Assisted Death and the Public Good

The movement toward physician-assisted suicide, also called assisted death (AD), is built upon a fundamental moral premise: each of us should have control over our lives and deaths. Moreover, the relief of suffering, a core premise of traditional medical ethics, is integral to the care of dying people. Physician assistance in facilitating death is therefore appropriate and justified. We disagree. Although autonomy is a fundamental principle...

Hospital Discharge Disposition of Stroke Patients in Tennessee

Objectives: Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with...

Resident Workshop Standardizes Patient Handoff and Improves Quality, Confidence, and Knowledge

Objectives: Residency programs are required to instruct residents in handoff; however, a handoff curriculum endorsed by the Accreditation Council for Graduate Medical Education does not exist. Although curricula are available, we preferred to use a curriculum that could be taught quickly, was easy to implement, and used a mnemonic that resembled current practices at our institution. We designed and implemented a novel handoff educational...

Management of Metastatic Spinal Cord Compression

Cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Metastatic disease can promote end-organ dysfunction and even failure through mass effect compression of various vital organs including the spinal cord. In such cases, prompt medical attention is needed to restore neurological function, relieve pain, and prevent permanent damage. The three therapeutic approaches to managing...

Commentary on “Hospital Discharge Disposition of Stroke Patients in the State of Tennessee”

In this issue of the Southern Medical Journal, Cho and colleagues assessed the hospital discharge location for patients with stroke and attempted to develop a tool to help determine the discharge location early in the clinical course.1 The treatment for acute ischemic stroke has come a long way since the approval of intravenous tissue plasminogen activator in 1995 to the advent and use of stent retrievers and large-bore aspiration catheters in...

Commentary on “Assisted Death and the Public Good”

The debate over whether physician-assisted suicide is ethically justifiable often focuses on the conflict between the principles of beneficence and autonomy. It is invigorating that Dugdale and Callahan remind us of an alternative, often neglected perspective by invoking the concept of the public good.1 The authors present a communitarian approach to the problem of assisted suicide, and this seems appropriate to describe a phenomenon that...

Chronic Kidney Disease in Pregnancy

With the increasing prevalence of chronic kidney disease (CKD) worldwide, the number of pregnant women with various degrees of renal dysfunction is expected to increase. There is a bidirectional relation between CKD and pregnancy in which renal dysfunction negatively affects pregnancy outcomes, and the pregnancy can have a deleterious impact on various aspects of kidney disease. It has been shown that even mild renal dysfunction can increase...

Idiopathic Thrombocytopenic Purpura in Individuals Older than 75 Years: A Rare Series

To the Editor: Idiopathic thrombocytopenic purpura (ITP), currently referred to as primary immune thrombocytopenic purpura, is an autoimmune disease linked to the presence of autoantibodies responsible for the peripheral destruction and central inhibition of platelet growth.1 Bleeding results from unusually low levels of platelets, the cells that help blood coagulate.2 Treatment of ITP is based on the recommendations of experts2; however, in...

Commentary on “Discussing Advance Care Planning and Directives in the General Population”

In this issue of the Southern Medical Journal, de Caprariis and colleagues make three recommendations in regard to the approach that healthcare professionals should use to promote the utilization of advance care planning (ACP) and advance directives (ADs).1. These recommendations address the ethical complexities raised when broaching the idea of planning for death with terminally ill patients and with prospective completers of ACP, especially...

Discussing Advance Care Planning and Directives in the General Population

The concept of end-of-life planning, along with medical and legal issues, has been discussed and has evolved over several years. The 1990 Patient Self-Determination Act and individual states’ Department of Health Advance Directive forms helped overcome past problems. Patients with terminal and chronic illness are now able to have their wishes recognized for their future care. Any healthy individual’s decision during an advance care planning...

On “Direct to Physician Journal Marketing”

To the Editor: An interesting threefold (by my observation) phenomenon is under way in the medical publication field: an explosion of new journals around the world that are pure ‘‘pay to publish’’ (ie, Open Access) as the business model; direct-to-physician invitations to join the new journals’ editorial boards; and direct invitations to submit a manuscript to a new journal, regardless of the match with the physician’s own specialty...

Assessing Disaster Preparedness Among Select Children’s Summer Camps in the United States and Canada

Objective: Children’s summer camps are at risk for multiple pediatric casualties during a disaster. The degree to which summer camps have instituted disaster preparedness is unknown. We assessed disaster preparedness among selected camps nationally for a range of disasters. Methods: We partnered with a national, web-based electronic health records system to send camp leadership of 315 camp organizations a 14-question online survey of...

Bedside Rounds Valued But Not Preferred: Perceptions of Internal Medicine Residents and Attending Physicians in a Diverse Academic Training Program

Objectives: Bedside rounds/rounding (BDR) is an important tool for patient-centered care and trainee education. This study aimed at understanding the attitudes toward BDR among residents and attending physicians. Methods: A survey was conducted using the Qualtrics survey tool. Responses were measured using a five-point Likert scale. Results: The survey was sent to 301 attending physicians and 195 residents. Attending physicians conducted...

Chester Step Test as a Reliable, Reproducible Method of Assessing Physical Fitness of Disaster Deployment Personnel

Field disaster response typically is strenuous, difficult work, both physically and mentally.1–3 Although hard evidence is lacking, it may be inferred that responders lacking appropriate physical fitness are at increased risk of injury or compromising safety operations during a...

Transfusion Practice in Trauma Resuscitation

Recognition of the acute coagulopathy of trauma and the limits of reconstituting whole blood with conventional blood components has led to a radical change in the way trauma patients with severe injuries are resuscitated. Massive transfusion protocols (MTP) have evolved toward the administration of conventional blood components in fixed ratios. Administration of a 1:1:1 unit ratio of fresh frozen plasma to whole-blood–derived platelets to...

Survey of Hospital Employees’ Personal Preparedness and Willingness to Work Following a Disaster

Objectives: Little is known about the personal readiness of hospital staff for disasters. As many as 30% of hospital staff say that they plan not to report for work during a large-scale disaster. We sought to understand the personal disaster preparedness for hospital staff. Methods: Surveys were distributed to the staff of a large academic tertiary-care hospital by either a paper-based version distributed through the departmental safety...

Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection

Objectives: Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality and is the most common nosocomial infection in the United States, with associated annual costs of approximately $3 billion. The epidemiology of CDI has changed with the identification of novel risk factors for incident and recurrent CDI. The aim of this study was to identify the predictors of 30-day mortality in hospitalized patients with...

Implementing a Disaster Preparedness Curriculum for Medical Students

Objectives: Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are...

Impact of Polypharmacy on Seniors’ Self-Perceived Health Status

Objectives: Polypharmacy is common among older patients and is linked to increased risk of adverse health outcomes. This study aimed to explore the association of polypharmacy and self-perceived health status (SPHS) among geriatric patients. Methods: This cross-sectional analysis of longitudinal observational research used national survey data from 2005–2008. Multivariate logistic regressions examined the likelihood of having a good/poor...

Opportunity for Collaboration Between Radiation Injury Treatment Network Centers and Medical Toxicology Specialists

Objectives: The Radiation Injury Treatment Network (RITN) comprises >50 centers across the United States that are poised to care for victims of a radiation emergency. The network is organized around bone marrow transplant centers because these facilities excel in both radiation medicine and the care of patients with severe bone marrow depression. A radiation emergency may cause not only irradiation from an external source but also internal...