Southern medical journal
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Southern medical journal · Mar 2020
Utilization of Acid Suppression Medication in an Underserved Population.
Acid suppression therapy (AST), composed of proton pump inhibitors (PPIs), histamine-2 receptor blockers, and antacids, is one of the most common medication groups used in the United States. Long-term AST is concerning, however, because it is linked with an increased risk of community-acquired pneumonia, Clostridium difficile infections, bone fractures, and nutritional deficiencies. The potentially harmful biological and economic consequences associated with the improper use of acid suppression medications presents a great deal of risk to those in underserved communities. We sought to determine the prevalence of AST in an underserved population and the common diagnoses and symptoms associated with therapy. In addition, we studied the frequency of suboptimal usage of PPIs in an indigent care population and the potential factors related to high-risk behaviors. ⋯ ASTs are prevalent in low-income populations, and patients are not being managed appropriately to minimize their risk for complications of AST.
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Previous studies have characterized the negative effects of graduate medical education on physicians; however, there is limited longitudinal data on how physicians' well-being changes during their training. This study aimed to demonstrate and quantify changes to trainees' wellness and health habits during the course of their first 2 years of graduate medical education. ⋯ Residents' health and wellness habits deteriorated during internship and did not improve in the second year of residency. Efforts to promote healthy habits in this population should be a priority.
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Southern medical journal · Feb 2020
Comparative StudySame-Admission Cholecystectomy Compared with Delayed Cholecystectomy in Acute Gallstone Pancreatitis: Outcomes and Predictors in a Safety Net Hospital Cohort.
Recent studies have shown a decrease in gallstone-related complications if same-admission cholecystectomy (SAC) is performed in mild gallstone pancreatitis (GSP); however, SAC often is not performed in resource-limited settings such as safety net hospitals. The aims of this study were to evaluate the rate of SAC and compare a composite endpoint of recurrent biliary events in patients undergoing SAC with patients in the delayed cholecystectomy (DC) group. Secondary aims included evaluating the rate of recurrent pancreatitis in patients in the DC group, identifying the predictors for DC and the reasons for not undergoing SAC. ⋯ Our findings support existing evidence that DC is associated with a significantly increased risk of recurrent biliary events and pancreatitis. Furthermore, we report a 56% adherence to the current guidelines for SAC and report that the most common reason for not undergoing SAC was the absence of surgical consultation. We conclude that ensuring SAC in eligible patients should be a priority for safety net hospitals because it may help decrease hospital costs in the long term, and active efforts should be made to identify patients who may be less likely to receive SAC.
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Southern medical journal · Feb 2020
Utilization of Healthcare Resources by HIV-Positive Children in the United States: A National Perspective.
We characterized and estimated the cost of inpatient hospital utilization by US pediatric patients who tested positive for the human immunodeficiency virus (HIV). ⋯ The results suggest that pediatric patients who were HIV positive were significantly older, from lower-income areas, and members of minority groups. They underwent more procedures during hospitalization, incurred more than twice the total cost, stayed in the hospital twice as long, and had statistically higher in-hospital mortality than children who were HIV negative. As we continue to explore effective and judicious treatment options for patients who are HIV positive, our national estimates of resource utilization can be used to conduct a more detailed examination of current medical practices and specific patterns of diagnoses associated with HIV infection in the US pediatric population.
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Southern medical journal · Feb 2020
Assessment of the Need for Immediate Trauma Team Presence for Infants Presenting in Cardiac Arrest.
Out-of-hospital cardiac arrest (OHCA) is rare in infants, with the cause of arrest often unknown upon presentation. Nonaccidental trauma is a potential etiology of OHCA among infants, but its occult presentation makes this etiology challenging to diagnose. In the absence of apparent injuries, identifying the need for trauma team activation is difficult during the initial resuscitation of infants with OHCA. ⋯ Infant OHCA had poor outcomes, with trauma as a rare etiology. In the absence of external signs of injury or known injury mechanism, immediate trauma team presence was not beneficial for these infants during the initial resuscitation phase.