The 10 most-cited articles in Southern Medical Journal, 2017

OBJECTIVES: We examined Adventist Health System (AHS)-affiliated providers and staff regarding controversial spiritual practices such as praying led by a practitioner, sharing of personal religious beliefs, and encouraging patients' religious beliefs for health reasons. METHODS: Approached were 1082 providers to participate in a project to integrate spirituality into outpatient care. Those who agreed were asked to identify staff in their practice to assist. Providers and staff were asked to complete a baseline questionnaire examining attitudes/practices concerning spiritual activities with patients. Regression models were used to identify predictors. RESULTS: Questionnaires were completed by 520 providers (83% physicians and 17% mid-level practitioners) and 217 nurses and other staff members. A significant proportion of providers and staff (29.6% vs 49.1%) indicated "often/very often" to a statement that healthcare professionals should pray with patients, should initiate an offer to pray (25.7% vs 49.1%), should pray if the patient initiates the request (72.2% vs 79.5%), and should…

OBJECTIVES: Patients' spiritual values, beliefs, and preferences are identified in outpatient medical settings by the taking of a screening spiritual history (SSH). We report the impact of an educational/training program on the attitudes/practices of physicians (MDs) and midlevel practitioners (MLPs). METHODS: A convenience sample of 1082 MDs or MLPs in outpatient practices was approached to participate in a 12-month educational/training program in this single-group experimental study. Of the 1082 professionals, 48% (427 physicians, 93 MLPs) agreed to complete a questionnaire assessing demographics, practice characteristics, religiosity, and attitudes/practices regarding the SSH. Changes in attitudes/practices over time were examined and baseline predictors identified using mixed-effects regression. RESULTS: = 0.001). Predictors of increased SSH taking across time among MDs were older age, female sex, family medicine specialty, prior training, and importance of religion; older age was the only predictor in MLPs. CONCLUSIONS: Although attitudes toward taking an SSH were not affected,…

OBJECTIVES: To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. METHODS: All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. RESULTS: Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported…

Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe pancreatitis is challenging to the clinician. C-reactive protein, pro-calcitonin, and the Bedside Index for Severity of Acute Pancreatitis appeared to be the best tools for the early and accurate diagnosis of severe pancreatitis. Early laparoscopic cholecystectomy is indicated for patients with mild gallstone pancreatitis. For patients who are going to have a prolonged hospitalization, enteral nutrition is preferred. Total parenteral nutrition should be reserved for patients who cannot tolerate enteral nutrition. Prophylactic antibiotics are not indicated for patients with pancreatic necrosis. Surgical intervention for infected pancreatic necrosis should be…

OBJECTIVES: In 2014, 726 bicyclists were killed and an additional 50,000 were injured in crashes with motor vehicles. The number of cyclists in the United States is increasing, and as a result there has been a call for more bike lanes. We examined the difference in the severity of injury of bicyclists involved in motor vehicle crashes when riding in the traffic lane compared with riding in a bike lane or on a paved shoulder. We also controlled for other safety factors, including alcohol use, travel speed, posted speed, helmet usage, and lighting conditions to determine their impact on bicyclist safety. METHODS: Single-year National Automotive Sampling System-General Estimates System files were used to analyze data regarding the bike lanes, and multiyear data were used to analyze the additional factors. Univariate and multiple regression analyses controlling for confounders were performed on the data. RESULTS: < 0.0001). CONCLUSIONS: Our findings suggest that simply having a dedicated space for bicyclists, such as a bike lane or a paved shoulder, does not reduce the severity of…

OBJECTIVES: Patients with upper gastrointestinal bleeding (UGIB) frequently require hospitalization, and a small but significant percentage of these patients have adverse outcomes. Risk-scoring tools can help clinicians organize care and make predictions about outcomes. The shock index (heart rate divided by systolic blood pressure) has been used in multiple acute disorders and has the potential to identify patients with UGIB who are at risk for adverse outcomes. METHODS: We retrospectively reviewed the electronic medical records of patients admitted with UGIB between January 1, 2012 and December 31, 2015. We collected information about patient demographics, presenting symptoms, underlying clinical disorders, endoscopic results, and outcomes. We calculated risk scores using the Glasgow-Blatchford score, the pre-endoscopy Rockall score, the full Rockall score, the AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age older than 65 years) score, and the shock index. RESULTS: This study included 214 admissions for acute UGIB. The mean age was 59.0…

Breast cancer remains the most common cancer in women in the United States, the second most common cause of cancer death, and the main cause of death in women ages 45 to 55 years. Molecular analyses have shown that breast cancer is divided into several subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 [HER2] enriched, and basal-like), based on microarray techniques. Patients diagnosed as having breast cancer may undergo adjuvant or neoadjuvant chemotherapy, depending on the tumor size, hormone receptor, HER2/neu status, and desire for breast preservation. Patients with positive estrogen and/or progesterone receptor status benefit from treatment with selective estrogen receptor modulators such as tamoxifen or aromatase inhibitors, based on menopausal status and risk of recurrence. HER2-targeted agents such as trastuzumab and pertuzumab are used in combination with chemotherapy in patients with HER2/neu breast cancer. Triple-negative breast cancer is a unique subtype that lacks specific targets, and its treatment primarily includes chemotherapy. This article…

BACKGROUND: Breast-conserving surgery with adjuvant radiation therapy (BCT) has been established as safe oncologically. Oncoplastic breast surgery uses both oncologic and plastic surgery techniques for breast conservation to improve cosmetic outcomes. We evaluated the risk factors associated with complications after oncoplastic breast reduction. METHODS: exact method; continuous variables were analyzed with the Wilcoxon rank sum test exact method. RESULTS: = 0.03). Bilateral versus unilateral oncoplastic breast reduction showed no statistically significant increase in complications. CONCLUSIONS: The overall complication rate after oncoplastic breast reduction was markedly higher than that in nationally published data for breast-conserving surgery. The complication rate resembled more closely the complication rate after bilateral mastectomy with immediate reconstruction. No risk factors were associated with major or overall complications. Age and pulmonary disease were associated with minor complications. Patients should be selected and counseled appropriately when considering…

OBJECTIVES: Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are significant. We evaluated medical students' experiences with mandatory disaster training during a 2-year period in a medical university setting. METHODS: Disaster training has been mandatory at Thomas Jefferson University since 2002 and requires all first-year medical students to attend lectures, undergo practical skills simulation training, and participate in the hospital's interdisciplinary disaster exercise. Medical students were encouraged to complete a survey after each component of the required training. Twenty-three survey questions focused on assessing students' experiences and opinions of the training, including evaluation of the…

OBJECTIVES: Little is known about the personal readiness of hospital staff for disasters. As many as 30% of hospital staff say that they plan not to report for work during a large-scale disaster. We sought to understand the personal disaster preparedness for hospital staff. METHODS: Surveys were distributed to the staff of a large academic tertiary-care hospital by either a paper-based version distributed through the departmental safety coordinators or a Web-based version distributed through employee e-mail services, depending on employee familiarity with and access to computer services. Surveys assessed the demographic variables and characteristics of personal readiness for disaster. RESULTS: Of the individuals who accessed the survey, 1334 (95.9%) enrolled in it. Women made up 75% of the respondents, with a mean age of 43 years. Respondents had worked at the hospital an average of 9 years, with the majority (90%) being full-time employees. Most households (93%) reported ≤4 members, 6% supported a person with special medical needs, and 17% were headed by a single parent. A small…