Southern Medical Journal最新文献

{"title":"α-Gal Syndrome in the South: Why We Need Treatment Trials, Not Just Tick Prevention.","authors":"Benjamin Warren Casterline, Christine Franzese, Yoonseong Park, Jane A McElroy","doi":"10.14423/SMJ.0000000000001971","DOIUrl":"10.14423/SMJ.0000000000001971","url":null,"abstract":"<p><p>α-Gal syndrome (AGS), a tick bite-associated allergy to mammalian meat, affects an estimated 450,000 Americans, with the highest prevalence concentrated in the US South and Southeast. The lone star tick (<i>Amblyomma americanum</i>), ubiquitous across the region, transmits AGS sensitization, making reexposure nearly inevitable for outdoor workers and residents. Current management relies on dietary avoidance of mammalian products of an indeterminant length, a recommendation that is neither practical in a region where mammalian meat is central to cuisine and culture nor evidence based regarding duration or necessity. In the absence of treatment options, patients are turning to alternative interventions such as acupuncture protocols that lack validation from controlled trials. Meanwhile, oral immunotherapy has demonstrated safety and efficacy for other immunoglobulin E-mediated food allergies, and individual case reports suggest desensitization may be feasible for AGS syndrome. The US South, with its high disease burden, clinical expertise, and patient populations, is uniquely positioned to lead the rigorous phase 1 and phase 2 trials needed to develop evidence-based treatment alternatives. Without such research, patients have only dietary restriction as an evidence-based option and may seek purported treatments that lack rigorous validation.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 6","pages":"328-332"},"PeriodicalIF":0.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151444","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":"Assessing the Accuracy and Reliability of ChatGPT-4 to Answer Clinical EHR Messages in Sports Medicine.","authors":"Fahad Nadeem, Caleb Berta, Dev Dayal, Clay Rahaman, Alexa Smitherman, Maxwell Harrell, Elizabeth Powell, Bradford Minor, Thomas Evely, Eugene Brabston, Amit Momaya","doi":"10.14423/SMJ.0000000000001977","DOIUrl":"10.14423/SMJ.0000000000001977","url":null,"abstract":"<p><strong>Objectives: </strong>Although advancements in electronic health records (EHRs) have improved clinical productivity, digital administrative responsibilities have led to increased physician burnout. With the emergence of large language models (LLMs), their incorporation into medicine is a potential solution to the increase in tasks such as charting and responding to patient messages. Previous studies have evaluated the efficacy of LLMs such as Chat Generative Pre-Trained Transformer-4 (ChatGPT-4) in clinical knowledge-based questions. Few studies, however, have evaluated the responses to clinical decision making in sports medicine. This study aims to evaluate the efficiency and clinical accuracy of ChatGPT-4 responses to common sports medicine questions that patients ask in the EHR system.</p><p><strong>Methods: </strong>ChatGPT-4 was prompted with few-shot exemplars involving different sports medicine injuries to generate 80 EHR scenarios. Next, ChatGPT-4 was programmed to respond to the 80 EHR scenarios using the created programmed approaches to generate LLM drafts. In stage 1, four board-certified orthopedic surgeons were asked to respond to the EHR responses, followed by a survey evaluating the difficulty and urgency of the situation. In stage 2, they were asked to edit the LLM drafts so that they were clinically acceptable to send to a patient.</p><p><strong>Results: </strong>In stage 1, the assessing physicians found responding to the LLM clinical question to be trivial in 60 out of 80 cases (75%). Most physicians disagreed that the patients in the LLM drafts were experiencing a severe medical event in 58 out of 80 cases (72.50%). In stage 2, the physicians rated the LLM-assisted responses as acceptable without modifications in 58 out of 80 cases (72.50%). Furthermore, the physicians agreed that the unedited LLM-assisted responses had a low chance of causing harm in 75 out of 80 cases (93.75%). Finally, the physicians rated the responses as generated by artificial intelligence in 65 out of 80 cases (81.25%).</p><p><strong>Conclusions: </strong>Surgeons rated the majority of the LLM responses as both clinically accurate and time-saving, with a low risk of causing harm. This finding suggests that LLMs have the potential to provide adequate responses to EHR messages within the field of sports medicine, potentially lessening physician burden and workload.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 6","pages":"313-317"},"PeriodicalIF":0.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151353","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":"Impact of Temperature Variation on Patients with Acute Severe Asthma.","authors":"Sumedha Nallamothu, Alhareth Al-Sagban, Scott Wright, Che Harris","doi":"10.14423/SMJ.0000000000001979","DOIUrl":"10.14423/SMJ.0000000000001979","url":null,"abstract":"<p><strong>Objective: </strong>Acute severe asthma (ASA) is associated with a heightened risk of death. The influence of ambient temperature on in-hospital mortality and healthcare utilization for patients with ASA is poorly characterized.</p><p><strong>Methods: </strong>Using the National Inpatient Sample, we compared adults hospitalized with ASA in the northeast with southern regions of the United States. We used multivariable regression to determine outcomes (mortality, length of stay, hospital charges, and discharge site after hospitalization). We coupled ambient temperature data for regional comparisons using the National Centers for Environmental Information.</p><p><strong>Results: </strong>From 2016 to 2019, 5485 patients were admitted with ASA; 2050 (37.4%) were in the Northeast, and 3435 (62.6%) were in the South. Comparison groups had similar mean ages, gender distribution, and comorbidity burden (all <i>P</i> values >0.05). No significant differences with respect to adjusted odds ratio (aOR) of mortality (aOR 0.65, 95% confidence interval [CI] 0.2-2.1, <i>P</i>=0.48) or adjusted mean difference (aMD) in length of stay (aMD 0.82 days, 95% CI -0.0 to 1.6, <i>P</i>=0.05) were observed. Patients in the Northeast had higher hospital charges (aMD $20,986, 95% CI 6743-35,228, <i>P</i>=0.04) and lower odds of being discharged to home (aOR 0.65, 95% CI 0.44-0.97, <i>P</i>=0.03), however. Throughout all months across the 4-year study period, average monthly temperatures were lower in the Northeast compared with the South.</p><p><strong>Conclusions: </strong>Patients with ASA in the cooler Northeast incurred greater hospital charges and were less likely to be discharged home after hospitalizations than in the South. Future interventions to improve outcome differences may consider ambient temperature factors.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 6","pages":"318-322"},"PeriodicalIF":0.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151297","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":"Aprocitentan: A New Option for Resistant Hypertension and Its Place in Patient Care.","authors":"Jason Powell, Jim Taylor","doi":"10.14423/SMJ.0000000000001972","DOIUrl":"10.14423/SMJ.0000000000001972","url":null,"abstract":"<p><p>Hypertension affects approximately 47.7% of US adults, with higher rates observed in men (50.8%) compared with women (44.6%). Risk factors and characteristics such as age, family history, race, and ethnicity also can increase the risk of developing high blood pressure and can make treatment more difficult. Aprocitentan is the first dual endothelin receptor antagonist approved for the treatment of resistant hypertension. The PRECISION clinical trial resulted in a mean change in office systolic blood pressure at 4 weeks of -15.3 mm Hg for aprocitentan 12.5 mg, -15.2 mm Hg for aprocitentan 25 mg, and -11.5 mm Hg for placebo, for a difference versus placebo of -3.8 mm Hg (97.5% confidence interval -6.8 to -0.8, <i>P</i>=0.0042) and -3.7 (1.3) mm Hg (97.5% confidence interval -6.7 to -0.8, <i>P</i>=0.0046), respectively. Aprocitentan has shown benifit in further reduction of blood pressure for individuals who have failed standard triple therapy, such as a combination of an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, nondihydropyridine calcium channel blocker, and thiazide or thiazide.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 6","pages":"299-302"},"PeriodicalIF":0.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151337","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":"Diagnostic Utility and Clinical Implications of Inpatient Fecal Occult Blood Testing.","authors":"Richard F Pearce, Shreya Narayanan, Carlos E Bertran-Rodriguez, Charles P Cavalaris, Ambuj Kumar, Athanasious Tsalatsanis, Nicole Tragash, Chanlir Segarra, Wesley Wright, Rene D Gomez-Esquivel","doi":"10.14423/SMJ.0000000000001973","DOIUrl":"10.14423/SMJ.0000000000001973","url":null,"abstract":"<p><strong>Objective: </strong>The objetive was to evaluate the utility of inpatient and emergency department (ED) fecal occult blood testing (FOBT) and its association with downstream healthcare utilization and costs.</p><p><strong>Methods: </strong>This was a retrospective cohort study of adult patients (18 years and older) who underwent FOBT in the ED or inpatient setting at our tertiary academic hospital between April 1, 2020 and April 1, 2021. Patients with known colorectal malignancy were excluded. The data collected included FOBT indications, test positivity, gastroenterology consultations, endoscopic procedures, bleeding source identification, colorectal cancer (CRC) diagnoses, and cost analysis. Statistical analyses were performed using χ² and <i>t</i> tests, with significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>In total, 826 patients were included, and 370 (45%) had a positive FOBT. Common indications were gastrointestinal bleed (60%) and anemia (22%). A bleeding source was identified in 43% of FOBT-positive versus 32% of FOBT-negative patients (<i>P</i> < 0.001). Positive results led to more gastroenterology consultations (72% vs. 33%, <i>P</i> < 0.001), esophagogastroduodenoscopies (36% vs. 10%, <i>P</i> < 0.001), and colonoscopies (15% vs. 7%, <i>P</i> < 0.001). CRC was diagnosed in 3% of FOBT-positive and 1% of FOBT-negative patients (<i>P</i> = 0.45). Mean cost per positive FOBT patient was $1185 versus $497 for negative FOBT.</p><p><strong>Conclusions: </strong>FOBT use in the inpatient and ED settings has limited diagnostic yield for CRC or evaluation of gastrointestinal bleeding and is associated with significantly higher downstream healthcare utilization and cost. Institutional guidelines and decision support tools are needed to curtail inappropriate FOBT use and promote evidence-based care.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 6","pages":"308-312"},"PeriodicalIF":0.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151287","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 Five Essential Concepts of Developmental Medicine: A Medical Paradigm for People with Developmental Disabilities.","authors":"Ryan Daniel, Bronwyn Bennett, Linda Edwards, Philip May, Rafik Jacob","doi":"10.14423/SMJ.0000000000001970","DOIUrl":"10.14423/SMJ.0000000000001970","url":null,"abstract":"<p><p>Developmental disabilities and neurodevelopmental disorders (NDDs) are lifelong conditions that present complex medical challenges, particularly as individuals transition from pediatric to adult health care. Although these disorders typically manifest in cognitive impairment, motor dysfunction, seizures, and behavioral dysregulation, the degree of these symptoms can vary widely. This article introduces a structured clinical model known as the \"Five Essential Concepts of Developmental Medicine,\" designed to guide the care of adults with NDDs. These concepts focus on understanding childhood-onset brain dysfunction, identifying the specific neurodevelopmental diagnosis, recognizing complications, assessing secondary consequences, and addressing syndrome-specific conditions. The model emphasizes the need for individualized care to prevent diagnostic overshadowing and ensure comprehensive health management. The authors advocate for integrated, multidisciplinary care systems, highlighting the critical importance of tailored screenings, early diagnosis, and proactive management to improve the quality of life for individuals with NDDs and developmental disabilities. This approach aims to bridge the gap in health care for this underserved population, addressing their unique medical needs and ensuring equitable access to care throughout the lifespan.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 6","pages":"333-336"},"PeriodicalIF":0.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151333","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":"Linking Breastfeeding Support Training and Certification to Knowledge, Self-Efficacy, and Attitudes among Alabama Healthcare Professionals.","authors":"Xifan Yang, Jen Nickelson, Amy Lee, Lisa Pawloski","doi":"10.14423/SMJ.0000000000001966","DOIUrl":"10.14423/SMJ.0000000000001966","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine whether healthcare professionals' breastfeeding-related training and certification are associated with breastfeeding support knowledge, self-efficacy, and attitudes.</p><p><strong>Methods: </strong>An online survey was created by modifying existing instruments. Items assessed Alabama healthcare professionals' certification in breastfeeding support, breastfeeding support-related training experience, knowledge, self-efficacy, and attitudes. Participants were healthcare providers and administrators serving infants and expectant or new mothers in Alabama, recruited by e-mailing through Alabama professional organization listservs and personal contacts. Multiple linear regression models were used to examine the relationship between breastfeeding support-related variables.</p><p><strong>Results: </strong>A total of 82 surveys were analyzed. Multiple linear regression showed that higher perceived training preparation was associated with higher self-efficacy (β=0.53, <i>P</i><0.001) and attitudes (β=0.27, <i>P</i>=0.040), but not higher knowledge (β=0.22, <i>P</i>=0.072), after controlling for sex and experience in breastfeeding their own infant. Certification status was associated with higher knowledge (β=0.34, <i>P</i>=0.005) and higher self-efficacy (β=0.32, <i>P</i>=0.003).</p><p><strong>Conclusions: </strong>Enhancing breastfeeding training for healthcare professionals in Alabama may help address the state's low breastfeeding rates and improve health equity for mothers and infants. Certification in breastfeeding support provides an additional level of training and should be encouraged. These findings underscore the need for targeted training interventions among healthcare professionals in Alabama.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"215-219"},"PeriodicalIF":0.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821193","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: Training with Artificial Intelligence: Are There Hidden Costs in Clinical Reasoning and Medical Education?","authors":"Maya Guhan, Chirayu Shah, Prathit A Kulkarni","doi":"10.14423/SMJ.0000000000001981","DOIUrl":"10.14423/SMJ.0000000000001981","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.14423/SMJ.0000000000001927.].</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"279"},"PeriodicalIF":0.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821208","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":"Mood Stabilizers Are the First Line of Treatment for Bipolar Disorder.","authors":"Shaishav Shah, Kirolos Ibrahim, Ahmed Sadah, Rif S El-Mallakh","doi":"10.14423/SMJ.0000000000001959","DOIUrl":"10.14423/SMJ.0000000000001959","url":null,"abstract":"<p><p>Although lithium and other mood stabilizers remain the preferred agents for bipolar disorder, their clinical use has been declining steadily while antipsychotic and antidepressant use has been increasing. We performed an integrative review of efficacy, mechanisms of disease, and drug effects. The most reproduced biologic abnormality during the ill phases of bipolar disorder is elevated intracellular sodium. This has been proposed to directly lead to the symptoms of the disease. Lithium and mood stabilizers directly reduce or normalize intracellular sodium concentrations. Dopamine D2 receptor blockade by antipsychotic agents indirectly increases sodium pump activity, thereby also reducing intracellular sodium. Antidepressants increase intracellular sodium, which is believed to contribute to the destabilization of the illness. Lithium and mood-stabilizing anticonvulsant drugs inhibit sodium entry in an activity-dependent fashion that may directly normalize documented biologic abnormalities in manic or depressed bipolar patients. This action makes them the preferred first-line pharmacologic agents. Antipsychotic medication indirectly lower intracellular sodium and would be reasonable adjunctive or second-line agents. Serotoninergic antidepressants increase intracellular sodium, which may explain why they destabilize the illness and should be avoided or used as third-line agents.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"274-278"},"PeriodicalIF":0.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821174","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 Evolution of Doula Care in Arkansas.","authors":"Pearl A McElfish, Anna B Cleek, Hannah McHardy, Bonnie Faitak, Nicolle Fletcher, Anna Strong, Molly Throgmorton, Krista Langston","doi":"10.14423/SMJ.0000000000001960","DOIUrl":"10.14423/SMJ.0000000000001960","url":null,"abstract":"<p><strong>Objective: </strong>Arkansas has significant health disparities for maternal and infant outcomes, including high rates of low birth weight, preterm birth, severe maternal morbidity, and both maternal and infant mortality. Multiple studies have identified advantages of including doulas in maternal care teams. The purpose of this article was to describe the evolution of doulas in Arkansas.</p><p><strong>Methods: </strong>Leaders began training the workforce with only a hope of reimbursement, and doula organizations continued to evolve from informal dispersed networks into a formal statewide organization, the Doula Alliance of Arkansas. Collaborative efforts were key in driving policy change for doula reimbursement.</p><p><strong>Results: </strong>The University of Arkansas for Medical Sciences and stakeholders throughout Arkansas have collaborated to expand doula workforce capacity. In 2025, Arkansas legislators passed two bills focused on Medicaid reimbursements for doulas, which Governor Sarah Huckabee Sanders signed into law (HB 1252/Act 965 and HB 1427/Act 124).</p><p><strong>Conclusions: </strong>The article documents the results of persistent stakeholder collaboration focused on improving maternal health through expanded access to doula care. This article can serve to inform other states' policies and practices by documenting Arkansas's relatively rapid progression from establishing its first doula organization to expanding the doula workforce and ultimately passing legislation for Medicaid coverage.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 5","pages":"225-228"},"PeriodicalIF":0.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821149","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}