Issue - Southern Medical Association

Original Article

Maternal/Perinatal Outcome in Women with Sickle Cell Disease: A Comparison of Two Time Periods

Objective: To compare pregnancy outcomes in women with sickle cell disease from recent deliveries with a similar group delivered earlier. Methods: During a 12-year period (2005–2016), data from pregnant women with hemoglobin SS or SC were collected from three university medical centers and compared with earlier studies (1979–2003) involving similar…

Multidisciplinary Clinical Case Study

Uremic Pericarditis: Distinguishing Features in a Now-Uncommon Clinical Syndrome

We present the case of a 47-year-old man with a history of diabetes mellitus and diabetic nephropathy who was admitted to our hospital with acute uremic myopericarditis. Echocardiography demonstrated a fibrinous pericardial effusion. The patient was initiated on hemodialysis for hyperkalemia, metabolic acidosis, and uremia. He subsequently developed shock from…

Original Article

Medical Student H&Ps: Do You Have to Observe Them All At Once?

Objectives: Direct observation of medical students’ history and physical examination (H&P) skills by attendings is essential in ensuring trainees’ competence. This study compared whether partial observations by multiple pediatric attendings across various clinical encounters versus a full observation by one attending affected students’ performance on the pediatric Objective Structured Clinical…

Original Article

Physician Advance Care Planning Experiences and Beliefs by General Specialty Status and Sex

Objectives: Advance care planning (ACP) involvement could be substantially different by physician specialty or sex group, with implications for training and methods to increase ACP activities. The objective of this article is to compare primary care physicians (PCPs) and other specialty physicians and female compared with male physicians’ views and…

Original Article

Prehospital Airway Management in Iraq and Afghanistan: A Descriptive Analysis

Objectives: Airway failures are the second leading cause of potentially preventable death on the battlefield. Improvements in airway management depend on identifying current challenges. We sought to build on previously reported data on prehospital, combat airway management. Methods: We used a series of emergency department procedure codes to identify patients…

Original Article

Demographic and Practice Characteristics of Physicians Who Care for Medically Underserved People: A National Survey

Objectives: Few national studies have examined the influence of role models as a potential predictor for caring for medically underserved (MUS) patients. This study tested associations between previous physician role model exposure and caring for MUS populations, as well as examines the practice environments of these physicians. Methods: Between October…

Original Article

Impact of an Innovative Psychiatric Consultation Liaison Model on Provider Satisfaction with Care of Behaviorally Complex Patients

Objectives: The increasing behavioral acuity and complexity of hospitalized patients overwhelms providers’ capacity to effectively manage their behaviors. Hospitals must train their providers in how to cope with these behaviors to provide high-quality care. In addition to improved patient care, increased capacity to manage these challenging patients may improve resilience…

Invited Commentary

Commentary on “Prehospital Airway Management in Iraq and Afghanistan: A Descriptive Analysis”

In this issue of the Southern Medical Journal, Schauer and associates address the vitally important issue of airway management in combat casualty care.1 Using data from the Department of Defense Trauma Registry, the authors provide qualitative information on the “what, where, when, and how” of airway placement in wounded patients…

Original Article

Influences on Primary Care Provider Imaging for a Hypothetical Patient with Low Back Pain

Objective: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. Methods: An online survey asking 469 primary care providers (PCPs) across four practice sites whether…

Original Article

Stress Electrocardiography vs Radionuclide Myocardial Perfusion Imaging among Patients Admitted for Chest Pain: Comparison of Teaching and Nonteaching Hospital Services

Objectives: The American Board of Internal Medicine Foundation’s Choosing Wisely initiative has identified the routine use of stress cardiac imaging among lower-risk patients as an expensive test that should be questioned by both physicians and patients. The objectives of this study were to determine how often patients hospitalized for chest…

Original Article

Teaching to Teach: An Effective and Feasible Teaching Curriculum for Internal Medicine Interns

Objectives: New competency requirements from the Accreditation Council for Graduate Medical Education have prompted greater emphasis on developing residents’ teaching skills. Many residents make their first foray into teaching during internship, making it an important yet underrecognized opportunity to develop basic teaching skills. In addition, in the current graduate medical…

Review Article

Invasive Mechanical Ventilation

Invasive mechanical ventilation is a potentially lifesaving intervention for acutely ill patients. The goal of this review is to provide a concise, clinically focused overview of basic invasive mechanical ventilation for the many clinicians who care for mechanically ventilated patients. Attention is given to how common ventilator modes differ in…

Original Article

Adverse Events in the Efficacy of Crotalidae Polyvalent Immune Fab Antivenom vs Placebo in Recovery from Copperhead Snakebite Trial

Objective: To compare the incidence of hypersensitivity reactions following copperhead envenomation treated with Fab antivenom (FabAV) or placebo. Methods: Patients with copperhead snakebites received treatment and follow-up in a prospective, randomized, double-blind, placebo-controlled trial of FabAV or placebo. The treatment allocation ratio was 2:1 (FabAV:placebo). All of the included patients…

Invited Commentary

Commentary on “A Misguided Venture: Presidential Fitness and the Duty to Warn”

For >40 years, the Tarasoff duty to warn of a threat to kill has become an accepted part of medical care. The use of this warning by physician political activists is new. In this response to the editorial by Kels and Kels1 in this issue of the Southern Medical Journal,…

Editorial

A Misguided Venture: Presidential Fitness and the Duty to Warn

A small but vocal cadre of mental health professionals has questioned President Donald Trump’s fitness for office and claimed that his mental state is dangerous.1,2 These experts have frequently cited a “duty to warn” as the ethical basis for their outspokenness.3 The rallying cry of an obligation to protect the…