Current SMJ : January 2018

Southern Medical Journal • Vol. 110 • No. 10 • October...

Multidisciplinary Perioperative Management of Pulmonary Arterial Hypertension in Patients Undergoing Noncardiac Surgery

Objectives: To describe the effect of implementing a contemporary perioperative pulmonary hypertension (PH)–targeted protocol in patients with pulmonary arterial hypertension (PAH) undergoing noncardiac surgery (NCS). Methods: The data of consecutive patients with PAH diagnosed by right heart catheterization who underwent NCS between January 1, 2006 and February 9, 2016 were reviewed. Patient demographics, etiology of PAH, clinical...

Helmets Matter: Kentucky Motorcycle Crash Victims Seen at a Tennessee Trauma Center

Objectives: Motorcycle helmet laws vary by state, with Kentucky requiring helmets only for younger riders. We hypothesized that motorcyclists injured in Kentucky and seen at a Tennessee trauma center would be more likely to be unhelmeted, have more severe head injuries, and sustain more fatal injuries than those injured in Tennessee or Virginia. Methods: A Trauma Registry review of 729 injured motorcyclists from January 2005 through June 2015...

Measuring Adherence to Hepatitis C Direct-Acting Antiviral Medications: Using the VAS in an HCV Treatment Clinic

Objectives: To implement the widespread treatment of hepatitis C virus (HCV), validated self-report measures to assess medication adherence are needed for monitoring patients who are prescribed HCV direct-acting antivirals (DAAs). The Visual Analog Scale (VAS) is an efficient and well-validated tool for measuring adherence to antiretrovirals in human immunodeficiency virus populations. This study compared VAS scores with pill counts and serum...

Associations of Prepregnancy Morbid Obesity and Prenatal Depression with Gestational Weight Gain

Objectives: Pregnancy outcomes and infant growth and development are influenced by various prenatal and postnatal factors. Gestational weight gain (GWG) is an important indicator of pregnancy management and outcomes. Information about the interaction between prenatal obesity and depression on GWG among low-income women is limited. There also is a lack of information about morbid obesity and GWG. The purpose of this study was to examine the...

Comprehension of Pelvic Organ Prolapse and Urinary Incontinence in Southern Appalachian Women

Objectives: Despite their growing prevalence, pelvic floor disorders (PFDs) remain undertreated and not well understood by patients, with treatment disparities noted in specific subgroups of women. The goal of the present study was to determine the basic understanding of PFDs of women in the southern Appalachian region of the United States, to determine factors that predict knowledge, and to explore the possible disparities in seeking access to...

Eradication Rate of Helicobacter pylori on the US–Mexico Border Using the Urea Breath Test

Objectives: Helicobacter pylori is prevalent worldwide, especially in Latin America. Triple and quadruple antibiotic therapies have been relatively effective; however, resistance has emerged in recent years. The treatment success rate of these regimens on the border of the United States and Mexico is unknown. Our study attempted to determine eradication rates of two major regimens based on urea breath test (UBT) results in patients previously...

Association Between Perceived Discrimination and Emergency Department Use Among Safety-Net Patients in the Southwestern United States

Objectives: Patients’ perceptions of how they are treated in their interactions with the healthcare system represent important and valid measures of healthcare quality that may influence health utilization, outcomes, and costs. Perceived discrimination or the sense of being treated unfairly is an important patient perception known to adversely affect health, but the relation of such perceptions to health-seeking behaviors related to low-acuity...

A Brief Drug Class Review: Considerations for Statin Use, Toxicity, and Drug Interactions

Abstract: For approximately 30 years, statins have been effectively used to control cholesterol, thereby reducing the morbidity and mortality associated with cardiovascular disease. Evidence-based recommendations regarding how these drugs are dosed and used have changed significantly through the years. There are seven statins approved for use in the United States, and although the mechanism of action pertaining to cholesterol reduction is the...

Femorofemoral Crossover Bypass Graft Has Excellent Patency When Performed with EVAR for AAA with UIOD

Objectives: To compare the durability of the crossover femorofemoral bypass graft (CFFBG) in combination with aorto-uni-iliac stent graft (AUIS) for abdominal aortic aneurysm with the durability of CFFBG used in the treatment of unilateral iliac occlusive disease (UIOD). Methods: We analyzed the clinical records of 69 patients who underwent CFFBG from 1992 until 2010. Group I consisted of 34 patients who received CFFBGs in combination with...

Getting it RITE: Impact of a Dedicated Hospital Medicine Curriculum for Residents

Objective: The goal of this study was to improve resident confidence in inpatient care and knowledge in hospital medicine topics with a newly developed rotation and curriculum called the Resident Inpatient Training Experience. Methods: This study was a prospective observational study completed by postgraduate year-2 (PGY-2) internal medicine residents in two affiliated hospitals. Forty-six PGY-2 residents each rotated on the Resident...

E-Cigarette Toxicity?

Abstract: Tobacco smoking is the most preventable cause of morbidity and mortality. In just a few short years, electronic cigarettes (e-cigarettes) have become increasingly popular, especially for younger individuals. Many people believe that e-cigarettes are safe. The inhaled aerosols of e-cigarettes contain numerous potential toxicities, some of which could be dangerous for health with long-term use. The safety of prolonged aerosol exposure is...

Dietary and Nutrition Recommendations in Pediatric Primary Care: A Call to Action

Abstract: Rapid increases in childhood obesity reflect widespread changes in diet and physical activity, which are of significant concern because obesity increases a child’s risk for negative health outcomes and frequently creates a pathway to adult obesity. Diet and nutrition play a key role in maintaining energy balance and preventing weight gain; therefore, they are obvious targets for obesity prevention efforts. Primary care providers are...

Current SMJ : December 2017

Southern Medical Journal • Vol. 110 • No. 10 • October...

EMS Patients and Walk-In Patients Presenting With Severe Sepsis: Differences in Management and Outcome: Erratum

In the December 2014 issue of Southern Medical Journal there was an error in the AMS (%) number under the “Died” column in Table 2....

Developing a Mass Casualty Surge Capacity Protocol for Emergency Medical Services to Use for Patient Distribution

Objectives: Metropolitan areas must be prepared to manage large numbers of casualties related to a major incident. Most US cities do not have adequate trauma center capacity to manage large-scale mass casualty incidents (MCIs). Creating surge capacity requires the distribution of casualties to hospitals that are not designated as trauma centers. Our objectives were to extrapolate MCI response research into operational objectives for MCI...

Reducing the Time Spent Writing Notes Could Help Solve the Physician Shortage

To the Editor: There is concern about physician shortages, with estimates of primary care physician shortages of 44,000,1 46,000,2 or 52,0003 by the year...

Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky

Objectives: The aim of this study was to investigate whether patients with lung cancer in Appalachian Kentucky are more likely to develop multiple primary cancers than patients in non-Appalachian Kentucky. Additional analyses were conducted to identify other factors that may be associated with an increased hazard of developing multiple primary cancers in patients with lung cancer. Methods: The data for this retrospective, population-based...

Commentary on “Internal Medicine Hospitalists’ Perceived Barriers and Recommendations for Optimizing Secondary Prevention of Osteoporotic Hip Fractures”

Osteoporotic hip fractures are a public health concern in the United States. The potential sequelae of a hip fracture are far reaching and can lead to a state of chronic pain, functional dependence, diminished quality of life, increased cost burden, and premature death. A patient’s chance of a second fracture doubles after the initial fracture. Reduction of these outcomes relies on prevention of the fracture, but in our healthcare system to...

Defining Medical Student Patient Care Responsibilities Before Intern Year: Results of a National Survey

Objectives: Program directors have noted that first-year residents struggle with many of the patient care responsibilities they assume as they enter the US graduate medical education system. A national description of medical students’ patient care experience in advance of graduation has not been published. We sought to describe the experience of US medical students during their clinical training by surveying the student representatives of each...