Hardware Repair

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

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Corresponding Author: Brandon Lucke-Wold, PhD, Bwold@mix.wvu.edu

Key Words: Volar locking plate-distal radius fracture-open reduction-internal fixation



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


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Scrotal Rupture

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

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Corresponding Author: Michael Bedgood BS, bedgood@uthscsa.edu

Key Words: neonate, meconium peritonitis, meconium periorchitis



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


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Tonsillar Ectopia

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

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

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Corresponding Author: Julia R. Saling, jsaling@neomed.edu

Key Words: Chiari Malformation Type I, Tonsillar Ectopia, Symptom Presentation




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.


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.


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).

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


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Wallis Implant

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.

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Corresponding Author: Carter Mohnssen, CarterMohnssen@creighton.edu

Key Words: intervertebral disc degeneration, case reports, orthopedics, therapeutics, biologics



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


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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

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

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.

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2016/03/H2Hepub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

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

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

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2015/04/Winter-2015-Care-for-Laotian-Minorities.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

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.


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

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

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2015/04/Winter-2015-Sticking-to-the-Plan.pdf” type=”big” color=”orange” newwindow=”yes”] Full Text Article PDF[/button]

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.




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