Time to Neurological Deterioration

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.

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Corresponding Author: Sheryl Martin-Schild, smartin2@tulane.edu

Key Words: Acute ischemic stroke, neurological deterioration, latency, time to event analysis



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


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Does Traditional Chinese Medicine Matter?

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

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Corresponding Author: Xiaoyue Mona Guo

Key Words: Traditional Chinese Medicine, Health-seeking behaviors, Rural China, Diabetes



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


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Combating Obstacles to Empathy

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.

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Corresponding Author: Francesca P. Kingery, fdprib01@louisville.edu

Key Words: Medical Humanities, Bioethics, Curriculum, Student-led, Empathy, Medical Education, Pre-Clinical



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


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Medals 4 Mettle

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.

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2016/03/M4Mepub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: McKenzie Vater, mrvate01@louisville.edu

Key Words: service learning, humanism, empathy, student/patient communication, extracurricular activity



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


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New Feature: MSRJ e-Publications

epub early access picture

MSRJ’s Exciting New Feature!

The staff of MSRJ is extremely pleased to announce the addition of an exciting new feature to our journal! Starting today, we will be launching MSRJ e-Publication, which will be our first ever early-access publication issue. MSRJ e-publication will enable us to publish articles “online before print” as many other journals do. This new feature has many advantages for our student contributors including:

  • Faster publishing time for accepted manuscripts
  • Increased ease of access
  • Greater longevity of published literature
  • Assignment of a unique Digital Object Identifier number

We want to express our appreciation and thanks to the authors who have been instrumental in getting this put together. We invite you to take a look at their articles in our first-ever e-Pub Early Access Issue:


Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students.

Authors: Francesca P. Kingery, M.S., Alexander Bajorek, M.D. M.A., Amber Zimmer Deptola, M.D. Karen Hughes Miller, Ph.D., Craig Ziegler Ph.D., Pradip D. Patel M.D.

Medals4Mettle: A Program to Enhance the Medical Student-Patient Bond

Authors: McKenzie Vater MS3, Pradip D. Patel MD, Kanyalakshmi Ayyanar, MD, Autumn Marks, RN BSN CPHON, Craig Ziegler, PhD, Karen Hughes Miller,PhD

Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China.

Authors: Xiaoyue Mona Guo, B.A., Shuiyuan Xiao, M.D., Ph.D.

Time to Neurological Deterioration in Ischemic Stroke.

Authors: James E. Siegler, MD; Karen C. Albright, DO, MPH; Alexander J. George, BS; Amelia K. Boehme, MSPH; Michael A. Gillette, MPH; Andre D. Kumar, MD; Monica Aswani MSPH; Sheryl Martin-Schild, MD, PhD


What is e-Publication?

With MSRJ ePubs, not only will student authors be able to see their manuscripts published earlier, but each article will be assigned an individual Digital Object Identifier (DOI) number. A DOI number is a unique alphanumeric string assigned to a digital object. The DOI number is then registered with CrossRef.org, which is an official DOI registration agency dedicated to providing reliable and efficient reference linking for online scholarly material.

Each DOI uniquely identifies the article and provides a permanent link that takes readers to that particular electronic document, even if the web address which originally hosted the article changes.

These DOI’s already exist in various online journals such as JAMA and NEJM. They also provide ease of citation since they provide a short, easy, and unchanging link to the original document as opposed to a lengthy web address.


What Does This Mean for Student Contributors?

The use of DOIs enables us to safely publish intellectual property on the internet, prior to print, and without fear of plagiarism. The fact that DOIs are registered with Crossref © makes them permanent, so our student authors will always be able to find their articles, even many years down the road, using just that unique identifier. Finally, it makes these articles easy to reference, for any future researchers.

At any point in the future, people can access an article just by typing doi.org/ followed by the DOI number. This will automatically take you to wherever the article is housed at that time. It’s that simple!

Starting from today onwards, accepted manuscripts which have been prepared for e-Publication will be available for viewing under the new tab “ePubs” under “Publications” on the MSRJ website. Once we are off the ground, our MSRJ Tech Team will continue to work with the Executive Editors to format and prepare accepted manuscripts for e-Publication, and will continue fine-tuning the process to ensure smooth and continuous e-Publishing.


Behind the Scenes Work:

We would like to extend a special thanks our wonderful MSRJ Tech Team for their endless energy and tireless work towards getting e-Publication launched and helping our journal continue to grow. This has been no small feat, and we could not have done it without them! Leading the charge are Danny Yau and Danielle Levy, second-year medical students at MSU-CHM. They have been instrumental in designing the MSRJ template for our e-Publications, getting the MSRJ set up to accept and publish e-Publications, andestablishing the procedure for assigning DOIs to our manuscripts for future online publication.

We would also like to thank our faculty advisors, Dr. Luz and Dr. Trottier, for their support in helping us coordinate this transition to e-Publication.


Final Words:

As the longest-running journal run by medical students for medical students, we at the MSRJ strive to provide the highest quality product and experience for our student contributors. We hope that the addition of e-Publication will provide medical students another platform to promote their scholarship and research. and would like to thank our authors for their great submissions, support, and patience as we transition into this new phase.