As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal 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. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.

As an accredited provider of CME by the Accreditation Council for Continuing Medical Education and in accordance with the ACCME’s Standards for Commercial Support, Southern Medical Association requires that all individuals in a position to affect the content of a CME activity disclose to the learners relevant financial relationships with commercial interests. Further, any relationship determined to be a conflict of interest will be resolved prior to the activity. For Journal CME articles, author disclosures are published in the footer section of each article. The editor, editorial staff, reviewers and planners for Journal CME articles have no relevant financial relationships to disclose and no conflicts of interest to be resolved.

Editorial Board

G. Richard Holt, MD, MSE, MPH, MABE, DBE
University of Texas Health Science Center
San Antonio, Texas

Associate Editor
Steven T. Baldwin, MD,  Pediatric Emergency Medicine 
University of Alabama at Birmingham, Children's Hospital of Alabama
Birmingham, AL

Editorial Office
Jennifer Price, MA, Managing Editor
Southern Medical Association
3500 Blue Lake Drive, Suite 360
Birmingham, Alabama 35243
Phone: (205) 421-4185

Lippincott Williams & Wilkins
Celia Braithwait, Publisher
Angela Arnold, Production Editor
Robert O’Malley, Marketing Manager

SMA Officers, 2018-2019
David Avery, MD, FAAFP
Vienna, WV

Philip Hartman, MD
Burlington, KY

Immediate Past President
Donald J. DiPette, MD, FACP, FAHA
Columbia, SC

Executive Director
Randall E. Glick, BSB/PM, MCP
Birmingham, AL

Editorial Board
Ines Anchondo, PhD, RD, LD, CSP, MPH
Public Health & Nutrition
Texas Tech University Health Sciences Center El Paso
El Paso, TX

John Birk, MD
Internal Medicine & Gastroenterology
University of Connecticut
Farmington, CT

Mary Ann Burton, MD, PhD
Infectious Diseases

University of Mississippi School of Medicine
Jackson, MS

Lawrence Frisch, MD, MPH
Population Health

Vancouver Coastal Health Research Institute
Vancouver, Canada

James H. Holmes, IV, MD

Assistant Editor for Surgery & Surgical Specialties
Wake Forest Burn Center
Winston-Salem, NC

Christopher Jackson, MD, Internal Medicine
Assistant Editor for Quality Care & Patient Safety
University of Tennessee Health Science Center
Memphis, TN

Rosalyn Stewart, MBA, MD, MS
Internal Medicine & Primary Care Medicine

Johns Hopkins University School of Medicine
Baltimore, MD

Michael A. Thomas, MD
Reproductive Endocrinology and Infertility
Assistant Editor for Women's Health
University of Cincinnati School of Medicine
Cincinnati, OH

Wendy Wilcoxson, DO, MBA, FACEP 
Assistant Editor for Emergency & Disaster Medicine

James Wooten, PharmD
University of Missouri-Kansas City
Kansas City, MO

International Editorial Board Members
Florian Bruns, MD
Medical Ethics
Charite Center for Humanities and Health Sciences
Berlin, Germany

Andrew Elder, MBChB, FRCP
Geriatric Medicine

Royal Infirmary of Edinburgh
Edinburgh, Scotland

Paul Froom, MD, MOccH
Epidemiology and Preventive Medicine
Sackler School of Medicine
Tel Aviv, Israel

Pablo Guisado-Vasco, PhD, MD
Internal Medicine

Complejo Hospitalario Ruber Juan Bravo
Madrid, Spain

Olivia Kreze, MD, PhD, FRCPath

Newham University Hospital
London, England

Edmund Leung, MBChB, MRCSEd, DM, FRCS, FEBS
Surgical Oncology, Gastroenterology, &
Critical Care/Emergency Medicine

Warwick Hospital,
Warwick, United Kingdom

Rowan Parks, MD, FRCS
General Surgery
Royal Infirmary of Edinburgh
Edinburgh, Scotland

Ramon Parsa-Parsi, MD
International Affairs German Medical Association
Berlin, Germany

Each member of the Southern Medical Journal Editorial Board, if not a current member of the Southern Medical Association, is supplied with a complimentary SMA membership for the term of his or her Board service. Association membership includes a complimentary subscription to the Southern Medical Journal. There is no other compensation

Publishing & Editorial Staff

Celia Braithwait

Production Editor
Susan Paynter

Reprints Representative (U.S.)
Kelle Ramsay
Phone: 410-528-4121

Reprints Representative (Europe)
George Killeen
Phone: +44 0203-197-6579

Rights, Licensing and Permissions

For questions about using the Rightlinks® service, please contact: Customer Support
Phone: 877/622-5543(Toll free from the US) or (US phone code) 978/777-9929

LWW Business Offices 
Two Commerce Square, 2001 Market Street
Philadelphia, PA 19103
Phone: 215-521-8300

G. Richard Holt, MD, MSE, MPH, MABE, D.Bioethics
325 E Sonterra Blvd, Suite 210
San Antonio, TX 78258

Managing Editor
Jennifer Price, MA

Author/Submission Questions

Association Headquarters
Southern Medical Association
3500 Blue Lake Drive
Suite 360
Birmingham, Alabama 35243
Phone: 800-423-4992 or 205-945-1840

Disclaimer: Opinions expressed by the authors and advertisers are their own and not necessarily those of the Southern Medical Association, the Publisher, the Editor, or the Editorial Staff. The Association, the Publisher, the Editor, and the Editorial Staff are not responsible for the authenticity of the opinions or statements made by the authors in communications submitted to the Journal for publication. The author or communicant shall be held entirely responsible. The Association, the Publisher, the Editor, and the Editorial Staff do not guarantee, warrant, or endorse any product, service, or claim made or advertised in this publication.