Tag: pubmed

J Natl Cancer Inst. 2025 Oct 1:djaf272. doi: 10.1093/jnci/djaf272. Online ahead of print.

ABSTRACT

BACKGROUND: Lung adenocarcinoma (LUAD) in never-smokers is a major public health burden, especially among East Asian women. Polygenic risk scores (PRSs) are promising for risk stratification but are primarily developed in European-ancestry populations. We aimed to develop and validate single- and multi-ancestry PRSs for East Asian never-smokers to improve LUAD risk prediction.

METHODS: PRSs were developed using genome-wide association study summary statistics from East Asian (8,002 cases; 20,782 controls) and European (2,058 cases; 5,575 controls) populations. Single-ancestry models included PRS-25, PRS-CT, and LDpred2; multi-ancestry models included LDpred2+PRS-EUR128, PRS-CSx, and CT-SLEB. Performance was evaluated in independent East Asian data from the Female Lung Cancer Consortium (FLCCA) and externally validated in the Nanjing Lung Cancer Cohort (NJLCC). We assessed predictive accuracy via AUC, with 10-year and (age 30-80) absolute risks estimates.

RESULTS: The best multi-ancestry PRS, using East Asian and European data via CT-SLEB (clumping and thresholding, super learning, empirical Bayes), outperformed the best East Asian-only PRS (LDpred2; AUC = 0.629, 95% CI:0.618,0.641), achieving an AUC of 0.640 (95% CI : 0.629,0.653) and odds ratio of 1.71 (95% CI : 1.61,1.82) per SD increase. NJLCC Validation confirmed robust performance (AUC =0.649, 95% CI: 0.623, 0.676). The top 20% PRS group had a 3.92-fold higher LUAD risk than the bottom 20%. Further, the top 5% PRS group reached a 6.69% lifetime absolute risk. Notably, this group reached the average population 10-year LUAD risk at age 50 (0.42%) by age 41, nine years earlier.

CONCLUSIONS: Multi-ancestry PRS approaches enhance LUAD risk stratification in East Asian never-smokers, with consistent external validation, suggesting future clinical utility.

PMID:41032288 | DOI:10.1093/jnci/djaf272

South Med J. 2025 Sep;118(9):634-638. doi: 10.14423/SMJ.0000000000001866.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the financial literacy of medical trainees and assess knowledge gaps in loan repayment, credit management, investment strategies, and financial planning.

METHODS: A cross-sectional survey study was conducted at a single institution between July 25, 2023 and January 10, 2024. A 52-question financial literacy survey was distributed to 97 residents and 101 first- and second-year medical students. The survey assessed knowledge across financial domains, including student loans, credit cards, mortgages, investing, and business ownership. Statistical analysis included independent samples t tests and analysis of variance to compare financial literacy scores across trainee levels.

RESULTS: Residents demonstrated significantly higher financial literacy scores than medical students (mean 18.80 vs 9.40 out of 35; P < 0.05). Despite this, substantial knowledge gaps persisted across multiple financial concepts. Of all respondents, 84.5% reported student loan debt exceeding $50,000, yet 64.6% were not enrolled in income-driven repayment plans, and 57.3% could not differentiate between Pay As You Earn and Revised Pay As You Earn. In addition, although 74.2% contributed to retirement accounts, 60.8% lacked knowledge about investment strategies. Despite limited financial literacy, 82.5% expressed interest in receiving structured financial education.

CONCLUSIONS: Medical trainees, including both medical students and residents, exhibit significant financial literacy deficits despite their progression through medical education. These findings underscore the need for structured financial education early in training to improve financial decision making, debt management, and long-term financial stability among future healthcare professionals.

PMID:41032276 | DOI:10.14423/SMJ.0000000000001866

South Med J. 2025 Sep;118(9):628-633. doi: 10.14423/SMJ.0000000000001877.

ABSTRACT

OBJECTIVES: The residency application process has become increasingly complex, with factors like holistic review, specialty signaling, and multiple application services posing new challenges for medical schools seeking to offer personalized support to students. In addition, fourth-year students often quickly dive into demanding externships, which make it challenging to access residency support services from their home institution and dedicate adequate time to the application process. To address these challenges, the Offices of Student Affairs and Medical Education at Florida International University Herbert Wertheim College of Medicine launched the mandatory Career Advising and Professional Development (CAPD) course, which aimed to standardize residency application support and reduce student stress while increasing preparedness.

METHODS: The 2-week CAPD course, piloted during the 2024-2025 academic year, occurred immediately after students’ dedicated Step 2 study period. Students with scheduling conflicts participated in a longitudinal, asynchronous version of the course with specified due dates for each assignment. Both course formats used a mixture of lectures, small-group activities, and written assignments to cover topics such as crafting a curriculum vitae, writing personal statements, completing residency applications, developing a match strategy, and preparing for interviews. To assess student satisfaction with the course, students were e-mailed three anonymous, optional surveys: one before the course, one just after it, and one after submitting their residency applications. Surveys consisted of a mixture of Likert-type and short-answer questions. Likert-type responses were analyzed using descriptive statistics; thematic review was employed for short-answer questions.

RESULTS: Of the 69 students who participated in the in-person course, 51 (74%) completed the precourse survey, and 48 (70%) completed the postcourse survey. Before the course, 27% of respondents felt confident about their application preparation; after the course, 92% felt confident. After the course, all students reported having completed drafts of key documents like the curriculum vitae, personal statement, and residency application. Free-text responses describing student emotions regarding the application process shifted from anxiety to excitement. In the longitudinal asynchronous version of the course, similar trends existed, but to a lesser extent when compared with the in-person course. In a subsequent survey sent after applications were submitted, 86 (61%) students from both course formats responded. Results showed that 95% felt the course, regardless of format, helped them prepare for the Match, and 90% considered it a valuable use of their time. In addition, 83% agreed that the course should be a curricular requirement.

CONCLUSIONS: The CAPD course successfully offered a framework for personalized support in the rapidly evolving residency application process. As a mandatory part of the curriculum, it allowed faculty to ensure that all students were engaged in the support services offered by our institution, which ultimately increased student confidence and decreased anxiety about the application process. Successful implementation requires significant logistical support (course coordinators, faculty, and career specialists) and the identification and participation of key stakeholders (academic advisors, department chairs, and content experts) to guide students through critical application components.

PMID:41032275 | DOI:10.14423/SMJ.0000000000001877

South Med J. 2025 Sep;118(9):614-617. doi: 10.14423/SMJ.0000000000001873.

ABSTRACT

OBJECTIVE: Extreme temperatures negatively impact pulmonary function. This study explored whether the variability in ambient temperatures across disparate geographic regions in the United States was associated with differences in hospital outcomes for patients admitted with chronic obstructive pulmonary disease (COPD).

METHODS: Using the 2016-2019 National Inpatient Sample database, we compared adults hospitalized with COPD in the US Northeast with those in the US South. We conducted multivariable regression analyses to study outcomes, including mortality, resource utilization, and posthospital discharge disposition.

RESULTS: From 2016 to 2019, 463,830 (30.1%) patients were admitted with COPD in the Northeast and 1,078,930 (69.9%) in the South. The lowest hospitalization rates for COPD were observed in both regions during the hottest months (July and August). Those in the Northeast had higher adjusted odds of in-hospital mortality (adjusted odds ratio: 1.1 [95% confidence interval {CI} 1.0-1.2]; P = 0.03) and a lower likelihood of being discharged to home after the hospitalizations (adjusted odds ratio: 0.63 [95% CI 0.61-0.65]; P < 0.01]) compared with patients hospitalized in the South. Patients in the Northeast had longer hospital stays (adjusted mean difference: +0.19 days; 95% CI 0.13-0.25; P < 0.01) and incurred greater hospital charges compared with patients in the South (adjusted mean difference: $3728; 95% CI 1840-5616; P < 0.01).

CONCLUSIONS: Patients hospitalized with COPD in the Northeast had worse clinical outcomes and greater resource utilization than in the South. These findings, coupled with the higher admission rates during colder months, raise questions about the influence of colder ambient temperatures on COPD exacerbations.

PMID:41032272 | DOI:10.14423/SMJ.0000000000001873

South Med J. 2025 Sep;118(9):602-605. doi: 10.14423/SMJ.0000000000001874.

ABSTRACT

OBJECTIVES: Concussions are one of the most frequent pediatric injuries, especially for high school athletes. Many of the psychological sequalae from concussions go unnoticed and undertreated particularly in the rural setting. There is limited research on optimizing recovery for these patients; however, newer studies are beginning to show the utilization of deep breathing exercises. In this study, we evaluated the effectiveness of self-administered relaxation techniques for postconcussive mood symptoms in an Appalachian population.

METHODS: Patients’ charts (N = 308) from a rural specialty concussion clinic between September 2020 and May 2023 underwent a review. Eligible patients included those who completed the Post-Concussion Symptom Scale (PCSS), Patient Health Questionnaire, and Generalized Anxiety Disorder scale (GAD-7) during their initial intake visit. Patients who suffered from at least mild to moderate depression and/or anxiety were educated on self-administered relaxation techniques, which consisted of 15 minutes of deep breathing exercises to be performed nightly. Their mood symptoms were reassessed, after monitoring patient compliance with breathing exercises, via a 4-point Likert scale at their follow-up appointment (average 13.5 days). The data were grouped based on the patient’s compliance (good vs limited) with their respective score improvement and analyzed via paired t tests. Good compliance consisted of performing the breathing exercises “most of the time” and the limited compliance group performed exercises “some of the time, seldom, or rarely/none.” The second part of the analysis investigated if there were any significant difference in improvements between the good and limited compliance groups using unpaired t test statistics.

RESULTS: The good compliance group experienced a significant improvement in Patient Health Questionnaire (7.11, P < 0.01), GAD (6.33, P < 0.01), and PCSS (24.33, P < 0.01) scores at follow-up. The limited compliance group only had a significant improvement in GAD (2.14, P = 0.025) and PCSS (29.77, P < 0.01). There was a significant difference in anxiety improvement between good and limited compliance groups by 4.19 points as assessed by the GAD scale (P < 0.01).

CONCLUSIONS: Self-administered deep breathing exercises are a cost-free, practical, and safe intervention that may benefit patients with persistent mood symptoms in the concussion rehabilitation process, particularly in resource scarce areas in Appalachia.

PMID:41032270 | DOI:10.14423/SMJ.0000000000001874

South Med J. 2025 Sep;118(9):596-601. doi: 10.14423/SMJ.0000000000001868.

ABSTRACT

OBJECTIVE: Incidental lesions identified clinically or on imaging are diagnostically challenging. The workup for these lesions is not well established. We investigated diagnostic modalities used at our institutions for undiagnosed lesions and the timeline from intake to biopsy and resultant diagnoses.

METHODS: We retrospectively analyzed data from all 3 Mayo Clinic sites (Arizona, Florida, and Minnesota) between November 1, 2018 and July 31, 2022. We evaluated the frequency of the biopsy technique used (if any) and how often the resultant diagnosis was malignant, benign, or inconclusive. The turnaround time from intake to biopsy and final diagnosis also was evaluated.

RESULTS: Of 93 patients with an undiagnosed lesion, 54 (58%) underwent biopsy; most patients underwent a single biopsy (n = 42, 77%), and 12 (23%) had two or more biopsies. Unbiopsied patients were diagnosed as having benign lesions according to imaging or had follow-up imaging. Of the 54 patients biopsied, 38 (70%) biopsies were obtained via fine-needle aspiration. Biopsy results were malignant for 34 patients (63%), benign for 14 (26%), and inconclusive for six (11%). Most patients were seen within 9 days of their initial contact (69/93, 74%), underwent biopsy within 20 days of seeing the physician (40/54, 74%), and had a final diagnosis within 30 days of the initial visit (72/93, 77%).

CONCLUSIONS: Our findings can help clinicians dispel the misconception that most undiagnosed lesions are malignant. Our findings also may help clinicians determine the appropriate workup for undiagnosed lesions. Further research is recommended to guide clinicians on the best sampling methodologies to obtain the highest yield of tissue for analysis. Dedicated patient workflows can help expedite diagnosis.

PMID:41032269 | DOI:10.14423/SMJ.0000000000001868

South Med J. 2025 Sep;118(9):589-595. doi: 10.14423/SMJ.0000000000001878.

ABSTRACT

OBJECTIVES: Despite the common performance of thoracentesis, predicting risk for adverse outcomes and abnormal postprocedural findings remains difficult. Although guidelines and experts have suggested that routine postprocedure imaging has low yield, compliance with these guidelines has not been well studied. In addition, previous studies have shown that pleural effusions are associated with high short-term mortality rates, longer hospitalizations, and higher readmission rates, increasing the importance of systematic study of procedural results. We aimed to determine the rate of imaging abnormalities, the utility of routine postprocedure imaging, and health outcomes for hospitalized patients requiring thoracentesis.

METHODS: An epidemiologic description including adult inpatients at one academic medical center who underwent thoracentesis outside of radiology-specialty procedural areas during a 2-year period. Charts were individually reviewed for data extraction.

RESULTS: In total, 425 thoracentesis procedures in 329 patients were included. A chest x-ray was obtained after 80.9% of procedures. Postprocedure imaging abnormalities included pneumothorax (8.0%), hemothorax (1.6%), reexpansion pulmonary edema (7.8%), and pneumothorax ex vacuo (4.7%). The average hospital length of stay was 13 days, and 15% required mechanical ventilation during their hospitalization. Fifty-five percent of participants were discharged home, 22.8% to a medical facility, 14.4% transitioned to hospice care, and 8.1% died during hospitalization.

CONCLUSIONS: Overall, approximately 20% of patients required clinical reassessment or intervention following thoracentesis. The findings confirm a high rate of secondary morbidity, in-hospital mortality, and long length of stay for hospitalized patients undergoing thoracentesis. The requirement for inpatient thoracentesis represents an opportunity to address end-of-life issues and to identify approaches to optimize resource utilization.

PMID:41032268 | DOI:10.14423/SMJ.0000000000001878

South Med J. 2025 Sep;118(9):585-588. doi: 10.14423/SMJ.0000000000001867.

ABSTRACT

OBJECTIVES: There has been growing evidence that insurance status is a major indicator of postoperative outcomes, which has been extensively reported in orthopedic procedures such as shoulder and knee arthroplasty. Patients with Medicaid public insurance had increased complications, longer lengths of stay, and increased costs compared with patients who had private insurance when controlling for demographic characteristics. Our study compared the outcomes of patients with Medicaid insurance with those patients with private commercial insurance who have undergone anterior cruciate ligament (ACL) reconstruction. We hypothesized that patients with Medicaid insurance coverage would have worse patient-reported outcomes and complication rates in comparison with a matched cohort of patients with private insurance.

METHODS: Our departmental registry was queried for all patients who underwent primary arthroscopically assisted ACL reconstruction by 10 surgeons in the practice between January 2018 and June 2022 and were at least 2 years out from their surgery. Eligible patients in the matched cohort model were contacted via telephone for consent to participate in this study and questioned about their pain level, return to sport, physical therapy compliance, and any incidence of retear rates or additional procedures in their ipsilateral or contralateral knee. Patients were then compared across insurance types based on Lysholm knee score, as well as the other patient-reported outcomes.

RESULTS: A total of 189 ACL reconstructions were screened during the study period. Fifteen private insurance and 15 Medicaid patients responded to the telephone call and consented to the study. Comparison of the clinical outcomes within the insurance cohorts revealed that there were no significant differences in Lysholm knee scores, pain scores, revision rate, and return to sport. The only significant difference observed was that Medicaid patients had a greater physical therapy compliance rate. Multivariate linear regression analysis revealed that males had the highest odds ratio associated with higher Lysholm scores, but there was no significance observed with any factor.

CONCLUSIONS: Although Medicaid patients did have greater physical therapy attendance, this did not improve their postoperative outcomes, which may suggest that Medicaid status may affect physical therapy effectiveness and can be a confounding variable related to other health disparities. Because the multivariate linear regression analysis did not show any associated factors with poorer postoperative outcomes, this may imply that some demographic factors or insurance status may not be contraindications to ACL reconstruction. Despite the lack of significance, males had a greater likelihood of achieving acceptable Lysholm knee scores based on the multivariate analysis.

PMID:41032267 | DOI:10.14423/SMJ.0000000000001867

South Med J. 2025 Sep;118(9):579-584. doi: 10.14423/SMJ.0000000000001875.

ABSTRACT

OBJECTIVES: An opioid-sparing, multimodal pain (MMP) protocol was initiated at our institution in August 2016 in the Division of Trauma and Acute Care Surgery (TACS). During the next year, the practice was codified into a protocol. This study aims to evaluate the dissemination and impact of MMP.

METHODS: We conducted a single-center retrospective cohort study of all patients admitted to a surgical service from May 2015 to July 2020 to evaluate opioid and nonopioid prescribing for analgesia. The analysis consisted of three populations: patients admitted to the TACS service, the General Surgery subspecialty (GSS) services (excluding TACS), and other surgical department (OSD) services.

RESULTS: Of the 12,010 patients who met the inclusion criteria, 1979 (16.5%) were admitted to the TACS service, 1106 (9.2%) to GSS services, and 8925 (74.3%) to OSD services. Opioid morphine milligram equivalents averaged 38.6 ± 33.3 daily but decreased in all groups over time. Nonopioid adjunctive medications were used in 5932 (49.4%) and increased in all groups after implementation of the protocol (all P < 0.001). After MMP introduction, nonopioid analgesic use increased most rapidly in TACS and the slowest in OSD. Conversely, the average daily morphine milligram equivalents decreased most quickly in TACS (24.4%, P < 0.001), while GSS and OSD services saw a subsequent decrease in opioid use (P = 0.004 and P < 0.001, respectively) as MMP increased.

CONCLUSIONS: Implementation of an MMP protocol by a single division can facilitate the spread of nonopioid adjunctive pain medication use and decrease opioid utilization throughout surgical specialties in a hospital.

PMID:41032266 | DOI:10.14423/SMJ.0000000000001875

ATS Sch. 2025 Oct 1. doi: 10.34197/ats-scholar.2025-0008OC. Online ahead of print.

ABSTRACT

Background: Burnout, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, negatively affects resident physicians and patients. Although burnout is common among intensive care unit (ICU) healthcare workers, data on its impact on resident physicians during their medical ICU (MICU) rotations are limited. Objective: This study aimed to determine the prevalence, key drivers, and mitigating factors for burnout among resident physicians rotating through the MICU. Methods: We conducted a single-center, mixed-methods prospective cohort study in the MICU of an academic quaternary care hospital. Over the course of a 9-month period, we surveyed residents at the end of their MICU rotation and assessed the prevalence of burnout using the Maslach Burnout Inventory, as well as perceived drivers and mitigators of burnout. Focus groups were conducted to further explore internal medicine (IM) residents’ perceptions of drivers and mitigators of MICU-related burnout. Results: Forty-nine residents completed the survey (80% response rate), and 25 IM residents participated in focus groups. The overall burnout prevalence was 88%. Although not statistically significant, higher burnout rates were observed among first-year residents (94% vs. 78%; P = 0.12) and non-IM residents (100% vs. 81%; P = 0.07). Fifty-three percent of residents believed that there was more burnout in the MICU than other ICU rotations. Three themes emerged as drivers of burnout: patient factors (high acuity, adverse outcomes, ethical dilemmas), team and unit dynamics (interdisciplinary tensions, MICU insider-outsider bias), and the clinical learning environment (limited work-life balance, steep learning curve, normalization of burnout). The primary mitigating factors were meaningful patient interactions, supportive team dynamics, structured debriefing, protected time, and focused skill development. Conclusion: Burnout in residents rotating through the MICU is extremely high, higher than the previously reported baseline resident burnout rate of 50-75%. First-year and non-IM residents may be especially vulnerable because of unfamiliarity with the unique team and unit dynamics and clinical learning environment of the MICU (high acuity, high intensity, frequent exposure to dying patients, and unit insider-outsider bias). This study highlights unique factors, which contribute to burnout among MICU residents, that differ from those affecting other critical care staff and could be addressed through targeted interventions.

PMID:41032260 | DOI:10.34197/ats-scholar.2025-0008OC