Medical Research as a Physician-in-Training

March 28, 2021 // Randy Glick

Saturday, April 17, 12:20-1:00 pm
Christopher D. Jackson, MD, FSSCI
Associate Program Director for Curriculum and Education
Assistant Clerkship Director for Internal Medicine
The University of Tennessee Health Science Center
Center for Health System Improvement
Memphis, TN

Dr. Christopher Jackson will provide guidance about finding research projects that are doable during training, examples of such projects, and the formula for starting and finishing projects.  

By the end of this session, attendees should be able to:

  • Identify various opportunities for research/scholarship from your daily work. 
  • Implement the five step formula that can help you turn any project into a scholarship. 
  • Address common pitfalls that come up with research projects during training. 
Posted in: Physicians-in-Training

Advocacy 101- A Primer for Practitioners

March 28, 2021 // Randy Glick

Christopher R. Morris, MD, FACR
Private Practice, Arthritis Associates
Southern Medical Association President, 2021
Kingsport, TN

 

 

Residents and medical students learn a mountain of scientific facts during medical school and residency; unfortunately most get little on factors that will affect them once they have completed their graduate medical education. This session will review the effects that activities in Washington and the state capitals have on the practice of medicine.  Another mysterious aspect of practicing medicine are insurance types and issues; a review of such foreign phrases such as MIPS, MACRA and the different types of medicare will help take the mystery of these components that are part of every-day medical practice and will be addressed.  Finally, the importance of being an “active advocate” for our patients, our practices and our profession will be presented. At the conclusion of this session the attendee will be better prepared to:

  • Define Advocacy and discuss its importance in medicine
  • Understand the various parts of government entities and how they affect medical practices and research
  • Describe the types of insurance, and how they affect patient care
  • Be aware of how to be an active Advocate for their patients, their practices and professions
  • Recognize the challenges medical professionals face every day
Posted in: Physicians-in-Training

SMA is excited to announce NAIFA Partnership

March 22, 2021 // Randy Glick

For over a century, the Southern Medical Association has supported medical professionals of every stripe, creating what we’re proud to call a true family of medicine. As medicine has evolved, so have we, even as our mission — providing our members with everything they need to improve the quality of patient care — has remained unchanged. 

SMA offers a vast range of products and services, including: 

  • Premiere Education: Taking full advantage of the collective expertise of our membership, we’ve provided thousands of hours of continuing medical education courses; and published more than 46,000 peer-reviewed articles in our premiere publication, the Southern Medical Journal 
  • Financial Support: Through the contributions of our members, we’ve been able to provide more than $3.5 million in research grants, loans, and scholarships
  • Practice Management Services: Through SMA Services, Inc., we offer a range of financial services, insurance products, and other tools to medical practices of every size and specialty.
  • Professional Networking Opportunities: As a family of medicine, we work hard to create an environment of mutual support and a free exchange of ideas. That includes online discussions, mentorship programs, in-person conferences, and more.

Every year, those benefits grow — as does our reach. What began as a regional organization in 1906 has become a truly national organization, with 66% of our members practicing outside the American South. To better serve the medical community nationwide, we strive to partner with other organizations whose goals align with our own, who can help support our mission just as we support theirs. 

We’re pleased to announce our newest educational partner: NAIFA, the National Association of Insurance and Financial Advisors. Together, SMA and NAIFA will provide financial professionals and consumers  across the country with broader access to SMA’s unique educational offerings. In addition, SMA will advance its position as a thought leader by providing content for NAIFA’s blog posts, social media platforms, Advisor Today magazine, and more.

More Details Can Be Found Here

Our partnership with NAIFA is just one more way we at SMA aim to improve the practice of medicine — another step in our continual evolution. We look forward to discovering all that we can do, together, for our family of medicine.

Opioid Use and Addiction during Covid-19

March 15, 2021 // Randy Glick

New figures have revealed a steep rise in the rate of deaths due to opioid overdose since the beginning of the Covid-19 pandemic. National statistics up to May 2020, published by the Centers for Disease Control and Prevention (CDC), suggest that synthetic opioids are the main driver of this increase.

In particular, there has been a sharp rise in the use of fentanyl, a powerful synthetic opioid which is increasingly produced illicitly, due to a shift in drug supply availability. Fentanyl is being detected in samples of heroin, creating effects such as euphoria, drowsiness, confusion, sedation, respiratory depress and arrest. This can lead to unconsciousness, coma and death.

Fentanyl is approximately 50 times more potent than heroin and 100 times more potent than morphine. As little as 2mg of Fentanyl is potentially fatal, so it greatly increases the risk of overdose.

The CDC statistics show that there were 81,003 drug overdose deaths in the United States in the year ending in May 2020. This represents the highest number ever recorded in a 12-month period.

Overdose deaths were already rising in advance of the Covid-19 pandemic, but the latest numbers suggest an acceleration during the pandemic, beginning with a spike in Spring 2020.

The rate of overdose deaths linked to synthetic opioids increased by 38.4% in the year ending May 2020 compared with the previous 12 months. Increases in synthetic opioid-involved overdose deaths were seen in 37 of the 38 US jurisdictions with available data during this time period, with increases greater than 50% seen in 18 of these jurisdictions.

In addition to synthetic opioid-related deaths, those linked to cocaine rose by 26.5%, and those involving psychostimulants rose by 34.8%.

Debra Houry, M.D., M.P.H., of the CDC commented, “Early in the pandemic, there was disruption to treatment services. We’re also hearing about disruptions to the drug market. The increase in overdose deaths is concerning. The disruption to daily life due to the Covid-19 pandemic has hit those with substance use disorder hard. 

"As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences. Our priority is to do everything we can to equip people on the ground to save lives in their communities.”

Opioid addiction is prevalent in Southeastern states, with the present overdose crisis compounded in this region, as in others, with factors such as job loss, homelessness and comorbidity. 

A spike in overdoses was seen in North Carolina during the spring and early summer of 2020. Overall, emergency room visits were down due to the virus, but the number of overdose-related visits were up to a rate 23% higher than in 2019. As in other areas of the US, fentanyl became an even bigger problem in North Carolina over the course of the pandemic. But following wider distribution of the opioid-reversal agent naloxone into local communities, the number of overdose emergency room visits is coming down.

Drug overdose deaths rose 15% in Tennessee last year, from 1,818 in 2018 to 2,089 in 2019. Health officials in the area say overdose deaths in 2020 are on track to exceed 2019 rates. Much of these are attributed to illicit fentanyl and psychostimulants, a category that includes methamphetamine. Nonfatal opioid overdoses also increased in 2020, peaking during the early months of the pandemic.

In Georgia, the number of reported overdoses is also rising amid the pandemic. Georgia’s Department of Public Health has noted a rise in drug overdose-involved emergency room visits throughout the state, overlapping with the emergence of Covid-19. The number of fentanyl-involved overdose deaths in the state has risen by 17% from December 2019 through April 2020, as compared with the previous five-month period.

The Covid-19 pandemic has exacerbated this crisis in a variety of ways. It has caused stress, isolation, and financial anxieties which are common triggers for drug addiction and relapse among those with substance use disorders. 

Social distancing has severely limited the resilience-building support structures normally in place for those at risk of relapse and coping methods like physical activity are limited.

In addition, the financial impact of the pandemic has forced the closure of many treatment services. Healthcare systems facing reduced funds have cut or drastically reduced addiction treatment programs, at a time when they are most needed.  

The pandemic has brought specific challenges for those struggling with substance use disorders. A hypersensitivity to stress may be combined with a diminished capacity to experience normal levels of reward, increasing the chance of relapse. Those who start using again after a period of time are susceptible to overdose because their tolerance has reduced.

Furthermore, people are more likely to die from overdose if they are using drugs alone, because no one is there to call 911 or give naloxone. 

Despite the challenges faced by organizations that provide treatment and support in the past year, adaptations are sometimes possible and many providers have found novel ways to overcome the obstacles. Appointments for people in recovery can be made possible within the limits of safe distancing in clinics and perhaps with rapid pre-testing. 

The ability to access care from a distance has led to marked benefits during the pandemic. The increased availability of telemedicine for substance use disorders gives options that otherwise wouldn't exist. Insurance providers and organizations are increasingly recognizing the need for this form of healthcare, lifting previous restrictions on telehealth approaches for behavioral health issues.

Federal, local and state rules have been relaxed due to the pandemic and it is currently possible for a physician to prescribe buprenorphine, a drug used for opioid recovery, to patients via telehealth - video or audio calls - without the requirement for an in-person evaluation. 

It is also easier to prescribe the medication across state lines, and the rules for take-home doses of methadone have been eased, with patients allowed larger gaps between in-person clinic visits and even to have methadone delivered to their home. 

These changes are currently only in effect until the public health emergency ends, however, some advocates and providers are calling for their extension or even to make many of the rule changes permanent.

One-to-one therapy and group support sessions are frequently moving online, with community-based groups like Narcotics Anonymous and Alcoholics Anonymous increasingly meeting virtually. 

Accessing this type of treatment and support can be difficult for people without reliable internet or phone service, but numbers of patients using these services are rising. The availability of telehealth may encourage some people to seek help who may not otherwise have attended in-person services.

Each person dealing with a substance use disorder has their own set of circumstances so expanding the spectrum of care could be beneficial. While online clinics and meetings work for some, they aren't best for everyone. 

Summing up the situation in a February 2021 article on drug testing in the journal Population Health Management, Harvey W. Kaufman, MD, of Quest Diagnostics, Secaucus, NJ, warns, "The convergence of the drug abuse epidemic and Covid-19 pandemic has led to an increased need for healthcare and public health resources dedicated to supporting vulnerable patients and addressing the underlying causes of these disturbing trends."

One long term consequence of the pandemic could be a permanent increase in the variety of options for care, opening up the possibility of reaching out to a larger number of people. This is more necessary than ever in light of the opioid crisis we are currently witnessing.

References and Resources

  1. https://www.drugwise.org.uk/fentanyl/
  2. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html
  3. https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdf
  4. https://www.statnews.com/2021/02/16/as-pandemic-ushered-in-isolation-financial-hardship-overdose-deaths-reached-new-heights/
  5. https://www.nbcnews.com/health/health-news/overdose-deaths-appear-rise-amid-coronavirus-pandemic-u-s-n1244024
  6. https://www.apa.org/monitor/2021/03/substance-use-pandemic
  7. https://www.nahb.org/advocacy/industry-issues/safety-and-health/opioids-in-the-home-building-industry/opioid-resources-southeastern-us
  8. https://www.northcarolinahealthnews.org/2021/02/05/covid-19-stressors-fuel-surge-in-overdoses-of-opioids-contaminated-street-drugs/
  9. https://www.liebertpub.com/doi/10.1089/POP.2020.0230
  10. https://www.memphisflyer.com/NewsBlog/archives/2020/12/03/covid-19-could-compound-holiday-suicides-drug-overdoses
  11. https://www.wabe.org/nonprofits-respond-to-a-reported-rise-in-overdoses-in-georgia-amid-the-pandemic/

About the Author

Jane Collingwood is a medical journalist with 17 years experience reporting on all areas of medical research for online and print publications. Jane has also worked on a range of medical studies funded by the UK National Health Service within the University of Bristol in the South West of England. Jane has an academic background in psychology and has authored books on stress management and respiratory infections. Currently she is combining journalism with a national coordinating role on the UK's largest surgical research trial.

Posted in: Patient Education

SMJ : March 2021 Vol. 114, No. 03

March 8, 2021 // Randy Glick

The Southern Medical Journal(SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Suicide Simulation in Primary Care

Candice Dye, MD, Sai Krishna Surapa Raju, MD, Abigail Dy, MD, Stacy L. Gaither, MSN, RN, Nancy M. Tofil, MD, MEd

How Does Black History Help Doctors? Addressing Cultural Competency through Cinemeducation at a Diverse Medical School

Sonjia Kenya, EdD, MS, BreAnne Young, MSPH, Janielle Taylor, MSPH, Olveen Carrasquillo, MD, MPH, Erin Marcus, MD, MPH, Joan St. Onge, MD

Loss of Meaning at Work Associated with Burnout Risk in Academic Medicine

Erick Messias, MD, Victoria Flynn, MD, Molly Gathright, MD, Carol Thrush, EdD, Timothy Atkinson, EdD, Puru Thapa, MD

Epidemiology, Clinical Features, and Outcomes of Hospitalized Adults with COVID-19: Early Experience from an Academic Medical Center in Mississippi

Jose Lucar, MD, Mary Joyce B. Wingler, PharmD, David A. Cretella, PharmD, Lori M. Ward, PhD, MS, Courtney E. Sims Gomillia, MS-PHS, Nicholas Chamberlain, MD, Luis A. Shimose, MD, James B. Brock, MD, Jessie Harvey, MD, Andrew Wilhelm, MD, Lance T. Majors, MD, Joshua B. Jeter, MD, Maria X. Bueno, MD, Svenja Albrecht, MD, MPH, Bhagyashri Navalkele, MD, Leandro A. Mena, MD, MPH, Jason Parham, MD, MPH

Pregnancy Risk Screening and Counseling for Women Veterans: Piloting the One Key Question in the Veterans Healthcare Administration

Lori M. Gawron, MD, MPH, Sara Simonsen, PhD, Morgan M. Millar, PhD, Jessica Lewis-Caporal, PhD, Shardool Patel, PharmD, Rebecca G. Simmons, PhD

Bedside Manner 2020: An Inventory of Best Practices

Sami Abuqayyas, MD, Christopher Yurosko, DO, Ambreen Ali, MD, Christopher Rymer, MD, James K. Stoller, MD, MS

Esophageal Cancer: An Updated Review

Michael DiSiena, MD, Alexander Perelman, DO, John Birk, MD, Houman Rezaizadeh, MD

OPEN: Sex Differences in Stroke Hospitalization Incidence, 30-Day Mortality, and Readmission in a Regional Medical Center in the Southwestern United States

Jeff A. Dennis, PhD, Yan Zhang, PhD, Fangyuan Zhang, PhD, Noah De La Cruz, MPH, Greg Hannabas, MD, MPH, MPA, Nan Mi, MA

Effects of Norepinephrine Infusion on Cutaneous Surface Temperatures of the Distal Extremities

Keitaro Nakamoto, MD, Paulina R. Skaff, MD, Brian H. McCully, MD, Todd W. Gress, MD, MPH, Farid B. Mozaffari, MD, David A. Denning, MD

Tale of the Frail: Understanding Frailty in Cirrhosis

Faruq Pradhan, MD, Natasha Narang, DO, Michael Fallon, MD

Point-of-Care Ultrasound for Posterior Shoulder Dislocation: A Better Standard than X-Ray?

Wen Cheng Huang, MD, Karen Chia Wen Chu, BMBS, Yuan-Pin Hsu, MD

Posted in: Bioethics & Medical EducationMedicine & Medical SpecialtiesPatient EducationPublic Health & Environmental MedicineQuality Health Care, Patient Safety, & Best Practices

SMJ : February 2021 Vol. 114, No. 02

February 4, 2021 // Randy Glick

The Southern Medical Journal(SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties

Peter T. Baltrus, PhD, Megan Douglas, JD, Chaohua Li, MPH, Lee S. Caplan, MD, MPH, PhD, Mitchell Blount, MPH, Dominic Mack, MD, Anne H. Gaglioti, MD, MS

Attended Automated Office Blood Pressure Measurement Versus Ambulatory Blood Pressure Monitoring in a Primary Healthcare Setting in Chile

Luis Michea, MD, PhD, Luis Toro, MD, PhD, Natali Alban, MD, Daisy Contreras, MSc, Patricia Morgado, MSc, Melanie Paccot, MD, Maria Cristina Escobar, MD, Eduardo Lorca, MD

Young Adult Males’ Perspectives of Male Hormonal Contraception

Megan R. Sax, MD, Emily G. Hurley, MD, Rocco A. Rossi, MD, MA, Suruchi Thakore,MD, Abhinav Hasija, PhD, Julie Sroga-Rios, MD

Improving Fecal Immunochemical Testing Rates for Colon Cancer Screening in the Outpatient Setting

We’am Hussain, MD, William Aurand, DO, Nneoma Onuorah, MBBS, Gabrielle Krstevski, DO, Ronald Markert, PhD, Kerianne Springer, MD, Sangeeta Agrawal, MD

High Prevalence of Diabetes Mellitus and Mental Illness Among Victims of Sudden Death

Murrium I. Sadaf, MD, Marie Caldwell, MD, Laura A. Young, MD, Mojtaba Mirzaei, MD, MPH, Sarah Chen, MD, Golsa Joodi, MD, MPH, Feng-Chang Lin, PhD, Yunhan Wu, BS, Ross J. Simpson, MD, PhD

Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure

Martha Carlough, MD, MPH, Ellen Chetwynd, PhD, MPH, Sarah Muthler, MS, Cristen Page, MD, MPH

Systematic Review and Meta-Analysis: Preoperative Vedolizumab and Postoperative Complications in Patients with IBD

Zain Moosvi, MD, Jacqueline T. Duong, BS, Matthew L. Bechtold, MD, Douglas L. Nguyen, MD

Using a Resident-Led School Outreach Program to Improve Knowledge of All-Terrain Vehicle Safety

Kristyn Jeffries, MD, A. Reid Burks, MD, Michele Nichols, MD, Julie Farmer, RN, Nipam Shah, MBBS, MPH, Charles A. Jennissen, MD, Gerene M. Denning, PhD, Kathy Monroe, MD, MSQI

CME Article: Supporting Trainees by Addressing Inappropriate Behaviors by Patients

Karla E. Williams, MD, Monica L. Baskin, PhD, Amanda L. Brito, MD, Sejong Bae, PhD, Lisa L. Willett, MD, MACM

Integrating Women’s Health Education into the Internal Medicine Residency Program Curriculum

Sneha Shrivastava, MD, Anshul Gandhi, PhD, Abby L. Spencer, MD, MS

Nutrition Education in Family Medicine Residency Training

Jeannie C. Sykes, PhD, MPH, Kehinde Eniola, MD, MPH, Jordan Shirley, DO, Kiersten Mullis, DO