Southern medical journal
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Gallbladder dyskinesia is a functional disorder of the gastrointestinal tract, which can result in debilitating episodes of abdominal pain and associated symptoms. Key diagnostic criteria include a diminished gallbladder ejection fraction on scintigraphy and absence of other causes for the symptoms. ⋯ Patients meeting the clinical and diagnostic criteria for gallbladder dyskinesia should be referred for cholecystectomy, and most of these patients will have relief of their symptoms. A comprehensive preoperative discussion on expected outcomes needs to take place.
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Southern medical journal · Nov 2022
ReviewTrends in ICD-10-CM-Coded Administrative Datasets for Injury Surveillance and Research.
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. ⋯ Injury surveillance relies on billing and reimbursement records. Financial motivations may interfere with the consistency of surveillance findings and mislead injury epidemiologists. Further investigation is essential to ensure the integrity of surveillance findings.
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Southern medical journal · Oct 2022
ReviewPathophysiology and Management of Neurogenic Pulmonary Edema in Patients with Acute Severe Brain Injury.
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. ⋯ Management strategies aim to address both brain and lung injury, and treatment modalities appear to work best when balanced toward maintaining a normal physiologic state. In summary, NPE is an often underdiagnosed but important sequela of ABI, which may result in additional long-term morbidity. It is therefore an important entity for providers to recognize and tailor their clinical approach toward.
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Southern medical journal · Oct 2022
ReviewIncreasing Nasal Tip Projection Using Structural Grafts: A Review of Outcomes.
Nasal tip projection (NTP) is an important criterion when evaluating the result of rhinoplasties. Increasing NTP is essential for nasal function and visual aesthetics. Grafts such as columellar strut grafts (CSGs) and septal extension grafts (SEGs) are commonly used. We analyzed the safety and efficacy of the most commonly used grafts for increasing NTP during surgical rhinoplasty. ⋯ Findings show that CSG and SEG grafts were safe and effective at increasing NTP. We suggest that CSG may be safer and more effective than SEG at increasing NTP in rhinoplasties. Further prospective studies may elucidate the mechanisms underlying the differences between CSGs and SEGs in patient safety and satisfaction when increasing NTP in surgical rhinoplasty.