year. No difference was found in age, education, employment, or income between these groups of women. Women in the nonlive birth cohort had higher body weights (78.7 versus 72.1 kg, <i>P</i> = 0.045). The Distressed Community Index was used as a marker for social determinants of health and was similar between the two groups, with a majority of both cohorts (61.7% and 52%) living in \"at risk\" and \"distressed\" communities. Complications related to SCD were high, including 43% of women experiencing pain during pregnancy, 5.2% developing acute chest syndrome, and 22.4% requiring transfusion. An additional 11% experienced preeclampsia. Unfavorable infant outcomes included 49% of the infants being premature and 40% having babies weighing less than 5.5 lb at birth.</p><p><strong>Conclusions: </strong>High rates of complications to both mother and infant were found in the women with SCD. Although few statistically significant predictors were found, by identifying and addressing specific needs of pregnant women with SCD, we can work toward reducing fetal and maternal mortality in an already vulnerable population.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"91-96"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068041","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":"Few Patients Are Treated for Both Obesity and Depression.","authors":"Elizabeth Pfoh, Ning Guo, Michael Rothberg","doi":"10.14423/SMJ.0000000000001785","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001785","url":null,"abstract":"<p><strong>Objectives: </strong>Understanding the epidemiology of treatment for patients with co-occurring depression and obesity can inform care quality. The objective of the study was to identify how patients with obesity and newly diagnosed depression are treated and whether treatment is associated with body mass index change.</p><p><strong>Methods: </strong>This cohort study included adults with obesity and newly diagnosed depression who had ≥2 primary care visits between 2015 and 2020 at a large integrated health system. Treatment within 45 days of a depression diagnosis was identified, including antiobesity medication and group or individual weight management visits (eg, bariatric medicine); antidepressant prescriptions; or visits with a psychologist, social worker, or psychiatrist. Patients were grouped into treatment groups: none, depression only, weight management only, or both. Generalized structural equation models were used to identify the association between treatment group and body mass index change at 6 and 12 months, accounting for demographic and health characteristics as fixed variables and clinician identifier as a random variable.</p><p><strong>Results: </strong>Of the 13,729 adults, 43% received depression treatment, 3% received weight management treatment, and 4% received both. Individuals who received weight management treatment only lost more weight at 6 months (β = -1.0 kg/m²) and 12 months (β = -1.07 kg/m²) than individuals with no treatment. Individuals who had both treatments lost more weight than individuals with depression treatment alone (6 months: β = -1.07 kg/m²; 12 months: β = -1.21 kg/m²) and underwent a similar average change than those who received weight management treatment alone (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>There is an opportunity to increase treatment for obesity among patients with newly diagnosed depression.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"134-139"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068037","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":"What Physicians Should Consider When Moving Academic Institutions.","authors":"Marquita Norman, Resa Lewiss, Jeffrey Druck","doi":"10.14423/SMJ.0000000000001788","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001788","url":null,"abstract":"<p><p>There is limited information and guidance for physicians transitioning from one academic institution to another. The following recommendations serve as a resource for academic faculty interested in moving to a different academic institution. The advice falls into three categories of preparation: self-reflection and discernment to determine personal preferences and professional priorities; considerations when preparing for an academic faculty interview; and aspects of the offer, opportunity, and negotiables to discern whether it is right. We acknowledge that the process is nuanced without one strategy that applies to all physicians.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 2","pages":"106-110"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On \"Comparison of the Usability and Reliability of Answers to Clinical Questions: AI-Generated ChatGPT versus a Human-Authored Resource\".","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.14423/SMJ.0000000000001770","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001770","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"48"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927871","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":"Social Determinants' Role in Pediatric Respiratory Health: Health Insights from Central Florida.","authors":"Aledie A Navas Nazario, Shedeline Ulysse, Emily C Craver, Tanvi R Patel","doi":"10.14423/SMJ.0000000000001772","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001772","url":null,"abstract":"<p><strong>Objectives: </strong>Despite advances in therapies and educational initiatives, pediatric allergy disorders, including asthma, allergic rhinitis, and eczema, continue to pose substantial health challenges. Understanding the social determinants of health (SDoH) linked with these conditions is a critical area of research due to their multifactorial nature. This study aimed to assess the SDoH influencing pediatric allergy disorders in central Florida, specifically examining four groups of children: with asthma only, with eczema only, with both asthma and eczema, and a control group without these conditions.</p><p><strong>Methods: </strong>An electronic survey was distributed to parents of children diagnosed as having asthma, eczema, or both, who received evaluations at Nemours Children's Health in Orlando, Florida. The patients were categorized into four groups: asthma only, eczema only, co-occurring asthma and eczema, and a control group. A subgroup consisted of patients with asthma and allergic rhinitis.</p><p><strong>Results: </strong>The survey revealed a significant prevalence of SDoH disparities, with 61.2% of respondents reporting at least one factor. A notable distinction emerged in parental employment status (<i>P</i> < 0.001). In the group of patients with allergic rhinitis, housing instability was an important factor.</p><p><strong>Conclusions: </strong>Investigating the central Florida pediatric population provided crucial insights into the social determinants affecting pediatric allergy disorders. The study highlighted significant health disparities, particularly in parental employment status and housing instability, underscoring the critical role of social factors in these conditions. These findings emphasize the need for targeted interventions addressing social determinants to improve health outcomes for children with allergy disorders.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"31-38"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928065","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 Moreton Lecture Series: The Renin-Angiotensin-Aldosterone System-Physiology, Pathophysiology, and Pharmacological Inhibition.","authors":"Prem Patel, Jessica Ammon, Sean Battle, Donald J DiPette","doi":"10.14423/SMJ.0000000000001775","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001775","url":null,"abstract":"<p><p>The renin-angiotensin-aldosterone system (RAAS) is a complex regulator comprising hormones, proteins, and enzymes. The discovery of the RAAS and its pharmacological manipulation has been essential in the management of cardiovascular diseases, including hypertension. Beyond the benefits of hypertension, RAAS inhibition has implications for heart failure, atherosclerotic disease, and kidney disease. This review discusses the history and mechanism of RAAS inhibition, cardiovascular benefits, affordability, and potential future pharmacological therapies.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"9-13"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928067","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":"Untapped Resources? Engaging Junior Faculty with Advanced Career Training in Near-Peer Mentoring to Build Professional Identity.","authors":"Emily Pinto Taylor, Dheepa R Sekar, Katherine Gielissen","doi":"10.14423/SMJ.0000000000001771","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001771","url":null,"abstract":"<p><p>Effective early mentoring is essential for propelling academic careers. There is a growing cohort of junior faculty with advanced skills in medical education and research; these individuals need both mentoring and the opportunity to take on mentorship roles. Generalists who pursue advanced training in medical education or clinical research often enter junior faculty positions alongside recent residency graduates, leaving their skillset untapped. Junior faculty with advanced training are challenged to establish their expertise and set themselves apart. By leveraging their unique skills as near-peer mentors, these individuals can build connections and reach career goals more cohesively and rapidly. In this perspective, we review the skills necessary for junior faculty with advanced career training to balance effectively the dual roles of mentee and near-peer mentor, as well as how departments can best support these unique new faculty members.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"45-47"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927999","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}