Fall 2013 – Direct Access to Physical Therapy in Michigan is Overdue

Direct Access to Physical Therapy in Michigan is Overdue.
Kevin C. Patterson1*, Rachel A. Patterson2
1College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
2College of Health Professions, Grand Valley State University, Grand Rapids, MI, USA


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*Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com
Key Words: Direct Access; Physical Therapy; Primary Care; Healthcare; Utilization
Direct access to physical therapists (PTs), the ability for a patient to seek care from a PT without physician referral, has been contested for many years. The traditional gatekeeper model of access to physical therapy has changed throughout the nation and only two states remain without direct access. Michigan is one of those states, and the state legislature has not advanced direct access legislation despite numerous opportunities over the past 12 years. However, no evidence exists to show that direct access causes harm to patients and the healthcare system and, on the contrary, easy and early access to physical therapy by patients has been shown to improve outcomes and decrease costs of care. Direct access to physical therapy is long overdue in Michigan and should be reconsidered in order to better serve our patients and the healthcare system.
Published: September 30, 2013
Senior Editor: N/A
Junior Editor: N/A
Patterson KC, Patterson RA. Direct Access to Physical Therapy in Michigan is Overdue. Medical Student Research Journal. 2013;3(Fall):13-16.
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Fall 2013 – Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms

Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms.
Zachary Jarou*, Nathaniel Harris, Liza Gill, Meena Azizi, Shayef Gabasha, Robert LaBril.
College of Human Medicine, Michigan State University, East Lansing, MI, USA


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*Corresponding author: Zachary Jarou; zachjarou[at]gmail.com
Key Words: Stroke; CVA; Risk Factors; Warning Signs; Patient Education; Public Health.

Background and purpose: Fewer than 1 in 20 patients with acute ischemic stroke are treated with thrombolytic drugs, with three quarters of otherwise eligible patients being excluded secondary to delay in seeking medical treatment. Lack of symptom recognition may contribute to low treatment rates and is an important focus of public health education. The purpose of this study was to determine if an individual’s cumulative number of stroke risk factors correlated with their ability to identify stroke symptoms. Methods: We surveyed adults about their stroke risk factors and knowledge of stroke symptoms at grocery stores and malls in a medium-sized university town in the Midwestern US. Results: In total, 245 adults completed surveys. Self-reported risk factors included high blood pressure (25%), high cholesterol (22%), diabetes (12%), tobacco use (11%), alcohol use (7%), heart disease (7%), and prior stroke (3%). Cumulatively, 56% of respondents had no risk factors, 41% had 13 risk factors, and 4% had 4risk factors. When administered a six-point stroke symptom knowledge test, respondents with 4 risk factors were significantly less knowledgeable, receiving a mean score of 3.2, compared to those with 13 risk factors, who scored a mean of 4.6. Those with four or more years of college were significantly more knowledgeable than those with only a high-school education, receiving mean scores of 4.6 and 3.9, respectively. There was no association between stroke knowledge and use of a primary care physician. Conclusions: Although it is known that individuals with more risk factors are more likely to have a stroke, in our study these respondents were less able to recognize stroke symptoms compared to respondents with fewer risk factors. Future public stroke awareness campaigns should be targeted toward those most at risk so they learn to recognize stroke symptoms and thus seek treatment in a timely manner.
Published: September 30, 2013
Senior Editor: Jack Mettler
Junior Editor: Tim Smith
DOI: Pending
Jarou Z, Harris N, Gill L, Azizi M, Gabasha S, LaBril R. Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms. Medical Student Research Journal. 2013;3(Fall):3-8.
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2. Wechsler LR. Intravenous thrombolytic therapy for acute ischemic stroke. N Engl J Med. 2011; 364:2138-46. http://dx.doi.org/10.1056/NEJMct1007370.

3. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359:1317-29. http://dx.doi.org/10.1056/NEJMoa0804656.

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8. Reeves MJ, Rafferty AP, Aranha AAR, Theisen V. Changes in knowledge of stroke risk factors and warning signs among Michigan adults. Cerebrovasc Dis. 2008; 25:385-91. http://dx.doi.org/10.1159/000121338.

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11. Centers for Disease Control and Prevention. 2011 behavioral risk factor surveillance system questionnaire. 2011. Available from: http://www.cdc.gov/brfss/questionnaires.htm [cited 10 August 2013].

12. National Institute of Neurological Disorders and Stroke (NINDS). Stroke information page. 2013. Available from: http://www.ninds.nih.gov/disorders/stroke/stroke.htm [cited 10 August 2013].
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14. Schneider AT, Pancioli AM, Khoury JC, et al. Trends in community knowledge of the warning signs and risk factors for stroke. JAMA. 2003; 289(3):343-6. http://dx.doi.org/10.1001/jama.289.3.343.

15. Reeves MJ, Hogan JG, Rafferty AP. Knowledge of stroke risk factors and warning signs among Michigan adults. Neurology. 2002; 59(10):1547-52. http://dx.doi.org/10.1212/01.WNL.0000031796.52748.A5.

16. Yoon SS, Heller RF, Levi C, Wiggers J, Fitzgerald PE. Knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population. Stroke. 2001; 32:1926-30. http://dx.doi.org/10.1161/01.STR.32.8.1926.

17. Greenlund KJ, Neff LJ, Zheng ZJ, et al. Low public recognition of major stroke symptoms. Am J Prev Med. 2003; 25(4):315-19. http://dx.doi.org/10.1016/S0749-3797(03)00206-X.

18. Pancioli AM, Broderick J, Kothari R, et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998; 279(16):1288-92. http://dx.doi.org/10.1001/jama.279.16.1288.

19. Wolf P, D’Agostino R, Belanger A, Kannel W. Probability of stroke: a risk profile from the Framingham study. Stroke. 1991; 22:312-18. http://dx.doi.org/10.1161/01.STR.22.3.312.

Fall 2013 – A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis

A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis.
Megan C. Hamre1*, Jennifer M. Eschbacher2, Frances Hahn2, Tilina Hu2
1School of Medicine, Creighton University, Omaha, NE, USA
2St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA


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*Corresponding Author: Megan C. Hamre; Meganhamre1[at]creighton.edu
Key Words: Breast Cancer; Carcinosarcoma; Clinical Protocols; Treatment Protocols; Lymphatic Metastasis.
Introduction and Patient Profile: Carcinosarcoma of the breast is a rare malignancy composed of two cell lines described as a ductal-type carcinoma with a sarcoma-like component. It is an aggressive neoplasm that is usually larger in size than epithelial breast cancers and characterized by a rapid increase in size. A 32-year-old woman presented with a palpable lump in the left upper outer breast. Imaging findings and an ultrasound-guided biopsy demonstrated a malignant neoplasm with chondroid differentiation. Interventions and Outcomes: The patient underwent a modified radical left breast mastectomy with sentinel node biopsy. Pathology report from the mastectomy demonstrated an infiltrating metaplastic carcinoma (MPC) with positive lymph nodes. Discussion: The most unusual feature of this case is the lymph node positivity, as lymphatic spread is uncommonly associated with carcinosarcoma or any subtype of metaplastic carcinoma of the breast. This case is important because it illustrates the potential future need for treatment guidelines for this uncommon tumor.
Published: September 30, 2013
Senior Editor: Skyler Johnson
Junior Editor: Alex Golec
DOI: Pending
Hamre MC, Eschbacher JM, Hahn F, Hu T. A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis. Medical Student Research Journal. 2013;3(Fall):9-12.
1. Beatty JD, Atwood M, Tickman R, Reiner M. Metaplastic breast cancer: clinical significance. Am J Surg. 2006; 191(5):657-64. http://dx.doi.org/10.1016/j.amjsurg.2006.01.038.

2. Esses KM, Hagmaier RM, Blanchard SA, Lazarchick JJ, Riker AI. Carcinosarcoma of the breast: two case reports and review of the literature. Cases J. 2009; 2:15. http://dx.doi.org/10.1186/1757-1626-2-15.

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4. Leddy R, Irshad A, Rumboldt T, Cluver A, Campbell A, Ackerman S. Review of metaplastic carcinoma of the breast: imaging findings and pathologic features. J Clin Imaging Sci. 2012; 2:21. http://dx.doi.org/10.4103/2156-7514.95435.

5. Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast clinical presenta- tion, treatment results and prognostic factors. Acta Oncol. 2006; 45(2):188-95. http://dx.doi.org/10.1080/02841860500513235.

6. Shin HJ, Kim HH, Kim SM, Kim DB, Kim MJ, Gong G, et al. Imaging features of metaplastic carcinoma with chon- droid differentiation of the breast. AJR Am J Roentgenol. 2007; 188(3):691-6. http://dx.doi.org/10.2214/AJR.05.0831.

7. Smith TB, Gilcrease MZ, Santiago L, Hunt KK, Yang WT. Imaging features of primary breast sarcoma. AJR Am J Roentgenol. 2012; 198(4):W386-93. http://dx.doi.org/10.2214/AJR.11.7341.

Fall 2013 – Incomplete Storytelling

Incomplete Storytelling.
Alexander S. Golec.
College of Human Medicine, Michigan State University, East Lansing, MI, USA

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Corresponding Author: Alexander S. Golec; golec@msu.edu
Key Words: N/A
Our interviews, physical exams, and laboratory tests only uncover select words of a patient’s story. Some days we may be lucky enough to stumble upon a phrase or complete sentence in their life’s tome. We base our diagnoses on these incomplete discoveries and hope for the best. Some of us may act like we have the Rosetta Stone in our pocket, granting us the ability to translate everything into our noble medical language. Others may focus too much time on the details of the letters and completely miss the story behind them. Deciphering the story of each patient requires not only a stellar medical acumen but also an ability to comprehend stories in languages that may seem foreign to us.

Published: September 30, 2013
Senior Editor: N/A
Junior Editor: N/A
DOI: Pending
Golec AS. Incomplete Storytelling. Medical Student Research Journal. 2013;3(Fall):2.

Fall 2013 – Letter From the Editors

Letter From the Editors.
Kevin C. Patterson, Jessica L. Wummel.


College of Human Medicine, Michigan State University, Grand Rapids, MI, USA


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Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com
Key Words: N/A
In the third MSRJ issue of 2013 and the first of the 2013-2014 academic year, we are very excited to present enlightening and thought-provoking articles. We are publishing the work of students from Michigan State University’s College of Human Medicine and Creighton University School of Medicine. This journal has seen large growth since the Spring 2013 issue, and we have bigger plans for the future.

Published: September 30, 2013
Senior Editor: N/A
Junior Editor: N/A
DOI: Pending
Patterson KC, Wummel JL. Letter from the Editors. Medical Student Research Journal. 2013;2(Fall):1.