Southern medical journal
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Southern medical journal · Jul 2021
ReviewPerioperative Resumption of Direct Oral Anticoagulants: Review of the Mayo Clinic Experience.
We aimed to review recommendations for the postoperative resumption of direct oral anticoagulants (DOACs) and report complications 30 days postoperatively. ⋯ We suggest withholding DOACs for 48 to 72 hours before surgery and resuming them 48 to 72 hours after surgery, if safe. The interruption of therapy was not associated with an increase in thrombotic events for patients who resumed DOACs within 72 hours postoperatively. Patients who resumed DOACs after 72 hours postoperatively had a low rate of thrombotic complications.
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Southern medical journal · Jul 2021
Multicenter StudyA Multicenter Curricular Intervention to Address Resident Knowledge and Perceptions of Personal Finance.
We evaluated internal medicine residents' confidence and knowledge of personal finance, perceptions of burnout, and relations between these issues before and after an educational intervention. ⋯ Our findings show that residents want to learn about finances. Our brief educational intervention is a practical way to improve overall knowledge. Our intervention suggests that improving knowledge of finance may be associated with decreased feelings of burnout.
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Southern medical journal · Jul 2021
Physicians' Total Burden of Occupational Stressors: More than Threefold Increased Odds of Burnout.
To assess the relation between total job stressor burden and physician burnout, identifying potentially contributory modifiable stressors, using a comprehensive, theory-based instrument created for physicians by physicians. ⋯ The total burden of job stressors is powerfully associated with personal and work-related burnout. The clinically defined total OSI cutpoint >88 warranting urgent intervention is corroborated by >3-fold odds of personal and work-related burnout. Lowering total OSI scores is an immediate priority, starting with potentially modifiable stressors that are already maximum/near-maximum (inadequate rest breaks, nightshifts, work hours, insufficient work-free vacation time, and infection hazards). These issues affect patient care.
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Southern medical journal · Jul 2021
Risk of Silent Myocardial Infarction in Prediabetic Patients: A Case-Control Study in a Veteran Population.
In the management of cardiovascular disease, it is important to identify patients at risk early on, to provide interventions to prevent the disease and its complications. The goal of our study was to investigate the association between glucose levels and silent myocardial infarction (SMI) among patients, who consisted of veterans within the Veterans Affairs clinical system. ⋯ SMIs have been shown to be predictive of subsequent cardiovascular events, including another MI and death, and that indicates the importance of identifying a group at high risk for a SMI. As such, our findings could be extremely beneficial for targeted intervention toward prediabetics and to improve health outcomes in the entire population.
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Southern medical journal · Jul 2021
HIT-It or Quit It: Heparin-Induced Thrombocytopenia Testing Appropriateness Using 4T Scoring and Inappropriate Testing Cost Analysis.
The American Society of Hematology's 4T scoring system is a validated tool to assess a patient's probability of having heparin-induced thrombocytopenia (HIT) before testing is performed. There is no benefit to testing patients with a low probability 4T score for HIT. This study aimed to assess for inappropriate HIT testing at our institution based on 4T scoring. ⋯ Inappropriate testing for HIT is still a prevalent issue despite literature supporting the 4T score for guidance in testing appropriateness.