Southern Medical Journal最新文献

{"title":"Management of Pulmonary Embolism: A Single-Center Experience.","authors":"R Holt Hammons, Sibu P Saha","doi":"10.14423/SMJ.0000000000001778","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001778","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary embolism (PE) is the third leading cause of cardiovascular death. The objective of this study was to examine the current management of pulmonary embolism at a single academic institution.</p><p><strong>Methods: </strong>With institutional review board approval, we conducted a retrospective chart review of 805 encounters among 775 patients presenting with acute PE from January 1, 2016 to June 30, 2019. We used American Heart Association guidelines for PE risk stratification.</p><p><strong>Results: </strong>In total, 409 patients were given the low-risk designation, 377 of these patients (92%) were anticoagulated with heparin or enoxaparin, and 32 patients (8%) were given a direct oral anticoagulant alone. There were two in-hospital mortalities (0.5%) in the low-risk group; 322 patients were in the true intermediate-risk category (ie, did not progress to high risk), and 320 patients received anticoagulation with heparin or enoxaparin (99.4%). Seventy-three patients (22%) received catheter-directed thrombolysis. There were eight in-hospital mortalities (2.5%) among the intermediate-risk group; eight intermediate-risk patients progressed to high-risk during their hospital stay, resulting in 6 in-hospital mortalities (75%) in this group. There were 66 patients designated as high-risk upon presentation. Sixty patients (91%) received heparin for anticoagulation and 47 patients (71%) required advanced therapies. Fourteen high-risk patients (21%) had bleeding complications, and there were 26 (39%) in-hospital mortalities.</p><p><strong>Conclusions: </strong>The management of PE has evolved, and proper risk stratification is key. Largely speaking, low- and intermediate-risk patients can be treated with anticoagulation, whereas patients with severe right ventricular strain and hemodynamic instability may require more advanced therapies.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"14-18"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927604","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":"Linkage to Treatment and Recovery Support Services for Patients with a Substance Use Disorder: A Survey of Kentucky Physicians.","authors":"Seif Atyia, Terry Bunn, Dana Quesinberry, Timothy Prince","doi":"10.14423/SMJ.0000000000001774","DOIUrl":"10.14423/SMJ.0000000000001774","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to survey current physicians in Kentucky to evaluate their management of patients with substance use disorder (SUD), with a focus on the identification of their referral methods for linkage to SUD treatment and recovery support services.</p><p><strong>Methods: </strong>A cross-sectional study was performed through a developed survey that was administered by e-mail to all 12,152 in-state physicians licensed in Kentucky; 524 responded. Addiction specialists, emergency physicians, and psychiatrists were categorized separately; family medicine and internal medicine (FM/IM) physicians were combined into one category; all of the other specialties were grouped into an \"Other\" category. The results were analyzed using descriptive statistics and cross-tabulations.</p><p><strong>Results: </strong>Of the 524 respondents, 271 (52%) said that they treated patients with SUD. Despite this, approximately 30% of them said that they do not screen for SUD. Across all specialties (except for addiction and psychiatry), many providers refer patients with SUD to treatment without prescribing any kind of treatment themselves. FM/IM physicians have a similar percentage to both addiction specialists and psychiatrists when analyzing the number of their patients who are willing to accept treatment; however, only approximately 30% of FM/IM physicians know about Kentucky's treatment and recovery placement Web site with near-real-time vacancies by geographic location with multiple filter options called FindHelpNowKY.org.</p><p><strong>Conclusions: </strong>There are gaps in screening and linkage to care, especially in internal medicine and family medicine physicians. Work is necessary to increase screening, build provider capacity to treat, and increase knowledge of SUD treatment and recovery resources in Kentucky.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927391","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":"Presidential Address of Dr Loretta Loftus, 2024-2025 President of the Southern Medical Association.","authors":"Loretta Loftus","doi":"10.14423/SMJ.0000000000001777","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001777","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"49-50"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927831","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":"SMA's 2024 Annual Scientific Assembly Abstract Presentations.","authors":"None Available","doi":"10.14423/SMJ.0000000000001779","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001779","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"51-84"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927853","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":"Liver Fibrosis and Cardiovascular Events.","authors":"Nso Nso, Kaveh Rezaei Bookani, Mia Trimingham, Richard Orji, Basile Njei, Senthil S Balasubramanian, Amit Pursnani","doi":"10.14423/SMJ.0000000000001769","DOIUrl":"10.14423/SMJ.0000000000001769","url":null,"abstract":"<p><strong>Objectives: </strong>Liver fibrosis represents a common sequela of nonalcoholic fatty liver disease (NAFLD) and other chronic liver diseases. Noninvasive liver fibrosis scores (LFSs) aim to evaluate the severity of liver fibrosis. Whether LFSs can predict the risk of future cardiovascular events (CVEs) remains unclear. This systematic review aimed to clarify the association between liver fibrosis and CVEs by studying the value of LFSs, namely the Fibrosis-4 (FIB-4) Index for Liver Fibrosis score and the NAFLD Fibrosis Score (NFS), for predicting CVEs.</p><p><strong>Methods: </strong>PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant prospective studies. Retrieved articles were screened to confirm their eligibility for the systematic review. We evaluated the quality of the included studies using the National Institutes of Health tool.</p><p><strong>Results: </strong>Twelve studies of high to fair quality were included in this systematic review. Of note, 10/12 studies reported an independent association between high LFSs and the risk of CVEs, cardiovascular mortality, and all-cause mortality (all <i>P</i> < 0.05). In addition, an advanced histological grade of liver fibrosis (grade 3 or 4) was suggestive of CVE occurrence. NAFLD also appeared to be associated with a higher risk of CVEs at any severity of fibrosis (all <i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>The findings of this review suggest that liver fibrosis in patients with NAFLD is an independent predictor of future adverse CVEs, cardiovascular mortality, and all-cause mortality. Noninvasive and easy-to-perform LFSs, including FIB-4 score and the NFS, appear useful in predicting such events in patients with a spectrum of cardiovascular diseases and the general population without known cardiovascular disease.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"19-25"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927502","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":"Trends in Medical Students' Legal Concerns Regarding Abortion Care in the Wake of the 2022 <i>Dobbs v Jackson Women's Health Organization</i> Decision.","authors":"Mikaela Koch, Kirsten Wohlars, Victoria Lazarov, Tova Ablove","doi":"10.14423/SMJ.0000000000001773","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001773","url":null,"abstract":"<p><strong>Objectives: </strong>The 2022 <i>Dobbs v Jackson Women's Health Organization</i> US Supreme Court decision dramatically shifted the legal landscape in health care, leaving state legislatures to redefine the ethics of medical practice. As gold-standard medical procedures become banned and criminalized, physicians are facing heightened legal uncertainty and grappling with moral dilemmas of where and how to practice. This study aimed to quantitatively assess trends in legal concern among medical students and identify correlations with decision making regarding future medical training.</p><p><strong>Methods: </strong>To assess the impact of the Dobbs decision on trainees, a 24-item RedCAP survey was distributed to 72 medical schools assessing both geographic residency preferences and level of legal concern surrounding 10 abortion provision scenarios. Level of concern was assessed on a 3-point Likert scale from \"not at all concerned\" to \"very concerned.\" To observe overall trends, an average level of concern score was computed by assigning numeric values to responses and averaging the scores for each respondent.</p><p><strong>Results: </strong>In total, 2298 medical students completed the survey and were included in the analysis. Students identifying with she/her pronouns and as Asian or studying in abortion-protected states had significantly higher levels of concern. Moreover, respondents located in abortion-restricted states with high levels of legal concern were more likely than their peers to indicate wanting to move to abortion-protected states for residency.</p><p><strong>Conclusions: </strong>Individuals with heightened proximity to reproductive healthcare may face greater ethical and moral dilemmas as they seek future career opportunities in a post-<i>Roe v Wade</i> world. These data suggest that they seem highly responsive to moving out of abortion-restricted states, indicating that the <i>Dobbs</i> decision, and the legal landscape it has created, may further exacerbate disparities in reproductive health care.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"26-30"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928069","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":"Increased Prevalence of Skeletal Anomalies on Ultrasound Evaluation of Buprenorphine-Exposed Human Fetuses.","authors":"Margaret Pepper Dean, Helen Mistler, Lori Moore, Nicole Lewis, Martin Olsen","doi":"10.14423/SMJ.0000000000001776","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001776","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, buprenorphine was the primary source of maternal opioid exposure at the time of initial prenatal evaluation. Current recommendations advise that level II ultrasounds be performed in patients with substance use disorders. For some patients, distance, transportation, and costs associated with obtaining ultrasounds from a specialist pose significant barriers. This study was thus undertaken to evaluate the value of level II ultrasounds in buprenorphine-exposed pregnancies.</p><p><strong>Methods: </strong>In a retrospective chart review comparing 1188 substance-exposed patients with 1261 nonexposed, anomaly data were collected from level I and level II anatomy scans, problem lists on prenatal flowsheets, and visit notes. If anomalies were detected, then they were further classified by the affected organ system. Two proportion tests were used to compare the exposed and unexposed groups. When the assumptions were not met, a Fisher exact test and the Benjamini-Hochberg method were used to adjust for multiple testing.</p><p><strong>Results: </strong>Buprenorphine-exposed fetuses have increased rates of composite skeletal anomalies when compared with nonexposed fetuses (P< 0.005). No statistically significant difference, however, was found between groups for any other system or for any specific skeletal anomaly. No statistical difference was found related to buprenorphine dose.</p><p><strong>Conclusions: </strong>This is the first report of skeletal anomalies in buprenorphine-exposed human fetuses. Causality is unproven, but this report is consistent with prior human and animal studies in which maternal opioid use has been linked to significant impairments in bone growth and development. Our findings suggest that anatomic surveys of fetuses exposed to buprenorphine should be performed by individuals with expertise in the detection of fetal skeletal anomalies.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 1","pages":"39-44"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927348","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":"Reducing Unnecessary Laboratory Testing: A Quality Improvement Initiative at Wellstar Spalding Medical Center.","authors":"Vishwanath Anil, Komal Harisinghani, Priyasi Monga, Nageshwar Reddy Kothur, Surya Prakash Reddy Bussa, Srikanth Maddika, Carole Ehleben, Ashok Kumar Kanugula","doi":"10.14423/SMJ.0000000000001761","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001761","url":null,"abstract":"<p><strong>Objectives: </strong>The healthcare industry is grappling with escalating expenses, partially attributed to the inefficient use of medical resources, particularly by ordering unnecessary laboratory tests. Such practices not only increase costs but also result in extended hospital stays, patient discomfort, and potential clinical complications such as iatrogenic anemia. Blood tests, although essential for guiding medical decisions, are associated with significant clinical and financial costs. This quality improvement project aimed to decrease unnecessary laboratory testing at Wellstar Spalding Medical Center, a community hospital with a newly established residency program.</p><p><strong>Methods: </strong>Our study team played a pivotal role in formulating an algorithm that outlined the indications for a complete blood count and basic or comprehensive metabolic profile. We then conducted standardized didactic sessions for resident physicians and faculty, educating them on the use of \"add-on\" laboratory values, providing electronic medical records training, and highlighting the compounding costs of these simple laboratory tests. We analyzed data during a 3-month period, both before and in the intervention phase, adjusting for the number of physician-patient interaction days to account for potential variations in patient census in the hospital.</p><p><strong>Results: </strong>The number of complete blood count orders and basic/comprehensive metabolic profile orders underwent an absolute decrease in the postintervention period. When adjusted for the number of physician-patient interaction days, this decrease remained consistent, although not statistically significant.</p><p><strong>Conclusions: </strong>Our project has yielded clinically and administratively meaningful results. We have seen a measurable decrease in costs and the prevention of unnecessary laboratory testing. If it also can be shown that we have prevented iatrogenic anemia, our project could be seen as enhancing the patient experience and reducing hospital length of stay. We also have raised awareness about high-value care and instilled clinical awareness among residents regarding ordering daily blood tests contributing to an improvement in patient care.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 12","pages":"730-735"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772292","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":"Medical Communication Training: The Effect of Gender and Experience and Goals of Care Discussions.","authors":"Ramona Jewel Maria Dorough, Maria Adamuti-Trache, Dheepa R Sekar, Caitlin Holt Siropaides","doi":"10.14423/SMJ.0000000000001768","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001768","url":null,"abstract":"<p><strong>Objectives: </strong>Communication skills are increasingly recognized as a crucial component of medical training; however, little is known about the efficacy of various training methods when considering diverse student backgrounds, such as gender and prior training experience (ie, year of residency). This study explores medical learners' perceptions of effective communication in conducting goals of care (GOC) discussions with patients after receiving communication training as well as assessing for differences in preparedness for GOC discussions by gender and prior training experience.</p><p><strong>Methods: </strong>This study included a sample of 114 residents in either their first, second, or third year of Internal Medicine residency. Participants took part in the communication training and completed pre- and postsurveys on perceived effectiveness in GOC discussions. We used multivariate analyses to examine residents' perceptions of preparedness as defined by residents perceived effectiveness of care, confidence in having GOC discussions with patients, confidence in making recommendations that align with patient values, and the perceived value of GOC training.</p><p><strong>Results: </strong>We found that after communication training, most residents, regardless of gender or year of residency, felt more effective in having healthcare conversations with patients and making GOC healthcare recommendations. The effect of training was statistically significant when considering either interaction with gender or year of residency. We have also discovered statistically significant differences in the experiences of male and female residents when it comes to engaging in GOC discussions, based on their prior training in medical school. Female participants reported an increased frequency of practicing GOC discussions between years 2 and 3, whereas male participants reported the increase occurring between years 1 and 2.</p><p><strong>Conclusions: </strong>The study shows that the same curriculum is effective for residents at each level of training, but more research on the interaction effect between prior training and gender is needed.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 12","pages":"725-729"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772479","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":"Examining Provider Attitudes and Barriers toward Prescribing PrEP within Primary Care Settings in Alabama.","authors":"Landon McNellage, Erin D Snyder, Ronnie M Gravett, Olivia T Van Gerwen","doi":"10.14423/SMJ.0000000000001767","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001767","url":null,"abstract":"<p><strong>Objectives: </strong>Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is an effective HIV prevention tool. Expanding PrEP access and utilization is made possible by incorporating it into primary care practice. This study explored the barriers in and attitudes toward prescribing PrEP to adults among primary care providers (PCPs) in Alabama, a priority HIV jurisdiction with low PrEP uptake.</p><p><strong>Methods: </strong>We conducted in-depth interviews grounded in the Health Belief Model with Alabama physicians and advanced practice practitioners in general internal and family medicine, exploring provider experiences in collecting sexual history information from patients and prescribing PrEP. Authors used thematic analysis of transcripts to further investigate the emerging themes.</p><p><strong>Results: </strong>From September 2022 to April 2023, eight PCPs participated in our study. Several themes regarding barriers in and attitudes toward discussing sexual health history emerged: time constraints, knowledge and training, comfort levels, and competing priorities. We identified stigma and knowledge as themes when exploring provider attitudes toward and barriers in prescribing PrEP. When discussing the benefit of PrEP provision in primary care, we also identified themes such as longevity of the patient-provider relationship and accessibility. Participants identified multiple opportunities to increase PrEP provision in primary care beyond provider education and training, such as normalizing the language, consistency in discussing sexual health history, and using streamlined efforts of gathering sexual history information.</p><p><strong>Conclusions: </strong>With barriers hindering PrEP prescribing by Alabama's PCPs, in addition to preexisting healthcare barriers experienced by patients in the US Deep South, immediate attention is warranted. Further exploration into developing policies for streamlining sexual history intake and inclusive medical education and training regarding PrEP is needed in Alabama.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 12","pages":"709-714"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772466","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}