On “Women’s Health Curriculum for Medical Students”

To the Editor: We would like to sincerely thank Sattari et al for their insightful piece on developing a diverse women’s health elective for medical students.1 As future doctors studying in a time of change from paternalistic to patient-centered medicine, we believe it is important that we empower female patients into making educated decisions about their lives, other than just the gynecological and obstetric aspects of...

Differences in Medical Students’ Academic Performance between a Pass/Fail and Tiered Grading System

Objectives: Medical school implementation of a pass/fail grading system offers the opportunity for a reduction in student stress and anxiety and the creation of a less competitive environment, leading to an improvement in overall well-being. Some critics of a pass/fail system have raised concerns of a decrement in academic performance. The purpose of this research project was to determine whether medical students at the Medical College of...

Prevalence and Impact of Diabetes Mellitus on the Frozen Shoulder

Objectives: The objective of this study was to estimate the prevalence of undiagnosed diabetes mellitus in patients with newly diagnosed frozen shoulder (FS) and study whether diabetes mellitus increases the severity of FS disease. Methods: Patients with newly diagnosed FS were consecutively included in this case-control study. Patients who were not already diagnosed as having diabetes mellitus were invited to be tested with the hemoglobin...

Effects of Respiratory Syncytial Virus Infection in Infancy on Asthma and Respiratory Allergy in 6-Year-Old Children

Objective: The purpose of this study was to examine the association between respiratory syncytial virus (RSV) infection in early infancy and health conditions such as asthma and respiratory allergies at 6 years of age in a cohort of US children born at term with no medical issues at birth. Methods: Data (1542 records) from the Infant Feeding Practices Study II and the Year Six Follow-Up study were used in the analysis. Descriptive statistics...

Obesity and Weight-Biased Shaming in South Carolina: A Medical Student’s Perspective

To the Editor: The economic cost of obesity in South Carolina alone has been estimated by the Department of Health and Environmental Control to be >$8.5 billion/year and growing. As of August 2017, South Carolina was ranked 12th in the nation for adult obesity — 32.3% of the state’s population is obese; the number was 12.0% in the 1990s. The combined overweight and obesity rate of children aged 10 to 17 years is even higher than the adult...

Resource Utilization with the Use of Seclusion and Restraint in a Dedicated Emergency Psychiatric Service

Objectives: There is a dearth of data regarding the use of emergency interventions in dedicated emergency psychiatric service settings, and reliable data are needed. This article describes the frequency and duration of the use of seclusion and restraint for imminent or existing agitation, aggression, or violence in a dedicated emergency psychiatric service located within an academic university hospital and staffed by sufficient numbers of...

Potential Provider Oversupply and Underserved Areas: The Future of Alabama Medicine

Alabama must turn around its primary care provider deficit in its rural areas or risk its population’s health, finances, and well-being. Recent data show that a large portion of Alabama’s population is moving from rural areas to urban areas of the state, seeking jobs, whereas others are leaving Alabama for other areas in the United States. In addition, the population growth of Alabama has slowed considerably during the last 50 years....

Role of Rifaximin in Spontaneous Bacterial Peritonitis Prevention

Cirrhosis affects millions of people around the world and is associated with increased morbidity and mortality. Spontaneous bacterial peritonitis (SBP) is a common complication of liver disease with cirrhosis and accounts for up to 30% of infections in patients with cirrhosis. Patients with a history of SBP and those deemed to be at high risk often are prescribed antibiotics to reduce the incidence of SBP. Fluoroquinolones and...

Late-Stage Melanoma: Be Sure to Screen Uninsured, Unmarried Men

Objective: The purpose of this study was to assess for any associations between individual and social factors and late-stage melanoma in Kentucky from 1995 to 2013. Methods: The study combines three datasets: individual-level data from the Kentucky Cancer Registry, census tract–level data from the US Census, and county-level physician licensure data from the Kentucky Department for Public Health. The study population is described by all...

Author’s Response

To the Editor: Kumar and Mathur eloquently highlight the importance of addressing not only the reproductive health of female patients but also preservation of their wellness and prevention of illness.1 Women’s health encompasses screening, diagnosis, and management of disease or conditions that are unique to or more common or serious in women; have distinct risk factors, causes, manifestations, or outcomes; or require different treatment or...

OPEN: Vaginal Anatomy on MRI: New Information Obtained Using Distention

Objectives: To demonstrate and confirm the presence of three anatomic zones of the vagina (a superficial sphincteric zone; a central wedge shaped transition zone; and a deep, expanded forniceal zone) using pelvic magnetic resonance imaging with contrast distention of the vagina. Methods: A total of 107 consecutive female pelvic magnetic resonance imaging scans using vaginal contrast distention were retrospectively reviewed. The images were...

Blood Pressure, HIV, and Cocaine Use Among Ethnically and Racially Diverse Individuals

Objectives: Racial minorities are at greater risk of cardiovascular disease (CVD), and CVD is the primary cause of mortality among human immunodeficiency virus (HIV)–infected individuals. Cocaine use also has been associated with hypertension. This study examined the contribution of lifestyle factors to systolic, diastolic, and mean arterial pressure (MAP) among people living with HIV and cocaine users from racially and ethnically diverse...

Outcomes and Predictors of Readmissions with GI Bleeding in Patients with Left Ventricular Assist Devices

Objectives: Gastrointestinal (GI) bleeding is a major comorbidity in patients with left ventricular assist devices (LVADs). The study aim was to estimate the rate of hospital readmissions for GI bleeding in patients with LVADs using a nationally representative database. Additionally, we evaluated the etiologies, costs, endoscopy utilization, mortality, and predictors of GI bleeding readmissions in these patients. Methods: We analyzed data...

Integration of Personalized Health Planning and Shared Medical Appointments for Patients with Type 2 Diabetes Mellitus

Objectives: This study describes the feasibility of implementing personalized health planning (PHP) within shared medical appointments (SMAs) for patients with type 2 diabetes mellitus. The PHP-SMA approach was designed to synergize the benefits of SMAs with those of PHP, enabling greater patient engagement focused on meeting individualized therapeutic goals in a group setting. Methods: Patients were assigned randomly to a PHP-SMA or a...

Provision of Buprenorphine to Pregnant Women by For-Profit Clinics in an Appalachian City

Objectives: This study was undertaken to confirm that patient reports on buprenorphine medication-assisted therapy in for-profit buprenorphine clinics in our community were personally costly. We contacted all 17 for-profit clinics in our community and confirmed the patient reports that a significant financial payment of ≤$100 was required for each visit. We also found that tapering of buprenorphine dosage in pregnancy was offered by several of...

Protocol to Improve Genotyping of Non-Small-Cell Lung Cancer Diagnosed Using EBUS-TBNA

Objectives: Targeted therapies for non-small-cell lung cancers (NSCLCs) are based on the presence of driver mutations such as epidermal growth factor receptor (EGFR) and the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocation. Endobronchial ultrasound-guided-transbronchial needle aspiration (EBUS-TBNA) is a first-line modality for diagnosing and staging NSCLC. A quality improvement protocol...

Group Battlefield Acupuncture in Primary Care for Veterans with Pain

Objective: To obtain preliminary data on the short- and intermediate-term effects of battlefield acupuncture (BFA) on self-reported pain intensity in a relatively large cohort of veterans to assess whether a more comprehensive clinical trial evaluation is warranted. Methods: The treatment, in an outpatient group setting, consisted of up to five auricular semipermanent needles inserted into each ear at prespecified points. Efficacy of...

Birth Weight and Risk of Childhood Acute Lymphoblastic Leukemia in Arizona, Illinois, and Kentucky

Objective: To confirm the previously reported increased risk of leukemia among macrosomic children (those with birth weight >4 kg). Methods: Birth certificates of Arizona, Illinois, and Kentucky children diagnosed as having acute lymphoblastic leukemia (ALL) before age 5 years were matched with birth certificates from leukemia-free children of the same sex, race, and ethnicity who were born in the same county on or about the same day. Odds...

Mobile Health (mHealth) Use or Non-Use by Residents of West Virginia

Objective: To compare mobile health (mHealth) usage by residents of West Virginia with national estimates. Methods: Pew Research Center data from its Internet and American Life Project were accessed for secondary data analysis. These data, available to the public, are a probability sample of Internet use in the United States, differences in use based on selected variables (eg, education, household income), and how usage affects the lives of...

Do Teaching-Focused Medical Schools Perpetuate the Thinking That Black Faculty Should Not Be Researchers?

To the Editor: In attempts to address concerns about a physician shortage, there has been an increase in the number of US medical schools. Many of these schools are community based and have been created with a focus on teaching to increase the numbers of primary care physicians and a strong commitment to social mission.1 Some schools even have historically high black student and black faculty...