The James H. Quillen College of Medicine is a medical school and a part of East Tennessee State University, which is located in Johnson City, Tennessee. It is one of two public medical schools in Tennessee, the other being the University of Tennessee College of Medicine at the University of Tennessee Health Science Center in Memphis. It was named for Congressman Jimmy Quillen, who led the fight to open a second public medical school in Tennessee. The school was originally named the ETSU Quillen-Dishner College of Medicine, but Dr. Paul Dishner's name was removed in 1989. In the 2011 edition of U.S. News & World Report's "America's Best Graduate Schools," the James H. Quillen College of Medicine at East Tennessee State University is ranked sixth in the nation for excellence in rural medicine education. For several consecutive years, ETSU has been ranked within the top 10 schools in the country for rural medicine. Additionally, Quillen College of Medicine at East Tennessee State University was recognized in the 2011 edition of U.S. News & World Report's "America's Best Graduate Schools" for ranking 20th in the nation for family medicine education. Quillen has also been recognized by the American Academy of Family Physicians as one of the top 10 schools in the nation for producing family physicians. ETSU was also ranked in the top 25% of medical schools for primary care education by U.S. News & World Report.A study published in the June 15, 2010 edition of Annals of Internal Medicine by a professor of health policy, Fitzhugh Mullan, ranked East Tennessee State University’s James H. Quillen College of Medicine as the top school in the nation for producing primary care physicians and 12th among U.S. medical schools on a “social mission” scale.
Purpose Transcatheter aortic valve replacement (TAVR) has become the standard of care for severe aortic stenosis (AS) across all surgical risk groups. However, concerns remain regarding equitable access to this life-saving procedure, particularly among racial minorities and underinsured populations. The objective of this research is to evaluate national trends and disparities in TAVR utilization among non-White and underinsured patients hospitalized with aortic stenosis in the United States. Methods We performed a retrospective cross-sectional analysis of the National Inpatient Sample (NIS) from 2016 to 2022. Adult hospitalizations with a primary or secondary diagnosis of aortic stenosis were identified using ICD-10 codes. TAVR procedures were identified using corresponding procedure codes. Patients were stratified by race/ethnicity and primary payer (Medicare, Medicaid, private insurance, or uninsured). We analyzed annual trends in TAVR use and conducted multivariable logistic regression to identify predictors of receiving TAVR, adjusting for demographics, comorbidities, hospital characteristics, and surgical risk. Results Among an estimated 1.2 million hospitalizations for aortic stenosis, 147,000 underwent TAVR. Over the 7-year period, TAVR volume increased overall, but disparities persisted: Black and Hispanic patients were significantly less likely to receive TAVR compared to White patients (adjusted OR 0.72 [95% CI 0.66–0.78] and 0.75 [0.69–0.82], respectively). Medicaid and uninsured patients had the lowest TAVR utilization rates, even after adjusting for age and comorbidities (adjusted OR 0.61 [0.53–0.70] and 0.47 [0.38–0.59], respectively). In high-volume centers, the disparity narrowed but remained statistically significant, suggesting structural and systemic barriers beyond hospital capacity. Conclusions Despite widespread adoption of TAVR, significant racial and insurance-based disparities persist in its utilization. Non-White and underinsured patients are less likely to receive TAVR even when clinically indicated. These findings highlight the urgent need for policy and system-level interventions to promote equitable access to advanced cardiovascular procedures.
INTRODUCTION: Maternal opioid use is associated with small-for-gestational-age infants. Emerging data from our institution suggest a potential increased incidence of shortened femur length in fetuses with buprenorphine exposure. This study aimed to evaluate whether buprenorphine use is associated with altered femur length and other fetal growth parameters and to explore a possible dose–response relationship. METHODS: Fetal anatomy scans were performed at ∼20 weeks of gestation, with serial growth scans starting at 32 weeks for patients on medication-assisted therapy (MAT) due to risk of growth restriction. We retrospectively reviewed ultrasound reports for three groups: low-dose MAT (less than 2 mg buprenorphine daily; n=127), high-dose MAT (greater than 8 mg daily; n=103), and controls without known buprenorphine exposure (n=212). RESULTS: At the anatomy scan, femur length was decreased in both high-dose ( P =.02) and low-dose ( P =.0004) buprenorphine groups versus controls. This persisted into the third trimester ( P =.00005 and P =.004, respectively), when estimated fetal weight was also reduced ( P =.006 and P =.02, respectively). High-dose exposure was further associated with decreased abdominal circumference ( P =.03), biparietal diameter ( P =.001), and mean cephalic index ( P =.02) in the third trimester. Birth weight was lower in the high-dose group compared with controls ( P =.0003). CONCLUSIONS/IMPLICATIONS: Fetal buprenorphine exposure is associated with decreased femur length at the anatomy scan and in the third trimester. High-dose exposure exhibits a broader effect on growth parameters, suggesting a dose–response relationship. These findings should not limit access to buprenorphine for pregnant persons, given the risks of withdrawal and relapse, but remain vital for well-informed counseling and antenatal surveillance.
Severe hyperglycemia during acute COVID-19 infection is an uncommon but clinically significant presentation. Here, we present an unusual case of an 82-year-old COVID-19-positive man who presented with severe hyperglycemia following several days of COVID-19 symptoms, with an admission HbA1c of 14.7%. He received standard treatment for a working diagnosis of diabetic ketoacidosis (DKA), improved clinically, and was discharged after five days, but continued to require exogenous insulin to maintain appropriate fasting and postprandial blood glucose levels. This case represents possible COVID-19-associated metabolic decompensation in previously unrecognized type 2 diabetes. It highlights the importance of monitoring patients with COVID-19 for severe hyperglycemia and metabolic decompensation, particularly in elderly individuals, those with metabolic risk factors, or those with severe clinical presentations.
Undertriage remains a significant challenge in rural trauma systems, where over 42 million Americans live more than an hour from a Level I or II trauma center. Paramedic discretion (PD) may serve as a practical adjunct to formal activation criteria by identifying patients who fall outside standard triggers yet require trauma system resources. The goal of this study was to evaluate the systems-level role of PD as a second-tier trauma activation (STA) criterion at a rural Level I Trauma Center. This was a retrospective study including adult patients evaluated as STA at a Level I Trauma Center over the course of 4.5 years using two comparison groups: STAs meeting criteria (2283 patients) and STAs activated by PD (1115 patients). PD-activated patients demonstrated equivalent outcomes to criteria-activated patients across all primary endpoints, including hospital length of stay (LOS) ≤ 48 hours (P = 0.116), mortality(P = 0.578), discharge home (P = 0.069), and Intensive Care Unit (ICU) admission (P = 0.156). PD preferentially identified geriatric patients, those with blunt trauma mechanisms, and those with open wounds; populations recognized as being at elevated risk of undertriage. These findings suggest PD functions as an effective triage adjunct that reduces undertriage in rural trauma systems where standardized criteria alone may be insufficient.
