Southern Medical Journal最新文献

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly, occurring in 0.3% to 0.5% of the general population and in 10% of patients with congenital heart disease. Historically considered benign, PLSVC is increasingly recognized for its clinical significance in the fields of interventional cardiology, electrophysiology, and surgery. The present narrative review combines the available evidence regarding PLSVC, focusing on its embryology, anatomical variants, diagnostic challenges, and tailored management strategies, to address clinical uncertainties and improve procedural outcomes for patients undergoing intervention. The clinician needs to understand the risk for right-to-left shunting of PLSVC, procedural risk during placement of the catheter or device, and its association with arrhythmias and stroke. Common in high-risk patients (eg, in congenital heart disorders, unexplained hypoxia), early detection by advanced imaging and forward procedural planning are key to reducing complications and optimizing patient outcomes.

Objectives: Internal Medicine (IM) clerkships are a core clinical experience in medical school where third-year students (MS3s) learn and apply their medical knowledge to patient care. How students approach learning from direct patient care is shaped by their team environment, notably their attending physicians. Less, however, is known about how attending physicians conceptualize their instructional role in supporting student learning within resident-led inpatient teams. We examined how IM attendings understand how MS3s learn on the wards and how attendings conceptualize their role in supporting that learning within resident-led inpatient teams.

Methods: The authors conducted 20 semistructured interviews of IM attendings who supervised MS3s on inpatient teams in 2024. Participants were asked about how students learn from patient care and their role in supporting this learning. Data were analyzed iteratively through qualitative description using inductive thematic analysis.

Results: Twenty attendings participated in 30-minute semistructured interviews, resulting in thematic sufficiency. Three major themes emerged from the interviews: attendings must navigate their teaching role within resident-led teams, competing system and evaluative demands shape student engagement in clinical learning, and integration of clinical experience and structured autonomy enhance medical knowledge learning. Attendings held varying interpretations of their role in supporting student learning and described how students required guidance in navigating competing expectations. This ranged from providing direct student teaching to coaching residents in their instructional skills.

Conclusions: Attendings described differing instructional approaches within resident-led inpatient teams. Understanding these conceptualizations may help identify opportunities to align instructional expectations and support student learning from direct patient care.

Objective: The South Carolina Department of Public Health (SCDPH) Prescription Drug Monitoring Program (PDMP) is used to monitor the prescribing patterns of controlled substances, including opioids and stimulants. Data collected by the National Center for Health Statistics show that the number of drug overdose deaths involving opioids and stimulants has been increasing since 1999. Although databases such as the PDMP monitor healthcare professionals' prescribing habits regarding opioids and stimulants individually, there has been little research regarding opioid-stimulant coprescribing patterns. Considering increasing death rates and the lack of research, data from the SCDPH PDMP were used to identify factors that influence opioid-stimulant coprescribing. It was hypothesized that younger age, higher daily morphine milligram milliequivalents (MMEs), increased duration of prescription, and male gender would be associated with increased opioid-stimulant coprescriptions.

Methods: Data were gathered from the SCDPH PDMP from 2016 to 2021. The variables assessed included patient age, patient sex, filling date, supply length, daily MMEs, and Lexicomp Drug Classification. A linear regression statistical analysis was then performed to analyze the data.

Results: Between January 1, 2016 and December 31, 2021, a total of 9,785,146 opioid prescriptions were filled by 2,158,564 individuals, with 161,103 (1.65%) of them receiving a concurrent stimulant prescription. Patients who were 50 years of age and younger had a 2.74 greater odds of receiving a concurrent stimulant prescription (P<0.001), along with those who had an opioid prescription length of ≥ 30 days (odds ratio [OR] 4.38, P<0.001). Being female (OR 1.58) and a daily MME ≥ 50 mg but ≤100 mg (OR 1.24) were both significantly found to indicate an increased odds of having a concurrent prescription.

Conclusions: This study indicates that those with longer opioid prescriptions, younger individuals, higher daily MMEs, and women are at an increased risk of opioid-stimulant coprescription. Future research should investigate other factors associated with opioid-stimulant coprescribing, such as education status, rurality, and whether specific opioid or stimulant agents are linked to coprescribing.

Objectives: In this study, we aimed to characterize the landscape of the literature and describe lower urinary tract symptom (LUTS) care experiences using the Agency for Healthcare Research and Quality's (AHRQ's) patient experience framework, describe the characteristics of the studies, and identify critical knowledge gaps.

Methods: We performed a systematic search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus of peer-reviewed publications from 1995 to 2024. The search terms were related to LUTSs, drivers of healthcare inequities, and the domains of the AHRQ. We then performed a content analysis of the included studies.

Results: Of the 4597 articles reviewed, we included 11 studies in the analysis. The most studied LUTS was urinary incontinence (10/11, 91%). Of the included studies, six were comparative, and most (4/6, 66.7%) found worse care experience in patients with limited English proficiency and low socioeconomic status. When examining the studies using the care experience framework of the AHRQ, the most frequently evaluated domains of care experience were communication with clinicians (8/11, 73%) and access to care (8/11, 73%). For communication with clinicians, language barriers (3/11, 27%) and symptom minimization by clinicians (3/11, 27%) were common, especially among patients with limited English proficiency and of older age, respectively. In regard to access to care, concerns about healthcare costs (5/11, 45%) and patients' fear or embarrassment about accessing LUTS care (4/11, 36%) were commonly occurring themes, especially among racially minoritized groups.

Conclusions: The findings of this systematic review demonstrated that patients with limited English proficiency, older age, low socioeconomic status, and racially minoritized backgrounds have poor LUTS care experiences.

Objectives: This study aimed to assess the impact of delivering a fellow-led educational presentation on human immunodeficiency virus (HIV) health to medical trainees as a strategy of interprofessional education and recruitment in HIV medicine and infectious diseases.

Methods: Between July 2024 and April 2025, at the University of Texas Southwestern Medical Center, Infectious Diseases fellows designed and delivered in-person presentations on HIV health to medical trainees, including third-year medical students and second-year categorical Internal Medicine residents. Pre- and postpresentation, the trainees completed an eight-question survey, which was developed in accordance with recommendations from the Association for Medical Education in Europe. Using a 5-point Likert scale, seven survey questions measured self-reported knowledge of HIV care; one measured subspecialty interest in HIV medicine and/or infectious diseases. After converting participants' Likert scale responses to continuous variables on a 1-to-5 numeric scale, the pre- and postpresentation survey responses of trainees and trainee subgroups (medical students, residents) were compared using Wilcoxon signed rank tests. Survey responses also were stratified by trainee type using a two-way mixed effects analysis of variance.

Results: In total, 121 trainees (86 medical students, 35 residents) attended the presentation and completed the surveys. On each content-based survey question, the trainees' self-reported knowledge of HIV care increased postpresentation (P<0.001). Trainees' subspecialty interest also increased postpresentation (P<0.001). Within the trainee subgroups, knowledge and interest increased on each survey question postpresentation (P≤0.003), and the change in interest was similar between the medical students and residents. Compared with the residents, medical students reported greater knowledge of the population groups disproportionately affected by HIV (P<0.001), HIV acquisition (P=0.009), and the HIV care continuum (P=0.002).

Conclusions: Among medical trainees at a single-site medical center in the southeastern United States, delivering a fellow-led educational presentation on HIV health was associated with increased self-reported knowledge of HIV care and subspecialty interest. This intervention may promote interprofessional education and recruitment.

[This corrects the article DOI: 10.14423/SMJ.0000000000001995.].

Florida was the fastest growing state in the United States in 2024, and it has the third highest state population in 2026. We reviewed health challenges related to rapid population growth, insurance coverage gaps, underinvestment in public health, policy trends, and the high proportion of older adults to assess Florida's health and healthcare system in comparison with national benchmarks. We conducted a comparative analysis using data from the US Census Bureau, the FLHealth Community Health Assessment Resource Tool Set, America's Health Rankings, and the peer-reviewed literature. Key indicators included demographic trends, insurance coverage, public health funding, and health outcomes. Florida has an estimated 2025 population exceeding 23 million-22.3% adults 65 years of age and older versus 18.2% nationally. Despite favorable metrics in smoking and obesity, Florida ranks 39th in overall state health system performance according to the Commonwealth Fund 2025 Scorecard on State Health System Performance. The state has not expanded Medicaid, and an estimated 315,000 residents are in an insurance coverage gap. Florida's rapid growth and proportion of older people present healthcare challenges. Disparities among uninsured, undocumented, and minority populations are exacerbated by limited insurance access and underfunded public health infrastructures. Declining public health budgets may increase costs from preventable hospitalizations. Given the high dental caries rates and low vaccination rates for Florida in 2025, a law forbidding water fluoridation and efforts to end mandatory vaccinations may exacerbate healthcare disparities. Strategic planning, adequate funding, and policy reform can address these systemic vulnerabilities and ensure equitable access to care in Florida and other southern states.

Objective: The objective of this study was to evaluate the impact of the stress intervention Docs for Dinner on factors related to physician disengagement and professional isolation.

Methods: A specifically designed survey was distributed to physicians who had participated in the program.

Results: The results indicate that physician participants found the experience to be positive and worthy of continuation and that it allowed a unique interaction with colleagues, increased engagement with colleagues, promoted a more positive view of the relationship with the healthcare system, enhanced a sense of well-being, and had a small but positive impact on motivation for patient care.

Conclusions: Docs for Dinner appears to be a readily implemented and well-received approach to enhancing physician engagement and collegial interaction, increasing the sense of well-being, and fostering perception of a healthcare organization that may help to mitigate contemporary stressors facing physicians.