Southern Medical Journal最新文献

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.

Objective: 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.

Methods: Medical students at the University of Tennessee Health Science Center were surveyed on unforeseen financial costs. Qualitative data were collected.

Results: Students spent significant extra funds in professional development, social spending, living, and technology.

Conclusion: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Objectives: Our aim was to compare the usability and reliability of answers to clinical questions posed of Chat-Generative Pre-Trained Transformer (ChatGPT) compared to those of a human-authored Web source (www.Pearls4Peers.com) in response to "real-world" clinical questions raised during the care of patients.

Methods: Two domains of clinical information quality were studied: usability, based on organization/readability, relevance, and usefulness, and reliability, based on clarity, accuracy, and thoroughness. The top 36 most viewed real-world questions from a human-authored Web site (www.Pearls4Peers.com [P4P]) were posed to ChatGPT 3.5. Anonymized answers by ChatGPT and P4P (without literature citations) were separately assessed for usability by 18 practicing physicians ("clinician users") in triplicate and for reliability by 21 expert providers ("content experts") on a Likert scale ("definitely yes," "generally yes," or "no") in duplicate or triplicate. Participants also directly compared the usability and reliability of paired answers.

Results: The usability and reliability of ChatGPT answers varied widely depending on the question posed. ChatGPT answers were not considered useful or accurate in 13.9% and 13.1% of cases, respectively. In within-individual rankings for usability, ChatGPT was inferior to P4P in organization/readability, relevance, and usefulness in 29.6%, 28.3%, and 29.6% of cases, respectively, and for reliability, inferior to P4P in clarity, accuracy, and thoroughness in 38.1%, 34.5%, and 31% of cases, respectively.

Conclusions: The quality of ChatGPT responses to real-world clinical questions varied widely, with nearly one-third or more answers considered inferior to a human-authored source in several aspects of usability and reliability. Caution is advised when using ChatGPT in clinical decision making.

Objectives: Periodically, medical publications are retracted. The reasons vary from minor situations, such as author attributions, which do not undermine the validity of the data or the analysis in the article, to serious reasons, such as fraud. Understanding the reasons for retraction can provide important information for clinicians, educators, researchers, journals, and editorial boards.

Methods: The PubMed database was searched using the term "COVID-19" (coronavirus disease 2019) and the term limitation "retracted publication." The characteristics of the journals with retracted articles, the types of article, and the reasons for retraction were analyzed.

Results: This search recovered 196 articles that had been retracted. These retractions were published in 179 different journals; 14 journals had >1 retracted article. The mean impact factor of these journals was 8.4, with a range of 0.32-168.9. The most frequent reasons for retractions were duplicate publication, concerns about data validity and analysis, concerns about peer review, author request, and the lack of permission or ethical violation. There were significant differences between the types of article and the reasons for retraction but no consistent pattern. A more detailed analysis of two particular retractions demonstrates the complexity and the effort required to make decisions about article retractions.

Conclusions: The retraction of published articles presents a significant challenge to journals, editorial boards, peer reviewers, and authors. This process has the potential to provide important benefits; it also has the potential to undermine confidence in both research and the editorial process.

Objectives: This study aimed to analyze the association between physical therapists' recommended number of visits for a full recovery from common orthopedic injuries/surgeries and the extent of insurance coverage for these visits.

Methods: A prospective observational study was conducted with board-certified physical therapists. A qualitative questionnaire was used to gather physical therapists' demographics and the recommended number of physical therapy visits to achieve a full recovery after 11 common orthopedic diagnoses. Physical therapists also were asked to report whether they believe that insurance provides an adequate number of visits overall. In addition to the qualitative survey, insurance coverage details of major Alabama companies were obtained for comparison. Descriptive statistics of the participating therapists were analyzed for sex, age, degree/training, and years of experience. Kruskal-Wallis statistics were used to analyze variance between the aforementioned groupings when compared with the reported average number of sessions.

Results: The survey (N = 251) collected data on the average number of physical therapy sessions that are necessary for a complete recovery as recommended by physical therapists for 11 common orthopedic diagnoses. From this survey, the average number of necessary visits ranged from 11.3 visits (ankle sprains) to 37.3 visits (anterior cruciate ligament reconstruction), with the overall average number of visits being 23.8. Only 24% of physical therapists believed that insurance companies provided enough coverage. Insurance coverage varied but often required additional procedures to allocate the adequate number of visits for the studied orthopedic pathologies.

Conclusions: The majority of practicing physical therapists in Alabama perceive insufficient insurance coverage for physical therapy visits for most orthopedic diagnoses. This study has implications for healthcare decision making and patient-centered rehabilitation goals. Physicians and physical therapists can use this information to optimize treatment decisions and rehabilitation goals. Patients will benefit from improved physical and economic well-being. This study has the potential to drive further research and influence national insurance policies to better serve patients' needs.