Southern Medical Journal最新文献

{"title":"Evaluating the Impact of a Second-Level Observation Unit on Patient Outcomes at a Large Academic Health Center with a Coexisting Type I Observation Unit.","authors":"Padageshwar Sunkara, Gary E Rosenthal, Chi-Cheng Huang, Gregory B Russell, Tareq S Islam, William C Lippert","doi":"10.14423/SMJ.0000000000001836","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001836","url":null,"abstract":"<p><strong>Background: </strong>Observation units (OUs) are a common healthcare delivery model for health systems across the United States. OUs vary from a type I to type IV based on several factors. Another category of OUs-second-level OUs-does not fit this traditional classification due to a different patient population composition and staffing model. The impact of a second-level OU in the setting of a coexisting type I OU has not been previously evaluated. As such, our study assesses the impact of patient outcomes in a second-level OU with a coexisting type I OU.</p><p><strong>Methods: </strong>We established a second-level OU comprising 14 beds on a medical-surgical floor. Patients designated as observation status who did not meet the criteria for the type I OU in the emergency department were cohorted on this unit and cared for by a multidisciplinary team that included nurses, case managers, pharmacists, and hospital medicine providers. We compared patient outcomes pre- and postsecond-level OU implementation for all observation status patients admitted to hospital medicine between January 1, 2019 and December 31, 2019.</p><p><strong>Results: </strong>Patients cohorted on the second-level OU had a shorter length of stay (estimated reduction in 11.7 hours; <i>P</i> < 0.0001) and a lower conversion rate from observation to inpatient status (\"admission rate\"; 14.5% vs 57.7%; <i>P</i> < 0.0001) in comparison to the nonintervention group; this led to a saving of 506.5 bed-days in comparison to the preimplementation phase.</p><p><strong>Conclusions: </strong>Implementation of a second-level OU in the setting of a coexisting type I OU led to a reduced length of stay, admission rate, and bed-days saved.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"324-329"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209590","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":"Over-the-Counter Therapies for Urinary Incontinence before Presentation at a Specialty Clinic: Patient Perspective and Use.","authors":"Megan Escott, Maya Fisher, Katherine L Woodburn","doi":"10.14423/SMJ.0000000000001837","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001837","url":null,"abstract":"<p><strong>Objectives: </strong>The estimated prevalence of female urinary incontinence (UI) is 60% in the United States, and several over-the-counter (OTC) therapies for bladder health and UI exist on the market. Safety, efficacy, and patient use profiles of OTC treatment for medical issues such as constipation and headache are well established; however, research on OTC treatment of female UI before specialist presentation is sparse. The goal of this study was to characterize patient use of and attitudes toward OTC therapies for UI.</p><p><strong>Methods: </strong>We developed an institutional review board-approved patient survey capturing demographic information and characterization of OTC therapy use. New patients presenting with a complaint of UI to the urogynecology providers at a tertiary care center were eligible for the study. Data analysis consisted of analyzing trends in participant responses.</p><p><strong>Results: </strong>Forty-five survey responses were collected as a convenience sample over 8 weeks. Two-thirds of patients experienced UI for more than 2 years before seeing a specialist; 87% of patients reported moderate or severe UI according to Sandvik's UI severity index. Two participants tried an OTC medication for UI and 17 tried pelvic floor exercises or devices. Sixty-two percent reported that they did not know any OTC treatments existed, and 71% believed healthcare providers were knowledgeable about OTC treatment and would be more likely to try these if recommended by their healthcare provider.</p><p><strong>Conclusions: </strong>In a small sample of women with predominately moderate and severe UI, only 4% of patients tried OTC medications before specialist presentation despite two-thirds of patients experiencing symptoms for more than 2 years. Most respondents did not know that OTC treatments existed, but they said that would be likely to try them if recommended by a healthcare provider. This survey-based study highlights the lack of patient awareness about OTC therapies for female UI and the need for provider knowledge on this topic.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"333-337"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209594","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":"Updates in the Management of Patients with Obstructive Sleep Apnea.","authors":"Adrian Davies, Nikhil Jaganathan, Yeilim Cho, Xiaoyue Liu, Sara J Healy, Younghoon Kwon, William J Healy","doi":"10.14423/SMJ.0000000000001838","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001838","url":null,"abstract":"<p><p>Obstructive sleep apnea (OSA), a condition with high prevalence, is characterized by reduced dilatory function of pharyngeal muscles, which can be influenced by upper airway narrowing, dilator muscle dysfunction, respiratory dysfunction, and genetics. Three of the most clinically important phenotypes of OSA include disturbed sleep, excessive sleepiness, and minimal symptoms, with varying implications for management and morbidity. This article reviews current perspectives on these OSA phenotypes, as well as the process of confirming a diagnosis of OSA. Lastly, this article delineates various current and future OSA therapy approaches through review and analysis of the existing literature with discussion on the outlook for OSA treatment.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"349-352"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209598","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":"Watch Your Career Like You Watch Your Money: Minority Tax Mitigation Strategies.","authors":"Edgar Figueroa, Julie E Lucero, José E Rodríguez","doi":"10.14423/SMJ.0000000000001834","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001834","url":null,"abstract":"<p><p>Academic medical center faculty members from historically underrepresented backgrounds in medicine in the United States face multiple factors that limit their recruitment, retention, and advancement in academic medicine. Although high-level system changes are needed to achieve an equitable and diverse academic workforce, academic health systems do not change rapidly. Faculty from minoritized backgrounds must learn how to continue working in the system while advocating for and implementing system redesign. One approach to career utilizes the metaphor of personal finance management. The authors identified 10 areas in which personal finance and career management overlap: get organized (learn requirements for success in academic medicine); establish goals (identify your career aspirations); craft a budget (link your actions to the goals); maintain a diverse portfolio (participate in activities that meet all academic missions); invest or save? (saving is citizenship tasks, while investing is accepting career-building assignments); keep good debt (minimize minority tax activities or use them to fuel your scholarship); check balances and run credit reports (evaluate your career progress often); meet with an expert (learn from mentors and late-career faculty); refinance or seek credit line adjustments (negotiate the terms of your job to concentrate on career-building activities); and change institutions (align your mission with your institution, sometimes by changing institutions). Although there may be many more pieces to a financial management plan, the illustrated steps can help those who are new to academic medicine.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"346-348"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209599","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":"Surgical Management of Primary Pulmonary Carcinoid Tumors.","authors":"Jordan M Howard, Sibu P Saha","doi":"10.14423/SMJ.0000000000001840","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001840","url":null,"abstract":"<p><strong>Objective: </strong>Primary pulmonary carcinoid tumors constitute 1% to 2% of primary lung neoplasms, with limited surgical outcome data due to the rarity of these neoplasms. The aim of our study was to review the complications and long-term outcomes following surgery for primary pulmonary carcinoid neoplasms.</p><p><strong>Methods: </strong>With institutional review board approval, the charts of patients with lung neoplasms from 2000-2022 were reviewed. In total, 605 total charts were reviewed, with 535 excluded for not having a primary pulmonary carcinoid tumor or not receiving surgical treatment. Typical, atypical, and cumulative survival rates were calculated along with complications.</p><p><strong>Results: </strong>Major presenting symptoms included 31% (n = 22) persistent cough, 30% (n = 21) dyspnea, 9% (n = 6) hemoptysis, and 7% (n = 5) constitutional symptoms (fever, weight loss, and/or night sweats). Fifty-one percent (n = 36) were found incidentally, and 14% (n = 10) had unknown presentation. There were complications in 26 patients (41%). Minor complications included chest wall pain (n = 6), chest tube air leak (n = 4), dyspnea (n = 3), atelectasis (n = 2), ileus (n = 2), postpneumonectomy syndrome (n = 1), and chronic cough (n = 1). Serious complications included atrial fibrillation (n = 2), respiratory failure (n = 1), hemothorax (n = 1), hypovolemic shock (n = 1), and intraoperative tension pneumothorax (n = 1). No patients died during surgery or secondary to any complications of surgery.</p><p><strong>Outcomes: </strong>The cumulative 2-year survival rate was 98.5%, and the cumulative 5-year survival rate was 96.3%. There were seven total deaths during the study period, but the cause of death was not reported.</p><p><strong>Conclusions: </strong>This study confirms that resection of primary pulmonary carcinoid tumors is relatively low risk, with excellent long-term survival rates.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"307-312"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209596","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":"Erratum: Where Are Future Doctors Who Southern Rural African Americans Will Trust? A Look Back into Rural Medical Scholars Data: Erratum.","authors":"John R Wheat, Antonio J Gardner, Cynthia E Moore","doi":"10.14423/SMJ.0000000000001833","DOIUrl":"10.14423/SMJ.0000000000001833","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.14423/SMJ.0000000000001803.].</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"356"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209589","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":"Handling the Challenges: Access to Certified Hand Therapy in Mississippi.","authors":"Anna G Boydstun, Hannah G Talbot, Mary E McMinn, Emily E Hecox, Shelley R Edwards, Katherine E Baker, Katherine C Benedict, Marc E Walker","doi":"10.14423/SMJ.0000000000001835","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001835","url":null,"abstract":"<p><strong>Objectives: </strong>Access to a certified hand therapist (CHT) plays a crucial role in enhancing postsurgical functional outcomes and reducing morbidity in complex hand surgery and trauma cases. Unfortunately, the availability of CHTs is uneven across regions, particularly in less populous states such as Mississippi. The financial and time-related burdens of traveling to a CHT to receive appropriate rehabilitation care affects patients recovering from hand surgery and hand trauma. This study investigated the accessibility of CHT services in Mississippi by analyzing physical proximity to CHTs and assessing the resultant economic implications, specifically focusing on transportation costs.</p><p><strong>Methods: </strong>County-level distances to the nearest CHT were mapped and evaluated. The associated cost of personal vehicle transport was calculated using 2024 Internal Revenue Service standard mileage rates of $0.67/mi. Distance from a CHT and travel costs were stratified based on published 2023 Rural-Urban Continuum Codes.</p><p><strong>Results: </strong>One-way analysis of variance revealed a significant difference in both the distance traveled to CHTs and the associated travel costs when stratified by Rural-Urban Continuum Codes (<i>P</i> < 0.05). On average, the distance to a CHT in Mississippi is 27.6 mi or 55.2 mi round trip, incurring a cost of $36.98 per visit. Residents of the farthest county from a CHT travel 86.4 miles or 172.8 miles round trip, however, resulting in a financial burden of $115.78 per visit to a CHT.</p><p><strong>Conclusions: </strong>This heightened cost for individuals residing farthest away poses substantial geographic, economic, and time-related barriers to accessing CHT services. Moreover, these barriers have a pronounced impact on the well-being of patients and their families, considering the frequency of required visits for adequate rehabilitation and functional recovery, typically occurring once or twice per week over several months. This study emphasizes the urgency of addressing disparities in CHT access to ensure equity across the state.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"341-345"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209591","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":"Suicide and Global Warming.","authors":"Rif S El-Mallakh, Omar H Elsayed, Shaishav Shah","doi":"10.14423/SMJ.0000000000001829","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001829","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"355"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209595","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":"Mitigating Health Disparities: Bridging the Digital Divide in Modern Health Care.","authors":"Daniel Elikman, Robert Anderson, Margarita Balish, Mihail Zilbermint","doi":"10.14423/SMJ.0000000000001830","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001830","url":null,"abstract":"<p><p>In the rapidly evolving landscape of US health care, technological advances promise significant improvements. The ongoing digital divide, however, is a critical factor affecting equitable access to health care. This perspective examines the multifaceted nature of the digital divide and its impact on health literacy, the use of electronic health tools, and disparities rooted in race, ethnicity, and socioeconomic status. The partnership between healthcare providers and health communication researchers, along with seamless data sharing, emerges as a crucial catalyst for elevating health literacy. To effectively address the digital divide, healthcare providers may find it beneficial to conduct assessments of the evolving health literacy and digital health landscape. An essential paradigm shift involves the customization of digital health solutions by medical providers, aligning them with the diverse needs and preferences of patients. This transformative approach necessitates a departure from static, one-way communication channels, emphasizing the dynamic adaptation of digital health interventions to enhance accessibility and relevance in patient care.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"330-332"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209593","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 Interpreter Utilization among Telephone Schedulers Assisting Patients with Non-English-Language Preference.","authors":"Alice J Lin, Eliana Bonifacino, Joyce Rowan, Sami Ahmad, Alessandra Leong, Keily Ortega, Shiva Yagobian, Tanya Nikiforova","doi":"10.14423/SMJ.0000000000001839","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001839","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with non-English-language preference (NELP) face language barriers that impede effective communication and delivery of high-quality care. Recognizing call centers as pivotal points of contact for patients with NELP, we proposed a quality improvement initiative to evaluate and enhance interpreter utilization among telephone schedulers within a tertiary healthcare system.</p><p><strong>Methods: </strong>Staff interpreters and medical students posing as patients with NELP placed test calls to schedulers to request five non-English languages. Schedulers were surveyed to assess their attitudes toward and confidence levels in accessing and utilizing interpreters. We subsequently informed scheduling leadership of preintervention test call and survey results and recommended areas of improvement. Postintervention test calls and surveys were conducted 3 months later to assess for improvement.</p><p><strong>Results: </strong>Schedulers' confidence in their ability to identify a caller in need of interpreter services improved by 9.2% (<i>P</i> = 0.046). The percentage of schedulers who accessed interpreter services in the last year increased by 14.3% (<i>P</i> < 0.001). Schedulers reported long wait times for an interpreter as the most frequently encountered difficulty when attempting to access a telephone interpreter. Test callers identified the telephone tree as the most significant barrier to scheduling.</p><p><strong>Conclusions: </strong>Our initiative improved schedulers' confidence in their ability to identify a caller in need of interpreter services, and it increased the percentage of schedulers who accessed interpreter services. Overall interpreter usage among telephone schedulers in this healthcare system remains suboptimal, however, and continuous internal testing and feedback with in-person scheduler education and larger test call sample sizes may facilitate sustained and meaningful improvements. We hope that our study can lay the groundwork for future studies to enhance the scheduling process for linguistically diverse patient populations.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 6","pages":"319-323"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209588","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}