Courses from the 2021 Annual Scientific Assembly are now available!

November 23, 2021 // Randy Glick

The 2021 Annual Scientific Assembly was held in Orlando, FL from October 28-30. In case you happened to miss it, all of the invited guest speakers' lectures are now available for CME credit in our Online CME Library!

The Paradoxical Role of Intestinal Stromal Cells in Healing and Disease

For the past 25 years, Dr. Powell’s research has focused on the biology of intestinal myofibroblasts, also called activated fibroblasts, intestinal mesenchymal cells, or intestinal stromal cells. This activity details information about this research.

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Diabetes: New Medicines, New Monitoring

The field of diabetes mellitus is rapidly expanding. In the past decade several new medications and new glucose monitoring and insulin delivery systems have been developed and approved for use in clinical practice. This activity is designed to review the most relevant and current aspects of the management of diabetes mellitus.

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Beyond the OR: Perioperative Evaluation and Management

This activity will highlight practice changing updates for the outpatient and inpatient general internists to manage patients prior to and after surgery. The information presented will address best practices for obtaining a perioperative history and physical, guidance on medication management, and conducting appropriate follow-up care.

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An Evidenced-based Approach to Chronic and Acute Pain Management: Getting Away from Opioids

This presentation seeks to delve into the current evidence surrounding the management of acute and chronic pains, as the lecturer takes an integrative approach, meaning, “if there is evidence supporting its use to help my patients, I want to know about it,” so as to impart this information which in turn may help them remain or become the most effective pain alleviators.

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Autism Spectrum Disorder—New Research, Diagnosis and Management

This activity is of benefit to healthcare providers (HCPs) who primarily treat patients with ASD, as well as providers who are not providing direct treatment to patients with ASD. An update is provided about the newest research on the etiology and neuroanatomy, the diagnostic work-up, and the importance of early intervention, as well as strategies on how to optimally communicate and provide medical treatment to patients with Autism to ensure compliance.

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Posted in: CME

Coping Skills Children Need To Know

November 23, 2021 // Randy Glick

We are about to embark on the season of giving. This year consider giving your children the gift of "life skills" to help them learn coping strategies to deal with the stressors of life in healthy and productive ways.

Although we hope our children will talk to us about the stress in their life and ask for our guidance, the reality is many young people attempt to manage stress on their own. In their attempts to reduce discomfort, children may turn to unhealthy coping strategies that make them feel better quickly. This may include risky behaviors like drinking or drug use, self-harm, or unhealthy relationships.

Equipping young people with a wide range of healthy coping skills reduces the need to turn to destructive behaviors and supports emotional health. Consider sharing the following strategies with your child to help them develop a stress management plan.

  1. Be Realistic
    Help your child understand stress is a normal part of life. In fact, a healthy amount of stress is what motivates us to get things done and achieve goals. However, too much stress is overwhelming and becomes counterproductive.
  2. Time Management
    Setting goals and priorities for the day is critical for stress management. Help your child identify the most important priorities (health, family, school, spirituality, close friends). Then ask them to think about the less important, but still necessary life tasks (extracurriculars, recreation, hobbies). Lastly, ask them to think about the time-wasters (video games, social media, TV, YouTube, TikTok, etc). Help them assess their daily routine and prioritize their time to the most important activities. The Jar of Life video is a good way to teach the abstract concept of time management in a concrete, visual way.
  3. Healthy Ways to Deal With Emotions
    Children naturally have fewer healthy coping strategies than adults because they have less life experience. Teaching children to use their breathing to calm themselves down is a tool all children need. One simple breathing technique is box breathing (Inhale for a count of 4; Hold for a count of 4; Exhale for a count of 4; Hold for a count of 4; Repeat the cycle). In addition to breathing, help your child think about other things they can do to cope with difficult emotions. Perhaps they like writing or expressing their feelings through music or art. Some children deal with emotions through physical activity such as taking a walk/run.
  4. Focus on Physical Health
    Getting enough sleep is one of the most important things children and teens can do to take care of themselves. The American Academy of Sleep Medicine recommends that children 6–12 years should regularly sleep 9–12 hours and teenagers, aged 13–18 years, should sleep 8-10 hours. Exercise and eating healthy are also important strategies to promote physical health.
  5. Set Healthy Boundaries (Time/Energy/Relationships)
    Not all stressful situations can be avoided but learning healthy boundaries can help. Help your child think of situations that provoke overwhelming stress and discuss ways to avoid or minimize those situations, if possible. When we think about boundaries we usually think of boundaries with people. But they also need to learn to set boundaries on their time and energy. Help your child think through time commitments for things like classes, extracurriculars, and recreation. Can they manage the workload and maintain their emotional and physical health?

About the Author:

Carissa Anthony is the Prevention and Development Coordinator for Homewood City Schools and serves as the Coordinator of the Safe & Healthy Homewood Coalition. She has over 20 years of experience in prevention. 

Carissa grew up on a family farm in south Alabama. She  received her Bachelors from Auburn University and Masters  from Georgia State University in Professional Counseling. She began her career as a community educator with the University of Tennessee and then with the University of Florida. In 2002 she and her husband moved to Birmingham and Carissa became the Prevention Coordinator for Hoover City Schools and coordinated the Hoover Coalition, a youth drug prevention coalition. In 2004, while serving as the Coordinator of the Hoover Coalition, Carissa received an award from the Office of National Drug Control Policy, for the Coalition’s successful efforts in reducing youth substance use. In 2007 she was a special guest at a Presidential Press Conference held by President George W. Bush recognizing outstanding drug free community coalitions. Working at the local level, helping communities come together to support healthy youth development is Carissa’s life work and passion. 

Carissa lives in Hoover, Alabama with her husband and two daughters.

Posted in: Medicine & Medical SpecialtiesMental HealthPatient EducationWomen’s & Children’s Health

2021 Alan R. Dimick Lecture from the 2021 Southern Region Burn Conference

November 11, 2021 // Randy Glick
The Alan R. Dimick Lecture was established to honor Dr. Dimick’s legacy as a pioneering surgeon, burn specialist, and leader in emergency care. His compassion and dedication to burn care led to the creation of the Southern Region Burn Conference.
The 2021 distinguished guest was Ernest Grant, PhD, RN,  FAAN, President of the American Nurses Association who spoke on The Year of the Nurse.

A distinguished leader, Dr. Grant has more than 30 years of nursing experience and is an internationally recognized burn-care and fire-safety expert. He previously served as the burn outreach coordinator for the North Carolina Jaycee Burn Center at University of North Carolina (UNC) Hospitals in Chapel Hill. In this role, Grant oversaw burn education for physicians, nurses, and other allied health care personnel and ran the center’s nationally acclaimed burn prevention program, which promotes safety and works to reduce burn-related injuries through public education and the legislative process. Grant also serves as adjunct faculty for the UNC-Chapel Hill School of Nursing, where he works with undergraduate and graduate nursing students in the classroom and clinical settings.

Learn More about Dr. Grant

2021 Annual Scientific Assembly Abstract Videos are now available!

November 9, 2021 // Randy Glick

Friday, October 29

Session 3 - Virtual Abstract Session

10:30-10:36 am Lung Cancer Presenting Solely as Ascending Paralysis and Bilateral Bells Palsy from Leptomeningeal Carcinomatosis, Sukhmanjot Kaur, MBBS

10:36-10:42 am Accuracy of Prostate Imaging Reporting and Data System Scores Among Varying Radiologists: A Retrospective Study, Robert Drury, BS

10:42-10:48 am Intranasal Deferoxamine Modulates Memory, Neuroinflammation, and the Neuronal Transcriptome in the Streptozotocin Rodent Model of Alzheimer Disease, Jacob Kosyakovsky, BS

10:48-10:54 am A Case of Extrapericardial Tamponade Caused by Bullous Emphysematous Chronic Obstructive Pulmonary Disease and Intra-thoracic Adhesions Following Recent Cardiothoracic Surgery, Masi Javeed, MD

10:54-11:00 am “Rash” Decisions- A Case Presentation and Management of a Rare Skin Lesion, Ishita Mehra, MBBS, MD

11:00-11:06 am Refractory Rhabdomyolysis: A Rare NAMe to Remember, Adam Bonner, BS

11:06-11:12 am The Collaborative of Pediatric American Indian Trainees (CoPAInT): Building a National Network for Trainees Interested in Native American Child Health, Joseph Burns, MD

11:12-11:18 am Epidermodysplasia Verruciformis – Tree Man Disease: A rare skin disorder, Sucheta Kundu, MD

11:18-11:24 am A Case of Scleroderma Renal Crisis (SRC) in a patient with New Onset Diffuse Systemic Sclerosis and Chronic Essential Hypertension, Ibimina Dagogo-Jack, MBChB, MPH

11:24-11:30 am A Surgical Approach to Persistent Orofacial Swelling: A Rare Case of Melkersson-Rosenthal Syndrome, Roxana Azimi, BS, MS

11:30-11:36 am Acute Aortic Occlusion Secondary to Embolism From Left Ventricle Thrombus Precipitated by Stress Cardiomyopathy, Sangeetha Isaac, MD

11:36-11:42 am An Adenoneuroendocrine Collision Tumor of the Pancreas: A Case Report, Christine Chung, DO

11:42-11:48 am A Very Rare Antibody Negative Goodpasture’s Disease Requiring Hemodialysis, Aksiniya Stevasarova, MD

11:48-11:54 am Ticagrelor Induced Dyspnea After Acute Coronary Syndrome, Mohammed Afraz Pasha, MBBS, MD

11:54 am-12:00 pm Unusual Pain in the Butt: A Gluteal Abscess from Coccidioidomycosis, Fletcher Eldemire

12:00-12:06 pm Focal Neurologic Findings After A Syncopal Episode: An Unusual Confluence, Linsay Ling

12:06-12:12 pm A Case of Pottery Induced Hypersensitivity Pneumonitis, Ariana Goldstein, MD, BA

12:12-12:18 pm Severe Rhabdomyolysis: In the Setting of Elderberry Supplementation and a 30-minute Moderate Workout, Sahil Parag, DO

12:18-12:24 pm A MAP3K7 Molecular Variant Presents a Diagnostic Dilemma Due to PhenotypicHeterogeneity, Arianna Lanpher, BA

12:24-12:30 pm Acute Psychosis Secondary to Tertiary Lyme, Cynthia Abraham, MS, BS

Session 5 - On-site Abstract Session

1:15-1:21 pm
Presumed Stroke Recrudescence Delays Diagnosis of Statin-Induced Myonecrosis, Christine Sykalo, DO

1:21-1:27 pm
A Culture Negative - Isolated Pulmonary Valve Endocarditis With 5 cm Vegetation, Niravkumar Patel, MD

1:27-1:33 pm
Macroglossia With A Peritonsillar Abscess: A Pediatric Airway Challenge in the Emergency Department From Beckwith-Wiedemann Syndrome, Sabrina Azavedo, MD, MHA, NREMT-P

1:33-1:39 pm
Detecting True Hypertensive Crises and Ensuring Appropriate Use of As Needed Anti-hypertensives in the Inpatient Setting, Jennifer Klein, MD, MPH

1:39-1:45 pm
Suicide Left Ventricle Post -TAVR, Celestine Odigwe, MD

1:45-1:51 pm
An Atypical Presentation of Meigs Syndrome with Elevated CA 125 Levels, Malvika Lall, BS

1:51-1:57 pm
Evaluating Perceptions of Fertility and Family Planning During Medical School in the United States, Katherine Cironi, BS and Rachel Dunn, MA

1:57-2:03 pm
Mixed Adenoneuroendocrine Cancer of Duodenum: A Rare Cause of Gastric Outlet Obstruction, Aimen Farooq, MBBS, MD

2:03-2:09 pm
Preliminary Analysis of Computed Tomography versus Physical Exam in the Diagnosis of Peri-Anal Abscesses, Tara Weaver, BS

2:09-2:15 pm
Not ACS: Typical Chest pain in Uremic Pericarditis, Junaid Alam, DO

2:15-2:21 pm
Idiopathic Pericardial Effusions in Children: Workup and Final Diagnosis, Emily Ribeiro, MD

2:21-2:27 pm
Improving Transition of Care from Pediatric to Adult Endocrinology for Adolescents with Diabetes, Felicia Cooper, MD

2:27-2:33 pm
Radical Treatment for Blastomycosis Following Failed Liposomal Amphotericin, Christopher Chew, BS, MPH, MD

2:33-2:39 pm
An Eye-Opening Presentation of Syphilis, Natalie Torrente, DO, MS

2:39-2:45 pm
Diagnostic Utility of Abdominal Radiographies in the Pediatric Emergency Department, Kacper Kubiszewski, BA

2:45-2:51 pm
Pregnancy Triggered Onset Diffuse Cutaneous Scleroderma, Olesya Balashova, BS, Ashley Diaz, and Priya Mohan

2:51-2:57 pm
Disseminated Histoplasmosis Associated Hemophagocytic Lymphohistiocytosis (HLH) in an Immunosuppressed Patient, Azad Patel, MD

2:57-3:03 pm
A Triple HIT Dilemma: Balancing Pulmonary Emboli, Hemorrhagic Shock, and HIT Syndrome, Magnus Chun, BS

3:03-3:09 pm
Acute ST Elevation Myocardial Infarction with Left Bundle Branch Block: Beyond Sgarbossa and Smith Modified Sgarbossa Criteria, Ibrahim Mohsin, MD

Session 6 - Virtual Abstract Session

3:24-3:30 pm
Covid 19 Related Pericarditis, Farhan Ali, MD

 3:30-3:36 pm
A Case of Central Alveolar Hypoventilation Secondary to Traumatic Brain Injury that Improved After Treatment with Ondansetron, Stephanie Wong, BS

3:36-3:42 pm
Dialing in the Immune System: Too low, Too High, or Just Right?, Shirisha Vallepu, MD

3:42-3:48 pm
Meconium Pseudocyst in a Preterm Infant: A Rare Surgical Condition, Priyanka Yadav, MD

3:48-3:54 pm
An Online Investigation of Lay Resources Available to Female Medical Students Interested in Orthopaedic Surgery, Gabrielle Owusu-Ansah, MS

3:54-4:00 pm
The Curse of Life-Threatening Spontaneity, Rudiona Hoxhaj, DO, MS

4:00-4:06 pm
The Genetics of Early Onset Familial Alzheimer's Disease -  A Literature Review, Mariyam Sadikot, MBBS

4:06-4:12 pm
Bilateral Lower Extremity Deep Venous Thrombosis Secondary to Congenital Inferior Vena Cava Hypoplasia, Leela Kantamnenil, MD

4:12-4:18 pm
An Atypical to Silent Intracranial Granuloma, Hira Imran, MD

4:18-4:24 pm
Takotsubo Cardiomyopathy: A COVID-19 Complication, Pejmahn Eftekharzadeh, DO

4:24-4:30 pm
Role of B12 and its Metabolites in Depression and Suicidality: A Review, Sara Khan, BS

4:30-4:36 pm
Amlodipine induced Gingival Hyperplasia: A Case Report and a Review of its Pathogenesis, Awana Chowdhury

4:36-4:42 pm
Epiploic Appendagitis: A Rare Cause of Left Lower Abdominal Pain, Aashvi Dalal, MBBS

4:42-4:48 pm
Pediatric Acetabulum Fracture in a 14 Year Old Male Following a Football Related Injury: A Case Report, Sarthak Parikh

4:48-4:54 pm
Fetal Cardiac Defects Associated with SSRI Usage in Pregnant Women, Zubiya Syed, BS, BA, Mariam Dar, BS and Sumaiya Haider, BS

4:54-5:00 pm
An Atypical Presentation of HSV-2 Meningoencephalitis Complicated by Concurrent STIs in an Adolescent Female, Chandanee Samaroo

5:00-5:06 pm
A Rare Case of Reversible Cerebral Vasoconstriction Syndrome in a Patient with Systemic Sclerosis, Jieying Liu, MD

5:06-5:12 pm
A Rare Cause of Secondary Hypertension in a Young Female, Bailiey Humphreys

5:12-5:18 pm
Cerebral Venous Thrombosis in a Patient with Adenovirus, Yasmin Rosshandler, DO, MHS

5:18-5:24 pm
Severe Hypokalemia Presenting As Guillian-Barre Syndrome In A Middle-Aged Caucasian Male, Utibe Ndebbio, MBBCh

Saturday, October 30

Session 7 - Virtual Abstract Session

8:00-8:06 am
Covid Antigen Crossreactivity and False Positives in Septic Shock, Kamini Rao, MBBS

8:06-8:12 am
A Rare Case of Cutibacterium Prosthetic Valve Endocarditis, Nikhilesh Srinivasan, MD

8:12-8:18 am
Choosing Mastectomy vs. Lumpectomy-with-Radiation: Experiences of Breast Cancer Survivors, Claudia Admoun, BS

8:18-8:24 am
It’s Time to B. Cereus: Bacillus-derived Fatal Hemorrhagic Bullous Soft Tissue Necrosis, Jeremy Hess, DO

8:24-8:30 am
Anti-psychotic Use in TBI Management: A Descriptive Analysis, Brennan Gagen, BS

8:30-8:36 am
Rare Case of Mixed Adenoneuroendocrine Carcinoma in a 73 Year Old Male with Dysphagia, Omer Yousaf, MD

8:36-8:42 am
Association of the RIETE Score with Occult Cancer in Patients with Venous Thromboembolism, Melissa Infosino, BA

8:42-8:48 am
Thrombotic Events in COVID-19 vs Sepsis Patients, Carlos Sanchez Parra, MD, and
Shaun Charkowick, MS2

8:48-8:54 am
Disseminated Cat Scratch Disease in an Immunocompetent child – A rare case presentation, Katie Langley, MS, MD

8:54-9:00 am
Muscle Infarction - A Case of Diabetic Myonecrosis, Jeffrey Jacob, MD, MPH

9:06-9:12 am
Staff Perceptions: Restraint Bed vs Chair,  A QI Project for the Management of Behavioral Emergencies in the Psychiatric Inpatient Setting, Briana Tillman, DO, MEd, BS

9:12-9:18 am
Improving Behavioral Health Diagnosis, Treatment, and Follow-up in a General Pediatric Clinic, Perrin Windham, BS, MD

9:18-9:24 am
Evaluation of Comorbidities and Biomarkers to Predict Hospital Length-of-Stay and Mortality in VTE Patients, Kesany Boupapanh, BS

9:24-9:30 am
Rare Presentation of Acute Hepatitis A, Acute Hepatitis B with Chronic Hepatitis C Causing Acute Liver Failure, Demilade Soji-Ayoade, MD

Posted in: Abstract

Sleep Quality – Its Impact and How It Can be Improved

November 8, 2021 // Randy Glick

Getting enough regular sleep is essential for a healthy immune system, and to enable relaxation. It is during sleep that the body repairs itself and revitalises organs and muscles. However, virtually all of us have trouble sleeping sometimes.

Those of us who have difficulty falling asleep, insomnia, or wake early, are not alone. A regular lack of sleep causes concentration, mood and energy levels to suffer. This reduces effectiveness, so it can actually increase stress levels. One glimmer of hope comes from a recent research study that suggests the health impact of poor sleep may be partly mitigated by adequate physical activity.

Previous work had suggested that low physical activity could exaggerate the concerning link between inadequate sleep and raised mortality. As such, Dr. Emmanuel Stamatakis of the University of Sydney, Australia, and colleagues examined the synergistic effect of physical activity and sleep quality. They used information on 380,055 men and women from the UK Biobank, followed for about 11 years. Physical activity was categorised as high, medium, low or no moderate-to-vigorous activity. Sleep was categorized into healthy, intermediate, and poor using a composite of sleep duration, insomnia, snoring, and daytime sleepiness.

Most (56%) of the participants had healthy sleep, 42% intermediate quality, and 3% poor. Poor sleep was linked to being older, having a higher body mass index, having mental health issues, smoking and shift work, among other factors. Analysis showed that sleep score was linked to all-cause mortality, as well as cardiovascular and ischaemic stroke mortality. In the British Journal of Sports Medicine, the authors explain that compared with participants with high physical activity plus healthy sleep, those with the lowest activity plus poorer sleep scores were at a 57% raised risk of all-cause mortality.

Their risks of cardiovascular disease, any cancer, and lung cancer specifically were also raised, but stroke risk was not. "The detrimental associations of poor sleep with all-cause and cause-specific mortality risks are exacerbated by low physical activity, suggesting likely synergistic effects," they report. "Our study supports the need to target both behaviours in research and clinical practice."

Many people are tempted to catch up on sleep lost during the week by staying in bed later on weekend mornings. But is this a sensible strategy? Research has also been done on the risks and benefits of weekend sleep patterns. The pattern of staying up late and sleeping in on the weekend was examined by a team from the Medical Research Council in Oxford, UK. They looked at the impact of "social jetlag", a term used to describe the sometimes uncomfortable difference in sleep patterns between work days and free days.

An estimated 87% of the population suffers from social jetlag to some extent, or greater tiredness on, for example, Monday mornings. The team used figures from 815 non-shift working participants in the long-term Dunedin Multidisciplinary Health and Development Study.

Participants were all born in New Zealand between 1972 and 1973, and were followed from age 3 to 38, when 95% of the 1007 study members were still alive. Their height, weight, and waist circumference were measured, along with C-reactive protein, a biomarker for inflammation, and glycated haemoglobin in the blood, a marker for diabetes.

Measurements were combined with results of a questionnaire on sleep duration and the individual's preference in sleep timing, known as "chronotype". Social jetlag was the comparison between each person's midpoint of sleep on work days and on free days. Findings showed that those with a greater difference in sleep patterns on free days and work days had a significantly higher risk of obesity and obesity-related disease, including metabolic disorder (the medical term for a combination of diabetes, high blood pressure, and obesity) and inflammation. Just a two-hour difference in sleep patterns at the weekend was linked to risk of an elevated body mass index and risk of inflammation and diabetes.

Lead author, Dr Michael Parsons, explains that while travel jetlag can cause temporary problems with metabolism, social jetlag "can occur chronically throughout an individual's working life so is more likely to induce more serious, chronic consequences for metabolism." He adds, "Social jetlag is an under researched but potentially key contributor to why living against our internal clock has an impact on our health. Our research confirms findings from a previous study that connected people with more severe social jetlag to increases in self-reported body mass index, but this is the first study to suggest this difference in sleeping times can also increase the risk for obesity-related disease."

Full details appear in the International Journal of Obesity. The team are unsure why social jetlag may cause the raised risk, but suggest it may be that it disrupts healthy habits such as diet and exercise in a way that may compromise health. "Further research aimed at understanding that the physiology and social features of social jetlag may inform obesity prevention and have ramifications for policies and practices that contribute to increased social jetlag, such as work schedules and daylight savings time," they add.

For those with concerns over the quality or quality of their sleep, here are several tips to improve the situation and get a good night's rest:

  • Stick to a regular bedtime, and try not to sleep in late on non-working days and push 'against' the body clock. Spending some time outside every day also helps regulate the body clock, as well as benefiting the lungs.
  • Regular exercise makes falling asleep, and staying asleep easier, in addition to the benefits described above. But be careful not to exercise too close to bedtime or you may have trouble nodding off.
  • Don't have drinks with caffeine or use other stimulants after about 6pm. Caffeine is found in coffee, tea, cocoa, cola and chocolate.
  • If you smoke, try to cut down - smokers tend to take longer to fall asleep and wake more often.
  • Eat a light dinner no later than two hours before going to bed. Any later, and your stomach will be too busy digesting to allow you to sleep well. Good bedtime drinks are warm milk and chamomile tea.
  • Do not drink alcohol near bedtime. It may help you fall asleep initially, but will dehydrate you, interrupting your sleep later on in the night and causing you to wake early.
  • Do something to relax before going to bed. Have a warm bath, listen to some quiet music, or do a relaxation exercise. Be peaceful for the hour before you go to bed and your body will unwind.
  • Don't work, study, or watch scary films just before bed.
  • Deal with worries and distractions several hours before going to bed. Write them down, or make a list of things to do, so you won’t think about them all night. Don't use the bedroom for chores like paying bills, or discussing the day's problems.
  • Keep the bedroom quiet, dark, and warm. Sleep on a good quality mattress, and wear soft and cozy nightwear.
  • Leave the bedroom if you are unable to sleep. After about 15 to 20 minutes, get up and engage in a quiet activity, such as reading. Return to bed when you are sleepy. You may need to repeat this process through the night. Do not watch the clock during the night and try not to panic about not sleeping.
  • Herbal remedies that may aid sleep include Valerian, Passiflora and Kava Kava. A few drops of lavender oil in the bath can work well.
  • On a hot night, open windows and doors to create a draft. Remove the duvet and blankets, and wear light cotton nightwear. Have a cool shower or bath before going to bed, and keep a glass of cold water nearby.
  • On a cold night, keep the bedroom warm but not too hot, and block any drafts. Use a fleecy under-blanket or use several layers of bedding. Have a warm bath and a warm drink just before bed. Finally, hot water bottles and electric blankets can make all the difference.

A word on insomnia. True insomnia, which affects about 1 in 10 people, is difficulty getting to sleep, staying asleep, or having non-refreshing sleep, three or more times a week for at least a month. Difficulty getting to sleep (sleep onset insomnia) is most common in young people, whereas waking in the night (frequent nocturnal awakening) is most common in older people. Early morning waking is also a frequent problem.

With insomnia, sleep is no longer refreshing and the daytimes are overshadowed by irritability, tiredness, or lack of concentration. Insomnia can last for days, months or even years. If the tips above do not seem to be helping, individuals may consider:

Sleeping pills. Benzodiazepines and newer medications such as Zopiclone or Zolpidem may be recommended. Both types of drugs work in a similar way. Ensure they do not interact with any other medications. Use the lowest dose and never mix with alcohol.

A sleep diary. Keeping a sleep diary to record bedtimes, wake times, hours slept, and sleep quality each morning may help when seeking medical advice. If continued during treatment, a sleep diary can be a useful indicator of progress.

Psychological treatments. Approaches such as cognitive behavioral therapy will focus on behavioral change. They may include methods such as sleep restriction, stimulus control, cognitive therapy and relaxation techniques.

References and Resources

  1. Huang, B-H. et al. Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk. British Journal of Sports Medicine, 30 June 2021 doi: 10.1136/bjsports-2021-104046
    https://bjsm.bmj.com/content/early/2021/05/25/bjsports-2021-104046
  2. Parsons, M. et al. Social Jetlag, Obesity and Metabolic Disorder: Investigation in a Cohort Study. The International Journal of Obesity, 20 January 2015 doi: 10.1038/ijo.2014.201. https://www.nature.com/articles/ijo2014201

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: November 2021 Vol. 114, No. 11

November 3, 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.

Walking Speed and Mortality: An Updated Systematic Review

Irene Rosmaninho, MD, Pedro Ribeirinho-Soares, MD, José Pedro L. Nunes, MD

OPEN: Sentinel Lymph Node Sampling in Robot-Assisted Staging of Endometrial Cancer

Erin Curcio, DO, Briana Miller, PA-C, Alexandra Giglio, DO, Arda Akoluk, MD, Brian Erler, MD, James Bosscher, MD, Mark Borowsky, MD, Verda Hicks, MD, Karim ElSahwi, MD

OPEN: Initial Institutional Experience with 18F-Fluciclovine PET-CT in Biochemical Recurrence of Prostate Cancer

Amy B. Farkas, MD, Edward D. Green, MD, Anson L. Thaggard, MD, Vani Vijayakumar, MD, John C. Henegan, MD, Seth T. Lirette, PhD, Mary R. Nittala, DrPH, Srinivasan Vijayakumar, MD

COVID-19-Related Stress on Physicians

Robert Frierson, MD, Steven Lippmann, MD

CME Article: Investigating Barriers to Completion of Postpartum Tubal Ligation: A Retrospective Chart Review

June Ng, MD, Diana Ho, MD, Jharna M. Patel, MD, Cybill Esguerra, MD, Meike Schuster, DO, Jennifer Amico, MD, MPH

Uncomplicated Distal Radius Fractures: An Opportunity to Reduce Emergency Medicine Opioid Prescribing?

Jonathan Altman, MD, Christopher R. Wyatt, MD, Lawrence H. Brown, PhD

Fibrin-Associated Diffuse Large B Cell Lymphoma Found on Revision Arthroplasty of the Knee

Jordan Hall, MD, Craig Kampfer, MD, Ned Williams, DO, Michael Osswald, MD, Bradie Bishop, MD, Misty Hall, MD, Joseph Alderete, MD

Chaplaincy and Hospital Ethics Committees

Jim Q. Ho, BA, John R. Fishman, MAHL, Ware G. Kuschner, MD

CME Article: Effect of Dysphagia on Hospital Outcomes and Readmissions in Patients with Human Immunodeficiency Virus

Rosemary Nustas, MD, Raj Dalsania, MD, Jason Brown, MD, Srikrishna V. Patnana, MD, Emad Qayed, MD, MPH

Effects of Gestational Weight Gain on Delivery Outcomes in an Obese, Low-Income Population

Allison Archer Sellner, MD, Abigail Hook Garbarino, MD, Di Miao, PhD, Lisa Marie Hollier, MD, MPH, Bani Maheshwari Ratan, MD

The Inauguration of Dr. Donna Breen as the 115th SMA President

November 1, 2021 // Randy Glick

During the 2021 Annual Scientific Assembly held in Orlando, Florida, Dr. Donna Breen was inaugurated as the 115th President of the Southern Medical Association!

Congratulations Dr. Breen!

Learn More about Dr. Breen (in her own words):

I am an Otolaryngologist practicing general ENT and allergy for the past 30 years in Marksville, Louisiana after finishing my residency at Tulane Medical Center in 1988. I graduated from University of Alabama Medical School cum laude in 1983. Also, I completed a fellowship in Otolaryngic Allergy in 1992. I am proud to serve the needs of a semirural small town community and take care of adults and children with ear, nose, and throat problems who would have to travel many miles for their care.

Practicing in a small community was very new to me when I first came here. I grew up in New Orleans, Louisiana and was educated in the public and parochial schools there. Living in a smaller community remained a challenge for me in adjustment, but I have come to realize that this environment is perfect for me. I get to know my patients and their families, and their extended families, and relatives, which engages me in their lives, both as a medical doctor, friend and mentor. It is truly the best of both worlds and I have come to treasure my practice as a small town doctor in this community.

I joined the SMA in 1984, while I was a resident and I have been a member ever since. I enjoyed the collegiality as well as the learning experience. It is a big organization with a small town atmosphere in that we are emboldened to learn from the experts in a spirit of congeniality and relaxed learning experience. It is an organization where everyone has equal time, every question has equal value, and everyone has the right to understand the concepts that are being presented. No question or thirst for knowledge is too little and everyone is included in the quest for medical knowledge and skills in the healing arts.

The Soldier to the Right

November 1, 2021 // Randy Glick

Written by: Zachary Olivos, BA, MS & Natalie Weiss, BA, BS

As I sat in a diner in Houston, I struggled to concentrate on the news broadcast covering Hurricane Ida’s course through Southeast Louisiana. I had only one thought on my mind, and that was when I could finally get back home to New Orleans and do something. My classmates shared my urgency. In the weeks since, I have largely returned to my normal life, focused on the work in front of me. And that is one of my biggest shortcomings. Once natural disasters have passed, we often forget to do the constant and boring work of sustained assistance. The time of greatest risk often comes long after the camera crews pack up and the donations stop flowing. The haunting echoes of our past experiences with Hurricane Katrina color our perception of the present with Hurricane Ida. Cycles repeat, until we learn our lessons from them. So, let me tell you what my time in the South has taught me.

The phalanx relied upon each soldier’s faith in the comrade to their right, who would use the shield on their left arm to protect not just their own body but that of their comrade. Enormous force could dissipate across this shield wall, and this simple formation enabled Alexander the Great to conquer the known world. I thought about the phalanx when I spent the week after Ida’s landfall with Cajun Navy Relief, tarping the roofs of first responders who were too busy serving the community to care for their own homes. I thought about it when I saw a state politician drive food that he and his wife had made to his hungry constituents, weeks removed from the power to cook for themselves, only to meet a downed tree blocking the only road into the neighborhood. I thought about it when I saw first responders using chainsaws to clear that road. I thought about the phalanx when, realizing our camp was flooding, a newly displaced volunteer swam through bacteria-infested water to clear debris from the drains, and save our supplies. 

There are times when action is needed. When hands are needed. When the act of protecting just one more person empowers them to do the same. And there are times when sustained aid is needed. In healthcare, we often are drawn to the superhero ideal. We idealize self-sacrifice and heroic effort, but I think the world more often needs a simpler, more communal form of heroism. 

Protect the neighbor to your left. And one day, when you need us, we will be there to answer. Occasionally, there come crises that render miracles feasible. Those miracles are manifestations of the communal spirit, and I can think of no more noble cause than that. We are all in healthcare because, on some level, we share that communal drive. More disasters are always coming, but no matter what, we will always have allies in each other, and that is a comforting thought indeed.

If you would like to contribute to the recovery of New Orleans and the rest of Southeastern Louisiana following Hurricane Ida, please consider donating by following the link below:

Donate Here Today

2021 Annual Scientific Assembly Abstract Competition Winners

November 1, 2021 // Randy Glick

SMA’s 2021 Physicians-in-Training Abstract Competition hosted during the 112th Annual Scientific Assembly October 28-30, 2021.

Thank you to all who participated and congratulations to the winners!

Session 3 Winners

1st Place
A Surgical Approach to Persistent Orofacial Swelling: A Rare Case of Melkersson-Rosenthal Syndrome, Roxana Azimi, BS, MS

2nd Place
Ticagrelor Induced Dyspnea After Acute Coronary Syndrome, Mohammed Afraz Pasha, MBBS, MD 

3rd Place
Intranasal Deferoxamine Modulates Memory, Neuroinflammation, and the Neuronal Transcriptome in the Streptozotocin Rodent Model of Alzheimer Disease, Jacob Kosyakovsky, BS

Session 5 Winners

1st Place
Presumed Stroke Recrudescence Delays Diagnosis of Statin-Induced Myonecrosis, Christine Sykalo, DO

2nd place
Idiopathic Pericardial Effusions in Children: Workup and Final Diagnosis, Emily Ribeiro, MD 

3rd place
Mixed Adenoneuroendocrine Cancer of Duodenum: A Rare Cause of Gastric Outlet Obstruction, Aimen Farooq, MBBS, MD

Session 6 Winners

1st Place
Cerebral Venous Thrombosis in a Patient with Adenovirus, Yasmin Rosshandler, DO, MHS

2nd Place
Epiploic Appendagitis: A Rare Cause of Left Lower Abdominal Pain, Aashvi Dalal, MBBS 

3rd Place
Severe Hypokalemia Presenting As Guillian-Barre Syndrome In A Middle-Aged Caucasian Male, Utibe Ndebbio, MBBCh

Session 7 Winners

1st Place
Staff Perceptions: Restraint Bed vs Chair,  A QI Project for the Management of Behavioral Emergencies in the Psychiatric Inpatient Setting, Briana Tillman, DO, MEd, BS 

2nd Place
Choosing Mastectomy vs. Lumpectomy-with-Radiation: Experiences of Breast Cancer Survivors, Claudia Admoun, BS

3rd Place
It’s Time to B. Cereus: Bacillus-derived Fatal Hemorrhagic Bullous Soft Tissue Necrosis, Jeremy Hess, DO

Artificial Intelligence in Medical Diagnosis

October 7, 2021 // Randy Glick

The use of Artificial Intelligence, or AI, is growing rapidly in the medical field, especially in diagnostics and management of treatment. To date there has been a wide range of research into how AI can aid clinical decisions and enhance physicians' judgement.

Accurate diagnosis is a fundamental aspect of global healthcare systems. In the US, approximately 5% of outpatients receive an incorrect diagnosis, with errors being particularly common for serious medical conditions, and carrying the risk of serious patient harm.

In recent years, AI and machine learning have emerged as powerful tools for assisting diagnosis. This technology could revolutionise healthcare by providing more precise diagnoses.

Last year, scientists at Babylon, a global tech company focusing on digital health, found a new way to use machine learning to diagnose disease. They developed new AI symptom checkers which they believe could help reduce diagnostic mistakes in primary care.

The new approach overcomes the limitations of earlier versions by using causal reasoning in its machine learning. Previously, diagnoses were based solely on correlations between symptoms and the most likely cause.

Writing in Nature Communications, Dr Jonathan Richens and colleagues outlined their new approach, which includes the ability to “imagine” the possibility of a patient’s symptoms being due to a range of different conditions.

Dr Richens explained, "We took artificial intelligence with a powerful algorithm, and gave it the ability to imagine alternate realities and consider 'would this symptom be present if it was a different disease'? This allows the artificial intelligence to tease apart the potential causes of a patient's illness and score more highly than over 70% of the doctors on these written test cases."

This method could provide diagnoses in regions where access to doctors is limited, according to Dr Ali Parsa, CEO of Babylon. He commented, "Half the world has almost no access to healthcare. So it's exciting to see these promising results in test cases. This should not be sensationalised as machines replacing doctors, because what is truly encouraging here is for us to finally get tools that allow us to increase the reach and productivity of our existing healthcare systems.

“Artificial intelligence will be an important tool to help us all end the injustice in the uneven distribution of healthcare, and to make it more accessible and affordable for every person on Earth."

Another group of scientists, from the University of Bonn, Germany, have found a technique using AI that can improve the diagnosis of leukaemia from blood samples. They developed a machine learning programme based on evaluating blood or bone marrow for the presence of cancer of the lymphatic system.

Dr Peter Krawitz and colleagues say the method improves a number of measurement values and "increases the speed as well as the objectivity of the analyses, compared to established processes". The freely accessible machine learning method can now be used by small laboratories with reduced resources, they report.

Dr Krawitz explained that sample analysis using flow cytometry is very time-consuming. "With 20 markers, the doctor would already have to compare about 150 two-dimensional images," he said, "that's why it's usually too costly to thoroughly sift through the entire data set."

The team explored how AI could be used to carry out flow cytometry testing. They trained their AI programme with information from over 30,000 data sets from patients with B-cell lymphoma. Full details were published recently in the journal Patterns.

Co-author Dr Nanditha Mallesh said, "AI takes full advantage of the data and increases the speed and objectivity of diagnoses. The result of the AI evaluations is a suggested diagnosis that still needs to be verified by the physician."

Dr Krawitz added, "The gold standard is diagnosis by haematologists, which can also take into account results of additional tests. The point of using AI is not to replace physicians, but to make the best use of the information contained in the data."

The team point out that, in contrast to classical diagnostic methods based on interpretation of results by human experts, AI and machine learning-based approaches have the potential for low cost per sample, once the system is trained.

For example, they analyzed over 12,000 samples from more than 100 individual studies to show that combining machine learning and gene expression profiling can "yield highly effective and robust diagnostic classifiers". Such classifiers could, in the future, potentially assist in primary diagnosis of this disease particularly in settings where hematological expertise is not sufficiently available or too costly.

Furthermore, they believe that similar analyses may be useful for other diseases when analyzing whole blood or gene expression profiles, or for multiple conditions in parallel. This would allow diagnosis of several conditions at essentially the same marginal cost per additional sample. Such approaches could lead to large efficiency gains in the future.

In the UK, researchers at Queen Mary University of London have found a way to use AI to analyse blood from rheumatoid arthritis patients and predict their response to treatment in advance.

This involved the identification of new biomarkers that serve as indicators of the effectiveness of disease modifying anti-rheumatic drugs, which do not benefit around half of patients. Levels of certain small molecules involved in regulating inflammation could predict the body’s ability to benefit from these drugs.

AI analysis of blood samples highlighted those who would be responsive to treatment and those who would not. Details were published in Nature Communications. Lead author, Professor Jesmond Dallifrom, said, “Currently a large proportion of patients are unresponsive to disease modifying anti-rheumatic drugs and are therefore unnecessarily exposed to their side effects.

“In addition, it can currently take up to six months from treatment initiation to determine whether someone will or will not respond to these medicines. For the patients who do not respond to the treatment, the disease gets worse before they are able to find a treatment that is more likely to work for them.”

The team are now beginning a larger study to check whether their findings are widely applicable to rheumatoid arthritis patients.

A separate UK-based team have developed machine learning technology that can spot several of the underlying red flags for a future heart attack. Professor Charalambos Antoniades at the University of Oxford, and colleagues created a new biomarker which they call the 'fat radiomic profile'.

It was discovered using machine learning to detect biological red flags in the perivascular space lining blood vessels which supply blood to the heart. Details appeared in the European Heart Journal, where the authors explain that it identifies inflammation, scarring and changes to these blood vessels.

The team hopes this will be a significant improvement on the current approach when a patient arrives at hospital with chest pain. The new method was developed after testing fat biopsies from 167 people undergoing cardiac surgery, to analyse the expression of genes associated with inflammation, scarring and new blood vessel formation.

Professor Antoniades said, “Just because someone’s scan of their coronary artery shows there’s no narrowing, that does not mean they are safe from a heart attack. By harnessing the power of AI, we’ve developed a fingerprint to find ‘bad’ characteristics around people’s arteries. This has huge potential to detect the early signs of disease, and to be able to take all preventative steps before a heart attack strikes, ultimately saving lives.”

A research team in India, led by Dr Vathsala Patil of the Manipal Academy of Higher Education in Karnataka, looked at the potential of AI to improve the work of radiologists. In a recent journal article they write, "Evolution in hardware and software application has led to an escalating number of tasks performed by machines that were initially unimaginable. The most noteworthy tool has been the introduction of learning algorithms. Tasks can now be performed, which were previously limited to humans, thus indicating that these algorithms have significantly improved recently."

They highlight the potential for deep learning algorithms, which they describe as "comparatively less challenging to train" and "able to outdo the performance of other AI approaches and medical experts in specific tasks such as recognizing pneumonia on imaging scans".

"The acquired information can be used throughout the clinical care path to improve diagnosis and treatment planning, as well as assess the potential and subsequent response to treatment," they write.

However, despite these and many more significant research efforts, algorithms have struggled to achieve the overall diagnostic accuracy of doctors. Future studies should continue to determine the effectiveness of AI algorithms as a clinical support system for diagnosis, guiding doctors by providing a second opinion.

It may be that combining whole-genome and a range of other patient data for use by machine learning algorithms will ultimately allow early detection, diagnosis, differential diagnosis, subclassification, and outcome prediction in an integrated fashion.

As Dr Jonathan Richens and colleagues at Babylon conclude, "It is likely that the combined diagnosis of doctor and algorithm will be more accurate than either alone."

References and Resources

  1. Richens, J. et al. Improving the accuracy of medical diagnosis with causal machine learning. Nature Communications, 11th August 2020 doi: 10.1038/s41467-020-17419-7 http://dx.doi.org/10.1038/s41467-020-17419-7 
  2. Mallesh, N. et al. Knowledge transfer to enhance the performance of deep learning models for automated classification of B-cell neoplasms. Patterns, 17 September 2021 doi: 10.1016/j.patter.2021.100351 https://doi.org/10.1016/j.patter.2021.100351 
  3. Dallifrom, J. et al. Blood pro-resolving mediators are linked with synovial pathology and are predictive of DMARD responsiveness in rheumatoid arthritis. Nature Communications, 27 October 2020 doi: 10.1038/s41467-020-19176-z http://dx.doi.org/10.1038/s41467-020-19176-z 
  4. Richens, J. G. et al. Improving the accuracy of medical diagnosis with causal machine learning. Nature Communications, 11 August 2020 doi: 10.1038/s41467-020-17419-7 https://www.nature.com/articles/s41467-020-17419-7
  5. Warnat-Herresthal, S. et al. Scalable prediction of acute myeloid leukemia using high-dimensional machine learning and blood transcriptomics. iScience, 18 December 2019 doi: 10.1016/j.isci.2019.100780 https://www.sciencedirect.com/science/article/pii/S2589004219305255?via%3Dihub
  6. Oikonomou, E. K. et al. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography. European Heart Journal, 3 September 2019 doi: 10.1093/eurheartj/ehz592 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz592/5554432?searchresult=1 
  7. Hameed, B. M. Z. et al. Engineering and clinical use of artificial intelligence (AI) with machine learning and data science advancements: radiology leading the way for future. Therapeutic Advances in Urology, September 2021 doi: 10.1177/17562872211044880 https://pubmed.ncbi.nlm.nih.gov/34567272/

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: Medicine & Medical SpecialtiesPatient Education

Online Emergency Preparedness Exercise for the Healthcare Sector

October 5, 2021 // Randy Glick

If this past two years has taught us anything, it is that we cannot be prepared for everything. However, with some basic preparation, we can get through anything, especially together.

Kassouf works closely with local organizations, such as the Birmingham InfraGard Members Alliance (IBMA), to foster information sharing between public agencies and the private sector, especially the heatlhcare and public health sectors.

We would like to invite you to participate in an online emergency preparedness exercise, hosted with IBMA and the support of state and local EMAs October 19-20, 2021.

This online emergency preparedness exercise will allow multiple healthcare organizations, or teams from multiple sectors, to experience a series of regional disasters and resulting critical grid failures together.  Participants will learn first-hand how their community and supply chain can be better prepared. Utilizing the Earth-Ex 2021 disaster preparedness engine, we are building a "virtual community" where teams will be able to move between their own workspace and shared areas and engage in one-to-one communications, as they might in a real-world situation.

You can read more and register for the online event here and make sure to indicate you are a guest of Kassouf when registering: https://hopin.com/events/infragard-on-line-community-preparedness-exercise-powered-by-earth-ex-2021/ 

However, if you cannot participate in our online event, we strongly encourage you to check out Earth Ex 2021 and participate in the exercise on your own, with your colleagues, or with your family, any time during the month of October: https://eiscouncil.org/earth-ex/ 

What is this event?
The InfraGard exercise will create a virtual community, with various organizations experiencing two shared disasters that cause widespread and prolonged utility outages and supply chain disruption. The disasters are a local wildfire and regional, devastating floods.

How much does it cost?
There is no cost for either the EIS Council exercise or the InfraGard online event.

How much time is required?
The InfraGard event takes place over two days.  However, a team can commit as little as 3 hours for just one simulation. Day one is for guest speakers, preparatory videos, and a facilitator workshop. Day two is the exercise. You can participate in one or both disasters, and each will require approximately 3 hours.

How much preparation is required?
Earth Ex 2021 is designed to be "come as you are," so you and your team can bring whatever emergency plans you have prepared, or come with nothing at all. The event includes a planning and exercise guide prepared by EIS Council.

Who should attend?
An organization's emergency management and response team, but also executive-level stakeholders and others in critical roles who may not have gone through this type of exercise. This is intended for a team, but an individual can also participate.

What is the experience like?
Earth Ex is a series of well-produced videos and numerous, randomly generated scenarios, designed to create an intense, immersive experience. The result is a realistic event that challenges a team's creative problem solving.

Where is it?
Ideally, you'll want to gather your team together in your "war room" with one video connection to Hopin. However, your team can each have their own Hopin accounts and meet in a virtual room through the platform.  

How to Prepare Your Home for a Loved One with Alzheimer’s

October 5, 2021 // Randy Glick

For the 5.4 million Americans with Alzheimer’s disease, carrying out the simplest tasks becomes harder and harder each day. The degenerative brain disorder comes on as we age and impairs everything from memory to problem solving.

 

According to HealthMatch, the unique symptoms of Alzheimer’s disease include:

  •       Extreme memory loss
  •       Inability to make decisions
  •       Difficulty concentrating and thinking
  •       Difficulty with everyday tasks
  •       Changes in personality

Eventually, people living with Alzheimer’s must receive constant care and attention, and many times this involves cases such as a parent with the disease moving in with their adult children. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias.

Because the disorder only gets worse with time, life becomes harder for victims to live day to day. Those planning on taking in a loved one with Alzheimer’s must make several adjustments in their lives. They must prepare mentally and emotionally, and making modifications around the house is often necessary. If you plan on taking in a loved one with Alzheimer’s, the Southern Medical Association invites you to consider making the following preparations at home in order to create a safe environment.

Ramp Over Stairs
Even if your loved one is not in a wheelchair, a ramp is safer than stairs. The steps eventually become cumbersome for a person with Alzheimer’s to navigate, putting them at risk for falls. A fall can seriously harm a senior. In fact, according to the National Council on Aging they are “the leading cause of fatal and non-fatal injuries for older Americans.” What’s more, an older adult is treated in the emergency room for a fall every 11 seconds, and an older adult dies from a fall every 19 minutes.

When picking a ramp, find one that has landings both on the bottom and at the top for easier mounting and dismounting. Your loved one also needs rails on both sides to hold on to as they ascend or descend. Finally, the materials need to be reflective and textured so they don’t slip. Consider checking into free or low-cost safety ramp programs for seniors at ProgramsForElderly.com.

Clear Obstacles from Walking Areas
Another way to prevent falls is making sure your loved one always has a clear path wherever they walk. If your home has a lot of furniture or accessories that clutter up hallways and rooms, consider getting rid of some of it. The less stuff around the house, the fewer tripping hazards that put your loved one at risk. Other potentially hazardous furniture include coffee tables and ottomans. Clear pathways all around the house including in the kitchen, bathrooms, and outside in the yard or garden.

Preparing their Room
Your loved one needs a space of their own where they can have privacy and be comfortable. Prepare a room on the first floor that has easy access to the bathroom. Avoid furniture with sharp corners or edges, or cover them with protective foam. Avoid hazardous knickknacks such as glass objects that can shatter into countless sharp pieces if dropped and broken. Provide them with ample light, including nightlights that can guide their way to the bathroom in the middle of the night.

Bathroom Essentials
The bathroom is perhaps one of the more dangerous areas for a loved one with Alzheimer’s. Install a bench and safety railing in the shower or tub to make bathing easier and safer for use. Clearly label the faucets with hot and cold to prevent confusion and possible scalding. Finally, safely stow hazardous chemicals like cleaners and bleach somewhere they cannot access them.

Millions of people afflicted with Alzheimer’s must move in with family and loved ones in order to get the round-the-clock care they need. That said, you are not alone. Avoid feeling like you are on an island and have to carry the load solo -- reach out and get connected with peer-to-peer support groups. Discover what others have done to prepare their homes and share your own experiences. You don’t have to do it alone. 

Photo via Pixabay

About the Author:
Lydia Chan is the co-creator of Alzheimers.net, a website that aims to provide tips and resources to help caregivers. After her mom was diagnosed with Alzheimer's, she found herself struggling with finding balance between the responsibilities of caregiving and her own life. She is passionate about sharing her knowledge and experiences with caregivers and seniors.

Posted in: Medicine & Medical SpecialtiesMental HealthPatient Education

SMJ: October 2021 Vol. 114, No. 10

October 1, 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.

CME Article: Trends in Incidence and Mortality Rates of Uterine Cancer in Kentucky

Matthew R. Nichols, MD, Jeremy T. Gaskins, PhD, Daniel S. Metzinger, MD, Sarah L. Todd, MD, Harriet B. Eldredge-Hindy, MD, Scott R. Silva, MD, PhD

Preparing Health Professions Students to Serve Southern Rural Communities in the Time of COVID-19 and Beyond: A Model for Interprofessional Online Telehealth Education

Teri Browne, PhD, Selina H. McKinney, PhD, Lauren Duck, MPH, Elizabeth W. Blake, PharmD, Beverly Baliko, PhD, Sara English, PhD, Rebecca Christopher, MSW

Do We Know Where They Go? Obtaining Travel History in Pediatric Patients

Pranaya H. Chilukuri, MD, MPH, Mary Orr, MD, MPH, Shaundra Blakemore, MD, Meghan E. Hofto, MD, MPH

Health Disparities of Coronavirus Disease 2019 in Texas, March–July 2020

Christy Xavier, MS, PharmD, Rafia S. Rasu, MPharm, PhD

National Resident Matching Program Rank Order and Performance in an Internal Medicine Residency

George D. Everett, MD, MS, Edward Maharam, MD, Fanchao, Yi MS

CME Article: Sugammadex Reduces PACU Recovery Time after Abdominal Surgery Compared with Neostigmine

Jin Deng, MS, Maha Balouch, MA, Michael Albrink, MD, Enrico M. Camporesi, MD

On “On Aristotle and Upper Leveling”

G. Richard Holt, MD, MSE, MPH, MABE, D Bioethics

Association between Opioids Prescribed to Medical Inpatients with Pain and Long-Term Opioid Use

Kaitlin E. Keenan, MD, Michael B. Rothberg, MD, MPH, Shoshana J. Herzig, MD, MPH, Simon Lam, PharmD, BCPS, Vicente Velez, MD, Kathryn A. Martinez, PhD, MPH

Pediatric Providers’ Knowledge, Attitudes, Practice, and Barriers to Firearms Safety Counseling

Avni M. Bhalakia, MD, Annalyn DeMello, MPH, RN, Kristen Beckworth, MPH, Brittany Johnson, MD, Bindi Naik-Mathuria, MD, MPH

On Aristotle and Upper Leveling

Benjamin W. Frush, MD, MA