Southern Medical Journal最新文献

Objectives: Racism is a public health crisis, and it is imperative that healthcare providers act to dismantle it. Although social determinants of health have been incorporated into graduate medical education, few longitudinal antiracism curricula exist. We evaluated a longitudinal antiracism curriculum for Internal Medicine (IM) residents, hypothesizing that participation would increase racism awareness and comfort with skills necessary to combat it.

Methods: We conducted four 1-hour antiracism educational didactic sessions and three 45-minute interactive small-group sessions for IM residents between 2021 and 2022. The curriculum was grounded in a governmentally commissioned regional racial inequality report. Curricular themes included structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Participants completed pre-postsurveys with two validated measures: the Antiracism Behavioral Inventory scale and the Color-Blind Racial Attitudes scale. We used McNemar or Wilcoxon signed rank tests to compare participants' pre-posttest scores.

Results: Eighty-three of 157 IM residents responded to the presurvey (response rate 53%) and 62 to the postsurvey (response rate 39%). Thirty-four residents representing postgraduate years 1-3 levels of training were eligible for response matching. We found statistically significant increases in awareness of racism/racial dynamics per overall Color-Blind Racial Attitudes scores (P < 0.001) and subcategories of racial privilege (P < 0.001) and blatant racial issues (P < 0.001). We also found an increase in individual advocacy (P = 0.008) per Anti-Racism Behavioral Inventory scores.

Conclusions: Our study indicates that this community-based longitudinal antiracism curriculum promotes increased racism awareness and antiracist behaviors across varying graduate medical education levels and may serve as a stepping stone for future antiracist curricula.

Objectives: Cardiac tumors affect fewer than 1 in 2000 people. This study is a retrospective review of diagnostic procedures, surgical management, and outcomes in patients treated for tumors of the heart at our institution. We compare our management approaches, clinical, and surgical outcomes with those reported in the literature.

Methods: The study population includes patients 7 to 79 years old who presented to our institution for tumors of the heart from July 2004 to January 2023. With institutional review board approval, subjects for this study were identified by searching the hospital's database on Current Procedural Terminology codes for tumors of the heart (benign neoplasm of the heart or malignant tumor). All of the data were stored on REDCap.

Results: There were 23 men and 29 women in the patient group. The average patient age was 54 years old. The most common presentation symptoms were dyspnea and fatigue. The most common diagnosis methods were transthoracic echocardiogram, transesophageal echocardiogram, cardiac magnetic resonance image, and computed tomography scan. Operative treatment was offered to 52 people; 47 had resection and 5 had biopsy only. The most common postoperative complication was respiratory insufficiency (22) and sepsis (2). Forty-eight patients were diagnosed as having a benign neoplasm of the heart and 4 diagnosed as having a malignant tumor. There were 49 primary tumors and three secondary tumors. The most common location of the tumor was the left atrium. The most common diagnosed cell type for the cardiac tumors was myxoma (61.5%). The average length of stay in the hospital was 12.5 days. Thirty-nine patients were discharged home in a stable condition. The study population had one operative mortality (death within 30 days after surgery). Forty-four of the 52 patients treated are alive after 2 years.

Conclusions: Data from this study strongly suggest that surgical removal is a viable and largely successful treatment approach for cardiac tumors. Clinical outcomes such as discharge status, postoperative condition, and length of survival after procedures are similar to those from other referral centers for such conditions. Complete resection was possible in 90% of our study cases; 85% of patients in this study surgically treated for cardiac tumors are alive after 2 years.

Objectives: Tocilizumab, originally used in the treatment of autoimmune disorders such as rheumatoid arthritis, had its use expanded to treat hyperinflammatory changes in coronavirus disease 2019. The objective of this study was to evaluate the risk of secondary infections and gastrointestinal side effects in patients treated with tocilizumab for severe COVID-19 infection.

Methods: We performed a retrospective cohort study of 97 patients to evaluate the safety of tocilizumab use in severely ill coronavirus disease 2019 patients. Thirty patients (30.9%) were diagnosed as having a secondary infection; all of these patients required mechanical ventilation.

Results: These patients had higher 30-day mortality and longer lengths of stay compared with those without a secondary infection.

Conclusions: The results of our study suggest a degree of safety in short-term tocilizumab use and suggests that clinicians pay attention to the elevated risk of secondary infection in the patient population treated with tocilizumab and require a ventilator for respiratory support.

Objectives: To evaluate the efficacy of Chat Generative Pre-Trained Transformer (ChatGPT) in generating antimicrobial management recommendations for pediatric patients with contaminated traumatic wounds, particularly in the absence of infectious disease (ID) consultation.

Methods: Three pediatric cases involving severely contaminated traumatic injuries were retrospectively presented to ChatGPT-4, including clinical data such as injury mechanism, cultures, susceptibilities, and presence of osteomyelitis. The model's antibiotic recommendations were compared with those made by the pediatric ID team. A pediatric ID specialist graded each recommendation based on appropriateness, pathogen coverage, and clinical judgment.

Results: ChatGPT provided 29 antibiotic recommendations: 3 for initial antibiotic selection, 8 for pathogen management, and 18 for follow-up changes. All of the initial antibiotic recommendations were deemed appropriate or identical to ID guidance. Of the pathogen-specific recommendations, 87.5% were appropriate and 12.5% were unnecessary. Among the follow-up changes, 11.1% were appropriate, 77.8% were unnecessary, and 11.1% were incorrect. In total, 41.4% of recommendations were appropriate or identical, 51.7% were unnecessary, and 6.9% were incorrect. The majority of unnecessary changes involved redundant adjustments to existing effective therapies.

Conclusions: ChatGPT performed well in initial antibiotic selection and pathogen-directed management but frequently proposed unnecessary follow-up modifications. Although promising as a supplemental tool in resource-limited settings, its current limitations highlight the need for further refinement before broader clinical application.

Objectives: In 2021, Tennessee high school youth reported a cigarette smoking rate of 4.9% and an electronic cigarette (e-cigarette) use rate of 19%, surpassing national averages of 2.3% and 11.3%, respectively. In 2019, 15.5% of 8th- and 9th-grade youth in northeast Tennessee reported current e-cigarette use. Primary care providers (PCPs) can prevent youth tobacco initiation and promote cessation through screening and counseling, yet little is known about these services in Tennessee. This study explored the experiences of PCPs in northeast Tennessee regarding youth tobacco use screening and counseling and identified barriers and facilitators to these services.

Methods: Semistructured interviews with 12 PCPs were conducted via Zoom between November 2023 and March 2024 using an interview guide based on McLeroy's ecological health promotion model. Transcripts were analyzed using ATLAS.ti 23.4 software. Coding and analysis followed Braun and Clarke's thematic analysis using a blended deductive-inductive approach.

Results: PCPs recognize the importance of youth tobacco use screening and counseling and employ tool-based screening, verbal questioning, motivational interviewing, and warm hand offs to behavioral health clinicians. Key barriers included knowledge gaps on e-cigarettes, balancing rapport and trust with screening and counseling, confidentiality and privacy issues, time constraints, negative social norms around tobacco use, limited community resources for youth tobacco cessation, and tobacco regulatory concerns. Facilitators included training and educational resources for PCPs, an integrated behavioral health model, and effective clinic policies and workflows.

Conclusions: Supportive policies and quality improvement measures are needed to strengthen youth tobacco prevention and cessation efforts in northeast Tennessee and statewide.

Objective: The objective of our study was to design a meal delivery and exercise program for homebound older adults to optimize their functional independence.

Methods: This article provides a transparent stepwise account of the development of a home-based meal delivery and exercise program, the use of home-based research procedures, preliminary outcomes, and program evaluation.

Results: The development of the Strength on Wheels intervention is described in six phases that follow the United Kingdom's Medical Research Council guidance for complex interventions. Preliminary results (N = 9) of the treatment group had fewer frail participants, decreases in inflammatory markers, and higher levels of vitamin C.

Conclusions: Strength on Wheels was well received by our participants. All of the participants completed the full 12-week study, and there were no adverse events. The participants enjoyed being part of the study and believed that they were contributing to society. We saw positive, meaningful changes in frailty and biomarkers of inflammation and nutrition. We hope that adding a simple home-based exercise program can improve frailty, inflammatory markers, and nutritional status so that homebound older adults can age in place successfully.

Antifat bias is common in US society, and research supports that it is seen frequently in the healthcare setting. In response, medical schools are including interventions to reduce antifat bias and improve patient care. To the authors' knowledge, there has been no study that focuses solely on educational interventions to address antifat bias aimed at medical students in the United States. This review examined the current state of research, exploring different methods of addressing antifat bias in US medical education to determine which methods were more effective. We did a literature search using PubMed, Web of Science, and Embase. Eight studies met the criteria for inclusion. Of the eight, one assessed current curriculum, one assessed lectures and case simulations, two were centered around engaging in art, two focused on watching video clips, one was a standardized patient encounter, and one used the elaboration likelihood model. All of the studies showed some decrease in bias in the short term in subjects, whether statistically significant or not. Bias was assessed long term in two studies, and consistent follow-up was identified as important for preserving the decrease in bias. We conclude that addressing antifat bias is sufficient to drive change in medical students, independent of method, at least in the short term. The limitations of the study included the short-term nature of the interventions, the small number of studies, and their differing methods of assessing bias. More research is necessary to evaluate the long-term effects of these interventions and other methods of assessing bias. We hope that this can increase the number of schools including education to challenge antifat bias.