Southern Medical Journal最新文献

Objectives: Hypertension (HTN) affects nearly half of US adults. Our multi-institutional survey revealed that Internal Medicine residents lack proficiency in advanced HTN topics. We developed a curriculum to address knowledge gaps in these topics and aimed to assess the effects of the curriculum on residents' confidence, desire for future training, and knowledge in advanced HTN topics.

Methods: HTN experts taught four advanced topics in HTN: conducting a workup for secondary HTN, managing HTN in chronic kidney disease, managing HTN in patients who are or may become pregnant, and managing hypertensive urgency (severe asymptomatic HTN) in the outpatient setting. The setting of the curriculum was an ambulatory educational half-day, during which residents rotated through small-group sessions dedicated to each HTN topic. We developed pre-, immediate post-, and 8 weeks postcurriculum surveys assessing residents' confidence and desire for future training in the four topics (4-point Likert scales), and multiple-choice quizzes to assess changes in knowledge. We used repeated-measures analysis of variance to compare means between time points for surveys and quizzes.

Results: A total of 112 Internal Medicine residents participated in the curriculum. The mean confidence scores for all four topics increased from 1.79 to 2.61 precurriculum to 2.90 to 3.45 immediately postcurriculum (all P < 0.001) and remained higher (2.53-3.18) than precurriculum at 8 weeks postcurriculum (all P < 0.02). The mean desire for future training scores decreased from 2.74 to 2.96 precurriculum to 2.06 to 2.36 immediately postcurriculum (all P < 0.001 except for managing HTN in patients who are or may become pregnant, which was P = 0.17) and remained lower (2.08-2.36) than precurriculum at 8 weeks postcurriculum (all P ≤ 0.003). The mean knowledge score increased from 48% precurriculum to 62% immediate postcurriculum (P < 0.001) and remained higher (55%) than precurriculum at 8 weeks postcurriculum (P = 0.015).

Conclusions: A curriculum on advanced HTN topics produced durable gains in confidence and knowledge and partially satisfied the desire for future learning among Internal Medicine residents.

Objectives: Adults with intellectual disabilities will frequently experience sedentary behavior and excessive weight, which may cause or exacerbate a multitude of medical and behavioral problems. This study examined a program to encourage increased activity and weight loss in an outpatient service for adults with intellectual disabilities.

Methods: Behavioral methods were used to treat obesity in 33 male and 21 female adults with intellectual disabilities for a mean of 9 months. They were retrospectively analyzed to determine the effects of treatment on muscle and adiposity using body composition analysis.

Results: The 54 participants of the original 122 (44.3%) who did not drop out were divided into three groups: weight loss ≥3 kg/3% (n = 20, 37%), weight loss <3 kg/3% (n = 17, 31.5%), and no weight loss or weight gain (n = 17, 31.5%). Only men and women who lost ≥3 kg/3%, demonstrated significant gain of relative muscle mass. Those who gained weight lost muscle mass.

Conclusions: If motivation remains high and follow-up is reasonably long, then a multicomponent obesity treatment program can lead to significant weight loss with preservation of muscle in adults with intellectual disabilities.

Objectives: Current evidence describing physical activity (PA) and sedentary time (ST) in people with and without heart failure (HF) is limited. This study examines PA participation and ST in a nationally representative sample of US adults with and without self-reported HF.

Methods: The study sample (N = 21,633) included US adult (40 years old and older) participants from the 2007-2018 National Health and Nutrition Examination Survey. PA participation, ST, and HF status were assessed via a questionnaire.

Results: Compared with participants without HF (68%), 84% of participants with HF reported not meeting PA recommendations (P < 0.05). Compared with participants without HF (63%), 75% of participants with HF reported >4.5 hours/day of ST (P < 0.05). Unadjusted analysis suggests that participants with HF had 60% (P < 0.05) lower odds of reporting meeting PA recommendations when compared with those without HF. In a fully adjusted model, these odds were attenuated (odds ratio 0.74, P < 0.05). Similarly, unadjusted analysis illustrated those individuals with HF had 42% (P < 0.05) lower odds of reporting ≤4.5 hours/day of ST. In a fully adjusted model, these odds also were attenuated (odds ratio 0.66, P < 0.05).

Conclusions: Our findings suggest that US adults with HF report significantly less PA and greater amounts of ST than those without HF.

Objectives: Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office.

Methods: Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ² tests to describe differences in contraceptive provision by type of abortion and continuity status.

Results: Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%).

Conclusions: The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.

Objectives: 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.

Methods: Patients with moderate or high-risk health concerns were paired with medical students at health fairs. Statistical analysis evaluates program success and demographic influences.

Results: 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.

Conclusions: 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.

Objectives: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.