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Time to Neurological Deterioration

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

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.

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Does Traditional Chinese Medicine Matter?

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

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.

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Combating Obstacles to Empathy

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

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.

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Medals 4 Mettle

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

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.

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