Southern Medical Journal最新文献

{"title":"Impact of Patient Demographics on Student-Led Patient Navigation Outcomes: A Study of a South Florida Medical School's Patient Navigation Program.","authors":"Lien Morcate, Sapna Kedia, Kristen Mascarenhas, Sabrina Taldone, Amar R Deshpande","doi":"10.14423/SMJ.0000000000001716","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001716","url":null,"abstract":"<p><strong>Objectives: </strong>Medical student-run patient navigation (PN) programs enhance healthcare access in underserved communities. This study examines the relationship between patient demographics and PN outcomes in a student-led PN program.</p><p><strong>Methods: </strong>Patients with moderate or high-risk health concerns were paired with medical students at health fairs. Statistical analysis evaluates program success and demographic influences.</p><p><strong>Results: </strong>Of 444 patients, 66.4% were female, 47.1% Hispanic White, 49.1% spoke English, and 63.7% earned <300% of the federal poverty level. More than half were uninsured and 52.5% achieved navigation goals. Insurance status and risk level significantly predicted PN outcomes, with \"other insurance\" and high-risk patients being 1.9 and 1.7 times more likely to complete navigation.</p><p><strong>Conclusions: </strong>The program achieved high completion rates, emphasizing the need for resources such as translators and financial assistance. Risk stratification successfully linked acute cases to resources. Navigation success was consistent, demonstrating the effectiveness of the program across diverse patient groups.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"478-482"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879452","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":"Videolaryngoscopy during Urgent Cesarean Delivery: Association with Neonatal Intensive Care Unit Admission.","authors":"Andrew King, Julie-Ann Thompson, Stewart Hart, Bobby Nossaman","doi":"10.14423/SMJ.0000000000001722","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001722","url":null,"abstract":"<p><strong>Objectives: </strong>Parturients are at increased risk for difficult airway management with subsequent fetal complications. Videolaryngoscopy was opined to be the new standard of airway care to facilitate orotracheal intubation under urgent care conditions. We examined in parturients requiring general anesthesia for urgent cesarean delivery the association of the type of laryngoscopy technique and time required to facilitate orotracheal intubation with the incidence of subsequent neonatal intensive care unit (NICU) admission.</p><p><strong>Methods: </strong>Following institutional review board approval, 431 parturients aged 18 years and older who underwent urgent cesarean section requiring general anesthesia were entered into this study. Patient characteristics, maternal comorbidities, and indications for urgent cesarean delivery were collected from the electronic medical records from January 2013 to November 2018. Orotracheal intubation times by type of laryngoscopy (video or direct) and NICU admission rates also were collected. A measure of effect size, risk differences with 95% confidence intervals (CIs), were calculated for the likelihood of NICU admission by difficult orotracheal intubation and by type of laryngoscopy used to secure the airway.</p><p><strong>Results: </strong>Videolaryngoscopy as the primary type of laryngoscopy was used in 24.1% (95% CI 20.3%-28.3%) of general anesthetics. The incidence of difficult orotracheal intubation was 4.4% (95% CI 2.8%-6.7%), with a higher incidence observed with videolaryngoscopy (8.7%) than with direct laryngoscopy (3.1%) and a risk difference of 5.6% (95% CI 0.001%-11.3%). The incidence of NICU admission was 38.4% (95% CI 34.0%-43.1%). Times for successful orotracheal intubation were longer with videolaryngoscopy. Videolaryngoscopy had a higher association for NICU admission (47%) than for direct laryngoscopy (36%), with a risk difference of 11.4% (95% CI 0.01%-22.3%).</p><p><strong>Conclusions: </strong>Videolaryngoscopy did not decrease the incidence of difficult orotracheal intubation, and it did not decrease the time associated with orotracheal intubation. Videolaryngoscopy was associated with a higher association of NICU admission. These results suggest that videolaryngoscopy does not supplant direct laryngoscopy as the standard of care for orotracheal intubation under urgent care conditions of general anesthesia for cesarean section.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"494-497"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879458","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":"Prescription of Nicotine Replacement Therapy for Hospitalized Tobacco Users.","authors":"Ellen M Nielsen, Emily C Ware, Marc Heincelman, Andrew D Schreiner, Leslie A Lenert, Benjamin A Toll","doi":"10.14423/SMJ.0000000000001719","DOIUrl":"10.14423/SMJ.0000000000001719","url":null,"abstract":"<p><strong>Objectives: </strong>In hospitalized patients, cigarette smoking is linked to increased readmission rates, emergency department visits, and overall mortality. Smoking cessation reduces these risks, but many patients who smoke are unsuccessful in quitting. Nicotine replacement therapy (NRT) is an effective tool that assists patients who smoke with quitting. This study evaluates NRT prescriptions during and after hospitalization at a large health system for patients who smoke.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to determine the number of patients who were prescribed NRT during an inpatient admission and at time of discharge from a network of nine hospitals across South Carolina between January 1, 2019 and January 1, 2023.</p><p><strong>Results: </strong>This study included 20,757 patients identified as actively smoking with at least one hospitalization during the study period. Of the cohort, 34.9% were prescribed at least one prescription for NRT during their admission to the hospital. Of the patients identified, 12.6% were prescribed NRT upon discharge from the hospital.</p><p><strong>Conclusions: </strong>This study identified significantly low rates of NRT prescribed to smokers during hospitalization and at discharge. Although the management of chronic conditions is typically addressed in the outpatient setting, hospitalization may provide an opportunity for patients to initiate health behavior changes. The low rates of prescriptions for NRT present an opportunity to improve tobacco treatment during hospitalization and beyond.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"517-520"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879454","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":"Abortion Stigma as a Barrier to Mifepristone Use among Obstetrician-Gynecologists in Alabama for Early Pregnancy Loss.","authors":"Mugdha Mokashi, Christina Boulineaux, Elizabeth Janiak, Margaret Boozer, Sara Neill","doi":"10.14423/SMJ.0000000000001717","DOIUrl":"10.14423/SMJ.0000000000001717","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of our study was to identify and characterize barriers to mifepristone use among obstetrician-gynecologists (OB-GYNs) for early pregnancy loss in a southern US state.</p><p><strong>Methods: </strong>In this qualitative study, we conducted semistructured interviews with 19 OB-GYNs in Alabama who manage early pregnancy loss. The interviews explored participants' knowledge of and experience with mifepristone use for miscarriage management and abortion, along with barriers to and facilitators of clinical mifepristone use. The interviews were coded by multiple study staff using inductive and deductive thematic coding.</p><p><strong>Results: </strong>Nearly all of the interviewees identified abortion-related stigma as a barrier to mifepristone use. Interviewees often attributed stigma to a lack of knowledge about the clinical use of mifepristone for early pregnancy loss. The stigmatization of mifepristone due to its association with abortion was related to religious and political objections. Many interviewees also described stigma associated with misoprostol use. Although providers believed that mifepristone use for abortion would not be accepted in their practice, most believed that mifepristone could be used successfully for miscarriage management after practice-wide education on its use.</p><p><strong>Conclusions: </strong>Mifepristone is strongly associated with abortion stigma among OB-GYNs in Alabama, which is a barrier to its use for miscarriage management. Interventions to decrease abortion stigma and associated stigma surrounding mifepristone are needed to optimize early pregnancy loss care.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"504-509"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879494","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":"Authors' Response on \"Rise in Neonatal Abstinence Syndrome Rate Is Associated with Rise in Buprenorphine Prescription Numbers\".","authors":"Summer Shore, Nicole Lewis, Martin Olsen","doi":"10.14423/SMJ.0000000000001712","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001712","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"511-512"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879495","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":"Development and Implementation of a Hospitalist Faculty Development Program in a University- and Community-Based Multihospital System.","authors":"Noble Maleque, Reena Hemrajani, Daniel Hunt, Annie Massart, Yoo Mee Shin, Mary Ann Kirkconnell Hall, Joanna Bonsall","doi":"10.14423/SMJ.0000000000001713","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001713","url":null,"abstract":"<p><strong>Objectives: </strong>Robust faculty development (FD) is an emerging area of focus within hospital medicine, a relatively new specialty with limited mentorship infrastructure to find and develop a professional niche. There are few descriptions in the literature of establishing and evaluating an FD program with strategies to evaluate success, invite collaboration, and achieve feasible, useful metrics.</p><p><strong>Methods: </strong>We created our University Division of Hospital Medicine's FD Program to help community and academic hospitalist faculty fulfill professional goals in (and beyond) quality improvement, leadership, education, and clinical skills. We describe program development, initial implementation, and early evaluation results. We outline program roles and offerings such as professional development awards, lectures, and mentorship structures.</p><p><strong>Results: </strong>Our program was successfully implemented, measured by engagement and participation via preliminary indicators suggesting programmatic effectiveness: faculty who applied for (and continued participation in) mentorship and faculty development awards and faculty who attended our lecture series. Since program implementation, faculty retention has increased, and percentages of faculty reporting they were likely to remain were stable, even during the coronavirus disease 2019 pandemic. Scholarly production increased and the number of division associate professors/professors grew from 2 in 2015 to 19 in 2024.</p><p><strong>Conclusions: </strong>Our experience can guide institutions seeking to support and encourage faculty professional development. Lessons learned include the importance of needs assessment and leadership commitment to meeting identified needs; how a steering committee can amplify the effectiveness and relevance of FD efforts; and the utility of multiple recognition strategies-quarterly newsletters, monthly clinical recognition, mentions on social media-to support and encourage faculty.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"483-488"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On \"Rise in Neonatal Abstinence Syndrome Rate Is Associated with Increase in Buprenorphine Prescription Numbers\".","authors":"Satyam K Ghodasara, Hyo J Yang, Zoltan H Nemeth","doi":"10.14423/SMJ.0000000000001711","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001711","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"510"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879453","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":"Sugar or Sweetener?","authors":"Arshag D Mooradian","doi":"10.14423/SMJ.0000000000001714","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001714","url":null,"abstract":"<p><p>Human beings have a natural craving for sweets. The intensity of this craving varies with genetic and environmental factors; however, excessive use of table sugar has been associated with adverse health outcomes, including increased risk of obesity, diabetes mellitus, and cardiovascular disease. As such, the World Health Organization has called for restricting sugar consumption to less than 5% of total energy intake. For those who have a \"sweet tooth,\" implementing these guidelines is not easy. Hence, the interest in alternative sweeteners. There are eight high-intensity sweeteners that are either approved by the Food and Drug Administration or designated as generally regarded to be safe. The safety of the currently available sweeteners has been questioned. Large cohort studies have reported a positive correlation between sweetener use with weight gain and metabolic risk. A recent meta-analysis, however, concluded that using low- or no-calorie sweetener was associated with small improvements in body weight and cardiometabolic risk factors without evidence of harm. Nevertheless, the World Health Organization advises against the use of nonsugar sweeteners. The biological effects of natural sweeteners such as steviol, monk fruit extract, tagatose, allulose, and sweet proteins (eg, brazzien, miraculin, thaumatin) are not well studied. Eating less sugar is a prudent thing to do, but for people with diabetes mellitus and those at risk of diabetes mellitus, diversifying the type of the sweetener and limiting the quantity may be reasonable.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"513-516"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879456","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":"Recent Trends and Challenges in Employment for Emergency Medicine Trainees: A Survey of Graduating Residents' Perspectives.","authors":"Josh Greenstein, Jennifer Kaminsky, Anthony Elias, Aron Friedlander, Barry Hahn, Abbas Husain","doi":"10.14423/SMJ.0000000000001720","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001720","url":null,"abstract":"<p><strong>Objectives: </strong>The landscape of the emergency medicine (EM) workforce has undergone significant changes recently, posing challenges for residents who are about to graduate from EM training programs. The objective of this study was to survey graduating residents' perceptions of the recent EM job market.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey study involving EM residents from programs in New York and New Jersey between August 2021 and November 2021. The survey consisted of 12 multiple-choice questions that focused on graduating EM residents' perceptions of the EM job market, its impact on their job search, and their interest in pursuing fellowship training.</p><p><strong>Results: </strong>During the study period, 436 survey results were collected from 26 EM residency programs. Of the 418 respondents, 233 (56%) expressed their intention to start their job search earlier than their counterparts in previous years, as highlighted by the survey. Among respondents, 141 (76%) postgraduate year (PGY)-2, 139 (79%) PGY-3, and 47 (85%) PGY-4 residents anticipated a challenging job search. Nearly 90% of respondents believed that the coronavirus disease 2019 pandemic would affect both academic and nonacademic medical centers in terms of job openings. A total of 248 (59%) were interested in pursuing a fellowship after residency. Most residents preferred job opportunities on the East and West Coasts of the United States.</p><p><strong>Conclusions: </strong>The findings highlight the increasing competitiveness and challenges residents face in securing their first job, the declining interest in pursuing fellowships as residents progress in their training, and the geographic preferences for job opportunities.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"489-493"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879455","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 Unforeseen Costs of Medical Education.","authors":"Anna Conner, Jarrett Rong, Eleanor Lee, Nia Zalamea","doi":"10.14423/SMJ.0000000000001721","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001721","url":null,"abstract":"<p><strong>Objective: </strong>Financial burdens of medical education are a major barrier for many students. The goal of this study is to identify and quantify unforeseen costs associated with being a medical student.</p><p><strong>Methods: </strong>Medical students at the University of Tennessee Health Science Center were surveyed on unforeseen financial costs. Qualitative data were collected.</p><p><strong>Results: </strong>Students spent significant extra funds in professional development, social spending, living, and technology.</p><p><strong>Conclusion: </strong>Schools and students should consider all aspects of life to have a fruitful education and appropriately provide loan funding and financial education for both enough and thoughtful use of financial resources during medical education.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 8","pages":"474-477"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879457","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}