Southern Medical Journal最新文献

Objectives: Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19.

Methods: A multicenter retrospective cohort study was conducted from January 2021 to December 2021. All of the consecutive patients with severe COVID-19 receiving 6 mg/day dexamethasone were eligible for inclusion. The primary outcome was the incidence of in-hospital mortality for patients treated with dexamethasone 6 mg/day for the standard duration of 10 days versus an extended duration of >10 days.

Results: A total of 1294 patients met the inclusion criteria: 803 received the standard duration of dexamethasone and 491 received the extended duration. The incidence of in-hospital mortality was significantly higher (P = 0.003) in the extended duration group (36.5%) compared with the standard duration group (28.5%), with no significant difference in in-hospital major adverse cardiac events (16.1% for extended vs 13.2% for the standard duration; P = 0.15).

Conclusions: The results show that extended duration of dexamethasone compared with standard duration is associated with a significant increase in in-hospital mortality in patients with severe COVID-19. These findings need to be confirmed in well-designed and performed randomized controlled trials.

Objectives: The level of knowledge about contraceptives overall is low in the United States. This qualitative study adds to the literature that explores gendered differences in contraceptive knowledge. Specifically, we examined knowledge regarding different contraceptive methods, directions on use, mechanism of action, efficacy, and adverse effects. We also looked at men's perspectives on their partner's knowledge.

Methods: Participants were interviewed at a Planned Parenthood Association of Utah clinic. They were asked about contraception knowledge, attitudes, and male involvement in contraceptive decision making. In this secondary analysis, we reanalyzed codes that were previously identified under primary analysis for specific content about contraceptive knowledge and differences by sex.

Results: We found an overall low level of knowledge about contraceptives, particularly in men as compared with women. Men often overestimate their female partners' knowledge. Men were more likely to understand how to use methods that require their direct participation. Although women's contraceptive knowledge was better than that of the male participants, it was still poor overall.

Conclusions: A low level of knowledge about contraceptives is associated with increased rates of unintended pregnancy. This study demonstrates a need for improved education about contraception. Given the impact of male opinion in contraceptive use, efforts to increase their knowledge could be important interventions to increase contraceptive uptake.

Objectives: As hospital medicine (HM) has grown as a specialty, it has been paralleled by an increase in HM fellowship training programs. Limited data are available surrounding clinical exposure for HM fellows. Using data from a large academic medical center with a long-standing HM fellowship program, we reviewed the types of clinical shifts and distribution of shift data completed by HM fellows from 2013 to 2023.

Methods: We performed a retrospective analysis of clinical shifts available from an internal Web-based scheduling program. Shifts performed by HM fellows were downloaded from May 2013 through February 2023. We characterized clinical service shifts as day coverage, off-hour coverage, teaching services, or jeopardy. We calculated summary statistics of the number of shifts worked by HM fellows per year.

Results: During a period of 10 years, 22 HM fellows completed 4430 shifts, with a mean total of 197.3 shifts during fellowship (standard deviation 56.7 shifts). Most of the shifts completed by HM fellows were off-hours shifts (51.0%, n = 2214), with less exposure to daytime shifts (n = 1285, 29.6%) and the least exposure to teaching shifts (n = 390, 9.0%).

Conclusions: HM fellows spend the majority of their clinical time on off-hours shifts, which does not reflect the clinical practice of an academic hospitalist. The least amount of time was spent attending on traditional teaching services. Because HM fellowships are designed to prepare HM fellows for careers as academic hospitalists, more work is necessary to determine how best to optimize and standardize clinical exposure while maintaining adequate time for opportunities to engage in academic development.

Objectives: Frail patients are at greater risk of experiencing adverse clinical outcomes in any critical illness due to decreased physiologic reserves, greater susceptibility to the adverse effects of treatment, and greater needs for intensive care. In this study, we sought to assess the prevalence of frailty and associated adverse in-hospital outcomes among coronavirus disease 2019 (COVID-19) hospitalizations using the 2020 California State Inpatient Database (SID).

Methods: For this study, we conducted a retrospective analysis of data from all COVID-19 hospital patients aged 18 years and older. We identified hospitalizations that were at high risk of frailty using the Hospital Frailty Risk Score. The primary outcome of our study was in-hospital mortality, and the secondary outcomes were prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit admission.

Results: The prevalence of frailty was 44.3% among COVID-19 hospitalizations. Using propensity score matching analysis, we found that the odds of mortality (odds ratio [OR] 4.54, 95% confidence interval [CI] 4.28-4.82), prolonged length of stay (OR 2.81, 95% CI 2.70-2.90), vasopressor use (OR 8.65, 95% CI 7.45-10.03), mechanical ventilation (OR 6.90, 95% CI 6.47-7.35), and intensive care unit admission (OR 7.17, 95% CI 6.71-7.66) were significantly higher among the group of frail patients.

Conclusion: Our findings show that frailty could be used for assessing and risk stratifying patients for improved hospital outcomes.

Objectives: During the course of the coronavirus disease 2019 (COVID-19) pandemic, numerous comorbidities were identified as risk factors for increased morbidity and mortality. Few studies have examined human immunodeficiency virus (HIV) and COVID-19 co-infection and the impact of HIV on COVID-19 outcomes. In this study, we compared outcomes of people living with HIV with COVID-19 with a control group to examine outcomes.

Methods: We identified 45 people living with HIV admitted with COVID-19 to one of three large healthcare systems in Memphis, Tennessee, between March 1 and October 31, 2020. We matched the people living with HIV in a 1:1 fashion to a control group of COVID-19-positive patients without a recorded history of HIV and compared clinical outcomes. Nine pairs were not able to be optimally matched, so a sensitivity analysis was completed by repeating the same analyses in the primary analysis while excluding the nine mismatched pairs.

Results: Patients did not differ significantly in demographic variables due to the matching algorithm, and there was no significant difference in measured outcomes between people living with HIV and controls. A CD4 count of <200 cells per microliter was not significantly associated with increased morbidity or mortality. Controlling for HIV status, an elevated Charlson Comorbidity Index score of >3 was associated with increased intubation (P = 0.02), vasopressor use (odds ratio [OR] 4.81, P = 0.04), intensive care unit level of care (OR 4.37, P = 0.007), mortality (OR 7.14, P = 0.02), and length of overall hospital stay in days (P = 0.004).

Conclusions: We found no difference in outcomes of people living with HIV in comparison to matched controls based on HIV status but found that an increased Charlson Comorbidity Index score led to increased morbidity and mortality regardless of HIV status.

With the number of medical school applicants more than doubling during the past 30 years, there has been an increased need to mentor premedical undergraduate students. The Vertically Integrated Training Program at the University of South Carolina School of Medicine, Columbia, was created to provide direct mentoring for college students interested in a career as a physician. Online surveys were distributed at the beginning and end of the Fall 2023 semester to gain insight into the success of the program's events from the undergraduate perspective. Data suggest a trend toward positive change in terms of increased confidence of undergraduate students regarding the process of applying to and finding success in medical school. This article reviews the development of the Vertically Integrated Training Program, evaluates the success of the program, and suggests next steps for the organization.

Objectives: There are no statewide statistics regarding the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Alabamians. To fill this gap, we used data collected by the Southern Equality Research and Policy Center to compare Alabama with other southern US states regarding the health and well-being of LGBTQ+ people.

Methods: We tested for unadjusted differences between Alabama and other southern states using χ² tests for dichotomous outcomes and the Wilcoxon rank-sum test for ordinal outcomes. Multivariate logistic models predicted dichotomous outcomes from an Alabama indicator, a continuous rurality variable, and a racial and ethnic minority indicator to control for differences in rurality and racial and ethnic composition; multivariate linear regression was used to approximate the point estimate of adjusted differences.

Results: Alabama and other southern states had statistically similar and high levels of abuse, harassment, and poor mental and physical health. Alabamians lived in ZIP codes with somewhat higher rural-urban commuting area code rurality scores (AL 1.76; South 1.70; P = 0.036, where 1 is the most urban category). More than one-fourth of Alabama respondents reported experiencing self-harming behaviors; one-third reported suicidal ideation (33.1%); more than half reported anxiety disorders (57.6%); more than two-thirds reported being depressed (69.2%); and 25% to 75% experienced or feared emotional and physical abuse because of their identity. Multivariate adjusted results were generally similar to unadjusted results.

Conclusions: Alabama LGBTQ+ populations, who live in more rural settings than in most prior studies, experience markedly poor outcomes.

Objectives: The reasons for and incidence of delay in screening colonoscopies during the coronavirus disease 2019 (COVID-19) pandemic are of major public health interest. The risks and reasons for delay likely vary between public and private institutions. This research sought to analyze data regarding the completion of screening colonoscopies after a positive fecal immunochemical test (FIT) before and during the COVID-19 pandemic and the reasons for a delay in obtaining these results at the Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center. The goals were to evaluate the institutional resilience and analyze the problems associated with this major healthcare crisis.

Methods: This closed cohort study included all positive FITs from our local Veterans Affairs (VA) medical center from October 2019 to January 2020 and July 2020 to May 2021. A total of 115 VA patients with a positive FIT prepandemic and 157 VA patients with a positive FIT during the pandemic were included. Completion rates within 180 days were measured, and charts were reviewed to identify the reasons for lack of completion. Both community and local VA procedures for veterans were included. Univariate and multivariable analyses were applied to calculate odds ratios (ORs). The Pearson χ² test was applied to calculate P values.

Results: VA patients' percentage of timely completion was lower pre-COVID-19 than it was during the pandemic, and the percentage of delayed completion was higher pre-COVID-19 than it was during the pandemic. Comparing patients who completed a colonoscopy with those who did not, increasing age had an OR of 0.947 (95% CI 0.920-0.975), and White race had an OR of 0.504 (95% CI 0.291-0.873). Evaluating delays in colonoscopy completion, VA colonoscopies versus referral to the community had an OR of 4.472 (95% CI 1.602-12.483), and pre-COVID-19 completion versus during COVID-19 had an OR of 4.663 (95% CI 1.727-12.594) with multivariable logistic regression.

Conclusions: There was a statistically significant increase in timely colonoscopy completion during the study period when compared with the pre-COVID-19 period. The completion rate was higher at the Lt. Col. Luke Weathers, Jr. VA Medical Center than a large population average in 2020, possibly related to community colonoscopies and an aggressive case management system. In addition, increasing age and White race were associated with decreased colonoscopy completion. Predictors of an increased delay in colonoscopy completion included a pre-COVID-19 positive FIT and colonoscopies performed within the VA rather than being referred to providers in the community. A common reason for delay in all of the groups was patients declining intervention and delay/lack of referral.

Objective: Lymphedema commonly affects females with Turner syndrome (TS), although it may be underrecognized and untreated. The objective of this study was to better understand self-reported lymphedema prevalence, knowledge, and experience in TS.

Methods: A 24-question anonymous survey was distributed to females with TS or their caregivers at a TS community event, a TS adult comprehensive care center, and an associated pediatrics clinic. Survey questions assessed lymphedema awareness, diagnosis and history, treatments and compliance, and sequelae. Data were analyzed using descriptive statistics.

Results: Forty-one surveys were returned, with 51.2% (n = 21) completed by the patient (mean age 25.8 years), 26.8% by the caregiver (n = 11), 2.5% by both the patient and the caregiver (n = 1), and 19.5% (n = 8) with unmarked respondent type. Greater than 75% (n = 31) reported having heard of lymphedema, 26.8% (n = 11) reported discussing lymphedema with a healthcare provider, and 22% (n = 9) reported receiving a diagnosis of lymphedema. The median age at the time of lymphedema diagnosis was 2 years. The most commonly affected body sites were legs/feet, followed by arms/hands and neck/face; the majority of patients experienced lymphedema at multiple body sites. Lymphedema resolution was reported by half, with a median duration of 4.25 years. Only one-third of those with lymphedema reported receiving treatment for the condition, including use of specialized massage/manual lymphatic drainage and compression garments.

Conclusions: Identification of knowledge gaps and experience with lymphedema in TS can help with the development of targeted educational interventions. Greater awareness and understanding of this treatable condition in TS may contribute to improved health outcomes.