SMJ // June 2006, Volume 99 - Issue 6

Original Article

Adherence and Persistence Associated with the Pharmacologic Treatment of Osteoporosis in a Managed Care Setting

Background: The effectiveness of chronic therapies can be compromised by poor adherence and persistence. Materials and Methods: Investigators identified a continuously benefit-eligible cohort of women from a large, geographically diverse, national managed care plan who were newly diagnosed and treated for osteoporosis with alendronate, risedronate, or raloxifene. Drug utilization parameters…

Case Report

Fusarium oxysporum Pneumonia in an Immunocompetent Host

Abstract:A case of symptomatic pulmonary infection caused by Fusarium oxysporum occurred in a woman after she had cleaned out bird droppings from a boat house. She was also a gardener who had mild, chronic obstructive lung disease, but who had no evidence of systemic immunosuppression. She was treated with oral…

Spirituality/Medicine Interface Project

A Prevalence Study of Faith-based Healing in the Rural Southeastern United States

Background:Although prayer and other spiritual practices are common among residents of the rural south, the use of faith-based healers (FBH), or healers who use prayer as their primary healing modality, has not been explored in this population. Methods:Secondary data analysis from a random digit dialing telephone survey of rural adults…

Case Report

Orbital Hydatid Cyst in Childhood: A Report of Two Cases

Abstract:Intraorbital hydatid disease (IHD) is quite rare and represents < 1% of the Echinococcus cases. In our current communication, we report two children with solitary, primary intraorbital hydatid cysts. Both children presented with nontender, nonpulsatile proptosis. Imaging workup, including CT and MRI scans of the head and the orbits, revealed…

Spirituality/Medicine Interface Project

Alcohol Recovery and Spirituality: Strangers, Friends, or Partners?

Abstract:Alcoholics Anonymous, with its steady but nonspecific promotion of belief in a higher power and its emphasis on the group process, long held a near-monopoly in the outpatient alcohol recovery field, but its hegemony has now been challenged by two very different perspectives. The first is a nonspiritual approach that…

Review Article

Efficacy and Central Nervous System Impairment of Newer-generation Prescription Antihistamines in Seasonal Allergic Rhinitis

Abstract:Allergic rhinitis is a highly prevalent disorder and oral antihistamines are often used to manage patient symptoms. Older-generation antihistamines, such as diphenhydramine and chlorpheniramine, are effective at relieving the symptoms of seasonal allergic rhinitis (SAR); however, they are associated with adverse events, including sedation and impairment, at, or above, the…

Original Article

Financing and Budgeting of Community-based Family Medicine Residency Programs

Abstract:Using an Internet-based survey for the fiscal year 2003 to 2004, 56 community-based family medicine residency programs participated in primary research of current financing and expenditures. A median of $194,125 was invested in training each resident annually. The bulk of funding stemmed from sponsoring institution support and clinical care revenues….

Spirituality/Medicine Interface Project

Chaplaincy in Europe

Abstract:Chaplaincy is organized in Europe in various ways, depending on the cultural, religious, social and governmental aspects which shape healthcare. One of the uniting forces in bringing national chaplaincies together into one united body has been the European Network of Health Care Chaplaincy (ENHCC). Chaplaincy in Europe faces two major…

Spirituality/Medicine Interface Project

What Training Should Be Required as an Education Standard for Healthcare and Hospital Chaplains?

Abstract:This document discusses training for hospital and healthcare chaplains in the light of different UK standards applied by various interested parties. It considers the different standards and concludes that there is no single applied standard for training for National Health Service (NHS) hospital chaplains across the UK. Those models that…

Review Article

Outpatient Management of Cirrhosis: A Narrative Review

Abstract:Cirrhosis is the 12th leading cause of death in the United States. Individuals with cirrhosis are at risk for many potential complications. Complications can be managed or detected early with proper outpatient management. The most lethal of these complications is bleeding esophageal varices. All patients with cirrhosis should be screened…

Case Report

A Newborn with Beals Syndrome

Abstract:We present the case of a newborn with multiple connective tissue abnormalities. Careful examination of the infant and a detailed history from his mother indicated that they were both affected by Beals syndrome (congenital contractural arachnodactyly). A viable-term male infant was delivered to a healthy 30-year-old. The parents had no…

Spirituality/Medicine Interface Project

The Development, Status, and Future of Healthcare Chaplaincy

Abstract:This review article provides insight into the evolution of professional healthcare chaplaincy. It identifies key historical developments identifying the training, qualifications, and competencies of chaplains. Consideration is given to both the unique character of the pastoral role in healthcare as well as the contribution of chaplains to the interdisciplinary care…

Expired CME Article

Perioperative Glucose Control in the Diabetic or Nondiabetic Patient

Patients with diabetes are more likely to undergo surgery than nondiabetics, and maintaining glycemic control in subjects with diabetes can be challenging during the perioperative period. Surgery in diabetic patients is associated with longer hospital stay, higher health care resource utilization, and greater perioperative mortality. In addition, several observational and…

Case Report

Invasive Aspergillosis with Central Nervous System Dissemination in a Presumably Immunocompetent, Non-neutropenic Patient: Case Report and Review

Abstract:We present a case of a 45-year-old gentlemen with invasive Aspergillosis who has no apparent immune deficiencies. Follow up imaging shows improvement after the initiation of therapy. The case is accompanied by a brief discussion over invasive aspergillosis.

Original Article

Adherence and Persistence Associated with the Pharmacologic Treatment of Osteoporosis in a Managed Care Setting

Background:The effectiveness of chronic therapies can be compromised by poor adherence and persistence. Materials and Methods:Investigators identified a continuously benefit-eligible cohort of women from a large, geographically diverse, national managed care plan who were newly diagnosed and treated for osteoporosis with alendronate, risedronate, or raloxifene. Drug utilization parameters were evaluated…

Original Article

Prevalence of Peripheral Arterial Disease in a Cohort of Diabetic Patients

Background:The aim of this study was to determine the prevalence of peripheral diseases in diabetics of different age groups, the role of color Doppler in peripheral arterial disease in diabetics, and to compare the prevalence of peripheral arterial disease (PAD) in diabetics taking different therapy modalities. Methods:In a hospital-based prospective…

Case Report

Ceftriaxone-resistant Salmonella Septicemia and Osteomyelitis in Sickle Cell Disease Adults

Abstract:The majority of data evaluating Salmonella infections in sickle cell anemia (SCD) comes from studies performed in children. We report a SCD adult who presented with ceftriaxone-resistant Salmonella bacteremia. After appropriate initial therapy, persistent back pain prompted evaluation by magnetic resonance imaging of the spine, which revealed osteomyelitis and a…

Case Report

Saw Palmetto-induced Pancreatitis

Abstract:Saw palmetto is a frequently used botanical agent in benign prostatic enlargement (BPH). Although it has been reported to cause cholestatic hepatitis and many medical conditions, Saw palmetto has not been implicated in acute pancreatitis. We report a case of a probable Saw palmetto induced acute hepatitis and pancreatitis. A…

Case Report

Management of a Circumferential Lower Extremity Degloving Injury with the Use of Vacuum-assisted Closure

Abstract:A 58-year-old male presented with a large circumferential degloving injury and was immediately taken to the operating room for further assessment of his wound. At that time, a plastic surgeon was consulted to manage the wound due to its size and significant soft tissue loss. The decision was made to…

Editorial

Negative Pressure Wound Therapy: An Important Adjunct to Wound Care

The advent of negative pressure wound therapy (NPWT) is a major development in wound care. It has now given physicians and primary care providers another option in dealing with complex wounds. Since Argenta first reported his series of patients who utilized NPWT in 1997,1 there has been an explosion in…

Editorial

Outpatient Management of Cirrhosis

Cirrhosis is an advanced stage of liver disease caused by a variety of insults to hepatic parenchyma including infections, autoimmune processes, genetic disorders and toxins. It is characterized by extensive fibrosis with nodule formation and interruption of normal hepatic blood flow. The major complications of cirrhosis are ascites, gastroesophageal varices-related…

Editorial

Perioperative Glucose Control: How Tight Is Just Right for Everyone?

In this issue of the Southern Medical Journal, Smiley and Umpierrez1 provide a concise summary of perioperative glucose control in the diabetic patient, a topic that deserves the attention of all practitioners caring for such patients. As they describe, in-hospital hyperglycemia is an independent risk factor for adverse outcomes in…

Expired CME Article

CME Questions: Perioperative Glucose Control in the Diabetic or Nondiabetic Patient

Expired CME Article Questions: Perioperative Glucose Control in the Diabetic or Nondiabetic Patient

Expired CME Credit Submission and Evaluation Form

CME Credit – June 2006 CME Topic: Perioperative Glucose Control in the Diabetic and Nondiabetic Patient

Expired CME Credit Submission and Evaluation Form – Perioperative Glucose Control in the Diabetic and Nondiabetic Patient

Letter to the Editor

A Case of Acute Hepatitis due to Brucellosis

To the Editor:Brucellosis is a multisystemic infection that can affect any organ system in the body as well as the liver. Hepatic involvement in brucellosis is not rare and hepatomegaly may be documented in 15 to 20% of cases. However, liver function tests are usually mildly elevated.1 Here, we report…

Letter to the Editor

Aspartame-induced Sjögren Syndrome

To the Editor:The publication of three features on Sjögren syndrome in the December 2005 edition of the Southern Medical Journal warrants brief comment because of my longstanding interest in this disorder, and personal observations/research therein relative to the provocative role of products containing aspartame (NutraSweet, Equal).

Letter to the Editor

Concomitant Nephrotic Syndrome with Antinuclear Antibody Seropositivity and Hashimoto Thyroiditis in a Patient with Mycosis Fungoides

To the Editor: Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of lymphoproliferative disorders, of which mycosis fungoides (MF) is the most common type. As premorbid conditions associated with CTCLs, kidney and thyroid disorders have rarely been reported.1–4 We present a case of nephrotic syndrome with antinuclear antibody (ANA) seropositivity…

Letter to the Editor

CT Scans and Appendicitis

To the Editor:The December issue of the Journal had an interesting perspective on appendicitis. The CT scan has usurped the physical diagnostic acumen of all doctors.

Medical Webwatch

Medical Webwatch

This Practical Guide to Clinical Medicine http://medicine.ucsd.edu/clinicalmed/head.htm is an extensive education package for medical students and other health care professionals. It is written by Charlie Goldberg,, MD, University of San Diego School of Medicine and describes the physical examination of a patient. Split into 25 parts it starts with the…

Acknowledgment

Patient’s Page

Alternatives to Alcoholics AnonymousAlcoholics Anonymous, or AA, is undoubtedly the most well-known alcohol treatment program in the United States, with over a million members. AA, which centers on group therapy and a spiritual-based approach to addiction, has become the standard outpatient model for continued recovery from alcoholism. AA teaches that…

SMA Centennial

Revolutions in the Care of Diabetes with the Help of Dogs and Lizards

During the last century, diabetes has changed in character from a relatively rare disease which was uniformly fatal, characterized by weight loss and best treated with a low-calorie, high-protein diet (type 1), to a common disease characterized by obesity and treated with agents that promote weight loss and a low-calorie…

Spirituality/Medicine Interface Project

A Physician CEO Looks at Clinical Pastoral Education

Having been involved in academic medical practice for most of my professional career, it was not surprising that this interest would extend to a personal evaluation of the value of a Clinical Pastoral Education (CPE) Program in the same fashion as other academic programs. All of my practice has been…

Spirituality/Medicine Interface Project

Best Practices in Professional Pastoral Care

Consensus is developing in the field of professional pastoral care around the several best practices. The discipline is becoming a multi-faith, referral service. Generally, it is no longer the case that particular clergy come in and visit all of the patients of their faith tradition. This model does not make…

Spirituality/Medicine Interface Project

Chaplains, the Hidden Assets

As we embark on our exploration of the Spirituality/Medicine Interface Project, I would like to emphasize that it is not our intention to advocate that clinicians attend to the spiritual needs of patients under their care. The overarching goal of this series is to highlight the impact the patients” spirituality…

Spirituality/Medicine Interface Project

Common Standards for Professional Chaplaincy

This document is one of four foundational documents affirmed by the constituent boards of the Council on Collaboration on November 7, 2004 in Portland, Maine. Collectively, these documents establish a unified voice for the six organizations that have affirmed them and describe what it means to these organizations to be…

Spirituality/Medicine Interface Project

Controversies in Medical Ethics: Training in Abortion

Confucianism has survived centuries of criticism and reform, and it is still the chief governing social force of modern Chinese. Sometimes, Confucianism is referred to as ethical humanism, due to its strong emphasis on societal living. Based on the premises that heaven and earth is one, and each individual is…

Spirituality/Medicine Interface Project

Eye on Religion: Confucianism, Autonomy and Patient Care

Chinese culture can be represented by two dominant philosophical traditions, Confucianism and Daoism. Both have focused their efforts in delineating Dao in a different sphere: Confucianists are concerned primarily with the proper way an individual should conduct his life in the social context, while Daoists are devoted to searching for…

Spirituality/Medicine Interface Project

Eye on Religion: Cultural Signs and Caring for Chinese Patients

Confucianism has survived centuries of criticism and reform, and it is still the chief governing social force of modern Chinese. Sometimes, Confucianism is referred to as ethical humanism, due to its strong emphasis on societal living. Based on the premises that heaven and earth is one, and each individual is…

Spirituality/Medicine Interface Project

Eye on Religion: Understanding the Cultural/Religious M’lange in Treating Chinese Patients

Confucianism, Daoism, Buddhism, and belief of cosmic and human connection have permeated the concepts of religion and health in Chinese culture for thousands of years. Awareness of this mélange of culture, religion, and body concept will equip healthcare professionals with the knowledge to support Chinese patients in achieving the best…

Spirituality/Medicine Interface Project

Interacting with Patients of a Different Faith: The Personal Reflection of a Buddhist Chaplain

How can a spiritual care provider interact on a meaningful level with patients whose faith beliefs are so radically different from his or her own? How can we provide spiritual comfort to families who are using religious resources that are so far outside the chaplain”s theological area of expertise? These…

Spirituality/Medicine Interface Project

Ministering to Patient and Person

As we have been frequently reminded, the spiritual and the medical were once joined in the same figure. Since the days of the Enlightenment, however, the trend has been to encourage a divide between the arts that minister to the body and those that minister to the soul. In so…

Spirituality/Medicine Interface Project

Setting Common Standards for Professional Chaplains in an Age of Diversity

The training of chaplains and ministers in the United States has a long history. The story has its beginnings in the mid 1920s, when the new form of theological education known as Clinical Pastoral Education (CPE) was developed by Dr. William A. Bryan, Superintendent of the Worcester State Hospital, MA,…

Spirituality/Medicine Interface Project

Standards for Healthcare Chaplaincy in Europe

Standards for Healthcare Chaplaincy in Europe is a collective statement, which expresses the caring work of faith groups in the area of healthcare throughout Europe. It is meant to be a point of reference and a guide for all faiths and denominations in shaping spiritual care offered in the area…

Spirituality/Medicine Interface Project

The Use of Spirituality in Alcohol Recovery

Alcoholics Anonymous (AA) is the 800-pound gorilla in the treatment of problem drinking, and for good reason. The 12-step treatment program has been the most popular method for treating alcoholism in the United States for the past 70 years. It currently boasts of having more than 100,000 groups with over…

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