Southern Medical Journal最新文献

Objectives: Concussions are one of the most frequent pediatric injuries, especially for high school athletes. Many of the psychological sequalae from concussions go unnoticed and undertreated particularly in the rural setting. There is limited research on optimizing recovery for these patients; however, newer studies are beginning to show the utilization of deep breathing exercises. In this study, we evaluated the effectiveness of self-administered relaxation techniques for postconcussive mood symptoms in an Appalachian population.

Methods: Patients' charts (N = 308) from a rural specialty concussion clinic between September 2020 and May 2023 underwent a review. Eligible patients included those who completed the Post-Concussion Symptom Scale (PCSS), Patient Health Questionnaire, and Generalized Anxiety Disorder scale (GAD-7) during their initial intake visit. Patients who suffered from at least mild to moderate depression and/or anxiety were educated on self-administered relaxation techniques, which consisted of 15 minutes of deep breathing exercises to be performed nightly. Their mood symptoms were reassessed, after monitoring patient compliance with breathing exercises, via a 4-point Likert scale at their follow-up appointment (average 13.5 days). The data were grouped based on the patient's compliance (good vs limited) with their respective score improvement and analyzed via paired t tests. Good compliance consisted of performing the breathing exercises "most of the time" and the limited compliance group performed exercises "some of the time, seldom, or rarely/none." The second part of the analysis investigated if there were any significant difference in improvements between the good and limited compliance groups using unpaired t test statistics.

Results: The good compliance group experienced a significant improvement in Patient Health Questionnaire (7.11, P < 0.01), GAD (6.33, P < 0.01), and PCSS (24.33, P < 0.01) scores at follow-up. The limited compliance group only had a significant improvement in GAD (2.14, P = 0.025) and PCSS (29.77, P < 0.01). There was a significant difference in anxiety improvement between good and limited compliance groups by 4.19 points as assessed by the GAD scale (P < 0.01).

Conclusions: Self-administered deep breathing exercises are a cost-free, practical, and safe intervention that may benefit patients with persistent mood symptoms in the concussion rehabilitation process, particularly in resource scarce areas in Appalachia.

Children and adolescents with autism spectrum disorder (ASD) have presentations and clinical needs in the inpatient psychiatric (IP) setting that are distinct from those of their neurotypical peers. This narrative review describes the clinical presentations and IP environmental management strategies for youth with ASD. Evidence suggests that traditional IP care teams often are poorly equipped to address the multifaceted specific needs of this population. The benefits for a multifaceted approach in youth IP units with an increased focus on family collaboration, youth communication, and various psychosocial modalities are described, as are specialized IP units for patients with ASD. We suggest that an established framework called the double empathy problem can be used to better understand the complexities of interpersonal interactions and psychosocial environments within IP units. Future research may integrate the double empathy problem into understandings of caring for youth with ASD in IP contexts to optimize pharmacological interventions and enhance therapeutic milieus.

Objectives: Homelessness is associated with poor health outcomes and increased healthcare utilization. The existing roles of social workers and case managers often are inadequate in addressing the complexity of patients' housing-specific needs. Our intervention aimed to pilot a novel housing support navigator (HSN) role within the existing electronic medical record workflow at one large safety-net hospital.

Methods: This innovation encompassed 877 adult patients with defined housing needs at Grady Health System (GHS), a large academic safety-net hospital in Atlanta, Georgia. All social workers and community health workers at GHS were surveyed to quantify the demand for housing resources, prioritize housing needs, and elucidate current barriers to housing placement. These results informed the creation of a new HSN role that could use the regional Homeless Management Information System to evaluate the housing needs of referred patients and connect them to community resources. All referrals to the HSN were tracked over the period 2021- 2022. A point-in-time count was subsequently conducted at GHS to capture patient needs and characterize the extent of sheltered and unsheltered patients experiencing homelessness. Program evaluation included descriptive data from each HSN referral documenting demographic data and discharge location.

Results: Nearly half of the patients referred to the HSN were connected with a housing resource such as a nonprofit organization, shelter, or rooming house. Key challenges in piloting the HSN program included management of timely referrals during brief inpatient stays and securing buy-in from stakeholders.

Conclusions: This early innovation report hopes to inform other institutions aiming to incorporate a housing navigator role into their care for unhoused patients. Future studies will assess for the impact of HSN utilization on long-term patient outcomes and healthcare utilization.

Objectives: Integrating the professional responsibilities of academic medicine with the demands of caregiving is a challenge that often weighs disproportionately on women. Supporting women caregivers in academia has been shown to benefit their professional development and prevent burnout. An initiative to support women faculty and trainees with caregiving responsibilities was created within the Department of Medicine (DOM) at Washington University School of Medicine in St. Louis called DOM Moms & Caregivers.

Methods: A needs assessment was completed by 111 women within the DOM, facilitating the formation of DOM Moms & Caregivers. Three events were held in the first year of the group, including informational and community-building events. Feedback on programming was collected in the form of surveys or interviews after each event and at the end of the academic year. Interviews were recorded, transcribed, and coded to identify themes.

Results: Thirty-six unique individuals engaged in the events, ranging from trainees to faculty, encompassing women caring for infants to aging parents, and with varied abilities and levels of family support. The unifying themes in feedback included the desire for more social engagement and space for community building through shared stories and experiences. Participants requested variations of programming format and time, such as creating space to connect in small groups within larger events.

Conclusions: DOM Moms & Caregivers will continue to evolve to support the diverse needs of the women within the department. Recent initiatives have included continuing to host informational events and creating a directory to connect trainee and faculty caregivers for advice and support.

Objective: In the United States, few elementary schools offer puberty education, leaving teaching girls about puberty-related body changes and hygiene practices to other sources. When school-based puberty education programs are taught, they often are inconsistently implemented and occur too late to help prepare girls before menarche. Rigorous evaluation of puberty education programs is lacking, but it is needed to improve these programs. To address this need, our team conducted a series of puberty education training workshops designed for and marketed to girls ages 8 to 13 years old and their caregivers. Our goal was to evaluate the implementation of this program for the purposes of quality improvement.

Methods: We used a mixed-methods approach using pre- and postevent surveys in four in-person puberty education training sessions to assess the program's effectiveness in improving knowledge, comfort, and preparedness for puberty among adolescent females. We also deductively analyzed open responses provided by program participants and extracted themes and subthemes.

Results: Our results indicated that increases in participants' understanding of puberty and female anatomy, as well as increases in participants' puberty preparedness, comfort with discussing puberty with caregivers, and comfort with puberty-related hygiene practices. We also identified several themes in the open responses, including positive workshop experience, learning/understanding, and communication, as well as training format feedback and discomfort and negative view of training content.

Conclusions: Overall, our mixed-methods results provide support for this implementation of a puberty education program. Future puberty education sessions will incorporate findings such as discomfort and disgust, particularly from the younger girls, as part of continuous quality improvement efforts for puberty education training sessions.

Objective: Innovation in medicine places the needs of our patients first by developing new solutions to healthcare challenges; however, formal education in innovation has not been previously established in Internal Medicine (IM) residency training programs. A novel innovation curriculum was implemented in the IM residency training program at an academic medical institution in the southeastern United States during the academic year 2022-2023.

Methods: The innovation curriculum was divided into three phases: Inspire, Acquire, Apply. The Inspire phase included presentations by innovators sharing their journey. The Acquire phase included presentations to help take an idea to implementation, including artificial intelligence (AI), three-dimensional (3D) printing, patents, and entrepreneurship. The Apply phase supported residents in implementing their own innovative project or idea, including preparation for local think tanks and engagement with institutional resources. Interactive presentations were scheduled during noon conference, which all residents were scheduled to regularly attend. A precurriculum survey was obtained before implementation to assess residents' baseline knowledge and experience in medical innovation, and a postcurriculum survey was obtained at the end of 1 academic year to assess resident perspective and knowledge after one cycle of the curriculum experience.

Results: At baseline, the majority of residents had never received formal education in innovation or entrepreneurship in medicine or patent filing. Few reported formal education on AI, 3D printing, virtual reality hardware/software, or medical application development. All respondents believed that innovation is important to clinical practice, and the majority believed that knowledge in innovation and entrepreneurship is important to being a well-rounded physician.

Conclusions: IM residents identified innovation as an important aspect of clinical training, yet they had limited exposure to and confidence in their knowledge and application of innovation and entrepreneurship in medicine. A curriculum dedicated to teaching innovation during IM training is important and can address this unmet need. Based on resident survey feedback, this curriculum has been adjusted to increase teaching in AI as well as expand the individual mentorship model for residents interested in taking their innovative idea to implementation.

Objectives: The southern United States is facing a burden of human immunodeficiency virus (HIV) diagnoses, with 52% of new diagnoses made in the region. The emergency department (ED) is an important access point for patient care, especially given nationwide shortages in primary care appointments. The objective of our study was to assess ED (ED) clinician knowledge regarding preexposure prophylaxis (PrEP), the perceived barriers to initiation of PrEP, and clinician willingness to initiate it in the ED.

Methods: An institutional review board-approved survey was distributed using an internal e-mail listserv to all ED physicians and advanced practice clinicians within a southern academic level I trauma center ED. The survey was available throughout August 2023. Descriptive statistics described survey responses.

Results: Fifty-six Emergency Medicine clinicians participated, for a response rate of 25.0%. Nearly one-fourth of clinicians reported not prescribing PrEP because they believed they lacked knowledge of or familiarity with the medication. Whereas 52 believed that PrEP could be integrated in the ED, 54 mentioned a potential barrier to implementation. The most common barrier to integrating PrEP into the ED was lack of information/training; additional barriers included time and staff constraints. More than half expressed a lack of confidence (58.9%) assessing PrEP eligibility. When asked how likely they would be to discuss linkage to PrEP, 52.8% answered confident or very confident and 52.8% were not confident or slightly not confident.

Conclusions: Despite recognition of the utility of prescribing PrEP in the ED, clinicians identified multiple barriers to providing this essential component of health care. Findings indicate, however, that Emergency Medicine clinicians would be willing to prescribe PrEP with appropriate education and connection to care.

Objective: The objective of the study was to investigate primary care physicians' (PCPs') level of awareness and indications for urology referral in patients treated with 5-α-reductase inhibitors (5-ARIs).

Methods: An anonymous 14-question survey was e-mailed to PCPs in the specialties of Family Medicine and Internal Medicine at an academic institution. Questions focused on residency graduation year, patient volume, medical practice characteristics, knowledge of 5-ARIs and their effects on prostate-specific antigen (PSA) kinetics, role of 5-ARIs in prostate cancer (PC) prevention, and indications for prostate biopsy referral.

Results: In total, 221 PCPs were e-mailed, 85 of whom responded (38.5% response rate). Approximately 39% of the PCPs surveyed were not aware of the suppressive effects of 5-ARIs on PSA, 63.5% were not sure or incorrectly answered when asked about calculating the corrected PSA of a patient who is taking 5-ARIs, 77.6% were not sure or would not refer for a prostate biopsy a patient who is taking 5-ARIs but has an elevated corrected PSA that needs to be calculated, 63.5% were not sure or believed that 5-ARIs may decrease the risk of high-grade PC, and 49.4% were not sure or believed that 5-ARIs are approved for the prevention of PC. There were no differences in responses between PCPs who were Family Medicine physicians and internists (P > 0.05 for all).

Conclusions: There is a general lack of awareness among PCPs about 5-ARIs and indications for biopsy referral in patients taking 5-ARIs. An educational opportunity exists to optimize usage of 5-ARIs and avoid delaying PC detection.

Objectives: End-of-rotation narrative evaluations by faculty of Internal Medicine residents provide feedback to residents directly and to the program leadership to assess resident competency; however, observing faculty often lack an understanding of what information is useful to the program leadership. Faculty also face barriers in completing evaluations and formulating high-quality evaluations. We sought to qualitatively evaluate the interplay of the needs of the program leadership and barriers faculty face in providing high-quality evaluations.

Methods: We conducted a descriptive qualitative study through semistructured interviews with six faculty with program leadership positions and six observing clinical faculty at a single large Internal Medicine residency program.

Results: Interview themes elucidated a multifaceted process that observing faculty must navigate in writing narrative evaluations and the important features of a useful narrative evaluation itself. Faculty must navigate assessment committee needs and their own competing priorities and be skilled in observing residents and navigating emotional barriers with residents. Successfully navigating these factors allows them to produce useful narrative evaluations that ultimately inform assessment committee decisions.

Conclusions: Understanding the complex dynamics of observing faculty factors and assessment committee needs can help guide future interventions to improve the quality and utility of written evaluations in assessing residents.