Southern Medical Journal最新文献

Objective: Despite advancements in heart failure (HF) diagnostics and treatment, many palliative care patients with HF often seek complementary and alternative medicine (CAM) to improve quality of life and address unmet physical and emotional needs. This study aimed to explore the prevalence and patterns of CAM use among HF patients in a large academic medical ambulatory HF clinic in Alabama.

Methods: This cross-sectional, descriptive study included HF patients from the University of Alabama at Birmingham HF clinic. Data collection involved CAM-related questions from the National Health Interview Survey, the Kansas City Cardiomyopathy Questionnaire, and sociodemographic variables. Descriptive statistics were computed for all study variables, and analyses were conducted using SPSS.

Results: Among 250 HF participants, 49 (19.6%) reported CAM use. The mean age of CAM users was 65 years (±14.76). Most CAM users were White (69%), male (63%), married or partnered (60%), had some college education (67%), and identified as Protestant (22%). The mean Kansas City Cardiomyopathy Questionnaire clinical summary score among CAM users was 54.48. Herbal products and dietary supplements were the most common CAM forms (57%). Of the CAM users, 53% discussed CAM with their healthcare providers, and 43% obtained CAM information from them. Regarding reasons for CAM use, 44.1% used it for pain relief, 29.4% for specific conditions, 20.6% for overall wellness, and 17.6% to complement conventional medicine; 15% cited multiple reasons. No significant sociodemographic predictors of CAM use were found.

Conclusion: CAM prevalence among HF patients in this cohort was relatively low compared with other populations. Herbal products and dietary supplements were the most common forms of CAM used. Further research is needed to assess the safety and efficacy of CAM, particularly herbal products and dietary supplements, in patients with HF.

These abstracts were accepted and presented during Southern Medical Association's 5th Annual Physicians-in-Training Leadership Conference that took place February 7-9, 2025, at the University of Alabama at Birmingham Heersink College of Medicine. For space consideration, abstracts have been formatted in the Editorial office. Abstract content is published as submitted. These abstracts may also be found in the PIT 2025 Playlist on SMA's YouTube Channel.

Objectives: Collegiate soccer may carry a high risk of injury during one's career. Although the long-term health outcomes of injuries in professional athletes have been well documented, less is known about the short- to mid-term health and physical activity levels of former collegiate soccer players. This study aimed to evaluate the activity levels as well as the physical and mental well-being of these athletes, with a secondary focus on the impact that injury status has on these outcomes.

Methods: We conducted a retrospective survey-based study involving former male and female collegiate soccer athletes who competed between 2011 and 2021. Participants completed a general survey assessing demographics, injury history, current physical activity levels using the Tegner Activity Scale (TAS), and self-reported health outcomes using the Patient-Reported Outcomes Measurement Information System (PROMIS) scale. A follow-up survey was administered to participants who reported injuries, focusing on joint-specific outcomes.

Results: Thirty-nine participants completed the initial survey with 86 injuries reported. Among reported injuries were foot/ankle (22), knee (20), hip (12), back (6), upper extremity (5), and other (21). The average physical activity quantity and TAS scores were 5.08 and 4.84, respectively. Average raw mental and physical PROMIS scores were 15.5 ± 1.7 and 15.6 ± 1.7, respectively. Single Assessment Numeric Evaluation (SANE) scores averaged 76.7 in the affected limb and 89.1 in the unaffected limb. Physical PROMIS scores showed a positive correlation with affected and unaffected limb SANE scores (P = 0.02 and P = 0.04, respectively), and affected limb SANE scores showed a positive correlation with physical activity quantity (P = 0.04). Of the injury-specific outcomes, the only significant correlation with activity levels was the Lysholm Knee Scoring Scale score with the TAS score (P = 0.03).

Conclusions: Although physical activity decreases in former collegiate soccer players, their overall mental and physical health remains stable. Future research should focus on larger cohorts to further explore the impact of specific injuries on long-term health outcomes in this population.

Objectives: Professional organizations have recognized the need to educate and empower medical students for equitable and inclusive care. One component of providing such care for patients of diverse backgrounds is culturally sensitive and patient-centered communication. The aim of this work was to improve skills in culture competency and spiritual history taking by implementing an interactive, educational session for undergraduate medical students. The session included an introduction to spiritual history, education about Kleinman's Explanatory Model, and an integrated case incorporating spiritual history taking and cultural understanding.

Methods: The intervention employed didactics and dyad role-playing clinical scenarios. Learners included first-year (n = 104) and fourth-year (n = 54) medical students. Participants completed an 8-item pre-post survey to assess the value of cultural competence and spiritual history taking (attitude), importance of assessing cognition (knowledge), and importance of assessing the learner's ability to practice this history (skill). Medical student religiosity was measured using the Duke University Religion Index.

Results: For both groups of learners, there was a statistically significant improvement between the pre- and postintervention surveys in medical students' attitude, knowledge, and skill. Results of the Duke University Religion Index found that a majority of participants infrequently attended organized religious services. Despite this, a statically significant proportion of participants agreed that it is important to identify patients' religion/spirituality following the intervention (P < 0.05).

Conclusions: The educational intervention used in this study fills a curricular gap in effectively integrating cultural competency and spiritual history-taking education. Limitations include that the study did not explore the long-term retention of knowledge or performance in the clinical setting.

Background: Observation units (OUs) are a common healthcare delivery model for health systems across the United States. OUs vary from a type I to type IV based on several factors. Another category of OUs-second-level OUs-does not fit this traditional classification due to a different patient population composition and staffing model. The impact of a second-level OU in the setting of a coexisting type I OU has not been previously evaluated. As such, our study assesses the impact of patient outcomes in a second-level OU with a coexisting type I OU.

Methods: We established a second-level OU comprising 14 beds on a medical-surgical floor. Patients designated as observation status who did not meet the criteria for the type I OU in the emergency department were cohorted on this unit and cared for by a multidisciplinary team that included nurses, case managers, pharmacists, and hospital medicine providers. We compared patient outcomes pre- and postsecond-level OU implementation for all observation status patients admitted to hospital medicine between January 1, 2019 and December 31, 2019.

Results: Patients cohorted on the second-level OU had a shorter length of stay (estimated reduction in 11.7 hours; P < 0.0001) and a lower conversion rate from observation to inpatient status ("admission rate"; 14.5% vs 57.7%; P < 0.0001) in comparison to the nonintervention group; this led to a saving of 506.5 bed-days in comparison to the preimplementation phase.

Conclusions: Implementation of a second-level OU in the setting of a coexisting type I OU led to a reduced length of stay, admission rate, and bed-days saved.

Objectives: The estimated prevalence of female urinary incontinence (UI) is 60% in the United States, and several over-the-counter (OTC) therapies for bladder health and UI exist on the market. Safety, efficacy, and patient use profiles of OTC treatment for medical issues such as constipation and headache are well established; however, research on OTC treatment of female UI before specialist presentation is sparse. The goal of this study was to characterize patient use of and attitudes toward OTC therapies for UI.

Methods: We developed an institutional review board-approved patient survey capturing demographic information and characterization of OTC therapy use. New patients presenting with a complaint of UI to the urogynecology providers at a tertiary care center were eligible for the study. Data analysis consisted of analyzing trends in participant responses.

Results: Forty-five survey responses were collected as a convenience sample over 8 weeks. Two-thirds of patients experienced UI for more than 2 years before seeing a specialist; 87% of patients reported moderate or severe UI according to Sandvik's UI severity index. Two participants tried an OTC medication for UI and 17 tried pelvic floor exercises or devices. Sixty-two percent reported that they did not know any OTC treatments existed, and 71% believed healthcare providers were knowledgeable about OTC treatment and would be more likely to try these if recommended by their healthcare provider.

Conclusions: In a small sample of women with predominately moderate and severe UI, only 4% of patients tried OTC medications before specialist presentation despite two-thirds of patients experiencing symptoms for more than 2 years. Most respondents did not know that OTC treatments existed, but they said that would be likely to try them if recommended by a healthcare provider. This survey-based study highlights the lack of patient awareness about OTC therapies for female UI and the need for provider knowledge on this topic.

Obstructive sleep apnea (OSA), a condition with high prevalence, is characterized by reduced dilatory function of pharyngeal muscles, which can be influenced by upper airway narrowing, dilator muscle dysfunction, respiratory dysfunction, and genetics. Three of the most clinically important phenotypes of OSA include disturbed sleep, excessive sleepiness, and minimal symptoms, with varying implications for management and morbidity. This article reviews current perspectives on these OSA phenotypes, as well as the process of confirming a diagnosis of OSA. Lastly, this article delineates various current and future OSA therapy approaches through review and analysis of the existing literature with discussion on the outlook for OSA treatment.