Please find below the third article featured in our Winter 2024 Issue, enjoy!

http://msrj.chm.msu.edu/wp-content/uploads/2024/04/MSRJ262_final.pdf

Background: Those experiencing homelessness face disproportionately large barriers in access to healthcare. Patient Navigation is a service that provides disadvantaged populations with guidance through healthcare systems. Acting as a patient navigator is found to help enhance learning in the pre-clinical years of medical school. Developed by medical students, the Patient Navigator Program (PNP) pairs medical students trained as patient navigators with individuals experiencing homelessness. The uniqueness of this program lies in its fully student-run format, simultaneously providing individuals experiencing homelessness with longitudinal navigation services toward self-defined goals and medical students with exposure to a disadvantaged and underserved population in their early years of medical school. The purpose of this study is to evaluate the growth and student experiences of PNP from its inception and inform those who aim to develop similar student-run patient navigation programs.

Methods: Participation metrics in the program were extracted from volunteer records, and five 30-min student leader semi-structured interviews were conducted using open-ended questions to investigate the experiences of those who developed the program. Interviews were transcribed, and responses were categorized by themes.

Results: Enduring involvement in PNP over years was demonstrated quantitatively through participation metrics and qualitatively through interviews. Positive aspects of participation in PNP were meeting and working with other students, utilizing their creative vision in developing the program, learning about those experiencing homelessness and the local resources available to them, shaping career goals and academic interests, and learning the soft skills necessary for medical clerkships. Negative experiences primarily revolved around time constraints of the program in addition to their academic responsibilities. Commonly stated advice included identifying an appropriate faculty mentor and building strong relationships with community partners.

Conclusions: Participation in PNP was felt to be beneficial both personally and professionally. Reporting these perspectives and experiences will provide insight to future student-led programs at other institutions.

Here’s the second article featured in our Winter 2024 Issue, enjoy!

http://msrj.chm.msu.edu/wp-content/uploads/2024/04/MSRJ263_final.pdf

Abstract: Dermatofibromas (DF) are small, noncancerous skin lesions typically found in the dermis layer of the skin and are often composed of a variable combination of inflammatory cells, which classically present as a firm, nonpainful, skin-colored nodule on the extremities or trunk. We present a case of a 53-year-old woman with a medical history of psoriasis who had bilateral leg swelling, erythema, and dry skin for which she underwent a punch biopsy of the left thigh. The punch biopsy sample was found to be a dermatofibroma, which was negative for malignancy or atypia. The skin rash and associated symptoms were due to Candida intertrigo, which was treated with broad-spectrum antibiotics and fluconazole. Following this, she was discharged and prescribed a course of fluconazole and linezolid for continued treatment of Candida intertrigo. This case report describes a rare presentation of benign dermatofibroma.

We’re back after some technical difficulties! Big thanks to everyone for their patience. Please find below the first addition to our Winter 2024 Issue, enjoy!

http://msrj.chm.msu.edu/wp-content/uploads/2024/04/MSRJ257_final.pdf

Purpose: Limited institutional resources exist for pregnant and parenting medical students; however, students’ opinions regarding pregnancy in medical school have not been reported. The authors assessed medical students’ perspectives regarding pregnant or parenting peers and underlying bias or resource gaps.

Methods: An online, cross-sectional survey was distributed in October 2022 to medical students at Michigan State University College of Human Medicine (n = 806) to explore demographics, bias, family planning, and available resources. Descriptive analyses, a two- tailed t-test comparing female and male responses, and a one-way analysis of variance test comparing medical school classes were used.

Results: The survey response rate was 13.2% (n = 106). Few respondents (n = 4, 3.8%) had been pregnant during medical school. The majority (n = 67, 71.3%) indicated family plans influence specialty choice. Furthermore, 78.0% (n = 42) cited career and education as their reason for choosing to delay pregnancy. Other descriptive analyses identified that 80.0% (n = 75) of respondents were not aware of resources available for pregnant or parenting classmates. Also, 13.0% (n = 12) of respondents had witnessed bias toward a pregnant medical student. Differences in opinions between males and females were present regarding bias and support available. Differences between medical student classes also exist regarding opinions indicating pregnancy as a barrier during school. The statements with the strongest overall agreement were: Pregnant medical students are resilient, face additional challenges, and parental leave should be available in medical school.

Conclusion: This study provides new information regarding pregnancy opinions in medical school and highlights pregnant medical students’ challenges and biases. We revealed common delays in pregnancy due to career or educational choices and uncovered the strong consensus among students that parental leave should be an option. Support efforts are warranted to decrease biases and offer parental leave to promote equity and inclusion.

The final article to be included in our Spring 2023 issue is linked below. Enjoy!

https://msrj.chm.msu.edu/wp-content/uploads/2023/04/236-ePub-final.pdf

Introduction: While some studies suggest probiotic supplements may prevent Gestational Diabetes Mellitus (GDM), it is unclear if probiotics effectively prevent GDM among overweight and obese patients. This systematic review synthesizes recommendations for clinical practice and future research by evaluating the quality of evidence regarding Lactobacillus and Bifidobacterium containing probiotics to prevent GDM among obese and overweight patients. 

Methods: PubMed, Embase, CINAHL, and Web of Science were searched using appropriate MeSH terms. Results were limited to randomized controlled trials published between 2011-2021. Titles and abstracts were screened for relevance after duplicates were removed. Included studies diagnosed GDM according to by International Association of Diabetes and Pregnancy Study Group criteria, suspended probiotic use prior to intervention, excluded participants with altered glucose metabolism, included participants with a BMI ≥25kg/m2, and provided a specified dose of probiotic supplements. Articles without statistical analysis were excluded. Resulting articles were critically appraised using Version 2 of the Cochrane Risk of Bias tool.

Results: This search strategy resulted in 24 articles after duplicates were removed. Five double- blind randomized controlled trials found the incidence of GDM during the third trimester was not significantly different between probiotic and control groups. There was wide variation in the bacterial species, dose and duration of probiotic treatments used. All studies have a high risk of bias due to non-adherence to the treatment.

Discussion: This review used a highly sensitive criteria for GDM diagnosis that may mask a preventative effect of probiotics. Non-compliance may bias results towards the null given insufficient analysis of the effect of adhering to the intervention. No patterns between length of probiotic intervention or probiotic species and improved glucose tolerance were noted.

Conclusions: Current evidence is not sufficient to recommend probiotic supplements to prevent GDM in overweight and obese patients. Future evidence should address the effect of adhering to probiotic interventions and develop consistent probiotic intervention protocols.

We are pleased to share another manuscript that will be included in our Spring 2023 issue.

https://msrj.chm.msu.edu/wp-content/uploads/2023/04/231-ePub-final.pdf

Background: The medical literature on vulvovaginal lacerations following consensual versus nonconsensual sexual intercourse is sparse and conflicting.

Objectives: To compare the predisposing factors, injury location and severity, as well as treatment of vulvovaginal lacerations sustained during consensual versus nonconsensual sexual intercourse, in adult women within a community-based cohort.

Methods: This is a retrospective comparative analysis of adult women presenting to the emergency departments of five hospitals and a free-standing nurse examiner clinic during a seven-year study period. All patients had documented vulvovaginal lacerations and reported vaginal penetration via consensual sexual intercourse (CSI) or nonconsensual sexual intercourse (NCSI) within 72 hours of presentation.

Results: A total of 598 cases were identified: 81 (14%) reported CSI, and 517 (87%) reported NCSI. CSI patients were younger (21.3 vs 25.7, p <0.001) and reported a greater incidence of penile penetration (97.5% vs 75.9%, p <0.001). While NCSI subjects had a higher incidence of vulvovaginal lacerations overall (1.7 vs. 1.0, p<0.001), their injuries were smaller (1.1 cm vs. 4.3 cm, p<0.001) and more likely to be located on the posterior vulva (83% vs. 69%, p=0.003) when compared to the CSI group. Additionally, all the lacerations in the NCSI group were superficial. In contrast, 27 (33%) of CSI subjects had lacerations sutured in the ED; six (7%) required aggressive fluid resuscitation and ten (12%) required surgical intervention.

Conclusions: In this community-based population, more severe vulvovaginal lacerations were noted in women following CSI. The predisposing factors, injury location, and subsequent treatment in this group were significantly different when compared with women reporting NCSI.

We are pleased to share our latest manuscript for our Spring 2023 issue.

https://msrj.chm.msu.edu/wp-content/uploads/2023/03/234-ePub-final.pdf

Abstract

Diffusion-tensor imaging has become common practice in radiology and imaging research due to its many applications in brain connectivity and neurodevelopment as well as for pathologies including tumors, ischemia, trauma, and neurodegeneration. However, its novelty compared to other neuroimaging techniques has meant that graduate programs, particularly medical schools, have not included opportunities to learn how diffusion tensor imaging can visualize the brain and interpretation of the data clinically and in research. Diffusion tensor imaging can be a challenging utility to understand for newcomers and is subject to wide interpretation. We offer for medical and graduate students as well as residents a step-by-step guide in interpreting diffusion tensor imaging results for clinical analysis using simple explanations of physics and neuroscience and its application in clinical and translational research.