Articles

Hardware Repair

Posted by on Dec 16, 2016 in Articles, ePubs | 0 comments

Re-fracture of Distal Radius and Hardware Repair in the Setting of Trauma Authors: Brandon P. Lucke-Wold, PhD1*, Patrick C. Bonasso, MD2, and Glen Jacob, MD3 Author Affiliations: 1 Department of Surgery, West Virginia University School of Medicine.  Medical student author. 2 Dept. of Surgery, West Virginia University School of Medicine. Co-author, pbonass3@hsc.wvu.edu. 3 Dept. of Surgery, West Virginia University School of Medicine. Faculty author, gjacob@hsc.wvu.edu Full Text Article PDF Corresponding Author: Brandon Lucke-Wold, PhD, Bwold@mix.wvu.edu Key Words: Volar locking plate-distal radius fracture-open reduction-internal fixation   Abstract: Distal radius fractures are one of the most common fractures in the elderly. Falls and motor vehicle collisions lead to increased risk for this type of fracture. A seventy-three year-old female had a previous history of distal radius fracture with repair by open reduction and internal fixation. She was involved in a motor vehicle collision that re- fractured the distal radius. The plate was bent and required removal, which is a very rare but potentially serious complication. Surgery was done to fix the open reduction and internal fixation with volar locking plates while removing damaged hardware. Only a select few cases have reported hardware failure as a cause of complications. Among those cases, high-energy activities and maintained stress on the hardware were likely causes. Distal radius fractures are the most common upper extremity fracture in the elderly. We highlight a unique case of re-fracture in the setting of trauma with prior hardware failure and describe the strategy for hardware repair.   Published on date: December, 2016   DOI: 10.15404/msrj/11.2016.0009 Citation: Lucke-Wold B, Bonasso P, Jacob G. Re-fracture of Distal Radius and Hardware Repair in the Setting of Trauma. Medical Student Research Journal (2016). doi:10.15404/msrj/11.2016.0009 References: Sebastin SJ, Chung KC. An Asian perspective on the management of distal radius fractures. Hand Clin. 2012;28(2):151-156. Kose A, Aydin A, Ezirmik N, Topal M, Can CE, Yilar S. Intramedullary nailing of adult isolated diaphyseal radius fractures. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2016;22(2):184-191. Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. The Journal of the American Academy of Orthopaedic Surgeons. 2009;17(6):369-377. Lattmann T, Meier C, Dietrich M, Forberger J, Platz A. Results of volar locking plate osteosynthesis for distal radial fractures. Journal of trauma. 2011;70(6):1510-1518. Harness NG. Fixation Options for the Volar Lunate Facet Fracture: Thinking Outside the Box. J Wrist Surg. 2016;5(1):9-16. Ezzat A, Baliga S, Carnegie C, Johnstone A. Volar locking plate fixation for distal radius fractures: Does age affect outcome? J Orthop. 2016;13(2):76-80. Dasari CR, Sandhu M, Wisner DH, Wong MS. Approaches to Distal Upper-Extremity Trauma: A Comparison of Plastic, Orthopedic, and Hand Surgeons in Academic Practice. Ann Plast Surg. 2016;76 Suppl 3:S162-164. Geissler WB, Clark SM. Fragment-Specific Fixation for Fractures of the Distal Radius. J Wrist Surg. 2016;5(1):22-30. Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J. [The volar locking plate for extension fractures of the distal radius]. Oper Orthop Traumatol. 2016;28(1):47-64. Korpelainen R, Korpelainen J, Heikkinen J, Vaananen K, Keinanen-Kiukaanniemi S. Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index–a population-based study. Bone. 2006;39(2):385-391. Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. The Journal of hand surgery. 2011;36(6):982-985. De...

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Scrotal Rupture

Posted by on Dec 16, 2016 in Articles, ePubs | 0 comments

Scrotal Rupture in a Premature Neonate with Cystic Fibrosis as a Consequence of Meconium Periorchitis Authors: Michael Bedgood1* BS, Christine Cortelyou1 MD, Cynthia Blanco1, MD, MSc, Rafael Fonseca2, MD, Alvaro Moreira1, MD Author Affiliations: 1University of Texas Health Science Center (UTHSC), San Antonio, TX; 2University of Texas Medial Branch (UTMB), Galveston, TX Full Text Article PDF Corresponding Author: Michael Bedgood BS, bedgood@uthscsa.edu Key Words: neonate, meconium peritonitis, meconium periorchitis   Abstract: Neonatal meconium periorchitis is a rare condition, with less than 60 cases described in the literature. Of the reported cases, only one describes the complication of a congenital rupture of the scrotum. We present a case of a Hispanic preterm neonate who was diagnosed with cystic fibrosis after scrotal rupture secondary to meconium periorchitis. The neonate was taken to the operating room for exploratory laparotomy and scrotal exploration. No calcification was noted and the patient’s left scrotum was surgically packed as well as creating a colostomy. The surgery proved successful and the patient was discharged home on day of life 79. This case of a neonate presenting with meconium periorchitis and scrotal rupture notes the varying degree of initial presentations for cystic fibrosis in a neonate. Successful outcomes for neonates presenting with a ruptured scrotum depend on early clinical assessment.   Published on date: December, 2016   DOI: 10.15404/msrj/11.2016.0008 Citation: Bedgood M, Cortelyou C, Blanco C, Fonseca R, & Moreira A. Scrotal Rupture in a Premature Neonate with Cystic Fibrosis as a Consequence of Meconium Periorchitis. Medical Student Research Journal (2016). doi:10.15404/msrj/11.2016.0008 References: Lange, M. Meconium peritonitis presenting in scrotal hydroceles. J. Surg. 1964; 51(12): 942-4 Varkonyi I, Fliegel C, Rosslein R, Jenny P, Ohnacker H. Meconium periorchitis: Case report and literature review. Eur J Pediatr Surg. 1998; 10: 404-407 Regev RH, Markovich O, Arnon S, Bauer S, Dolfin T, Litmanovitz I. Meconium periorchitis: Intrauterine diagnosis and neonatal outcome: case reports and review of the literature. Journal of Perinatology. 2009: 29; 585-7 Salle JLP, Fraga JCS, Wojciechowski M, Antunes CRH. Congenital rupture of scrotum: An unusual complication of meconium peritonitis. The Journal of Urology. 1992; 148: 1242-43 Jeanty C, Bircher A, Turner C. Prenatal Diagnosis of Meconium Periorchitis and Review of the Literature. J Ultrasound Med.2009; 28: 1729-1734. Williams HJ, Abernethy LJ, Losty PD, Kotiloglu E. Meconium periorchitis – a rare cause of paratesticular mass. Pediatr Radiol. 2004; 34: 421-423 Soferman R, Ben-Sira L, Jurgenson U. Cystic fibrosis and neonatal calcified scrotal mass. Journal of Cystic Fibrosis. 2003; 2: 214-216 Wax JR, Pinette MG, Cartin A, Blackstone J. Prenatal sonographic diagnosis of meconium periorchitis. J Ultrasound Med. 2007; 26: 415-417 Herman TE, Siegel MJ. Meconium Periorchitis. Journal of Perinatology. 2004; 24: 188-190 Alanbuki, Ammar Hameed, Ashwith Bandi, and Nick Blackford. “Meconium Periorchitis: A Case Report and Literature Review.” Canadian Urological Association Journal 7.7-8 (2013): E495–E498. PMC. Web. 27 Apr....

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Tonsillar Ectopia

Posted by on Aug 29, 2016 in Articles, ePubs | 0 comments

Determining if a Relationship Exists Between Tonsillar Ectopia and Symptom Presentation in Chiari Malformation Patients Author: Julia R. Saling, B.S.1, Paige Marty, B.S.2, Rebecca Fischbein, Ph.D3, Michelle Chyatte, Dr.PH., MPH4 Author Affiliations: 1 Student Research Fellow, Northeast Ohio Medical University 2 Student Research Fellow, Northeast Ohio Medical University 3 Research Coordinator and Assistant Professor of Family and Community Medicine, Northeast Ohio Medical University 4 Assistant Professor of Family and Community Medicine, Northeast Ohio Medical University Full Text Article PDF Corresponding Author: Julia R. Saling, jsaling@neomed.edu Key Words: Chiari Malformation Type I, Tonsillar Ectopia, Symptom Presentation   Abstract: Purpose Chiari Malformation Type I (CM I) is characterized by cerebellar tonsil ectopia and has varying symptomatology . Previous research has shown a relationship between tonsillar dominance and related conditions but few examined association with symptomatology. This study attempts to elucidate a relationship between cerebellar tonsil dominance, age, and symptomatology. Methods Data from CM I patients were extracted from the Conquer Chiari Patient Registry. Tonsillar dominance was determined using a ratio of right-to-left herniation length. Pearson’s correlation and one-tailed Student’s T-test were used for analysis. Results Length of tonsillar descent appears to be negatively correlated to age of onset (r = -0.266; p < 0.001; n = 113) and diagnosis (r = -0.323; p < 0.001; n = 113). No correlation was found between tonsillar dominance and symptom location, nor between tonsillar dominance and symptom severity bilaterally (p > 0.05).  Symptom location and severity ratios appear to be correlated (r = 0.666; p < 0.001). Tonsillar descent length appears to be strongly correlated bilaterally (r = 0.972; p < 0.001; n = 50). Conclusion Inconsistency between tonsillar dominance as related to symptomatology suggests a multifactorial contribution to clinical presentation. The inverse relationship between tonsillar herniation length and age of symptom onset and diagnosis suggests herniation length may be an important predictor for clinical outcomes. Further research is needed to elucidate additional contributing factors and tonsillar dominance and symptomatology association.   Published on date: August, 2016   DOI: 10.15404/msrj/08.2016.0007 Citation: Saling et al. Determining if a Relationship Exists Between Tonsillar Ectopia and Symptom Presentation in Chiari Malformation Patients Medical Student Research Journal (2016). doi:10.15404/msrj/08.2016.0007 References: Siasios J, Kapsalaki EZ, Fountas KN. Surgical Management of Patients with Chiari I Malformation. Int J Pediatr. 2012;2012:1-10. doi:10.1155/2012/640127. Heiss J. Epidemiology of the Chiari I Malformation. In: Tubbs RS, Oakes WJ, eds. The Chiari Malformations. New York: Springer Science + Business Media; 2013:83-92. Milhorat TH, Chou MW, Trinidad EM, et al. Chiari I malformation redefined: Clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005-1017. doi:10.1097/00006123-199905000-00042. Deng X, Wang K, Wu L, et al. Asymmetry of tonsillar ectopia, syringomyelia and clinical manifestations in adult Chiari I malformation. Acta Neurochir (Wien). 2014;156(4):715-722. doi:10.1007/s00701-014-2000-5. Tubbs RS, Wellons JC, Oakes WJ. Asymmetry of tonsillar ectopia in Chiari I malformation. Pediatr Neurosurg. 2002;37(4):199-202. doi:10.1159/000065399. Wu T, Zhu Z, Sun X, et al. Is curve direction correlated with the side of dominant displacement of cerebellar tonsil and syrinx deviation in thoracic scoliosis secondary to Chiari malformation type I and syringomyelia? Stud Health Technol Inform. 2012;176(Cmi):286-290. doi:10.3233/978-1-61499-067-3-286. Kaplan Y, Oksuz E. Chronic migraine associated with the Chiari type 1 malformation. Clin Neurol Neurosurg. 2008;110(8):818-822. doi:10.1016/j.clineuro.2008.05.016. Lewis AR, Kline LB, Sharpe JA. Acquired esotropia due to Arnold-Chiari I malformation. J Neuro-Ophthalmology. 1996;16(1):49-54. <Go to ISI>://WOS:A1996UE52700012. Shamji MF, Ventureyra ECG,...

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Wallis Implant

Posted by on Aug 29, 2016 in Articles, ePubs | 0 comments

Pain Relief and Intervertebral Disc Rehydration Following Wallis® Interspinous Device Implantation: a Case Report. Author: Carter R. Mohnssen, B.S.1,2, Kenneth Pettine, MD2, and Nicole Rittenhouse, MA, CCRC2 Author Affiliations: 1 Creighton University School of Medicine, Omaha, Nebraska, USA. 2 The Spine Institute, Loveland, Colorado, USA. Full Text Article PDF Corresponding Author: Carter Mohnssen, CarterMohnssen@creighton.edu Key Words: intervertebral disc degeneration, case reports, orthopedics, therapeutics, biologics   Abstract: Introduction: Degeneration of the lumbar motion segment is the primary cause of low back pain in many individuals. Therefore, new minimally invasive treatments are being sought. Patient Profile: A 47-year old man presented with severe low back pain and radicular symptoms of several years duration. Lumbar MRI revealed severe desiccation, loss of disc height, and an annular tear with right lateral disc protrusion at L4-5. Interventions/Outcomes: After conservative treatment failed, the patient received a Wallis® interspinous spacer at the affected level. 100% subjective pain relief was obtained at 3 months post-op. Nucleus pulposus rehydration on MRI was observed. Discussion: Controversy exists over whether disc dehydration is a reliable indicator of low back pain; however, interspinous spacers seem to alter abnormal motion segment’s biomechanics in a way that results in alleviation of low back pain and increased range of motion. With the advent of biologic therapy, this may provide an intriguing minimally invasive treatment modality, although further research is needed.   Published on date: August, 2016   DOI: 10.15404/msrj/04.2016.0006 Citation: Mohnssen, C. Pain relief and intervertebral disc rehydration following Wallis interspinous device implantation: a case report. Medical Student Research Journal (2016). doi: 10.15404/msrj/04.2016.0006 References: Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminem A. Low back pain in relation to lumbar disc degeneration. Spine. February 2000; 25:487-92. Mooney V, Robertson J. The facet syndrome. Clinical Orthopedic Related Research. March-April 1976; 115:149-56. Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine. December 1978; 3:319-27. Yang KH, King AI. Mechanism of facet load transmission as a hypothesis for low-back pain. Spine. September 1984; 9:557-65. Guyer RD, McAfee PC, Banco RJ, et al. Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of total artificial disc replacement with the CHARITE artificial disc versus lumbar fusion: five year follow-up. Spine. May 2009; 9(5): 374-86. Zigler J, Delamarter R, Spivak JM, et al. Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine. May 2007; 15;32(11): 1155-62. Sénégas J. Minimally invasive dynamic stabilisation of the lumbar motion segment with an interspinous implant. Minimally Invasive Spine Surgery: A Manual, edited by HM Mayer. 2005; 459-65. Sénégas J. Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: the Wallis system. European Spine Journal. October 2002; Suppl 2 S164-69. Sénégas J, Vital JM, Pointillart V, Mangione P. Clinical evaluation of a lumbar interpsinous dynamic stabilization device (the Wallis system) with a 13-year mean follow up. Neurosurgery Review. July 2009; 32:335-342. Boeree NR. Dynamic stabilization of the degenerative lumbar motion segment: the Wallis system. Spinal Arthroplasty Society Annual Meeting. May 2005; New York, New York. Sandu N, Schaller B, Arasho B, Orabi M. Wallis implantation to treat degenerative spine disease: description of the method and case series. Expert Review of ...

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Time to Neurological Deterioration

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

Time to Neurological Deterioration in Ischemic Stroke. Author: James E. Siegler, MD1†, Karen C. Albright, DO, MPH2,3,4,5†, Alexander J. George, BS1, Amelia K. Boehme, MSPH2, Michael A. Gillette, MPH 1, Andre D. Kumar, MD1, Monica Aswani MSPH6, Sheryl Martin-Schild, MD, PhD1 Author Affiliations: 1 Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, LA 70112. 2 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 35294. 3 Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, 35294. 4 Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, 35294. 5 Department of Neurology, School of Medicine, University of Alabama at Birmingham, 35294. 6 Department of Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35249. † Siegler and Albright contributed equally to this article as first authors. Full Text Article PDF Corresponding Author: Sheryl Martin-Schild, smartin2@tulane.edu Key Words: Acute ischemic stroke, neurological deterioration, latency, time to event analysis   Abstract: Background: Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 hours of stroke.  The timing of ND with respect to ND etiology and reversibility has not been investigated. Methods: At our center, we define ND as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours and categorize etiologies of ND according to clinical reversibility.  ND etiologies were considered non-reversible if such causes may have produced or extended any areas of ischemic neurologic injury due to temporary or permanent impairment in cerebral perfusion. Results: Seventy-one of 350 ischemic stroke patients experienced ND.  Over half (54.9%) of the patients who experienced ND did so within the 48 hours of last seen normal.  The median time to ND for non-reversible causes was 1.5 days (IQR 0.9, 2.4 days) versus 2.6 days for reversible causes (IQR 1.4, 5.5 days, p=0.011).  After adjusting for NIHSS and hematocrit on admission, the log-normal survival model demonstrated that for each 1-year increase in a patient’s age, we expect a 3.9% shorter time to ND (p=0.0257).  In addition, adjusting for age and hematocrit on admission, we found that that for each 1-point increase in the admission NIHSS, we expect a 3.1% shorter time to ND (p=0.0034). Conclusions: We found that despite having similar stroke severity and age, patients with nonreversible causes of ND had significantly shorter median time to ND when compared to patients with reversible causes of ND.   Published on date: March, 2016   DOI: 10.15404/msrj/03.2016.0005 Citation: Siegler J, Albright K, et al. Time to Neurological Deterioration in Ischemic Stroke. Medical Student Research Journal (2016). doi:10.15404/msrj/03.2016.0005 References: Davalos A, Toni D, Iweins F, Lesaffre E, Bastianello S, Castillo J. Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I. Stroke; a journal of cerebral circulation. 1999;30(12):2631-6. Siegler JE, Martin-Schild S. Early Neurological Deterioration (END) after stroke: the END depends on the definition. International journal of stroke : official journal of the International Stroke Society. 2011;6(3):211-2. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S. What change in the...

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Does Traditional Chinese Medicine Matter?

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China Author: Xiaoyue Mona Guo, B.A.1, Shuiyuan Xiao, M.D., Ph.D.2 Author Affiliations: 1Yale University School of Medicine, New Haven, CT USA 2Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China Full Text Article PDF Corresponding Author: Xiaoyue Mona Guo Key Words: Traditional Chinese Medicine, Health-seeking behaviors, Rural China, Diabetes   Abstract: Introduction: With an aging, urbanizing population, China is home to the world’s largest number of adult diabetics. Although more diabetic patients currently live in cities, the prevalence of pre-diabetes is greater in the rural population due to changing dietary and physical habits, as well as the relative poverty. This demographic is thus an important target for public health intervention. As Traditional Chinese Medicine (TCM) is viewed in China as useful for treating chronic diseases and widely accepted, we sought to explore its use for rural diabetic patients. Methods: The study population included 63 diabetic patients and two village doctors from four rural villages near Changsha, China. An initial survey was orally conducted with all 63 participants to collect demographics, financial situation, health-seeking behaviors, treatment beliefs, and medical expenditure. Three focus groups of six rural patients each were subsequently held at village health centers. For analysis, questionnaire data was summarized using means and standard deviations or medians and quartiles. Focus group sessions were voice-recorded and transcripts were coded for thematic analysis. Results/Conclusions: Questionnaire data revealed that for the majority of participants, seeing a doctor is costly in terms of time and money. Patients often do not have the luxury of choosing their medical provider. Despite the benefits of TCM, its slow speed and cumbersome preparation methods do not fit a need for immediate results. Furthermore, TCM doctors are not as available or accessible as Western medicine doctors. As such, although 20% of rural patients rated higher trust in TCM than WM, no patient solely used TCM for their treatment. Instead, almost 40% of patients try to use both TCM and WM. Village practitioners similarly believed that although diabetes treatment should go towards integrative treatment, TCM’s development is hindered by its slow onset and inconvenience coupled with a more systemic lack of TCM infrastructure and research in China. In summary, the continued trust that rural patients place in TCM supports further research for better understanding the true economic, social, and health benefits of having combined TCM-WM treatment be part of diabetes standard of care. Published on date: March 2016 DOI: 10.15404/msrj/03.2016.0004 Citation: Guo X, Xiao S. Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China, Medical Student Research Journal (2016). doi:10.15404/msrj/03.2016.0004 References: Hesketh T, Zhu WX. Traditional Chinese medicine: One country, two systems. BMJ: British Medical Journal (International Edition). 1997;315(7100):3p. Covington MB. Traditional Chinese medicine in the treatment of diabetes. Diabetes Spectrum. 2001;14(3):154-159. Yu H, Wang S, Liu J, Lewith G. Why do cancer patients use Chinese Medicine?-A qualitative interview study in China. European Journal of Integrative Medicine. 2012;4:c197-c203. Lee GBW, Charn TC, Chew ZH, Ng TP. Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Fam Pract. Dec 2004;21(6):654-660. Yang WY, Lu JM, Weng JP, et al. Prevalence of Diabetes among Men and...

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Combating Obstacles to Empathy

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students Author: Francesca P. Kingery, M.S.1*, Alexander Bajorek, M.D. M.A.2, Amber Zimmer Deptola, M.D.3 Karen Hughes Miller, Ph.D.4, Craig Ziegler Ph.D.5, Pradip D. Patel M.D.6 Author Affiliations: 1School of Medicine, University of Louisville, Louisville, KY, USA. 2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA, USA. 3Washington University School of Medicine, St. Louis, MO, USA.   4Graduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA. 5Office of Medical Education, University of Louisville School of Medicine, Louisville, KY, USA. 6Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA. Full Text Article PDF Corresponding Author: Francesca P. Kingery, fdprib01@louisville.edu Key Words: Medical Humanities, Bioethics, Curriculum, Student-led, Empathy, Medical Education, Pre-Clinical   Abstract: The expression of humanism in patient encounters is a core component of the medical profession and evolving national medical student curriculum. Growing evidence suggests that empathetic care improves patient outcomes and diagnostic accuracy while decreasing physician stress and rates of litigation. Unfortunately, multiple recent studies using different scales and survey tools have consistently shown empathy to decrease during the third and fourth years of medical school. We developed a replicable, case-based, student and expert-driven, small-group discussion series designed to address this decline. Over two years, the series included four separate discussions over controversial topics seldom addressed by formal courses (Chronic Pain Management vs. Prescription Drug Abuse, Balancing Business and Medicine, and Domestic Violence). We utilized pre- and post-session surveys to qualitatively and quantitatively evaluate the program. Our results demonstrated significant improvement in participants’ comfort with the subject matter and desire to approach faculty and peers regarding humanistic patient care. Future and more frequent interactions, combined with optimization of the format could further uncover the utility of this program. Ultimately, we believe our discussion series could be replicated on other medical campuses.   Published on date: March, 2016   DOI: 10.15404/msrj/03.2016.0001 Citation: Kingery et al. Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students Medical Student Research Journal (2016). doi: 10.15404/msrj/03.2016.0001 References: Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine. October 2007;22(10):1434-8. http://dx.doi.org/10.1007/s11606-007-0298-x. Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine. September 2009;84:1182–1191. Mangione S, Kane GC, Caruso JW, Gonella JS, Nasca TJ, Hojat M. Assessment of empathy in different years of internal medicine training. Medical Teacher. July 2002;24:370–3. Newton BW, Barber L, Clardy J, et al. Is there hardening of the heart during medical school? Academic Medicine. March 2008;83:244–249. http://dx.doi.org/10.1097/ACM.0b013e3181637837. Rosenthal S, Howard B, Schlussel YR, et al. Humanism at heart: preserving empathy in third-year medical students. Academic Medicine. March 2011;86(3):350-8. http://dx.doi.org/10.1097/ACM.0b013e318209897f. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Academic Medicine. January 2006; 81(1):82-5. Gold A, Gold S. Humanism in medicine from the perspective of the Arnold Gold Foundation: challenges to maintaining the care in health care. Journal of Child Neurology. June 2006;21(6): 546-9. Mueller PS. Incorporating professionalism into medical education: the Mayo Clinic experience. Keio Journal of Medicine. September 2009;58(3):133-43. Shiau S, Chen CH. Reflection and critical thinking of humanistic care...

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Medals 4 Mettle

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

Medals4Mettle: A Program to Enhance the Medical Student-Patient Bond Author: McKenzie Vater MS31*, Pradip D. Patel MD2, Kanyalakshmi Ayyanar, MD3, Autumn Marks, RN BSN CPHON4, Craig Ziegler, PhD5, Karen Hughes Miller, PhD6 Author Affiliations: 1Medical Student, University of Louisville School of Medicine, Louisville, KY, USA. 2 Professor of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA. 3 Associate Professor, Division of Pediatric Hematology Oncology, University of Louisville, Louisville, KY, USA. 4Practice Manager, University of Louisville Physicians Pediatric Cancer and Blood Disorders, Louisville, KY, USA. 5 Biostatistician, University of Louisville School of Medicine, Louisville, KY, USA. 6 Associate Professor, University of Louisville School of Medicine, Louisville, KY, USA. Full Text Article PDF Corresponding Author: McKenzie Vater, mrvate01@louisville.edu Key Words: service learning, humanism, empathy, student/patient communication, extracurricular activity   Abstract: Introduction: Humanism is a necessary component of patient care. Medical schools are implementing strategies to educate students about humanism in medicine. The University of Louisville School of Medicine (ULSOM) encourages such practices through collaboration with Medals4Mettle (M4M), a non-profit organization that gives marathon medals to patients battling debilitating illnesses. The ULSOM’s chapter matches students participating in the Kentucky Derby Half/Full Marathon with pediatric patients, allowing students to establish a relationship with their “running buddies” prior to gifting their medals on race day as an act of support and acknowledgement of their struggle. The goal of this study was to evaluate the ULSOM chapter and to create a replicable model for other institutions to employ. Methods: We conducted a survey for current and previous student and patient/parent participants. Participants were asked to complete six 5-point Likert scaled questions anchored with “Strongly Disagree” to “Strongly Agree” and three open-ended questions. The surveys were analyzed using the Mann-Whitney U test for quantitative analysis and Pandit’s variation of Glaser and Straus’ constant comparison for qualitative analysis. Results: Data was collected from 62 medical students and 21 patients or parents (49% and 33% response rate, respectively). Five of the scaled questions had mean scores above 4.0, revealing that the majority of participants would recommend the M4M program to others and that M4M helped students relate to their patient on a personal level. The qualitative analysis identified four themes among participants: M4M is a wonderful program, it provides a patient benefit, people want to re-participate, and it allows you to connect with others. Discussion: Findings from the survey suggest the implementation of programs like M4M will promote the integration of humanistic practices into medical school curricula. In the future, we plan to pair medical students with the patients earlier to create a longer-lasting, more meaningful relationship prior to the race.   Published on date: March, 2016   DOI: 10.15404/msrj/03.2016.0002 Citation: McKenzie et al. Medals4Mettle: A Program to Enhance the Medical Student-Patient Bond, Medical Student Research Journal (2016). doi: 10.15404/msrj/03.2016.0002 References: Dossett ML, Kohatsu W, Nunley W, Mehta D, Davis RB, Phillips RS, Yeh G. A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self care: an evaluation of the HEART program. Explore. 2013 Sep-Oct;9(5):292-8. Moyer CA, Arnold L, Quaintance J, Braddock C, Spickard A 3rd, Wilson D, Rominski S, Stern DT. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Acad Med. 2010 Nov;85(11):1800-7. Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. Acad Med. 2014...

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Winter 2015 – Care for Laotian Ethnic Minorities: A Cross-National Study of Medical Students in Laos and California

Posted by on Jan 1, 2015 in Articles | 0 comments

Care for Laotian Ethnic Minorities: A Cross-National Study of Medical Students in Laos and California Author: Katherine Crabtree1,Oanh L. Meyer2, Tonya L. Fancher3 Author Affiliations: 1UC Davis College of Medicine, Sacramento, CA, USA 2UC Davis School of Medicine, Alzheimer’s Disease Center, Department of Neurology, Sacramento, CA, USA 3UC Davis School of Medicine, Division of General Internal Medicine, Sacramento, CA, USA Full Text Article PDF Corresponding Author: Katherine Crabtree, katcrabtree[at]gmail.com Key Words: Hmong; Mien; Laos, refugees; cross-cultural healthcare; medical education. Abstract: Background: In both the United States and Laos, Lao ethnic minority patients face cultural and linguistic challenges to adequate medical care. We may be able to learn from Lao experiences to improve care for patients in the United States. This study explored Laotian and American medical students’ experiences in care for these patients. Methods: Laotian and American medical students (n_19) participated in five interview groups discussing barriers to health care and strategies for addressing barriers for Laotian ethnic minority patients. Results: The students identified similar barriers to care. Laotian students identified unique strategies to address barriers to care. American students focused on general approaches to cross-cultural care. Discussion: The strategies that Laotian medical students learn in their training reflect their extensive exposure to Hmong and other Laotian ethnic minority patients, while American students learn broad strategies to care for many minority groups. Further work is needed to determine if their experience can be translated into the domestic context. Published on date: January 1, 2015 Senior Editor: Ghadear Shukr Junior Editor: Nadine Talia DOI: Pending Citation: Crabtree K, Fancher TL, Meyer TL. Care for Laotian Ethnic Minorities: A Cross-National Study of Medical Students in Laos and California. Medical Student Research Journal. 2015;4(Winter):66-70. References: Ghent A. Overcoming migrants’ barriers to health. Bull World Health Org 2008; 8: 583-4. Habarad J. Refugees and the structure of opportunity: transitional adjustments to aid among U.S. resettled Lao Iu Mien, 1980-1985. Center Migrat Stud Spec Issues 1987; 5: 66-87. Yeung B. We are the people: the history of the Iu-Mien. SF Weekly 2001; 20. Lum T. Laos: background and U.S. relations. Congressional Research Service Report for Congress 2008. Available from: http://www.fas.org/sgp/crs/row/RL34320.pdf [cited 20 December 2011]. US Census Bureau, 2010 United States Census. 2010. Available from: http://www.census.gov/2010census [cited 20 December 2011]. Catanzaro A. Health status of refugees from Vietnam, Laos, and Cambodia. JAMA 1982; 247: 1303-8. Laos overview. World directory of minorities and indigenous peoples. 2005. Available from: http://www.minorityrights.org/4014/laos/laos-overview.html [cited 20 January 2014]. Depke J. Coalition building and the intervention wheel to address breast cancer screening in Hmong women. Clin Med Res 2011; 9: 1-6. Murphy-Thalacker K. Hypertension and the Hmong community: using the health belief model for health promotion. Health Promot Pract 2010; 13: 6. Johnson S. Hmong health beliefs and experiences in the western health care system. J Transcult Nurs 2002; 13: 126-32. Culhane-Pera K. ‘We are out of balance here’: a Hmong cultural model of diabetes. J Immigr Minor Health 2007; 9:179-90. BBC. Thai army deports Hmong to Laos. 2009. Available from: http://news.bbc.co.uk/2/hi/8432094.stm [cited 7 January 2013]. de Boer H, Lamxay V. Plants used during pregnancy, childbirth and postpartum healthcare in Lao PDR: a comparative study of the Brou, Saek and Kry ethnic groups. J Ethnobiol Ethnomed 2009; 5: 25. Sydara K. Use of traditional medicine in Lao PDR. Complement Ther Med 2005; 13: 199_205. Douangphachanh X. Availability and use...

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Winter 2015 – Sticking to the Plan: Patient Preferences for Epidural Use During Labor

Posted by on Jan 1, 2015 in Articles | 0 comments

Sticking to the Plan: Patient Preferences for Epidural Use During Labor Author: Lauren Ann Gamble1, Ashley Hesson1, Tiffany Burns2. Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA 2Department of Family Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding Author: Lauren Ann Gamble, gambleL2[at]msu.edu Key Words: epidural; birth plan; labor analgesia; patient preference, decision making. Abstract: Background: Women have been shown to value control in the labor experience, a desire that is often formalized into an explicit birth plan. Epidural preferences are a primary component of this plan. Despite this specification, women’s plans are not always carried out. This may be due to patient factors (e.g., dissatisfaction with labor), provider behaviors (e.g., frequent epidural offers), or situational variables (e.g., prolonged labor). Purpose: The current study investigates the relative impact of patient preference for epidural use as compared to provider suggestion and circumstances of labor. It hypothesizes that providing an epidural preference in a birth plan and receiving frequent epidural offers will predict epidural administration. Methods: Adult, postpartum women were surveyed about their labor experience at a high-volume obstetrics unit in a medium-sized community hospital. Responses to a structured survey instrument focused on prelabor preferences and labor characteristics. Descriptive statistics and multiple logistic regression modeling were used to analyze participant responses. Results: Eighty-three postlaboring women completed surveys, of which 79 surveys were analyzed. Eighty-four percent (N_66) received an epidural during their labor process, while 73% (N_58) desired an epidural as a part of their birth plan. Women were offered an epidural at a mean frequency of 0.2790.48 times per hour (median_0.14). The significant predictors of epidural administration were desire for an epidural in the birth plan (pB0.01) and the frequency of epidural offers (pB0.01). Wanting an epidural was associated with receiving an epidural. Conversely, increased frequency of being offered an epidural negatively correlated with epidural administration. Conclusions: Our findings indicate that personal preference is the most influential factor in determining whether or not a laboring woman will receive an epidural. Increasing provider attempts to offer an epidural – as represented by increased frequency of queries- decreased the likelihood that an epidural would be received. Published on date: January 1, 2015 Senior Editor: Tina Chaalan Junior Editor: Jennifer Monacelli DOI: Pending Citation: Gamble LA, Hesson A, Burns T. Sticking to the Plan: Patient Preferences for Epidural Use During Labor. Medical Student Research Journal. 2015;4(Winter):59-65. References:     Pilnick A, Dingwall R. On the remarkable persistence of asymmetry in doctor/patient interaction: a critical review. Soc Sci Med 2011; 72: 1374-82. Simkin P. Birth plans: after 25 years, women still want to be heard. Birth 2007; 34(1): 49-51. Namey EE, Lyerly AD. The meaning of ‘‘control’’ for childbearing women in the US. Soc Sci Med 2010; 71(4): 769-76. Miller AC, Shriver TE. Women’s childbirth preferences and practices in the United States. Soc Sci Med 2012; 75(4):709-16. Pennell A, Salo-Coombs V, Herring A, Spielman F, Fecho K. Anesthesia and analgesia_related preferences and outcomes of women who have birth plans. J Midwifery Women’s Health 2011; 56(4): 376-81. Horowitz ER, Yogev Y, Ben-Haroush A, Kaplan B. Women’s attitude toward analgesia during labor – a comparison between 1995 and 2001. Eur J Obstet Gynecol Reprod Biol 2004; 117(1): 30-32. Thompson R, Miller YD. Birth control: to what extent do women report being informed...

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Winter 2015 – In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism

Posted by on Jan 1, 2015 in Articles | 0 comments

In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism Author: Virginia Corbett1, Houria Hassouna2, Reda Girgis3 Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA 2Division of Thrombosis, Department of Internal Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA 3Department of Pulmonary Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA Full Text Article PDF Corresponding Author: Virginia Corbett, corbettv[at]msu.edu Key Words: pulmonary embolism; in situ pulmonary artery thrombosis; deep vein thrombosis (DVT); pulmonary circulation; Virchow’s triad Abstract: The annual incidence of pulmonary embolism(PE) in the United States is reported to be 0.69 per1,000 persons with mortality of up to 30% depending upon the size of the emboli.1 PE and deep venous thrombosis (DVT) are both considered manifestations ofthe same disease of venous thromboembolism. Virchowpostulated that dysfunction of vessel walls, alternationsin blood flow and hypercoagulability of theblood triggered inappropriate thrombus formation.2 DVT most commonly occurs as local clot formation in the deep calf veins. PE arises when clots break off from a peripheral DVT and become lodged within the pulmonary arterial vasculature. PE is routinely diagnosed when filling defects are found in the pulmonary arteries on computed tomography angiogram (CTA). Among the general population of patients presenting to emergency rooms, absence of DVT may occur in up to 57% of those diagnosed with PE.3 A high prevalence of isolated PE may suggest localized thrombus formation in the pulmonary arteries instead of embolization from peripheral clots. Published on date: January 1, 2015 Senior Editor: Kailyne Van Stavern Junior Editor: Garrett Roe DOI: Pending Citation: Corbett V. Hassouna H. Girgis R. In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism . Medical Student Research Journal. 2015;4(Winter):54-8. References: Office of the Surgeon General (US); National Heart, Lung, and Blood Institute (US). The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44181/ [cited 15 February 2014]. Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet 2005; 365(9465): 1163_74. doi: 10.1016/S0140-6736(05)71880-8 Sohns C, Amarteifio E, Sossalla S, Heuser M, Obenauer S. 64-Multidetector-row spiral CT in pulmonary embolism with emphasis on incidental findings. Clin Imaging 2008; 32(5): 335_41. doi: 10.1016/j.clinimag.2008.01.028 Van belle A, Bu¨ ller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295(2): 172_9. doi: 10.1001/jama.295.2.172 Kumar NG, Clark A, Roztocil E, Caliste X, Gillespie DL,Cullen JP. Fibrinolytic activity of endothelial cells from different venous beds. J Surg Res 2015; 194(1): 297_303. doi: 10.1016/j.jss.2014.09.028 Rosenhek R, Korschineck I, Gharehbaghi-schnell E, Jakowitsch J, Bonderman D, Huber K, et al. Fibrinolytic balance of the arterial wall: pulmonary artery displays increased fibrinolytic potential compared with aorta. Lab Invest 2003; 83(6): 871_6. doi: 10.1097/01.LAB.0000073127.46392.9D Ryan US. Metabolic activity of pulmonary endothelium: modulations of structure and function. Annu Rev Physiol 1986; 48(1): 263_77. doi: 10.1146/annurev.ph.48.030186.001403. Goodman LR. Small pulmonary emboli: what do we know? Radiology 2005; 234(3): 654_8. doi: 10.1148/radiol.2343041326 Ryan US. Structural bases for metabolic activity. Annu Rev Physiol 1982; 44(1): 223_39. doi: 10.1146/annurev.ph.44.030182.001255 Key NS, Bach RR. Tissue factor as a therapeutic target. Thromb Haemost 2001; 85(3): 375_6. doi: 10.1517/14728222.6.2.159 Martinelli I. Unusual forms of venous thrombosis and thrombophilia. Pathophysiol Haemost Thromb 2002; 32(5_6): 343_5. doi: 10.1159/000073595...

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Winter 2015 – White Coat Sparty

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White Coat Sparty. Author:  Carter Anderson Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding author: Carter Anderson; carterbanderson[at]yahoo.com Key Words: N/A Abstract: Professional responsibility, compassion, honesty, respect for others, competence, and social responsibility are the characteristics that the Michigan State University College of Human Medicine strives to instill in every student. Published on date: January 1, 2015 Senior Editor: N/A Junior Editor: N/A DOI: pending Citation: Anderson C. White Coat Sparty. Medical Student Research Journal. 2015;4(Winter):52-53. References: N/A  ...

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Winter 2015 – Letter from the Editors

Posted by on Jan 1, 2015 in Articles | 0 comments

Letter From the Editors. Author: Jessica L Wummel1, Jack C Mettler2 Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA, 2College of Human Medicine, Michigan State University, Flint, MI, USA Full Text Article PDF Corresponding Author: Jessica L Wummel; Jessica[at]msrj.org, Jack C Mettler; Jack[at]msrj.org Key Words: N/A Abstract: The editors of MSRJ are excited to announce our Winter 2015 issue. As always, we were incredibly impressed by the caliber of submissions. This issue includes interesting articles written by medical students from UC Davis College of Medicine and Michigan State University College of Human Medicine. Published on date: January 1, 2015 Senior Editor: N/A Junior Editor: N/A DOI: Pending Citation: Wummel JL, Mettler JC. Letter From the Editors. Medical Student Research Journal. 2015;4(Winter):51. References: N/A  Share...

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Fall 2014 – The Growth of Medical Student Opportunities in Global Health

Posted by on Sep 30, 2014 in Articles | 0 comments

The Growth of Medical Student Opportunities in Global Health. Author: Johnathan Kao, MPH Author Affiliations: College of Human Medicine, Michigan State University, Flint, MI, USA Full Text Article PDF Corresponding Author: Johnathan Kao; johnathan.kao[at]msrj.org Key Words: sexual health; relationships; intimacy; radiotherapy; psycho-supportive treatment; hormone therapy. Abstract: Since the establishment of the World Health Organization on April 7, 1948,1 global health has grown in prominence and popularity among health care workers at all levels of training. International clinical rotation electives have been available to students for over half a century2 and interest in these programs has risen steadily over the decades. During this period, many organizations established programs for students and faculty interested in global health research and service. In 2006, these organizations united under the WHO’s Global Health Workforce Alliance to assist students and faculty in becoming more involved in global health activities.3 Despite these Changes, in 2007, Drain et al recognized a lack of global health education in medical schools and growing student interest, calling for more opportunities to fill the gap.4 Published on date: September 31, 2014 Senior Editor: N/A Junior Editor: N/A DOI: Pending Citation: Kao J. The Growth of Medical Student Opportunities in Global Health. Medical Student Research Journal. 2014;4(Fall):48-50. References: World Health Organization. History of WHO. 2014. Accessed from: http://www.who.int/about/history/en/ [cited 21 June 2014]. Bissonette R, Route C. The Educational Effect of Clinical Rotations in Nonindustrialized Countries. Fam Med 1994; 26(4):226-31. World Health Organization. Global Health Education Consortium. 2014. Accessed from: http://www.who.int/workforcealliance/members_partners/member_list /ghec/en/ [cited 21 June 2014]. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global Health in Medical Education: A Call for More Training and Opportunities. Acad Med 2007; 82(3):226-30. doi: 10.1097/ACM.0b013e3180305cf9 Hag C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A. New World Views: Preparing Physicians in Training for Global Health Work. Fam Med 2000; 32(8):566-72. Medical School Graduation Questionnaire: All School Summary Report. 2013. Accessed from: https://www.aamc.org/download/350998/data/2013 gqallschoolssummaryreport.pdf [cited 21 June 2014]. Imperato PJ. A Third World International Health Elective for U.S. Medical Students: The 25-year Experience of the State University of New York, Downstate Medical Center. J Community Health 2004; 29(5):337-73. doi:10.1023/b:johe.0000038652.65641.0d Pust RE, Moher SP. A Core Curriculum for International Health: Evaluating Ten Years’ Experience at the University of Arizona. Acad Med 1992; 67(2):90-4. doi:10.1097/00001888-199202000-00007 Haq C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A. New World Views: Preparing Physicians in Training for Global Health Work. Fam Med 2000; 32(8):566-72. Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E. A Model for Sustainable Short-Term International Medical Trips. Ambul Pediatr 2007; 7(4):317-20. doi: 10.1016/j.ambp.2007.04.003 Montgomery LM. Short-Term Medical Missions: Enhancing or Eroding Health? Missiology 1993; 21(3):333-41. doi: 10.1177/009182969302100305 Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and Best Practice Guidelines for Training Experiences in Global Health. Am J Trop Med Hyg 2010; 83(6):1178-82. doi: 10.4269/ajtmh.2010.10-0527 AAMC GSA Steering Committee. Guidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences. AAMC 2011. Accessed from: https://www.aamc.org/download/181690/data/guidelinesforstudentsprovidingpatientcare.pdf [cited 21 June 2014]. DeCamp M, Enumah S, O’Neill D, Sugarman J. Perceptions of a Short-Term Medical Programme in the Dominican Republic: Voices of Care Recipients. Glob Public Health 2014; 9(4):411-25. doi: 10.1080/17441692.2014.893368 Accreditation Council of Graduate Medical Education. Common Program Requirements. ACGME 2013. Accessed from: https://www.acgme.org/ acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf [cited 21 June 2014]. Thompson MJ, Huntington MK, Hunt DD, Pinsky LE,...

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Fall 2014 – Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice?

Posted by on Sep 30, 2014 in Articles | 0 comments

Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice? Author: Puneet K. Singh Author Affiliations: Saba University School of Medicine, Saba, Dutch Caribbean Full Text Article PDF Corresponding Author: Puneet K. Singh; pun33t.singh[at]gmail.com Key Words: Colonoscopy; colorectal neoplasms; sigmoidoscopy; CT colonography; mass screening. Abstract: Colorectal cancer (CRC) is the third most common form of cancer and the second leading cause of cancer death in the Western world. Presently, screening tools such as colonoscopy, sigmoidoscopy, fecal occult blood test (FOBT) and computed tomographic colonography (CTC) are available for CRC screening. The debate over which screening tool is most effective in detecting CRC and precancerous lesions is ongoing. Many recent studies have identified colonoscopy as the most sensitive and specific screening modality for CRC. However, a number of factors have prevented colonoscopy from being widely accepted. Less invasive techniques such as sigmoidoscopy and CTC are growing in popularity among physicians and patients who are apprehensive about colonoscopy screening; although many still are yet to experience the procedure first-hand. This literature review will attempt to validate the growing theory that colonoscopy is superior to other modalities for the diagnosis and screening of CRC and reduces the risk of CRC mortality. In order to do so, the paper will compare the risks and benefits of colonoscopy to sigmoidoscopy and CTC. It will further look at the different aspects that encompass a patient’s decision to partake in screening, such as basic knowledge about CRC, history of CRC in the family, advice from physicians and individual beliefs about what screening entails. Finally, this paper will propose ways in which colonoscopy screening can be improved and thus surpass other screening modalities to universally become the first choice for CRC screening. Published on date: September 31, 2014 Senior Editor: Jack Mettler Junior Editor: David Carr DOI: Pending Citation: Singh PK. Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice? Medical Student Research Journal. 2014;4(Fall):34-47. References: Holt PR, Kozuch P, Mewar S. Colon cancer and the elderly: from screening to treatment in management of GI disease in the elderly. Best Pract Res Clin Gastroenterol. 2009;23:889-907. doi: 10.1016/j.bpg.2009.10.010 Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10-29. doi:  10.3322/caac.20138 Manne U, Shanmugam C, Katkoori VR, Bumpers HL, Grizzle WE. Development and progression of colorectal neoplasia. Cancer Biomark. 2010;9:235-265. doi: 10.3233/CBM-2011-0160 Qaseem A, Denberg TD, Hopkins RH, Jr., et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156:378-386. doi: 10.7326/0003-4819-156-5-201203060-00010 Centers for Disease C, Prevention. Vital signs: Colorectal cancer screening, incidence, and mortality–United States, 2002-2010. MMWR Morb Mortal Wkly Rep. 2011;60:884-889. Lieberman D. Colorectal cancer screening: practice guidelines. Dig Dis. 2012;30 Suppl 2:34-38. doi: 10.1159/000341891 Centers for Disease C, Prevention. Vital signs: colorectal cancer screening test use – United States, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:881-888. Kahi CJ, Anderson JC, Rex DK. Screening and surveillance for colorectal cancer: state of the art. Gastrointest Endosc. 2013;77:335-350. doi: 10.1016/j.gie.2013.01.002 Rabeneck L, Paszat LF, Saskin R, Stukel TA. Association between colonoscopy rates and colorectal cancer mortality. Am J Gastroenterol. 2010;105:1627-1632. doi: 10.1038/ajg.2010.83 Manser CN, Bachmann LM, Brunner J, Hunold F, Bauerfeind P, Marbet UA. Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study. Gastrointest Endosc. 2012;76:110-117. doi: 10.1016/j.gie.2012.02.040 Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in...

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Fall 2014 – Alzheimer’s Disease: A Clinical and Basic Science Review

Posted by on Sep 30, 2014 in Articles | 0 comments

Alzheimer’s Disease: A Clinical and Basic Science Review.  Author: Igor O. Korolev Author Affiliations: College of Osteopathic Medicine and Neuroscience Program, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding Author: Igor O. Korolev; korolevi[at]msu.edu Key Words: Alzheimer’s disease; mild cognitive impairment; dementia; neurodegeneration; neuroimaging; biomarkers. Abstract: Alzheimer’s disease (AD) is the most common cause of dementia in older adults and an important public health problem. The purpose of this review article is to provide a brief introduction to AD and the related concept of mild cognitive impairment (MCI). The article emphasizes clinical and neurobiological aspects of AD and MCI that medical students should be familiar with. In addition, the article describes advances in the use of biomarkers for diagnosis of AD and highlights ongoing efforts to develop novel therapies. Published on date: September 31, 2014 Senior Editor: Liza Gill Junior Editor: Timothy Smith DOI: Pending Citation: Korolev IO. Alzheimer’s Disease: A Clinical and Basic Science Review.  Medical Student Research Journal. 2014;4(Fall):24-33. References: Alzheimer A. About a Peculiar Disease of the Cerebral Cortex. Allg Z Psychiatr. 1907; 64: 146-148. Alzheimer A. About a Peculiar Disease of the Cerebral Cortex. Alzheimer Dis Assoc Disord. 1987; 1: 3-8. Maurer K, Volk S, Gerbaldo H. Auguste D and Alzheimer’s Disease. Lancet. May 1997; 349(9064): 1546-1549. doi: 10.1016/S0140-6736(96)10203-8 Gilman, S. Oxford American Handbook of Neurology. Oxford, England: Oxford University Press; 2010. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, et al. The diagnosis of dementia due to Alzheimer’s disease: Rocommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. May 2011; 7(3): 263-269. doi: 10.1016/j.jalz.2011.03.005 Shadlen M, Larson E (2012) Evaluation of cognitive impairment and dementia. In: Basow D, editor. UpToDate. Waltham, MA: UpToDate. Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, et al. Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study. Neuroepidemiology. 2007; 29: 125–132. doi:10.1159/000109998 Thies W, Bleiler. 2013 Alzheimer’s disease facts and figures. Alzheimers Dement. 2013; 9: 208–245. doi:10.1016/j.jalz.2013.02.003 Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, et al. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013; 9: 63–75.e2. doi:10.1016/j.jalz.2012.11.007 Ott A, Breteler MM, van Harskamp F, Claus JJ, van der Cammen TJ, et al. Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam study. BMJ 1995; 310: 970–973. Querfurth HW, LaFerla FM. Alzheimer’s disease. N Engl J Med. 2010; 362: 329–344. doi:10.1056/NEJMra0909142 Holtzman DM, Morris JC, Goate AM. Alzheimer’s disease: the challenge of the second century. Sci Transl Med. 2011; 3: 77sr1. doi:10.1126/scitranslmed.3002369 Reiman EM, Chen K, Alexander GE, Caselli RJ, Bandy D, et al. Correlations between apolipoprotein E epsilon4 gene dose and brain-imaging measurements of regional hypometabolism. Proc Natl Acad Sci. USA 2005; 102: 8299–8302. doi:10.1073/pnas.0500579102 Hebert LE, Scherr PA, McCann JJ, Beckett LA, Evans DA. Is the Risk of Developing Alzheimer’s Disease Greater for Women than for Men? Am J Epidemiol. 2001; 153: 132–136. doi:10.1093/aje/153.2.132 Stern Y. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol 2012; 11: 1006–1012. doi:10.1016/S1474-4422(12)70191-6 Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol. 2011; 10: 819–828. doi:10.1016/S1474-4422(11)70072-2 Mann DM. Pyramidal nerve cell loss in Alzheimer’s disease. 1996; 5: 423–427. Norfray JF, Provenzale JM. Alzheimer’s disease: neuropathologic findings and recent advances in imaging. AJR Am J Roentgenol. 2004; 182: 3–13. doi:10.2214/ajr.182.1.1820003 Selkoe DJ. Alzheimer’s disease is a synaptic...

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Fall 2014 – A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot

Posted by on Sep 30, 2014 in Articles | 0 comments

A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot. Author: Joseph B. Meleca1, Maria Tecos1, Abigail L. Wenzlick1, Rebecca Henry2, Patricia A. Brewer3. Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, US 2Office of Medical Education, Research and Development, College of Human Medicine, Mighigan State University, East Lansing, MI, USA 3Office of Preclinical Curriculum, College of Human Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding Author: Joseph B. Meleca; melecajo[at]msu.edu Key Words: curriculum reform; medical business; medical finance; student-led; course; elective; module; student debt. Abstract: Background:  As the knowledge needed by physicians expands past basic science and patient care, students are calling for their medical school education to do the same. At Michigan State University College of Human Medicine, students addressed this concern by developing a pilot elective, Medical Business and Finance (MBF). The goal of this student-led elective was to provide a basic understanding of personal finance, student debt handling, business management, and insurance reimbursement issues. Methods:  A preliminary needs assessment was conducted to discern if students wanted medical business and finance supplementation to the medical school curriculum.  Ninety percent of students reported interest in a business and finance elective. Once the course was instated, student satisfaction and knowledge-base in medical business and finance was analyzed through pre-elective, pre-session and post-elective survey. Results:  Results were analyzed on forty-eight students’ pre-survey and post-survey responses.  After the course, self-assessed student knowledge regarding finance and business nearly doubled.  The average pre-elective self-assessed knowledge of finance was 3.02 on a ten-point scale and knowledge of business was 2.61. This was compared to an average post-elective self-assessed knowledge of 5.75 and 5.44, respectively. Satisfaction in MSU CHM business and finance resources also slightly increased at the completion of the course.  Nearly 85% of students felt they benefited from participating in the elective.  Similarly, 85% felt that incoming students would also benefit from taking the course. Almost 30% of students believed the material covered in the MBF Elective should be in the required medical school curriculum. Conclusion:  A student led elective can be an effective way to introduce students to an array of topics related to medical business and finance. Students felt that their knowledge of these topics increased and they valued the addition of medical business and finance education to their curriculum. A student-led elective is one potential way for others to successfully incorporate these topics into medical school curricula across the country. Published on date: September 31, 2014 Senior Editor: Jon Zande Junior Editor: Ghadear Shukr DOI: Pending Citation: Meleca JB, Tecos M, Wenzlick AL, Henry R, Brewer PA. A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot. Medical Student Research Journal. 2014;4(Fall):18-23. References: Cuckler GA, Sisko AM, Keehan SP, et al. National health expenditure projections, 2012-22: Slow growth until coverage expands and economy Improves.  Health Affairs. 2013; 32: 1820-31. doi: 10.1377/hlthaff.2013.0721 Asch DA, Nicholson S, Vujicic M. Are we in a medical education bubble market? N Engl J Med. 2013; 369: 1973-1975. doi: 10.1056/NEJMp1310778 Tilburt JC, Cassel CK. Why the ethics of parsimonious medicine is not the ethics of rationing. JAMA. 2013; 309: 773-744. doi: 10.1001/jama.2013.368 Wholey MH, Chapman JE. Business and managerial education in the medical school curriculum. South Med J. 1990; 83(2): 204-6. doi: 10.1097/00007611-199002000-00017 Hsu BS, Hosokawa MC, Maria...

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Fall 2014 – A Case of Severe, Refractory Antipsychotic-induced Orthostatic Hypotension

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A Case of Severe, Refractory Antipsychotic-induced Orthostatic Hypotension. Author: 1Sahil Gambhir, 2Nicholas Sandersfeld, DO, 2Dale D’Mello, MD Author Affiliations: 1College of Human Medicine, Michigan State  University, East Lansing, MI, USA; 2Department of Psychiatry, College of Human  Medicine, Michigan State University, East Lansing, MI Full Text Article PDF Corresponding Author: Sahil Gambhir, Gambhir1[at]msu.edu Key Words: Orthostatic hypotension; antipsychotics; refractory; side effects; schizophrenia; management guidelines. Abstract: Introduction: Antipsychotics have many adverse effects including orthostatic hypotension. Orthostatic hypotension is ideally treated with non-pharmacological strategies; however, these often fail leading to utilization of pharmacological methods. Currently, there is no agreed upon management or protocol for addressing antipsychotic-induced orthostatic hypotension and research in this area is limited. Patient profile: A 60-year-old man with a long history of schizophrenia who was receiving Haldol† Deconoate 200 mg injections every 4 weeks due to previous non-compliance. He was admitted to the inpatient psychiatric service due to worsening psychosis and suicidal behavior. Intervention: Despite use of medications, the patient was switched to risperidone with a goal of transition to an atypical long-acting injectable. The psychosis improved, but the patient developed orthostatic hypotension. After his medications were held, his blood pressure continued to be grossly abnormal. A number of different tests were completed followed by standard non-pharmacological treatment, which proved unsuccessful. Despite receiving intravenous fluid boluses to maintain his blood pressure, the patient required pharmacological treatment. This included midodrine and fludrocortisones, and concluded with Adderall† as his blood pressure stabilized. Conclusion: This case of a 60-year-old man with antipsychotic-induced orthostatic hypotension elucidates the frustration healthcare professionals and patients face with this common treatment-resistant condition. A treatment algorithm for managing drug-induced orthostatic hypotension is proposed and is a nidus for development of future protocols. Published on date: September 31, 2014 Senior Editor: Kaitlyn Vitale Junior Editor:Mike Klinger DOI: Pending Citation: Gambhir S, Sandersfeld N, D’Mello D. A Case of Severe, Refractory Antipsychotic-Induced Orthostatic Hypotension. Medical Student Research Journal. 2014;4(Fall): 15-7. References: Cardiac side effects of psychiatric drugs. Mackin, P. Hum Psychopharmacol, 2008 Jan; 23 (1): 3-14. doi: doi: 10.1002/hug.915 Stahl, S. Chapter 10. Antipsychotic Agents. In: Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 3e. New York: Cambridge University Press; 2008. Effect of midodrine on chlorpromazine-induced orthostatic hypotension in rabbits: comparison with amezinium, etilefrine, and droxidopa. Kurihara, J; Takata, Y; Suzuki, S; Okubo, Y; Kato, H. Biological Pharmacology Bulletin, 2000 Dec; 23(12):1445-9. Evaluation and Management of Orthostatic Hypotension. Lanier, Jeff; Mole, Matt; Clay, Emily. American Family Physicians, 2011 Sept 1; 84(5): 527-536. Antipsychotic pharmacotherapy and orthostatic hypotension: identification and management. Gugger, JJ. CNS Drugs, 2011 Aug; 25(8): 659-71 Freeman R. Chapter 20. Syncope. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 18e. New York: McGraw-Hill; 2012. Crawford MH. Chapter 16. Syncope. In: Crawford MH. eds. Current Diagnosis & Treatment: Cardiology, 4e. New York: McGraw-Hill;...

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Fall 2014 – Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome

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Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome Author: Stacie L. Clark Author Affiliations: College of Human Medicine, Michigan State University, Grand Rapids, MI, USA Full Text Article PDF Corresponding Author: Stacie L. Clark, clarkst[at]msu.edu Key Words: sebaceous gland; sebaceous carcinoma; abdominal wall; Muir-Torre syndrome; colorectal cancer; HNPCC. Abstract: Introduction: Sebaceous carcinoma is a rare dermatologic tumor affecting the pilosebaceous apparatus of the skin. While the majority of sebaceous carcinomas arise from sebaceous glands in the ocular area, extraocular sebaceous carcinomas, arising from any region populated with sebaceous glands have also been reported. Sebaceous carcinoma can present as a single lesion or in association with secondary malignancies, most commonly with those found in Muir Torre syndrome (MTS), an autosomal dominant condition associated with several types of sebaceous neoplasms as well as a variety of visceral malignancies. The most common form of MTS has been described as a variant of hereditary non polyposis colorectal cancer (Lynch syndrome). Patient profile: Here, we describe the case of a 55-year-old male, with a known history of colorectal cancer, presenting with a rapidly enlarging abdominal wall mass. Interventions and outcomes: Surgical excision of the mass histologically demonstrated sebaceous carcinoma. This diagnosis, the incidental discovery of a papillary thyroid carcinoma and the patient’s history of colorectal cancer, prompted referral for genetic counseling, the results of which are still pending. Discussion: Sebaceous carcinoma is one of several diagnostic criteria of MTS and its presence should prompt a complete evaluation for underlying internal malignancies. Published on date: September 31, 2014 Senior Editor: Timothy Smith Junior Editor: Joginder Singh DOI: Pending Citation: Clark SL. Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome. Medical Student Research Journal. 2014;4(Fall):12-4. References: Nelson BR, Hamlet KR, Gillard M, Railan D, Johnson TM. Sebaceous carcinoma. Journal of the American Academy of Dermatology. July 1995;33(1):1-15. doi: 10.1016/0190-9622(95)90001-2 Ponti G, Ponz de Leon M. Muir-Torre Syndrome. The Lancet Oncology. Dec 2005;6(12):980-987. doi:10.1016/S1470-2045(05)70465-4 Dores GM, Curtis RE, Toro JR, Devesa SS, Farumeni JF. Incidence of cutaneous sebaceous carcinoma and risk of associated neoplasms: insight into Muir-Torre Syndrome. Cancer. July 2008;113(12):3372-3381. doi: 10.1002/cncr.23963 Schwartz RA, Torre DP. The Muir-Torre syndrome: a 25-year retrospect. Journal of the American Academy of Dermatology. July1995;33(1):90-104. doi:10.1016/0190-9622(95)90017-9 Cohen PR, Kohn SR, Kurzrock R. Association of sebaceous gland tumors and internal malignancy: the Muir-Torre syndrome. The American Journal of Medicine. May 1991;90:606-613. doi:10.1016/S0002-9343(05)80013-0 Srivastava D, Taylor R. Appendage Tumors and Hamartomas of the Skin. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. eds. Fitzpatrick’s Dermatology in General Medicine, 8e. New York, NY: McGraw-Hill; 2012:1337-1362. Dasgupta T, Wilson LD, Yu JB. A retrospective review of 1349 cases of sebaceous carcinoma. Cancer. July 2008;115(1):158-165. doi: 10.1002/cncr.23952...

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Fall 2014 – Acute Bronchiolitis – Case Report and Review of Management Guidelines

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Acute Bronchiolitis – Case Report and Review of Management Guidelines. Author: Neil D. Dattani, Clare M. Hutchinson Author Affiliations: Norwich Medical School, Faculty of Medicine and health Sciences, University of East Anglia, Norwich, United Kingdom Full Text Article PDF Corresponding Author: Clare M. Hutchinson, claremhutchinson[at]gmail.com Key Words: Bronchiolitis; Case reports; Pediatrics; Practice guidelines; Therapeutics. Abstract: Introduction: The treatment of acute bronchiolitis is controversial, despite the fact that several well-designed trials have been conducted on the subject. Patient profile: A 10-month-old boy presented to the emergency department with a 3-day history of upper respiratory tract symptoms and an expiratory wheeze. Chest X-ray showed right upper lobe atelectasis. He was diagnosed with acute bronchiolitis. Interventions: He received nebulized salbutamol (albuterol) and oral dexamethasone in the emergency department. He was admitted to hospital overnight for continued salbutamol treatment via a metered-dose inhaler. Discussion: Five main treatment regimens exist for acute bronchiolitis nebulized epinephrine (adrenaline), other bronchodilators, nebulized hypertonic saline, glucocorticoids, and combinations of these. Nebulized epinephrine decreases the rate of hospitalization, other bronchodilators improve symptoms, and nebulized hypertonic saline reduces the length of hospitalization. There is no strong evidence for glucocorticoids or combinations of these treatments. Combined treatment with epinephrine and dexamethasone reduces rate of hospitalization. Published on date: September 31, 2014 Senior Editor: Kevin Patterson Junior Editor: Patrick Roach DOI: Pending Citation: Dattani ND, Hutchinson CM. Acute Bronchiolitis – Case Report and Review of Management Guidelines. Medical Student Research Journal. 2014;4(Fall):8-11. References: Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010 Feb;125(2):342-9. doi: 10.1542/peds.2009-2092 Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen TP, Patel H, Fernandes RM. Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD003123. doi: 10.1002/14651858.CD003123.pub3 Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. New England Journal of Medicine2013 June 13;368(24):2286-93. doi: 10.1016/j.jemermed.2013.10.022 Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD001266. doi: 10.1002/14651858.CD001266.pub4 Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD006458. doi: 10.1002/14651858.CD006458.pub3 Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson DW, Klassen TP, Hartling L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004878. doi: 10.1001/jama.2013.284921 Ducharme FM. Management of acute bronchiolitis. British Medical Journal 2011 Apr 6;342:d1658. doi: 10.1136/bmj.d1658 Plint AC, Johnson DW, Patel H, et al. Epinephrine and Dexamethasone in Children with Bronchiolitis. New England Journal of Medicine 2009 May 14;360(20):2079-89. doi: 10.1056/NEJMoa0900544 Enriquez A, Chu IW, Mellis C, Lin WY. Nebulised deoxyribonuclease for viral bronchiolitis in children younger than 24 months. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008395. doi: 10.1002/14651858.CD008395.pub2 Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004873. doi: 10.1002/14651858.CD004873.pub4 Beggs S, Wong Z, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD009609. doi: 10.1002/14651858.CD009609.pub2 Umoren R, Odey F, Meremikwu MM. Steam inhalation or humidified oxygen for acute bronchiolitis in children up to three years of age. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD006435....

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