Major Complications Associated with Conventional Transbronchial Needle Aspiration

Objectives: Transbronchial needle aspiration (TBNA) is a widely used sampling technique for diagnosis and staging of lesions centered around bronchoscopically accessible airways. We report our single-institution experience of complications associated with conventional TBNA (C-TBNA) performed in 606 consecutive cases. Methods: Electronic medical records with bronchoscopy log data of C-TBNAs performed from January 2003 to December 2016 were...

Commentary on “Major Complications Associated with Conventional Transbronchial Needle Aspiration”

In this issue of the Southern Medical Journal, Zaman and Shrestha1 provide a retrospective on their 14 years of experience with the major complications associated with conventional transbronchial needle aspiration (TBNA) and an extensive review of the published literature in the field. They make recommendations based on the available evidence regarding the approaches that physicians should use to prevent, whenever possible, these...

Religious Characteristics of Physicians Who Care for Underserved Populations or Work in Religiously Oriented Practices

Objectives: This study examined the relation between physicians’ religious characteristics and working for medically underserved populations or in religiously oriented practices. Methods: Secondary data analysis of 2009–2010 national survey of 896 primary care physicians (PCPs) and 312 psychiatrists. Predictors included physicians’ religious characteristics. Results: Adjusted response rates among eligible physicians were 63% (896 of...

Some Thoughts on Implementing Remote Telehealth

The Department of Veterans Affairs (VA) has had a major focus on increasing access to care, including by use of telehealth. Telehealth technology has been used in direct patient care by numerous VA providers, up to and including the cabinet secretary in charge of the agency.1 The potential of telehealth also has excited interest in many other healthcare...

Uric Acid Control in Advanced Chronic Kidney Disease in a Southeastern US Urban Cohort

Objectives: Uric acid (UA) control may be insufficient in chronic kidney disease (CKD) patients in the current era. It is unclear, however, whether this is the result of environmental effects, patient anthropometrics or insufficient dosing of medical therapy (allopurinol). Methods: We have collected data on multiple clinical and laboratory parameters of 114 CKD clinic patients attending the nephrology clinic of the University of Mississippi...

OPEN ACCESS: Association Between System Factors and Acute Myocardial Infarction Mortality

Objectives: We conducted a cross-sectional study to assess the association between healthcare system factors and death from acute myocardial infarction (AMI), in terms of access (distance to the hospital, mode of transportation), availability (emergency medical services, hospitals), and capability (emergency medical services’ 12-lead electrocardiogram capability, continuous percutaneous coronary intervention and cardiothoracic surgical...

Parental Age and the Risk of Gestational Hypertension and Preeclampsia

Objectives: To determine the effect of maternal age (MA) and paternal age (PA) on the risk of gestational hypertension, preeclampsia, and eclampsia in women who delivered on the Texas–Mexico border. Methods: A cohort study using birth certificate data (singleton pregnancies, years 2005–2010) from El Paso County, Texas, was conducted. Six parental age–exposure categories were created with MA 20 to 34 years and PA younger than 35 years...

Commentary on “Religious Characteristics of Physicians Who Care for Underserved Populations or Work in Religiously Oriented Practices”

In recent years, the common understanding has been that the United States is becoming increasingly less religious. Certainly as far as religious observance and active participation in organized faith communities is concerned, this is demonstrably the case. Paradoxically, however, attention to the role of religion and spirituality in how patients and caregivers cope with illness and make decisions about their care has increased. The rise of...

How Much Time Do Residents Spend on Inpatient Clinical Computing?

Objective: To evaluate the time that residents spend on clinical computing. Methods: Our electronic health record system was used to record clinical computing time. Residents were unaware that we were tracking their time. Prior studies have reported computing times by watching the users. We evaluated residents in internal medicine, general surgery, and emergency medicine. The postgraduate year 1 (PGY1) and PGY3 residents were evaluated in...

Hospitalist Infectious Disease Service in Academic Medical Centers: A Win-Win for Hospitalists and Fellows

In the last decade, inpatient care has changed dramatically at academic centers nationwide. In part this has been driven by resident work-hour restrictions, which have forced most teaching hospitals to develop and expand hospitalist services.1,2 Our institution initiated an inpatient hospitalist team, called the Collaborative Inpatient Medical Service, in 2000. The service has grown significantly since its inception, and in 2014 included 40...

Patient Beliefs and Preferences Regarding Surrogate Decision Makers

Objectives: Many patients lose the capacity to make medical decisions because of severe illness or the effects of sedation or anesthesia. Most states in the United States designate the next of kin (NOK) as a default surrogate decision maker (SDM), but this may not always reflect patient preferences. Our objective was to determine how frequently the default SDM matched the patient’s preferred SDM, and whether patients knew who would serve as...

Commentary on “Patient Beliefs and Preferences Regarding Surrogate Decision Makers”

In this issue of the Southern Medical Journal, Hunter and Walters report an ongoing problem with surrogate decision making in the absence of legally sufficient advance directives: the default choice as defined by state law may not be the patient’s preferred surrogate.1 This mismatch is particularly important because so few hospitalized patients (in this case, fewer than one-third) complete advance directives. Although the nature and weight of...

Is It “In” to Wear Scrubs Out?

Objective: This study aimed to identify differences in perceptions between healthcare and non-healthcare personnel when it comes to wearing scrubs in non-healthcare settings. Methods: An anonymous survey with 11 closed-ended questions sent via e-mail to healthcare students and employees at The University of Texas Health San Antonio and non-healthcare students and employees at The University of Texas at San Antonio. The answers were scored...

Team-Based Learning Activities for First-Year Medical Students: Perception of the Learners

Objectives: Team-based learning (TBL) is an active learning strategy that is used increasingly in medical education to promote critical thinking, knowledge application, teamwork, and collaboration. The aim of this study was to assess the students’ perspective on the utility of TBL compared with traditional lectures. Methods: We used a validated TBL student assessment instrument comprising three subscales studying accountability, preference...

Playing Music for Hospitalized Patients Enhances Mood and Reduces Perceptions of Pain

Objectives: For most people, music serves as a calming influence or as a pleasurable stimulus that lifts their spirits. In an attempt to both distract and cheer up hospitalized patients, we designed a brief intervention that would bring music to their hospital rooms in attempt to enhance their mood and minimize their awareness of pain. Methods: In this prospective study of adult patients on the general medicine ward at Johns Hopkins Hospital,...

Effect of the Adoption of a Comprehensive Electronic Health Record on Graduate Medical Education: Perceptions of Faculty and Trainees

Objectives: Health systems are adopting electronic health records (EHRs). There are few studies on the effects of EHR implementation on graduate medical education. The authors sought to longitudinally assess perceptions of the impact of EHRs on graduate medical education during implementation and 2 years after implementation. Methods: A survey was distributed to faculty and trainees during the first year (2013) of adoption of the EHR system....

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Use for Subclassification and Genotyping of Lung Non-Small-Cell Carcinoma

Objectives: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the primary method for the diagnosis and staging of lung cancer. The purpose of this study was to assess the yield of EBUS-TBNA in the subtyping and genotyping of lung adenocarcinoma. Methods: Sixty-nine patients at Indiana University Hospital and Sidney and Lois Eskenazi Hospital with possible or confirmed lung adenocarcinoma underwent EBUS-TBNA using...

Association Between the Frank Sign and Cardiovascular Events

Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time. An interesting example of such signs is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. Our goal was to summarize the clinical trials and observational studies that had examined the association between the Frank sign and cardiovascular diseases....

Placental Chorioangioma with Nonimmune Hydrops Fetalis

A 38-year-old woman was found to have a large placental chorioangioma. The fetus was studied using ultrasound. The pregnancy became complicated by hydrops fetalis, polyhydramnios, and abruptio placenta. The infant delivered at 29 weeks’ gestational age. The neonatal course was complicated by nonimmune hydrops fetalis, respiratory distress syndrome, anemia, pulmonary hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, and...

Are All Teaching Activities Valued the Same? Their Relative Worth Is in the Eye of the Beholder

Objectives: The pressures for generating revenue from clinical activities dissuade clinician-educators from teaching; taking the steps to develop an educational value system is a way to recognize and perhaps support education. We compared the perceived educational value of diverse pedagogical activities during clinical training from students, residents, and faculty in medical and surgical specialties. Methods: Between 2016 and 2017, a survey...