Southern Medical Journal最新文献

{"title":"Validity of Endometrial Cavity Length on 3D Pelvic Ultrasound before Endometrial Ablation.","authors":"Kayla Shine, Rachael Cowherd, Alexandra Rowin, Raksha Soora, Michelle Meglin","doi":"10.14423/SMJ.0000000000001736","DOIUrl":"10.14423/SMJ.0000000000001736","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare endometrial cavity length measurements obtained by preoperative three-dimensional (3D) reconstruction of coronal images on pelvic ultrasound with intraoperative endometrial cavity measurements obtained in advance of Minerva endometrial ablation.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 41 individuals who underwent a Minerva endometrial ablation between August 1, 2018 and March 15, 2022 at a single academic medical center. Patients were excluded if they had an in-clinic ablation or no ultrasound with 3D uterine volume within 180 days before surgery. Physician sonologists measured the endometrial cavity length using 3D coronal reconstruction of the cavity. Two measurements were obtained by separate physicians who were blinded to intraoperative values. Intraoperative endometrial cavity lengths were obtained from operative reports. A Bland-Altman plot was used to evaluate the agreement of intraoperative and ultrasound measurements.</p><p><strong>Results: </strong>The mean intraoperative endometrial cavity length (50.7 ± 7.8 mm) was greater than the mean endometrial cavity length by 3D coronal reconstruction of pelvic ultrasound (36.1 ± 6.2 mm, <i>P</i> < 0.0001). The average difference between intraoperative and ultrasound measurements of cavity length was 14.6 ± 9.0 mm. The agreement between measurements was poor (Lin's concordance correlation coefficient 0.06). Using a Bland-Altman plot, the limits of agreement (-3.1 to 32 mm) exceeded the a priori acceptable limits of agreement (-10 to 10 mm).</p><p><strong>Conclusions: </strong>Our findings suggest that preoperative coronal endometrial cavity length measurements by ultrasound are not a valid substitute for intraoperative measurements before Minerva ablation.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"599-602"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376072","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":"Fit Testing Failure of Reprocessed \"Duckbill\"-Type N95 Masks.","authors":"Phillip Moschella, Wesley Liao, Alain H Litwin, Jonn Foulk, Jeff Anthony, Xiyan Tan, Christine Cole","doi":"10.14423/SMJ.0000000000001738","DOIUrl":"10.14423/SMJ.0000000000001738","url":null,"abstract":"<p><strong>Objectives: </strong>In response to worldwide shortages of N95 masks during the severe acute respiratory syndrome-coronavirus-2 pandemic, various strategies have been used. The Centers for Disease Control and Prevention recommend several strategies, including simple isolation to reprocessing methods using vaporized hydrogen peroxide to guide reuse of masks up to five times. National Institute for Occupational Safety and Health (NIOSH) quantitative fit testing was performed after five trials of donning and doffing in one cohort of new masks and two cohorts of repeatedly sterilized \"duckbill\"-type N95 masks.</p><p><strong>Methods: </strong>One cohort of new masks and two cohorts of sterilized masks were repeatedly subjected to 35% vaporized hydrogen peroxide for either five or 10 cycles. Then, they were subjected to five trials of donning and doffing, with NIOSH quantitative fit testing performed after each wear cycle to assess for any degradation on fit performance caused by sterilization and/or repeated donning and doffing up to the recommended Centers for Disease Control and Prevention limit of five times. All of the fit testing was performed on a single volunteer.</p><p><strong>Results: </strong>The means and 95% confidence intervals for each cohort and the individual results for each mask within each cohort were reported. A χ² analysis showed significant differences in percentages of masks that pass fit testing in both recycled mask cohorts.</p><p><strong>Conclusions: </strong>These data show the variability of NIOSH fit testing results of both new and sterilized masks. The mask recycling program of our partner health systems thus discarded these types of masks due to the variable failure rate. Health systems should consider individual evaluation to inform their overall policies on mask reuse and recycling.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"623-627"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376065","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":"Racial and Ethnic Disparities in Pediatric Atopic Dermatitis.","authors":"Urdur Jonsdottir, Emily S Craver, Tanvi R Patel","doi":"10.14423/SMJ.0000000000001743","DOIUrl":"10.14423/SMJ.0000000000001743","url":null,"abstract":"<p><strong>Objectives: </strong>Atopic dermatitis (AD) is one of the most common chronic childhood conditions. Disparities in treatment and access to care can result in poor disease control and decreased quality of life. The aim of this study was to determine whether race and ethnicity affect treatment and healthcare utilization for pediatric atopic dermatitis in central Florida.</p><p><strong>Methods: </strong>This study of 4008 children with AD compared healthcare utilization and management using the numbers of AD-related healthcare visits, prescriptions, testing, and subspecialty referrals. Multivariable models were used to compare racial and ethnic groups (Black, Hispanic, Asian, and Other) with the reference group of non-Hispanic White, while adjusting for common confounders.</p><p><strong>Results: </strong>The mean number of urgent care visits for the Hispanic group was 1.61 times that of the non-Hispanic White group, and the mean number of emergency department visits was 3.71 (<i>P <</i> 0.001) times the reference group. Black or African American patients had a mean number of emergency department visits that was 1.52 times that of non-Hispanic White patients (<i>P =</i> 0.021). The mean count of primary care visits was lower among Hispanic patients and higher among Asian patients (<i>P =</i> 0.012). Visits to subspecialty clinics and hospitalizations did not differ significantly. There were no consistent patterns in differences of AD-related prescriptions, testing, or subspecialty referrals.</p><p><strong>Conclusions: </strong>This study indicates that racial and ethnic disparities exist in healthcare utilization in pediatric AD. The underlying factors contributing to these disparities need to be further studied and addressed to reach health equity within pediatric AD.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"603-608"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376070","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":"Optimizing Dermatological Care Triage in a Safety-Net Hospital: Retrospective Analysis of Diagnoses and In-Person Referrals.","authors":"Allen Shih, Alexandria Riopelle, Aaron Ordan, Stephanie Sanchez, Jag Bhawan, Christina S Lam","doi":"10.14423/SMJ.0000000000001737","DOIUrl":"10.14423/SMJ.0000000000001737","url":null,"abstract":"<p><strong>Objectives: </strong>Teledermatology is a cost-effective and efficient approach to delivering care and is particularly beneficial for patients with limited access to specialized services. Considering the rapid expansion of telehealth, it is crucial to focus on optimization. The purpose of our study was to evaluate the triaging of dermatologic care in an electronic consultation (e-consultation) service in a safety-net hospital.</p><p><strong>Methods: </strong>This was a 2-year retrospective review of a dermatology asynchronous store-and-forward e-consultation service.</p><p><strong>Results: </strong>A total of 1425 patients completed 1502 e-consultation. Of these e-consultations, 46% of the patients had Medicaid and 44% were Black or African American. The top three diagnoses were dermatitis unspecified, neoplasm of uncertain behavior, and acne/rosacea. Most (68%) were managed via e-consultation and did not require an in-person appointment. Children and adolescents were more likely to require an in-person appointment (74%) compared with adults (30%, <i>P</i> < 0.0001). Patients with a chief complaint of hair loss or skin lesion were more likely to require in-person evaluation (58% and 41%, respectively) compared with rash (24%) and acne (18%) (<i>P</i> < 0.0001). There was no difference found in recommendations for in-person evaluation based on race, non-English-language preference, or insurance status.</p><p><strong>Conclusions: </strong>E-consultation services seem well suited for certain concerns, and underserved populations can be evaluated by teledermatology.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"577-581"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376069","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":"A Qualitative Study of Transportation-Related Barriers to HIV Care in South Carolina.","authors":"Sarah J Miller, Mariajosé Paton, Divya Ahuja, Sharon Weissman, Tammeka Evans, Cassidy A Gutner, Sayward E Harrison","doi":"10.14423/SMJ.0000000000001742","DOIUrl":"10.14423/SMJ.0000000000001742","url":null,"abstract":"<p><strong>Objectives: </strong>Addressing structural barriers to care for people living with human immunodeficiency virus (HIV) in the southern United States is critical to increase rates of viral suppression and to reduce existing HIV disparities. This qualitative study aimed to describe transportation-related barriers experienced by people living with HIV in South Carolina, understand perceived effects of transportation vulnerability on HIV care, and explore strategies used by individuals to overcome transportation-related challenges.</p><p><strong>Methods: </strong>We conducted semistructured interviews with 20 people living with HIV from South Carolina who were either reengaging in HIV care after a prolonged absence (>9 months) or in care but with a detectable viral load (ie, >200 copies/mL). All people living with HIV reported transportation vulnerability. A deductive/inductive approach was used to identify transportation-related barriers perceived to negatively affect HIV care. We also identified strategies and resources described by people living with HIV as helpful in addressing transportation challenges.</p><p><strong>Results: </strong>Participants described a range of transportation-related barriers to HIV care, including lack of access to reliable, safe, and affordable transportation, as well as stigma due to HIV and socioeconomic statuses. These barriers were reported to negatively affect engagement in care and worsen both physical and mental health. Participants indicated flexible clinic policies and instrumental support from family and friends were useful in overcoming barriers.</p><p><strong>Conclusions: </strong>This study offers insight for the development of transportation interventions to improve equitable access to HIV care for people living with HIV in South Carolina. It also calls attention to the ways in which transportation vulnerability, HIV-related stigma, and disability status intersect to create unique challenges for some people living with HIV.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"617-622"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More Technology, Fewer Boundaries, and Physician Burnout in Academic Primary Care Physicians.","authors":"Laura Porterfield, Ashley Collazo, Karen E Schlag, José E Rodríguez, Kendall M Campbell","doi":"10.14423/SMJ.0000000000001735","DOIUrl":"10.14423/SMJ.0000000000001735","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"587-590"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Bias in Health Care: Using Art to Facilitate a Narrative Medicine Approach among Third-Year Medical Students.","authors":"Erij Elkamel, Daniela Guerra, Marquita Samuels, Sarah E Stumbar","doi":"10.14423/SMJ.0000000000001740","DOIUrl":"10.14423/SMJ.0000000000001740","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Teaching medical students about biases in health care poses challenges due to the complexity of modifying preexisting beliefs and the possibility of triggering strong emotional reactions. Narrative medicine fosters reflection and discussion among healthcare providers, and visual thinking strategies (VTS) enable providers to improve diagnostic ability through close and methodical examination of art. This study investigated the effectiveness of a session integrating narrative medicine and VTS to enhance third-year medical students' understanding of bias in health care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 90-minute \"Narrative Medicine Rounds\" session was implemented in the Family Medicine clerkship for all third-year medical students in the Florida International University Herbert Wertheim College of Medicine class of 2024. The session included a faculty-facilitated discussion of Robert Colescott's painting &lt;i&gt;Emergency Room&lt;/i&gt;, an overview of narrative medicine principles, and a sharing of student narratives related to bias experienced in the healthcare setting. After the session, students wrote and submitted their narrative essays. Students also completed an anonymous, optional, computer-based evaluation with Likert-type and free-response questions. Likert questions were analyzed using descriptive statistics. For the short-answer questions, teams of two researchers (D.G. and S.E.S., E.E. and M.S.) analyzed responses for themes and subthemes, met to reach consensus on a codebook through discussion, and recoded data as needed until frequencies of themes were mutually determined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 101 students, 87 (86%) provided responses to the Likert questions. Seventy percent of respondents agreed that Robert Colescott's &lt;i&gt;Emergency Room&lt;/i&gt; was a useful tool for discussing bias in medicine, whereas 25% were neutral. Fifty-one percent of respondents agreed that the session enhanced their understanding of bias in patient care, with 33% being neutral. Forty-seven percent of respondents agreed that the session made them more familiar with narrative medicine as a tool that they can use in patient care, with 28% being neutral. Students identified five themes for recognizing bias: empathy (16%), self-reflection (60%), active listening (17%), communication (13%), and education (7%). When addressing bias, students outlined five strategies: drawing from personal experiences (1%), self-reflection (64%), communication (29%), education (15%), and advocacy (26%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Combining narrative medicine and VTS in a single session offers a promising approach for discussing bias in healthcare education. Through reflective experiences and art interpretation, students demonstrated an awareness of often interconnected strategies to identify and mitigate bias while caring for patients. Future next steps for this study involve exploring longitudinal impacts and integrating narrative medicine st","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 10","pages":"612-616"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intimate Partner Violence: Physicians Must Address Physical and Mental Health Harms.","authors":"Donna Ewy","doi":"10.14423/SMJ.0000000000001724","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001724","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"521-523"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Efficacy of Video Interventions about Adverse Events in Medical Student Education.","authors":"Eric Wahlstedt, Brittany Levy, William Cranford, Adam Dugan, Justin Ziemba, Andrew Harris","doi":"10.14423/SMJ.0000000000001733","DOIUrl":"10.14423/SMJ.0000000000001733","url":null,"abstract":"<p><strong>Objectives: </strong>The coronavirus disease 2019 pandemic catalyzed a rapid shift toward remote learning in medicine. This study hypothesized that using videos on adverse events and patient safety event reporting systems could enhance education and motivation among healthcare professionals, leading to improved performance on quizzes compared with those exposed to standard, in-person lectures.</p><p><strong>Methods: </strong>Participants were randomly assigned to a group both watching the video and attending an in-person lecture or a group that received only the in-person lecture in this study performed in 2022. Surveys gathered demographic information, tested knowledge, and identified barriers to reporting adverse events.</p><p><strong>Results: </strong>A total of 83 unique participants responded to the survey out of the 130 students enrolled (64%; 83/130). Among the students completing all of the surveys, the group who watched the Osmosis video had a higher average quiz score (6.46/7) than the lecture group (6.31/7) following the first intervention. Only 25% of respondents agreed or strongly agreed that they knew what to include in a patient safety report and only 10% agreed or strongly agreed that they knew how to access the reporting system.</p><p><strong>Conclusions: </strong>This study suggests virtual preclass video learning can be a beneficial tool to complement traditional lecture-based learning in medical education. Further research is needed to determine the efficacy of long-term video interventions in adverse events.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"551-555"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Enduring Value of the VA in Health Professions Education: Medical Student Perspectives.","authors":"Drupad Annapureddy, Joelle Abdallah, Zuhair Hawa, Hyemi Chong, Reuben J Arasaratnam","doi":"10.14423/SMJ.0000000000001726","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001726","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 9","pages":"562-564"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}