Southern medical journal
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Education in cultural competence is critical to training medical students to care for patients from all backgrounds, but it is unclear what experience students have in the clinical learning environment. We describe the medical student experience in directly observed cross-cultural encounters within two clinical clerkships, and we identify areas of need for further resident and faculty training in providing high-quality feedback following these encounters. ⋯ Significant variability exists in the quality of feedback provided to students following the direct observation of cross-cultural clinical skills. Faculty and resident training to improve feedback should focus on corrective feedback in less commonly observed cross-cultural skills.
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Southern medical journal · May 2023
ReviewConvalescent Plasma Therapy in Late-State, Severe COVID-19 Infection.
Current evidence favors plasma to be effective against coronavirus disease 2019 (COVID-19) in critically ill patients in the early stages of infection. We investigated the safety and efficacy of convalescent plasma in specifically late-stage (designated as after 2 weeks of hospital admission) severe COVID-19 infection. We also conducted a literature review on the late-stage use of plasma in COVID-19. ⋯ This case series provides evidence that convalescent plasma may be safe and effective in late-stage, severe COVID-19 infection. Results showed clinical improvement posttransfusion as well as decreased all-cause mortality in comparison to pretransfusion predicted mortality. Randomized controlled trials are needed to conclusively determine benefits, dosage, and timing of treatment.
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Southern medical journal · May 2023
ReviewDirect Use of Clinical Tolerance Limits for Assessing the Degree of Agreement between Two Methods of Measuring Blood Pressure.
A large number of new methods of measuring blood pressure (BP) have recently emerged with advances in technology. Different methods of measuring BP generally provide varying readings compared with one another. Clinicians must decide how to respond to these variations and how to assess the degree of agreement. ⋯ This method requires a comparison of Bland-Altman limits with the prespecified clinical tolerance limits. This review describes an alternative simple and robust method that directly uses clinical tolerance limits for assessing agreement without calculating Bland-Altman limits. The many advantages of this method are illustrated with the help of real-life examples of BP measurements.
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Southern medical journal · May 2023
Impact of Preoperative Echocardiograms on In-Hospital Outcomes of Patients Undergoing Surgical Hip Fracture Repair and Their Clinical Appropriateness.
Preoperative transthoracic echocardiograms (TTE) before hip fracture repairs are controversial. This study aimed to quantify the frequency of ordering TTE, the appropriateness of testing based on current guidelines, and the impact of TTE on in-hospital morbidity and mortality outcomes. ⋯ Patients subjected to TTE before hip fracture surgery had a longer LOS and time to surgery, with higher mortality and intensive care unit up triage rates. TTE evaluations were typically conducted for inappropriate indications, which rarely made meaningful changes to patient management.
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Southern medical journal · May 2023
Medical Students' Perspectives on Opportunities to Engage in the Clinical Care of COVID-19 Patients during the Pandemic.
Recent disease modeling suggests that pandemics are likely to increase in frequency and severity. As such, medical educators must learn from their experiences with coronavirus disease 2019 (COVID-19) to develop systematic strategies for ensuring that medical students receive hands-on training in the management of emerging diseases. Here, we outline the process by which the Florida International University Herbert Wertheim College of Medicine developed and updated guidelines for student participation in the care of patients with COVID-19 and report on students' experiences. ⋯ Many graduating students felt unprepared to care for patients with COVID-19 during residency and many wished they had had more opportunities to care for patients with COVID-19 during medical school. Curricular policies must evolve to allow students to gain competency in the care of patients with COVID-19 so that they are prepared for day one of residency.