Current SMJ : May 2018

And Now, Please Sign on the Dotted Line: Teaching Residents About Professional Life After Residency

Objectives: Despite possible long-term repercussions, few training programs teach their residents about the business of medicine. In particular, certain contractual issues can adversely affect a young physician’s career mobility. Methods: We designed a business-of-medicine curriculum and used a survey to determine whether the curriculum satisfied attendees’ perceived knowledge gaps about the topics covered in the course, which included...

Evaluation of Renal Function Estimation Formulas Specific to Dynamic Renal Function for Drug Dosing in Critically Ill Patients

Objectives: The study compared estimated creatinine clearance (eCrCl) between the Cockcroft-Gault (CG) equation and the Jelliffe, Chiou, and Brater equations designed for estimation in dynamic renal function and resulting antimicrobial dosing concordance of five antimicrobials (cefepime, meropenem, piperacillin/tazobactam, vancomycin, and fluconazole) commonly used in the intensive care unit (ICU). Methods: Electronic medical records were...

Commentary on “At the Vatican, Physicians Debate Euthanasia and Assisted Suicide”

We are pleased to publish in this issue of the Southern Medical Journal an editorial by Dr Ramin W. Parsa-Parsi of Germany regarding a conference in Europe on the topics of euthanasia and assisted suicide.1 This conference was held at the Vatican under the auspices of the World Medical Association (WMA) and other institutions, and although focused on medical practices in Europe, the discussions have clear global...

Alabama Children’s Body Mass Index, Nutritional Attitudes, and Food Consumption: An Exploratory Analysis

Objectives: This study had three aims: assess the extent to which middle school children in southern Alabama were classified as overweight or obese; determine the magnitude of the relation between children’s attitudes toward healthy eating and their actual dietary choices; and examine the role of race, sex, and ZIP codes on children’s eating attitudes and behaviors. Methods: Registered dietitians took height and weight measurements of...

Assessing Mentorship Experiences of Faculty at a Military Academic Center: Challenge and Opportunity

Objectives: Mentor relationships are a key component of professional development within academic medicine. To date, there are no investigations into the prevalence and effects of mentor relationships within military academic medicine. This quality improvement initiative aimed to establish the prevalence and effects of mentorship, including whether sex differences exist among faculty at a military academic center, the San Antonio Uniformed...

Commentary on “And Now, Please Sign on the Dotted Line: Teaching Residents About Professional Life After Residency”

When is a resident’s training complete? When her test scores prove she has retained a set of medical knowledge? When she attains behavioral milestones in communication skills, interprofessional teamwork, and quality improvement? When she embraces diversity, listens for unspoken pain, and satisfies the standards set by Hippocrates and HIPPA (Health Insurance Portability and Accountability...

Innovative Technique for Endoscopic Placement of Sengstaken-Blakemore Tube

Objectives: The Sengstaken-Blakemore (SB) tube is used in cases of uncontrolled variceal bleeding. Because of the complexity of the procedure and the lack of visualization, various techniques have been described to avoid blind placement. We report an innovative and simple technique for placement of the SB tube under direct endoscopic visualization. Methods: A grasp-and-place technique for endoscopic placement of SB tubes is described and a...

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

Objectives: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is recognized increasingly as a distinct clinical entity and is associated with higher comorbidities compared with patients with asthma and COPD alone. Little is known about the leading causes of death related to ACO in the US general population, however. Our aim was to define the causes of mortality among patients with ACO compared with asthma and COPD in the US...

Teaching Medical Educators How to Teach Communication Skills: More than a Decade of Experience

Objectives: Although opportunities exist for medical educators to gain additional training in teaching, literature that describes how to teach educators to teach communication skills to trainees is limited. The authors developed and evaluated a faculty development course that uses didactics, demonstration, drills, and role-play in a small-group format. Methods: The course has been offered through the Institute for Clinical Research Education...

At the Vatican, Physicians Debate Euthanasia and Assisted Suicide

Should euthanasia and assisted suicide be the task of physicians? Is it unethical for physicians to perform these procedures at the request of their patients in countries where they are legally permitted? How can medical professionals reconcile patient autonomy with professional responsibility in end-of-life care? Continued advancements in medical technology and lifeprolonging treatments have added a new dimension to debates about...

Patients’ Perceptions of Bedside Rounding

Objectives: Concerns regarding lack of privacy, poor patient understanding, and physician discomfort have led to a decline in rounding at the bedside. Our project explored patient perceptions of the implementation and value of bedside rounding. Methods: This mixed-methods study used semi-structured qualitative interviews and a five-item Likert survey, which included questions about patients’ experiences with rounds, their comfort level with...

Commentary on “Teaching Medical Educators How to Teach Communication Skills: More than a Decade of Experience”

The article by Spagnoletti and colleagues in this issue of the Southern Medical Journal makes a strong argument for the benefits of faculty development in how to help medical trainees build and refine clinical communication...

Minimal Use of Opioids for Pain Relief in an Internal Medicine Department

Objectives: The objective of the study was to determine if pain control was adequate despite our policy of limited opioid use. Methods: In this observational cohort study, we reviewed 300 consecutive patient charts from an internal medicine department. We extracted demographic data, as well as the patients’ primary diagnosis, pain on admission, daily pain evaluations (numerical rating score ), and treatment. Significant pain was defined as...

Management of Emotionally Challenging Responses of Hospitalized Patients with Cancer

Cancer is the second leading cause of death in the United States, and the majority of hospital admissions of patients with cancer occur because of uncontrolled, urgent symptoms. In addition to complex physical presentations, these patients often manifest a number of complex emotional and psychological responses resulting in a unique set of healthcare needs and expectations. Inpatient generalists or hospitalists frequently serve as the primary...

Current SMJ : April 2018

Postponing Childbearing and Fertility Preservation in Young Professional Women

Objectives: To evaluate young women’s awareness of ovarian reserve testing and oocyte cryopreservation (OC) and assess how testing ovarian reserve may affect the desire for fertility preservation. Methods: Three questionnaire-based observational studies were conducted among female students/young professionals 20 years of age and older. The third survey was completed after participants were offered anti-Mullerian hormone (AMH) testing. The...

Clinical Context and Detection of the Murmur of Advanced Aortic Stenosis

Objectives: Auscultation is an important clue to the presence of aortic stenosis (AS). We sought to assess the effect of symptom status, prior knowledge of diagnosis, and other patient factors on murmur detection. Methods: Patients with moderate-to-severe AS by echocardiography at a single center between June 2015 and June 2016 were included. Five consecutive patient encounters (inpatient and outpatient) within 12 months before the...

Measuring Functional Status in Hospitalized Older Adults Through Electronic Health Record Documentation

Objectives: Hospitalization-associated disability affects up to 60% of older adults; however, standardized measures of function are not routinely used and documented. We sought to determine whether nursing documentation in electronic medical records can be used to determine mobility status and associated clinical outcomes. Methods: A retrospective study of 2383 medical patients aged 75 years and older was conducted at a large academic...

Provider Variation in Antibiotic Prescribing and Outcomes of Respiratory Tract Infections

Objectives: Inappropriate antibiotic use for respiratory tract infection (RTI) is an ongoing problem linked to the emergence of drug resistance and other adverse effects. Less is known about the prescribing practices of individual physicians or the impact of physician prescribing habits on patient outcomes. We studied the prescribing practices of providers for acute RTIs in an integrated health system, identified patient factors associated with...