The 10 most-cited articles in Southern Medical Journal, 2022

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on medical education at all levels, particularly on applicants applying to residency programs. The objective of the study was to gain a comprehensive understanding of applicants' perspectives on virtual interviews in the setting of the COVID-19 pandemic. METHODS: We conducted a quantitative survey and a qualitative study between March and April 2021. The link to an anonymous online survey was emailed to fourth-year medical students from one allopathic medical school. The survey link also was posted on the social media page of one allopathic medical school and one osteopathic medical school. Participants were then invited to participate in a follow-up 15- to 45-minute qualitative virtual interview. RESULTS: A total of 46 participants completed the survey, with a response rate of approximately 29.1%. The most beneficial aspect of the virtual interview was saving money on travel (31, 78.39%). In contrast, the least beneficial aspect of the virtual interview was the inability to personally explore the…

Training healthcare workers in disaster preparedness has been shown to increase their willingness and ability to report to work during disasters. Little is known, however, about the relation between sociodemographic, household, and workforce characteristics and the desire for such training. Accordingly, this study aimed to assess healthcare workers' desire for additional workforce preparedness training, and the determinants that influence the need for such training, for three types of disasters (natural, pandemic, manmade).The US Department of Veterans Affairs (VA) Preparedness Survey was a random, anonymous, Web-based questionnaire fielded nationwide (October-December 2018). Multivariate, logistic regression analyses were conducted.In total, 4026 VA employees, clinical and nonclinical, responded. A total of 61% of respondents wanted additional training for natural, 63% for pandemic, and 68% for manmade disasters. VA supervisors (natural: odds ratio [OR] 1.28, pandemic: OR 1.33, manmade: OR 1.25, P < 0.05) and clinicians (natural: OR 1.24, pandemic: OR 1.24, manmade: OR 1.24, P <…

OBJECTIVES: In this study, we explore the role of Coronavirus Disease 2019 pandemic-related stress, social support, and health on unmet healthcare needs during the Coronavirus Disease 2019 pandemic, particularly among lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) adults. METHODS: 62). Limiting analyses to the LGBTQ+ subsample, we also assessed the unique role of LGBTQ+ discrimination and depressive symptoms. RESULTS: 0.01) were associated with higher odds of forgone care among LGBTQ+ participants. CONCLUSIONS: Future research should examine the unique factors shaping the access to health care of LGBTQ+ adults in the United States, and healthcare practitioners should consider strategies to screen for discrimination and leverage the protective benefits of social support.

: COVID-19 has affected many people all around the world for more than two years now have suffered many long-term consequences which is commonly referred to as long-haulers. Despite multiorgan complaints in long haulers, symptoms related to cognitive functions commonly referred as brain fog are seen in the high risk covid patients with age more than 50, women more than men, obesity, asthma and those who experienced more than five symptoms during the first week of covid illness. Long term isolation has certainly contributed to high level of anxiety and stress calling for an empathetic response to this group of covid patients as there is no specific test to detect long haulers and no specific cognitive rehabilitation techniques available as of today.

Acute brain injury (ABI) consists of any acquired insult to the brain and is a significant cause of morbidity and mortality worldwide. Approximately 20% to 30% of patients with ABI develop a lung injury called neurogenic pulmonary edema (NPE), and its development often results in poor outcomes. This article provides a narrative review of the evidence regarding proposed mechanisms of injury, diagnosis, and treatment of NPE in the critical care setting. PubMed and Ovid databases were searched for observational or prospective studies relevant to the diagnosis and treatment of NPE. Overall, studies showed that although the specific mechanisms responsible for NPE remain uncertain, putative mechanisms include vaso- and venoconstriction, catecholamine release with resultant pulmonary vasoconstriction called the "blast injury theory," increased vagal tone, and increased capillary permeability. Diagnosis involves identifying signs of pulmonary edema in patients who experienced a neurologic insult. Management strategies aim to address both brain and lung injury, and treatment modalities…

Half of the foreign-born population in the United States speaks English "less than very well." The extant literature suggests that low-English-proficient (LEP) patients experience poorer healthcare outcomes than do language-concordant patients. It remains unclear which methods of interpreter services are best for communicating effectively and achieving positive health outcomes for LEP patients. This review examines interpretation methods to compare their effectiveness and frequency of use and identifies the remaining gaps in our knowledge. The evidence suggests that any type of professional language service is superior to untrained interpreting and vastly better than not using an interpreter at all. Even with this knowledge, use of interpreter services is unacceptably low and gaps remain. Further research is needed to isolate and examine different methods of interpretation and measure objective health outcomes. In addition, education is needed for interpreters and healthcare providers to ensure the most effective communicative strategies for LEP patients.

OBJECTIVES: Accurate injury surveillance depends on data quality in administrative datasets created for billing and reimbursement. Significant effort has been devoted to testing the ability of candidate injury case definitions to identify injury cases accurately in these datasets. We used interviews with experienced coders, informed by a review of the current literature, to identify three clinical coding trends that may affect the consistency of surveillance data: "clinical documentation improvement or clinical documentation integrity" (CDI), coding by treating clinicians, and certain electronic health record features. METHODS: An extensive literature review informed interviews with coding experts to identify potential issues in coding practice. To determine whether physician coding was associated with information loss, we analyzed data from two hospitals serving the same geographic area. One hospital had used physician coding of emergency department data for the past decade; the other used professional coders. We compared the proportion of emergency department records missing…

OBJECTIVE: Readmission to the hospital after hospitalization with coronavirus disease 2019 (COVID-19) is associated with significant morbidity and mortality. Hospital clinicians may identify the presence of a patient's comorbid conditions, overall severity of illness, and clinical status at discharge as risk factors for readmission. Objective data are lacking to support reliance on these factors for discharge decision making. The objective of our study was to examine risk factors for readmission to the hospital after COVID-19 hospitalization and the impact of vital sign abnormalities, within 24 hours of discharge, on readmission rates. METHODS: In total, 2557 COVID-19-related hospital admissions within the Lifespan Health System, a large multicenter health system (Rhode Island), of 2230 unique patients aged 18 years and older, occurring from April 1, 2020 to December 31, 2020 were analyzed. Risk factors associated with readmission within 30 days were identified and analyzed using Cox regression. A moderation analysis by vital signs at discharge on the risk of readmission was…

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in unprecedented hospitalizations, ventilator use, and deaths. Because of concerns for resource utilization and surges in hospital capacity use, Texas Executive Order GA-29 required statewide mask wear beginning July 3, 2020. Our objective was to compare COVID-19 case load, hospital bed use, and deaths before and after implementation of this mask order. METHODS: This was a retrospective observational study using publicly reported statewide data to perform a mixed-methods interrupted time series analysis. We compared outcomes before and after the statewide mask wear mandate per Executive Order GA-29. The preorder period was from June 19 to July 2, 2020. The postorder period was July 17 to September 17, 2020. Outcomes included daily COVID-19 case load, hospitalizations, and mortality. RESULTS: The daily case load before the mask order per 100,000 individuals was 187.5 (95% confidence interval [CI] 157.0-217.0) versus 200.7 (95% CI 179.8-221.6) after GA-29. The number of daily hospitalized patients with COVID-19…

OBJECTIVES: Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation. METHODS: A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed. Respondents completed validated measures of moral elevation as well as markers of professional identity formation, including patient-centered virtues (empathic compassion, interpersonal generosity, mindfulness) and measures of well-being (life meaning, life satisfaction, spirituality, burnout). RESULTS: The study obtained adjusted response rates of 56.2% (1047/1863, physician survey) and 48.7% (448/919, student survey).…