Southern medical journal
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Southern medical journal · May 2020
Frequency of Care Fragmentation and Its Impact on Outcomes in Acute and Chronic Pancreatitis in a Nationally Representative Sample.
Hospitalized patients with acute and chronic pancreatitis (AP and CP) are prone to frequent readmissions to different hospitals. The rate of care fragmentation and its impact on important outcomes are unknown. The aims of this study were to evaluate the rate and predictors of care fragmentation in patients hospitalized with AP and CP using a nationally representative sample, and to analyze the impact of care fragmentation on mortality, cost, and hospital readmissions. ⋯ In patients with AP and CP, one-third of 90-day readmissions occur at a nonindex hospital. Care fragmentation is associated with increased mortality, readmissions, and cost of care.
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Southern medical journal · May 2020
National Estimates of Noncanine Bite and Sting Injuries Treated in US Hospital Emergency Departments, 2011-2015.
Injuries resulting from contact with animals are a significant public health concern. This study quantifies and updates nonfatal bite and sting injuries by noncanine sources using the most recent data available (2011-2015) from the National Electronic Injury Surveillance System-All Injury Program with the purpose of using these updates to better understand public health consequences and prevention techniques. Increased rates of bites and stings can be expected in this study's time frame, possibly caused by the increasing human population expanding into animal territories, as well as changes in animal geographic distribution and pet ownership. ⋯ Various sources of bite and sting injuries had an outsized effect on injury rates and identify potential areas of focus for education and prevention programs to reduce the burden of these injuries on health and healthcare costs. The study describes the diversity of animal exposures based on a national sample of EDs. Noncanine bite and sting injuries significantly affect public health and healthcare resources. Priorities can be focused on animal sources with the most impact on bite and sting injury rates, healthcare costs, and disease burden.
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Southern medical journal · May 2020
Perceived Barriers to Contraceptive Access and Acceptance among Reproductive-Age Women Receiving Opioid Agonist Therapy in Northeast Tennessee.
Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee. ⋯ Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.
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Southern medical journal · May 2020
A Retrospective Study of Students Referred to a Psychiatric Clinic at a College Counseling Center in Appalachia.
This study describes the clinical problems and psychiatric diagnoses of college students who sought services at a student counseling clinic and were subsequently referred for evaluation by a psychiatrist. Several important psychiatric problems present before leaving for college that could mandate the selection of a college with psychiatric services at the university or nearby community. This study confirms the importance of having psychiatric consultation available in addition to the range of counseling services found in a campus mental health clinic. ⋯ These results indicate that this student sample referred for psychiatric treatment has significant psychiatric illness. Our findings also confirm the need for the availability of psychiatric consultation as a part of college mental health services. Those students most in need of psychiatric consultation had almost all received psychiatric treatment and almost half had suicidal ideation in the month preceding the appointment with the psychiatrist. The specific problems that may lead a student applying to college to take into consideration the availability of psychiatric services include a previous psychiatric hospitalization, previous suicidal ideation that had already come to the attention of a mental health professional, or a previous diagnosis of depressive disorder or anxiety disorder.
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Southern medical journal · May 2020
Midnight Report: A Novel Faculty-Guided Night Curriculum to Enhance Resident Nighttime Education.
A large discrepancy exists in resident educational activities between daytime and nighttime medical rotations. The Accreditation Council for Graduate Medical Education duty-hour regulations led to the increased adoption of the dedicated nighttime rotation called night float. Nighttime education has largely been negatively perceived by night float medical residents. Although there have been attempts to improve nighttime education, none of the initiatives included faculty-guided structured night curriculum. Our objective was to improve resident experience with and perception of nighttime education by implementing a structured, faculty-guided, nighttime educational curriculum. ⋯ Compared with the published literature reporting negative perceptions of the nighttime educational environment by residents at different academic centers, our results showed that the majority of our residents positively perceived the impact of our new faculty-guided nighttime educational curriculum.