Southern medical journal
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Southern medical journal · Sep 2015
Risk Factors for Unscheduled 30-day Readmission after Benign Hysterectomy.
Readmission rates after hysterectomy have been reported, but specific risk factors for readmission have not been fully delineated. We aimed to determine risk factors for and implications of 30-day unscheduled readmission after benign hysterectomy using data from the American College of Surgeons National Surgical Quality Improvement Program. ⋯ Using a large national database, we identified several patient-related and procedural risk factors for unscheduled 30-day readmission after hysterectomy. Readmission was associated with significantly higher rates of complications, a return to the operating room, and a 30-fold increase in mortality. Our findings reinforce the importance of patient selection and optimization of comorbidities before hysterectomy. Future research should aim to further delineate differential risks of readmission by surgical route as well as modifiable risk factors for readmission.
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Southern medical journal · Aug 2015
Multicenter Study Comparative StudyNumber of General Medicine Hospital Admissions Performed by Internal Medicine Residents Before and After the 2011 Duty-Hour Regulations.
In July 2011 the Accreditation Council for Graduate Medical Education implemented new resident duty-hour regulations in an effort to improve resident well-being, clinical performance, and patient care. These regulations have the potential, however, to reduce the number of new patient encounters handled by trainees and thereby could be detrimental to resident education. Our objective was to describe how the 2011 duty-hour regulations affected the volume of new inpatient general medicine encounters at two large academic medical centers. We looked specifically at new patient encounters because we assumed they provided the richest learning opportunities. We hypothesized that the implementation of the Accreditation Council for Graduate Medical Education regulations would be associated with a reduction in the number of new admissions per day and result in a decrease in the number of annual admissions performed by first-year medical residents. ⋯ Medicine residents admit fewer patients on daytime inpatient general medicine services under the new duty-hour regulations; however, this is completely offset by an increase in the number of admissions performed on the night rotation, resulting in no net change in the total number of new inpatient encounters handled by first-year medical residents during the course of the academic year. Although this is reassuring, changes that were made in response to the work-hour rules have altered how new admissions are distributed to teams, which has important implications for curricular design and supervision.
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Southern medical journal · Aug 2015
Limited Uptake of Planned Intrauterine Devices During the Postpartum Period.
The primary objective of this study was to determine the percentage of women with a documented plan for postpartum intrauterine device (IUD) insertion who had a device inserted within 8 weeks of delivery. The secondary objective was to determine factors associated with successful initiation of postpartum IUDs as planned. ⋯ Failure to establish planned postpartum intrauterine contraception occurs frequently, even in a setting with a high rate of postpartum follow-up.
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Southern medical journal · Aug 2015
Understanding the Health Needs and Barriers to Seeking Health Care of Veteran Students in the Community.
Access to care at Veterans Affairs facilities may be limited by long wait times; however, additional barriers may prevent US military veterans from seeking help at all. We sought to understand the health needs of veterans in the community to identify possible barriers to health-seeking behavior. ⋯ Veterans face a range of personal, societal, and logistical barriers to accessing care. In addition to decreasing wait times for appointments, efforts to improve the transition to civilian life; reduce stigma; and offer assistance related to work, housing, and convenient access to health care may improve health in veteran students.
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To compare the fetal mortality rate in the Delta counties of a state in the Mississippi Delta region of the United States with that of the non-Delta counties of the same state. ⋯ Fetal mortality is significantly greater in the Delta counties compared with the non-Delta counties, with a 21% increase in the odds of overall fetal death in the Delta counties compared with non-Delta counties and a 28% increase in the odds of fetal death at ≤28 weeks.