Southern Medical Journal

OBJECTIVES: The objective of this study was to describe ethical and professional issues encountered and the ethical and professional values cited by medical students during their critical care clerkship, with a comparison of issues encountered before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In this single-center, retrospective mixed-methods study, two investigators at a midwestern US academic medical center performed qualitative content analysis on reflections written by fourth-year medical students about ethical and professional issues encountered during their critical care rotations between March 2016 and September 2021...

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OBJECTIVES: Interhospital transfer (IHT) and in-hospital delirium are both independently associated with increased length of stay (LOS), mortality, and discharge to facility. Our objective was to investigate the joint effects between IHT and the presence of in-hospital delirium on the outcomes of LOS, discharge to a facility, and in-hospital mortality. METHODS: This was a single-center retrospective cohort study of 25,886 adult hospital admissions at a tertiary-care academic medical center...

Letters of recommendation (LORs) are an essential component of a career in medicine. The process for obtaining certain letters, particularly those associated with scheduled periods of professional transition, often is governed by established institutional or specialty norms. The process of requesting LORs in more common scenarios-local or national awards, committee assignments, and leadership positions-many times is less clearly defined, however. Despite the important role that LORs play in professional development, the published literature on how to solicit a recommendation is limited, creating challenges for both those requesting LORs ("applicants") and the letter writers...

OBJECTIVES: In the United States, falls are the leading cause of fatal and nonfatal injuries for geriatric patients. With a growing aging population, medical trainees must gain experience with geriatric assessments, including fall risk and prevention. To the authors' knowledge, no prior studies have explored who most often initiates fall discussions between Internal Medicine (IM) residents and geriatric (age 65 years and older) patients. Our objective was to determine who most often initiates fall discussions between IM residents and geriatric patients and the barriers to having these discussions...

OBJECTIVE: Women physicians face various forms of inequities during their training process that inhibit them from reaching their full potential. As a response, several academic institutions have established women in medicine (WIM) programs as a support system. Our objective was to investigate the prevalence of WIM programs at university-based Internal Medicine residency programs as of December 2021. METHODS: Using the Fellowship and Residency Electronic Interactive Database, we identified 145 university-based Internal Medicine residency programs...

OBJECTIVES: Diversity, equity, and inclusion (DEI) training is essential to graduate medical education, but it lacks standardization. Although the impact of providers' biases and cultural competency on patient outcomes is well documented, the value of and satisfaction with DEI curricula in Pediatrics residency training programs is not well studied. This study aimed to complete a cross-sectional evaluation of the current DEI curriculum at a large Pediatrics-focused academic institution and identify areas of perceived deficiency among Pediatrics trainees...

OBJECTIVES: Inflammatory bowel disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC). These two chronic inflammatory conditions can differ in severity, presentation, and anatomical localization, and can greatly affect quality of life if not managed properly. Given the many healthcare challenges during the coronavirus disease 2019 pandemic, we studied the effects of the pandemic and corresponding changes to medical resources on surgical outcomes for patients with IBD...

OBJECTIVES: Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol, illicit drugs, or both. SUDs are pervasive and endemic among US adolescents, with potentially negative health and social consequences. Although the term experimentation normalizes adolescent substance abuse, the long-term consequences of this behavior beginning in adolescence can be detrimental to not only the adolescent but also the adult into which he or she develops. Our objective was to examine the epidemiology of SUD among hospitalized US adolescents, 13 to 19 years of age, during the time period 2000-2019...

OBJECTIVES: Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database. METHODS: We used the 2020 California State Inpatient Database for this retrospective analysis...

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Without rural hospitals, many patients may not have access to essential services, or even any health care. Rural hospitals provide a community hub for local access to primary care and emergency services, as well as a bridge to specialized care outside the community. The goal of this review was to demonstrate how the University of Arkansas for Medical Sciences supports and empowers rural hospitals through an alliance that provides cost savings through clinical networks, collaborative purchasing, and leveraged services; workforce recruitment and education; telemedicine and distance learning; community outreach; and access to best practices, resources, and tools for hospital transformation...

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OBJECTIVES: The management of patients at risk of severe alcohol withdrawal is challenging because conventional treatment with as-needed benzodiazepines may be ineffective. We created a fixed-dose phenobarbital protocol and compared patient outcomes using this protocol with an as-needed benzodiazepine protocol. METHODS: Patients admitted from the emergency department (ED) to General Medicine from January 1 to June 30, 2022 and treated for alcohol withdrawal with a novel phenobarbital protocol were compared with all of the patients admitted from the ED to General Medicine from January 1 to June 30, 2018, and treated with as-needed benzodiazepines...

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OBJECTIVES: The objective was to understand the characteristics of patients who used telemedicine for diabetes management to inform future implementation of telemedicine. METHODS: We examined patient characteristics associated with telemedicine use for diabetes mellitus (DM) care between March 1, 2020 and April 1, 2021 (the coronavirus disease 2019 pandemic period) in a large university health system when telemedicine visits increased rapidly. Logistic regression models assessed patient characteristics associated with telemedicine visits and delays in DM process measures (hemoglobin A1c checks, nephropathy, and retinopathy evaluations) during the pandemic period after adjusting for potential confounders and corresponding values before the pandemic period (March 1, 2019-February 29, 2020)...