Issue - Southern Medical Association

SMJ Response

SMJ Response

As emergency medicine physicians, we are aware of the dreaded recurring patient: the “regulars,” “frequent flyers,” “repeaters,” “frequent visitors,” and “superusers.” The problem, however we name it, is recidivism. Recidivism is “a tendency to relapse into a previous condition or mode of behavior; especially: relapse into criminal behavior.1

Original Article

Chronic Opioid Users Are More Difficult to Sedate than Alcoholics and Controls

Objectives: Diagnostic and therapeutic colonoscopy is performed using conscious sedation. Excessive alcohol users, chronic benzodiazepine and opioid users, and polysubstance users are commonly cited as difficult to sedate. Few studies have compared and analyzed medication dosages to achieve sedation in these groups. Methods: The endoscopic database was searched for patients…

Original Article

Open-Access Single Balloon Enteroscopy: A Tertiary Care Experience

Objectives: To compare single balloon enteroscopy (SBE) between patients seen in consultation by a member of our gastroenterology team with those performed as open-access cases. Methods: Retrospective study of all patients who underwent SBE at a single tertiary care center from April 2008 to January 2012. Open- and closed-access procedures…

Original Article

Overuse of Acid-Suppression Therapy at an Urban Tertiary Hospital

Objectives: Acid-suppressive therapy (AST) is widely used for gastrointestinal prophylaxis in hospitalized patients, particularly to prevent stress-related mucosal bleeding in critically ill individuals. Previous reports suggest gross overutilization and continuation of unnecessary therapy, which have been linked to several adverse effects. Methods: Retrospective chart review at a large tertiary care…

Letter to the Editor

Characteristic Predictors that Increase the Pretest Probability of Legionnaires Disease: “Don’t Order a Test Just Because You Can” Revisited

To the Editor: I read with interest the article “Don’t Order a Test Just Because You Can” by Galen and colleagues on the overordering of diagnostic tests in community-acquired pneumonia (CAP) for Streptococcus pneumoniae and Legionnaires disease (LD). The authors’ title summarizes the problem with the current test-driven approach to…

Original Article

Pain Scores and Exposure Rates after Polypropylene Mesh for Pelvic Organ Prolapse

Objectives: To characterize pain and exposure after Prolift placement and identify risk factors. Methods: A case series of women who underwent Prolift vaginal mesh were surveyed. Pain was assessed using a visual analog scale. Exposure was evaluated clinically. Results: Of 183 eligible patients, 160 completed the survey, and 45 returned…

Original Article

Impact of Neighborhood Environments on Health Consciousness, Information Seeking, and Attitudes among US-Born and Non–US-Born Free Clinic Patients

Key Points Social cohesion is important for health education because of its positive role on health consciousness, information seeking, and attitudes among free clinic patients. Lower levels of the availability of healthy food in the community were associated with higher levels of health consciousness among free clinic patients. Although Spanish-speaking…

Perspectives

Reducing Readmission Rates by Improving Transitional Care

Hospital readmission rates are used increasingly as a measure of healthcare systems’ overall efficacy. Improving care coordination across the continuum of healthcare delivery is crucial to reducing readmission rates. Patients with ambulatory sensitive conditions and patients without a primary care physician (PCP) often seek care in emergency departments (EDs) in…

Invited Commentary

Commentary on “Pain Scores and Exposure Rates after Polypropylene Mesh for Pelvic Organ Prolapse”

In the past decade, mesh has evolved into “MESH,” a 4-letter word for the information age. It has permeated the mainstream media, dominating both the airwaves and the Internet. The populace has been told that the mere presence of mesh in the human body is equivalent to a ticking time…

Review Article

Limitations of A1c Interpretation

Hemoglobin A1c is the measurement of glycated hemoglobin and can aid in both the diagnosis and continued management of diabetes mellitus. Accurate glycosylated hemoglobin A1c (A1c) measurements are an essential part of decision making in the diagnosis and treatment of type 2 diabetes mellitus. Although national standards exist to eliminate…

Original Article

Is Early Reperfusion a Good Thing? Optimal Timing of CABG Surgery Postacute Myocardial Infarction

Objectives: The optimal timing of coronary artery bypass grafting (CABG) following an acute myocardial infarction (AMI) is a topic of debate. The present study was designed to evaluate patients undergoing CABG both early (5 days) after AMI in the era of percutaneous coronary intervention. Methods: The medical records at our…

Original Article

Developing and Implementing a Citywide Asthma Action Plan: A Community Collaborative Partnership

Objectives: Asthma affects 1 in 10 children in the United States, with higher prevalence among children living in poverty. Organizations in San Antonio, Texas, partnered to design and implement a uniform, citywide asthma action plan to improve asthma management capacity in schools. Methods: The asthma action plan template was modified…

Original Article

Enteral Nutrition Support Reduces the Necessity of Total Parenteral Nutrition to Reach Patient-Specific Caloric Goals Postpancreaticoduodenectomy

Objectives: Pancreaticoduodenectomy (PD) is associated with significant rates of postoperative complications. Although there is evidence that enteral nutrition support (ENS) may reduce postoperative sepsis, the true value of ENS in the abrogation of septic complications remains controversial. The aim of our study is to investigate the postoperative outcome of patients…

Invited Commentary

Commentary on “Limitations of A1c Interpretation”

The measurement of hemoglobin A1c (A1c) is an essential element in the clinical management of diabetes mellitus. The single most important advance in diabetes mellitus care during the past century was the introduction of insulin. The second most important advance, arguably, was the development of home glucose monitoring methods, which…

Letter to the Editor

Familiarity Breeds Contempt: “Frequent Fliers” in Medicine

To the Editor: “Oh, he is here again after swallowing some razor blades,” thought the emergency department (ED) team members when Mr R presented to the ED with suicidal ideation and abdominal pain. As per the routine, he was placed in the psychiatry unit of the ED while he was…