The Southern Medical Journal 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.
SMJ // Browse the Southern Medical Journal
SMJ Article | Original Article
Association between Main Pancreatic Duct Size, Comorbidities, and Fistula Formation after Whipple Procedure for Pancreatic Cancer
Objective: Studies have associated abnormally dilated or constricted main pancreatic duct (MPD) diameter sizes in postproximal pancreatectomies (Whipple procedures) with postoperative complications. As such, we studied the clinical factors associated with both abnormally dilated or constricted MPD diameters and perioperative factors that may influence postoperative pancreatic fistula formation. Methods: We...
Posted in: Gastroenterology49 Pancreatic Disease2
SMJ Article | Original Article
Diagnostic Utility and Clinical Implications of Inpatient Fecal Occult Blood Testing
Objective: The objetive was to evaluate the utility of inpatient and emergency department (ED) fecal occult blood testing (FOBT) and its association with downstream healthcare utilization and costs. Methods: This was a retrospective cohort study of adult patients (18 years and older) who underwent FOBT in the ED or inpatient...
SMJ Article | Original Article
Perspectives on Contraceptive Research for Individuals with Increased Thrombosis Risk: A Qualitative Exploration of Patients and Clinicians
Objectives: Although most progestin-only contraceptives are generally considered safe for most patients at increased risk of arterial and venous thrombosis, patients and clinicians may be wary of their use based on limited studies. Large prospective contraceptive studies with primary data collection would improve the evidence base for people at increased...
Posted in: Family Planning & Reproductive Health17
SMJ Article | Original Article
Trends in Reported End-of-Life Concerns after the Legalization of Physician-Assisted Suicide
Objectives: Understanding the concerns that motivate requests for assisted dying (euthanasia or assisted suicide) is essential for understanding these practices. Our objective was to determine whether there are significant trends in end-of-life concerns cited in requests for physician-assisted suicide (PAS) in Oregon and Washington. Methods: We estimated regressions using data...
SMJ Article | Review Article
Aprocitentan: A New Option for Resistant Hypertension and Its Place in Patient Care
Hypertension affects approximately 47.7% of US adults, with higher rates observed in men (50.8%) compared with women (44.6%). Risk factors and characteristics such as age, family history, race, and ethnicity also can increase the risk of developing high blood pressure and can make treatment more difficult. Aprocitentan is the first...
Posted in: Hypertension11
SMJ Article | Perspectives
The Five Essential Concepts of Developmental Medicine: A Medical Paradigm for People with Developmental Disabilities
Developmental disabilities and neurodevelopmental disorders (NDDs) are lifelong conditions that present complex medical challenges, particularly as individuals transition from pediatric to adult health care. Although these disorders typically manifest in cognitive impairment, motor dysfunction, seizures, and behavioral dysregulation, the degree of these symptoms can vary widely. This article introduces a...
Posted in: Neurology18
SMJ Article | Original Article
Impact of Temperature Variation on Patients with Acute Severe Asthma
Objective: Acute severe asthma (ASA) is associated with a heightened risk of death. The influence of ambient temperature on in-hospital mortality and healthcare utilization for patients with ASA is poorly characterized. Methods: Using the National Inpatient Sample, we compared adults hospitalized with ASA in the northeast with southern regions of...
Posted in: Pulmonary Disease19
SMJ Article | Perspectives
α-Gal Syndrome in the South: Why We Need Treatment Trials, Not Just Tick Prevention
α-Gal syndrome (AGS), a tick bite-associated allergy to mammalian meat, affects an estimated 450,000 Americans, with the highest prevalence concentrated in the US South and Southeast. The lone star tick (Amblyomma americanum), ubiquitous across the region, transmits AGS sensitization, making reexposure nearly inevitable for outdoor workers and residents. Current management...
Posted in: Allergy and Immunology11 Anaphylaxis1
SMJ Article | Original Article
Prostate Cancer Screening Shared Decision Making and Prostate-Specific Antigen Testing in Black and Non-Black Men in Primary Care in South Carolina
Objective: Black men experience disproportionate prostate cancer mortality compared with men of other races. As of 2018, major guidelines concur that all men make informed decisions about whether to be screened for prostate cancer after a discussion with their clinician. The objectives of this study were to determine the frequency...
Posted in: Prostate Disorders4
SMJ Article | Acknowledgment
Joint Effect of Paternal and Maternal Age on the Prevalence of Low Birth Weight in the United States
Objective: Prior studies of the effect of father's age on the risk of low birth weight (LBW, infant weight < 2500 g) have been inconclusive. In addition, previous investigators have not conducted a detailed analysis to determine whether paternal age (PA) interacts with maternal age (MA) on the outcome of...
Posted in: Obstetrics and Gynecology87 Pregnancy35
SMJ Article | Original Article
Assessing the Accuracy and Reliability of ChatGPT-4 to Answer Clinical EHR Messages in Sports Medicine
Objectives: Although advancements in electronic health records (EHRs) have improved clinical productivity, digital administrative responsibilities have led to increased physician burnout. With the emergence of large language models (LLMs), their incorporation into medicine is a potential solution to the increase in tasks such as charting and responding to patient messages....
SMJ Article | Original Article
When the Dog Bites: A 5-Year Retrospective on Canine Bite Encounters
Objectives: This study addresses two objectives: to describe the epidemiology of dog bite-related emergency department (ED) visits and to evaluate changes in the rate of dog bite visits from 2019 to 2023. Methods: Dog bite visit data from the Children's Injury Database were analyzed. Descriptive statistical and epidemiologic analyses were...
SMJ Article | Original Article
Insurance Type Affects Access to Care for Young Football Athletes with Hip Labrum Tears
Objectives: Patients with Medicaid compared with private insurance have increased difficulty gaining access to orthopedic care. How insurance status affects access to care for young athletes (football; from here, all "young athletes" are football players) with hip labrum tears has yet to be assessed. The purpose of this study was...
Posted in: Rheumatology and Orthopedics26
SMJ Article | Review Article
Therapeutic Approach to Heart Failure Management: Insight from Clinical Trials
Heart failure (HF) is a global burden and, irrespective of age, sex, race, nationality, and geography, affects individuals across the world. Several reports mentioned that, globally, more than 64 million people, which accounts for 1% to 3% of the total global population, are living with HF. In the United States,...
Posted in: Cardiovascular Disease34
SMJ Article | Original Article
Outcomes of Hepatitis C Virus Testing and Treatment at a Rural Safety Net Clinic in East Tennessee
Objectives: Hepatitis C virus (HCV) is the most common bloodborne infection in the United States and a leading cause of liver-related morbidity. Tennessee is among the top 10 states for a patient population living with HCV, and it is especially prevalent in the Appalachian counties. The purpose of this study...
Posted in: Infectious Disease144
SMJ Article | Original Article
Practical Wisdom Through Narratives as Told by Medical Students and Physicians
Objective: Medicine, as both clinical and moral practice, is increasingly complex. As such, there is growing appreciation for the importance of practical wisdom (phronesis), a multidimensional capacity that clinicians develop as they navigate practice. Narrative serves as a mode by which clinical exemplars communicate wisdom and therefore provides a rich...
SMJ Article | Review Article
Mood Stabilizers Are the First Line of Treatment for Bipolar Disorder
Although lithium and other mood stabilizers remain the preferred agents for bipolar disorder, their clinical use has been declining steadily while antipsychotic and antidepressant use has been increasing. We performed an integrative review of efficacy, mechanisms of disease, and drug effects. The most reproduced biologic abnormality during the ill phases...
Posted in: Psychiatry10 Mood Disorders1
SMJ Article | Errata
Training with Artificial Intelligence: Are There Hidden Costs in Clinical Reasoning and Medical Education?
Training with Artificial Intelligence: Are There Hidden Costs in Clinical Reasoning and Medical Education? Maya Guhan, MD, MBA, Chirayu Shah, MD, and Prathit A. Kulkarni, MD When this article was originally published in the February 2026 issue, the following disclaimer should have been included. The views and opinions expressed in...
SMJ Article | Original Article
NET Rounding: A Standardized Rounding Intervention to Improve Rounding Efficiency and Optimize the Inpatient Experience for Internal Medicine Attendings and Residents
Objectives: There is a scarcity of published best practices for efficient and effective hospital rounds. We introduced a standardized rounding intervention (NET Rounding, or Novel Rounding Practices, Shared Expectations, and Time Management) with the primary aims of improving rounding efficiency, reducing resident work-hour violations, and positively affecting clinician experience. Secondary...
SMJ Article | Original Article
Linking Breastfeeding Support Training and Certification to Knowledge, Self-Efficacy, and Attitudes among Alabama Healthcare Professionals
Objectives: This study aimed to determine whether healthcare professionals' breastfeeding-related training and certification are associated with breastfeeding support knowledge, self-efficacy, and attitudes. Methods: An online survey was created by modifying existing instruments. Items assessed Alabama healthcare professionals' certification in breastfeeding support, breastfeeding support-related training experience, knowledge, self-efficacy, and attitudes. Participants...
Posted in: Obstetrics and Gynecology87
