Category Archives: Articles

Individual Articles in MSRJ

Comparing Student Satisfaction with Traditional and Modular Group Peer-Tutoring Session

Posted on by

Authors:

Jeff Cross, MD1, Rodney Nyland PhD2, Sarah Lerchenfeldt, PharmD, BCPS, BCOP3

Author Affiliations:

1Oakland University William Beaumont School of Medicine, Rochester, MI, USA
2Department of Organizational Leadership, School of Education and Human Services, Oakland University, Rochester, MI, USA
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA

Full Text Article PDF

*Corresponding Author: Jeff Cross; Jcross818@gmail.com

Key Words: education; medical; teaching; tutoring

Abstract:

Background: Our allopathic medical school has utilized a peer-tutoring program since inception in 2011, where second-year medical students teach first-year students in 2-h lecture-style review sessions. In 2015, an alternative format was implemented using four, repeating 30-min modules. This study was designed to compare student satisfaction with both approaches.

Methods: An online survey was emailed to students graduating in 2018 (n = 97) and 2019 (n = 127).

Results: A total of 72 (32.6%) responding students were included in the study, 35 from the class of 2018 (Co2018) and 37 from the class of 2019 (Co2019). Fewer Co2018 students, who received traditional instruction, were ‘very satisfied with the session timing’ compared with Co2019 students, who received the modular format (proportion difference: 0.42; P < 0.001, 95% confidence interval [CI] [0.21–0.63]). Co2018 students were more likely than Co2019 students to stop attending because their time was better utilized another way (proportion difference: 0.22; P = 0.054, 95% CI [-0.003 to 0.45]).

Conclusions: Students preferred the session length and timing of the modular format. Future studies are warranted to evaluate the effectiveness of this approach.

Published: Spring, 2019

References:

1. Benè KL, Bergus G. When learners become teachers:
a review of peer teaching in medical student education.
Fam Med 2014; 46(10): 783–7.

2. Sobral DT. Cross-year peer tutoring experience in a medical school: conditions and outcomes for student tutors. Med Educ 2002; 36(11so): 1064–70. doi: 10.1046/j.1365-2923.2002. 01308.x

3. Buckley S, Zamora J. Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors’ skills and attitudes towards teachers and teaching. BMC Med Educ 2007; 7(1): 20. doi: 10.1186/ 1472-6920-7-20

4. Yu TC, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG. Medical students-as-teachers: a systematic review of peer- assisted teaching during medical school. Adv Med Educ
Pract 2011; 2: 157–72. doi: 10.2147/amep.s14383

5. Lockspeiser TM, O’Sullivan P, Teherani A, Muller J. Understanding the experience of being taught by peers:
the value of social and cognitive congruence. Adv Heal Sci Educ 2008; 13(3): 361–72. doi: 10.1007/s10459-006-9049-8

6. Ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach 2007; 29(6): 591–9. doi: 10.1080/01421590701606799

7. Santee J, Garavalia L. Peer tutoring programs in health professions schools. Am J Pharm Educ 2006; 70(3): 70.
doi: 10.5688/aj700370

8. Swindle N, Wimsatt L. Development of peer tutoring services to support osteopathic medical students’ academic success. J Am Osteopath Assoc 2015; 115(11): e14–19. doi: 10.7556/jaoa.2015.140

9. Brown G, Manogue M. AMEE medical education guide
no. 22: refreshing lecturing: a guide for lecturers. Med Teach 2001; 23(3): 231–44. doi: 10.1080/01421590120043000

A Needs Assessment Pilot Study of Patients with High Utilization in an Academic Inpatient Setting

Posted on by

Authors:

Alexander S. Roseman, M.D.1*, Hannah Thompson, M.D.1, Audrey Jiang, BS1, Lisa Obasi, BA1, Andrew M. Pattock, BS1, Jamie P. Schlarbaum, BS1, Daniel R. Wells, BS1, Andrew P.J. Olson, M.D.2,3

Author Affiliations:

1University of Minnesota Medical School, Minneapolis, MN, USA
2Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
3Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA

Full Text Article PDF

*Corresponding Author: Alexander S. Roseman; alexander.rosemanMD@baystatehealth.org

Key Words: needs assessment; high utilization; super utilizers; high utilizers; academic medical centers

Abstract:

Background: A disproportionate amount of health care spending in the United States is attributed to a small subset of patients who employ inpatient and emergency department (ED) services. While patients with high ED utilization have previously been well- described, patients seen in an inpatient academic medical setting may differ with regard to demographics, medical conditions, and social factors.

Objectives: We aimed to characterize patients with high utilization in an academic inpatient setting for the purpose of identifying unmet needs.

Setting and Patients: Adults aged 18–80 were eligible for inclusion if they had more than three admissions to a general medicine service of an academic medical center within a large health care system. Patients who were admitted for pregnancy, oncology, trauma, or surgical procedures for acute conditions or were diagnosed with dementia or encephalopathy were excluded. Twenty-six patients met inclusion/exclusion criteria and were approached to be interviewed, of which 13 agreed to be interviewed. Measurements: Face-to-face administration of a self-reported survey assessing unmet needs regarding services for medical or mental health needs, access to health care, housing, transportation, or legal services, and any other barriers to health the respondent identified.

Results: All of those surveyed had health insurance and regular visits with primary care providers (mean 14 visits per 12 months). The most prevalent medical conditions identified were depression (85%) and chronic pain (77%). In addition, patients self-identified having an average of 2.2 chronic conditions. Financial struggles were common as 62% of the respondents reported annual incomes of <$12,000, and 77% were unemployed over the previous 12 months.

Conclusion: These results indicate unique clinical and social characteristics associated with high readmission rates at one academic medical center, suggesting the need for additional patient-centered research of this population to aid in the development of novel strategies to reduce over-utilization and improve health.

Published: Spring, 2019

References:

1. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010; 56(1): 42–8. doi: 10.1016/j.annemergmed.2010.01.032
2. Harris LJ, Graetz I, Podila PS, Wan J, Waters TM, Bailey JE. Characteristics of hospital and emergency care super-utilizers with multiple chronic conditions. J Emerg Med 2016; 50(4): e203–14. doi: 10.1016/j.jemermed.2015.09.002
3. Statistical Brief #190. Healthcare Cost and Utilization Project (HCUP). May 2016. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/ statbriefs/sb190-Hospital-Stays-Super-Utilizers-Payer-2012.jsp (accessed 10/14/2016)
4. Ronksley PE, Kobewka DM, McKay JA, Rothwell DM, Mulpuru S, Forster AJ. Clinical characteristics and preventable acute care spending among a high cost inpatient population. BMC Health Serv Res 2016; 16: 162–5. doi: 10.1186/ s12913-016-1418-2
5. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2): 377–81. doi: 10.1016/j. jbi.2008.08.010

6. Team RDC. R: A language and environment for statistical computing. 2017. Available from: http://www.r-project.org (accessed 08/1/2015)
7. Team Rs. RStudio: integrated development for R. RStudio, Inc. 2017. Available from: http://www.rstudio.com/ (accessed 08/1/2015)

8. Blank FS, Li H, Henneman PL, Smithline HA, Santoro JS, Provost D, et al. A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs 2005; 31(2): 139–44. doi: 10.1016/j.jen.2005.02.008

9. Stockbridge EL, Suzuki S, Pagan JA. Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey. Health Serv Res 2015; 50(3): 847–70. doi: 10.1111/1475-6773.12263
10. Von Korff M, Lin EHB, Fenton JJ, Saunders K. Frequency and priority of pain patients’ health care use. Clin J Pain 2007; 23(5): 400–8. doi: 10.1097/AJP.0b013e31804ac020

11. Blyth FM, March LM, Brnabic AJM, Cousins MJ. Chronic pain and frequent use of health care. Pain 2004; 111(1–2): 51–8. doi: 10.1016/j.pain.2004.05.020

12. Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med 2006; 48(1): 1–8. doi: 10.1016/j. annemergmed.2005.12.030

13. Mautner DB, Pang H, Brenner JC, Shea JA, Gross KS, Frasso 335 R, et al. Generating hypotheses about care needs of high
utilizers: lessons from patient interviews. Popul Health Manag
2013; 16(Suppl 1): S26–33. doi: 10.1089/pop.2013.0033; 10.1089/pop.2013.0033

14. Resources H, Administration S. State-level projections 340 of supply and demand for primary care practitioners:
2013–2025 about the National Center for Health
Workforce Analysis. 2016:2013–2025. Available from: http://bhw.hrsa.gov/healthworkforce/index.html [cited 11 February 2018]. 345

15. Williams BC, Paik JL, Haley LL, Grammatico GM.
Centralized care management support for ‘high utilizers’ in
primary care practices at an academic medical center. Care Manag J 2014; 15(1): 26–33.

16. Tourangeau R, Smith TW. Asking sensitive questions: the 350 impact of data collection mode, question format, and
question context. Public Opin Q 1996; 60(2): 275–304. doi:
10.1086/297751

17. Alonso A, Beunza JJ, Delgado-Rodriguez M, Martinez-
Gonzalez MA. Validation of self reported diagnosis of
hypertension in a cohort of university graduates in Spain.
BMC Public Health 2005; 5: 94. doi: 10.1186/1471-2458-5-94

18. Kriegsman DMW, Penninx BWJH, Van Eijk JTM,
Boeke AJP, Deeg DJH. Self-reports and general practitioner
information on the presence of chronic diseases in 360 community dwelling elderly. A study on the accuracy of
patients’ self-reports and on determinants of inaccuracy.
J Clin Epidemiol 1996; 49(12): 1407–17. doi: 10.1016/ S0895-4356(96)00274-0

Expert Opinions on Healthcare for Immigrants in Norway

Posted on by

Authors:

Andrea Kubicki1, Haben Debessai1, Megan Masten1, Reena Pullukat1, Kirsten Salmela1

Author Affiliations:

1College of Human Medicine, Michigan State University, East Lansing, MI, USA

Full Text Article PDF

*Corresponding Author: Megan Masten; mastenme@msu.edu

Key Words: Norway; healthcare; immigrant; barriers to care; language

Abstract:

Background: Documented immigrants eligible to stay in Norway for more than 6 months can enroll in the universal healthcare system for full healthcare services, such as acute, chronic, and preventative care.1 All other non-citizens only have access to emergency services. With an increasing influx of immigrants to Norway, it is advantageous to evaluate the Norwegian healthcare system, how documented and undocumented immigrants utilize the system, and any barriers they may face when doing so. The aim of this study is to identify barriers to healthcare for immigrants in Norway in order to better address them in the future.

Methods: Sixteen subjects with knowledge of immigrant healthcare in Norway were interviewed. Participants were asked the same standardized four questions; answers were audio-recorded, transcribed, and analyzed.

Results: Major themes that emerged included the following: (1) universal access is a benefit once accepted into the system, (2) timeliness is an issue, (3) chronic disease and mental health are common immigrant-specific health issues, and (4) language and lack of cultural competency are major barriers to care.

Conclusion: There is a need for improved translation services and cultural competency as the immigrant population in Norway increases.

Published: Spring, 2019

References:

1. Goth UG, Berg JE. Migrant participation in Norwegian health care. A qualitative study using key informants.
Eur J Gen Pract 2010; 17(1): 28–33. doi:10.3109/1381478 8.2010.525632.

2. Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June–22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948.

3. Bollini P. Health policies for immigrant populations in the 1990s. A comparative study in seven receiving countries.
Int Migrat 1992; 30 (Special Issue: Migration and Health in
the 1990s): 103–19.

4. Summary Report on the MIPEX Health Strand & Country Reports. pp. 1–101, Rep. No. 52. 2016. Brussels: International Organization for Migration. Available from: https://publications. iom.int/system/files/mrs_52.pdf [cited 15 August 2016].

5. CooperB. Migrant quality, not quantity. Washington, DC: Migration Policy Institute. 2005. Available from: https://www.migrationpolicy.org/article/norway-migrant-quality-not- quantity [cited 16 July 2018].

6. Large diversity in little Norway. ssb.no. Available from: https://www.ssb.no/en/befolkning/artikler-og-publikasjoner/ large-diversity-in-little-norway. Published 2019 [cited 21 March 2019].

7. Abebe DS. Public health challenges of immigrants in Norway: a research review. NAKMI Report 2010; 2.

8. Eli K, Ytrehus S. Barriers to health care access among undocumented migrant women in Norway. Soc Health Vulnerability 2015; 6(1): 28668.

9. This is Norway 2016: what the figures say. pp. 1–2. Statistics Norway. Available from: https://www.ssb.no/a/histstat/norge/ this-is-norway-2016.pdf [cited 15 August 2016].

10. Heim T. Problems of general practitioner’s care of migrants. Misunderstandings – Not only because of language. MMW Fortschr Med 2004; 146: 4–6.

11. Priebe S, Sandhu S, Dias S, Gaddini A, Greacen T,
Ioannidis E, et al. Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health 2011; 11(1): 187.

12. Jensen NK, Nielsen SS, Krasnik A. Expert opinion on best practices “in the delivery of healthcare services to immigrants in Denmark”. Dan Med Bull 2011; 57(8): A4170.

13. Mladovsky P. Migrant health in the EU. Eurohealth London 2007; 13(1): 9.

14. Wachtler C, Brorsson A, Troein M. Meeting and treating cultural difference in primary care: a qualitative interview study. Fam Pract 2005; 23(1): 111–15.

Opioid Safety Education in Adolescent Students

Posted on by

Authors:

Alexandra K. Feiertag, B.A.1*, Catherine A. Martin, M.D.1,2, Gregory E. Guenthner, M.L.I.S.2

Author Affiliations:

1College of Medicine, University of Kentucky, Lexington, KY, USA
2Department of Psychiatry, University of Kentucky, Lexington, KY, USA

Full Text Article PDF

*Corresponding Author: Alexandra K. Feiertag; alex.feiertag@uky.edu

Key Words: opioid; overdose; safety; education; adolescent

Abstract:

Purpose: Opioid overdoses profoundly impact thousands of families across the United States. Behind this issue lies the accessibility of opioid prescriptions right inside our medicine cabinets. Our goal was to educate adolescent students in Kentucky schools about this matter because they comprise a vulnerable population.

Methods: Pre- and posttestings were used to analyze 26 adolescents’ knowledge, attitudes, and awareness regarding opioid overdoses pre- and post-intervention.

Results: Adolescents displayed significantly improved results from pre-test to post-test. Overdose Knowledge scores improved by 16% from pre- to post-intervention (p = 0.01). Attitude to Act scores improved by 35% (p = 0.03). Drug Disposal Awareness scores improved by 54% (p < 0.01).

Conclusions: This study demonstrates that education improves adolescents’ opioid overdose knowledge, attitudes, and awareness. The evidence shows that there are educational gaps that should be filled by teaching adolescents about the opioid epidemic and providing them with resources.

Published: Spring, 2019

References:

1. Overdose death rates. National Institute on Drug Abuse. August 2018. Available from: https://www.drugabuse.gov/ related-topics/trends-statistics/overdose-death-rates [cited 10 August 2018].
2. Drugs of abuse. U.S. Department of Justice Drug Enforcement Administration. June 16, 2017. Available from: https://www.dea.gov/sites/default/files/sites/ getsmartaboutdrugs.com/files/publications/DoA_2017Ed_ Updated_6.16.17.pdf#page=40 [cited 10 August 2018].
3. Curtin SC, Tejada-Vera B, Warner M. Drug overdose deaths among adolescents aged 15–19 in the United States: 1999– 2015. Centers for Disease Control and Prevention. August 16, 2017; Available from: https://www.cdc.gov/nchs/products/ databriefs/db282.htm [cited 10 August 2018].
4. Slavova S, Bunn TL, Gao W. Drug overdose deaths in Kentucky, 2000–2013. Kentucky Injury Prevention and Research Center. March 6, 2015; Available from: http:// www.mc.uky.edu/kiprc/projects/ddmarpdak/pdf/ KyDrugOverdoseDeaths-2000-2013.pdf [cited 10 August 2018].
5. Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the epidemic of prescription opioid overdose deaths. Am J Public Health 2018; 108(4): 500–2. doi: 10.2105/ AJPH.2017.304265
6. Williams AV, Strang J, Marsden J. Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales for take-home naloxone training evaluation. Drug Alcohol Depend 2013; 132(1–2): 383–6. doi: 10.1016/j. drugalcdep.2013.02.007
7. Whiteside LK, Walton MA, Bohnert ASB, Blow FC, Bonar EE, Ehrlich P, et al. Nonmedical prescription opioid and sedative use among adolescents in the emergency department. Pediatrics 2013; 132(5): 825–32. doi: 10.1542/peds.2013-0721 8. Frank D, Mateu-Gelabert P, Guarino H, Bennett A, Wendel T, Jessell L, et al. High risk and little knowledge: overdose experiences and knowledge among young adult nonmedical prescription opioid users. Int J Drug Policy 2015; 26(1): 84–91. doi: 10.1016/j.drugpo.2014.07.013
9. Tilley JC, Ingram V. 2016 overdose fatality report. Kentucky Office of Drug Control Policy. 2016. Available from: https:// odcp.ky.gov/Documents/2016%20ODCP%20Overdose%20 Fatality%20Report%20Final.pdf [cited 10 August 2018].

Advance Directive Status in >65yo ED Population

Posted on by

Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population

Author: Kelsey Grace , Michelle Carson MD, August Grace, David Betten MD

Author Affiliations: Sparrow Hospital Department of Emergency Medicine

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2018/02/ADirectiveEpub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: Kelsey Grace, gracekel@msu.edu

 

Abstract:

Advance directives are an important aspect of medical care for the elderly given the uncertainty of health and longevity. In their absence, family and physicians are often left with questions regarding what patient’s wishes would entail if they become incapacitated. Individuals >65 years presenting to the ED were surveyed during the months of June-September 2015 by study investigators regarding their knowledge and utilization of advance directives. 168 patient surveys were completed with a mean age of 77.2 (SD ±7.45 years; range 65-97). Of those, 91% were either ―very familiar‖ or ―somewhat familiar‖ with Advance Directives with 76.1% having some form of documented advance directives in place. Of those who felt family were aware of their wishes, 84.9% had assigned a Medical Durable Power of Attorney. Only a small minority had developed advance directives with their physician’s assistance (6.8%). The majority of patients stated that they had prepared their end of life documents with a Lawyer (72%). Only 35.8% of patients sampled had even mentioned the topic or their specific wishes with their primary care or ED physician. Overall rates of formalized advance directives would appear to be highly utilized in this patient population with little variation based upon respondents’ self-assessment of physical health. A surprising finding was how minor of a role physicians appear to play in the development of ADs. This provides an opportunity to enhance the physician-patient relationship and improve patient education regarding end of care discussions. Physicians should take initiative and begin having these conversations, in order to ensure that patients are making educated decisions and that proper documentation is occurring.

Published on date: February, 2018

DOI: 10.15404/msrj/02.2018.0152

Citation: Grace, K., Carson, M., Grace, A. et al. Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population, Medical Student Research Journal (2018). doi:10.15404/msrj/02.2018.0152

References:

1. Koch, K. Patient Self-Determination Act. J Fla Med Assoc. 1992. 79:240–243.

2. O’Sullivan, R., Malio, K., Angeles, R., Agarwal, G. Advance directives: survey of primary care patients. Can Fam Physicians. 2015. 61(4):353-356.

3. Oulton, J., Rhodes, S., Howe, C., et al. Advanced directives for older adults in the emergency department: a systematic review. J Pallait Med. 2015. 18(6):500-505.

4. Llovera, I., Ward, M., Ryan, J., et al. Why don’t emergency department patients have Advanced directives? Academic Emergency Medicine. 1999. 6(10):1054-1060.

5. Ishihara KK, Wrenn K, Wright SW, Socha CM, Cross M. Advance directives in the emergency department: too few, too late. Acad Emerg Med. 1996. 3:50–53.

6. Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care—a case for greater use. New Engl J Med. 1991;324(13):889–895.

7. Spoelhof GD, Elliott B. Implementing Advance directives in office practice. Am Fam Physician. 2012. 85(5):461–466.

8. Edinger W, Smucker DR. Outpatients’ attitudes regarding Advance directives. J Fam Pract. 1992. 35(6):650–653.

9. Tierney WM, Dexter PR, Gramelspacher GP, Perkins AJ, Zhou XH, Wolinsky FD. The effect of discussions about Advance directives on patients’ satisfaction with primary care. J Gen Intern Med. 2001;16(1):32–40. (Patient satisfaction with physicians increases if directives are discussed).

Case Report of Glanzmann Thrombasthenia

Posted on by

Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia

Author: Ahmed Al Wahab1 , Alaa Nugud, M.D.2 , Shomous Nugud M.D.3, Zahran Alras1

Author Affiliations:

1College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
2Department of Pediatrics, Dubai Health Authority, Dubai, United Arab Emirates
3Department of Research, Sharjah Institute for Medical Research, Sharjah, United Arab Emirates

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2017/09/GlanzmannEPub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: Ahmed Al Wahab, a7md13@gmail.com

Key Words: Glanzmann Thrombasthenia, inherited platelet disorder, the disorder of hemostasis

Abstract:

Background

Glanzmann Thrombasthenia (GT) is a rare inherited genetic platelet disorder characterized by a qualitative, or quantitative mutation in GPIIb/IIIa receptor; which results in defective platelet aggregation and diminished clot retraction.

Case

A 19-year-old Arab descent female presented to emergency department with severe menorrhagia. On examination an ill looking pale patient in addition to generalized fatigue of one-week duration.

Conclusion

Acquired platelet disorders are more frequently encountered in practice than inherited ones, usually due to medical therapy or an underlying medical condition. GT, was previously known as hereditary hemorrhagic thrombasthenia, is an autosomal recessive disorder that is often disregarded as it has many clinical and laboratory findings similar to some acquired platelet disorders.

Published on date: September, 2017

DOI: 10.15404/msrj/09.2017.0127

Citation: Al Wahab, A., Nugud, A., Nugud, S., & Alras, Z. Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia, Medical Student Research Journal (2017). doi:10.15404/msrj/09.2017.0127

References:

  1. Stevens, R. & Meyer, S. (2002). Fanconi and Glanzmann: the men and their works. British Journal Of Haematology, 119(4), 901-904. http://dx.doi.org/10.1046/j.1365-2141.2002.03812.x
  2. Nurden, A., Ruan, J., Pasquet, J., Gauthier, B., Combrié, R., Kunicki, T., & Nurden, P. (2002). A novel 196 Leu to Pro substitution in the β3 subunit of the αIIbβ3 integrin in a patient with a variant form of Glanzmann thrombasthenia. Platelets, 13(2), 101-111. http://dx.doi.org/10.1080/09537100220122466
  3. Solh, M., Solh, T., & Botsford, A. (2015). Glanzmann&#39;s thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options. Journal Of Blood Medicine, 219. http://dx.doi.org/10.2147/jbm.s71319
  4. Di Minno, G., Zotz, R., d’Oiron, R., Bindslev, N., Di Minno, M., & Poon, M. (2015). The international prospective Glanzmann Thrombasthenia Registry: treatment modalities and outcomes in non-surgical bleeding episodes in Glanzmann thrombasthenia patients. Haematologica. http://dx.doi.org/10.3324/haematol.2014.121475
  5. iore, M., Nurden, A., Nurden, P., & Seligsohn, U. (2012). Clinical utility gene card for: Glanzmann thrombasthenia. European Journal Of Human Genetics, 20(10), 1102-1102. http://dx.doi.org/10.1038/ejhg.2012.178
  6. George, J., Caen, J., & Nurden, A. (1990). Glanzmann’s thrombasthenia: the spectrum of clinical disease. Blood, 75(7), 1383-1395.
  7. Seligsohn, U. (2003). Glanzmann thrombasthenia: a model disease which paved the way to powerful therapeutic agents. Pathophysiology Of Haemostasis And Thrombosis, 32(5-6), 216-217. http://dx.doi.org/10.1159/000073569.

Three Wishes Survey

Posted on by

Are medical students becoming less altruistic and more money-oriented? A three wishes survey

Author: Anna I. Perera MSc1, Anna Serlachius PhD1, Roger J. Booth PhD2 & Keith J. Petrie PhD1

Author Affiliations:

1Department of Psychological Medicine, University of Auckland, NZ

2Department of Molecular Medicine and Pathology, University of Auckland, NZ

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2017/09/MedAltruismEpub-1.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: Anna I. Perera, anna.perera@auckland.ac.nz

Key Words: undergraduate, motivations, altruism, money, specialization

Abstract:

Purpose

In this study we assessed the underlying values and goals of current medical students by examining personal wishes. The authors also aimed to determine the impact of the increased financial burden of medical training on students‟ motivations by comparing current wishes to those of students from 1999. We also examined the relationships between types of wishes, choice of future medical specialty, and demographic characteristics.

Methods

An anonymous survey with the question: “If you had three wishes, what would you wish for?”, and items pertaining to specialization choice and demographics was completed by 418 medical students. Wishes were coded into seventeen categories. Results were compared to a previous survey conducted in 1999.

Results

The largest category of wishes was altruism (40% of students) followed by achievement (36%), and money (34%). Significantly more medical students in 2015 had altruistic and achievement wishes compared to 1999. However, there was no significant increase in money-related wishes in the 2015 cohort compared to students from 1999. Final year students were more likely to report power-related wishes and male medical students had significantly more wishes related to power, money, and self-esteem. Students who aspired to be surgeons had more affiliation wishes and fewer knowledge-related aspirations. Conversely, medical students planning to enter internal medicine training were more likely to have wishes related to power and self-esteem. Achievement wishes were more common among individuals wanting to enter family medicine.

Conclusion

There was no evidence that medical students are becoming less altruistic and more money-orientated. Further, individuals did not appear to become less altruistic or increasingly financially driven as they progressed through the medical course.

Published on date: September, 2017

DOI: 10.15404/msrj/09.2017.0145

Citation: Perera, A., Serlachius, A., Booth, R., & Petrie K. Are Medical Students becoming Less Altruistic and More Money-Oriented? A Three Wishes Study, Medical Student Research Journal (2015). doi:10.15404/msrj/09.2017.0145

References:

  1. Vidayarthi AR, Kamei, R, Chan, K, Sok-Hong, G, Ngee, L. Factors associated with medical students clinical reasoning and evidence based medicine practice. Int J Med Educ 2015;6:142-148. http://dx.doi.org/10.5116/ijme.563a.5dd0
  2. Borges NJ, Hartung PJ. Stability of values during medical school. Med Teach 2010;32(9):779-781. http://dx.doi.org/10.3109/01421591003692706
  3. Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med 2008;83(3):244-249. http://dx.doi.org/10.1097/ACM.0b013e3181637837.
  4. Hojat M, Vergare MJ, Maxwell K, Brainard G, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med 2009;84(9);1182-1191. http://dx.doi.org/10.1097/ACM.0b013e3181b17e55
  5.   Chen DCR, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach 2012;34(4):305-311. http://dx.doi.org/10.3109/0142159X.2012.644600
  6. Morley CP, Roseamelia C, Smith J, Villarreal AL. Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution. Med Ed 2013;18:21194. http://dx.doi.org/10.3402/meo.v18i0.21194
  7. Mader EM, Roseamelia C, Morley CP. The temporal decline of idealism in two cohorts of medical students at one institution. BMC Med Ed 2014;14:58. http://dx.doi.org/10.1186/1472-6920-14-58.
  8. Stephens MB, Landers MB, Davis G, Durning, SW, Crandall SJ. Medical student attitudes toward the medically underserved: the USU perspective. Mil Med 2015;180(4):61-63. http://dx.doi.org/10.7205/MILMED-D-14-00558.
  9. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med 2011;86(8):996-1009. http://dx.doi.org/10.1097/ACM.0b013e318221e615.
  10. Dwinnell B, Adams L. Why we are on the cusp of a generalist crisis. Acad Med 2001;76(7);707-708.
  11. Morra DJ, Regehr G, Ginsburg S. Anticipated debt and financial stress in medical students. Med Teach 2008;30(3):313-315. http://dx.doi.org/10.1080/01421590801953000.
  12. O‟Grady G, Fitzjohn J. Debt on graduation, expected place of practice, and career aspirations of Auckland Medical School students. NZ Med J 2001;114:468-70.
  13. Faculty of Medical and Health Sciences [Internet]. Auckland: The University of Auckland; c2016 [cited 2016 Aug 18]. Available from: http://www.fmhs.auckland.ac.nz/en/faculty/for/future-undergraduates/undergraduate-study-options/mbchb.html
  14. Collins MG. Medical students and debt: a survey of students at the School of Medicine, University of Auckland. NZ Med J 1999;112(1085):123-6.
  15.  Ministry of Social Development [Internet]. Students studying a Bachelor of Medicine and Bachelor of Surgery receiving student loan payments between 2008 and 2012. Wellington: New Zealand Government; c2013 [cited 2013 Sep 2]
  16. Moore J, Gale J, Dew K, Davie G. Student debt amongst junior doctors in New Zealand; Part 1: Quantity, distribution, and impact. NZ Med J 2006;117(1229):12-20
  17. Greysen SR, Chen C, Mullan F. A history of medical student debt: Observations and implications for the future of medical education. Acad Med 2011; 86:840-845.
  18. Bazemore A, Peterson L, Jetty A, Wingrove P, Petterson S, Phillips R. Over half of graduating family medicine residents report more that $150,000 in educational debt. J Am Board Fam Med 2016; 29:180-181.
  19. Woolf K, Elton M, Newport M. The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study. BMC Med Ed 2015;15:46. http://dx.doi.org/10.1186/s12909-015-0328-z.
  20. Lynch DC, Newton DA, Grayson MS, Whitley TW. Influence of medical school on medical students’ opinions about primary care practice. Acad Med 1998;73(4):433-5.
  21. Pawelczyk A, Pawelczyk T, Bielecki J. Differences in medical specialty choice and in personality factors among female and male medical students. Pol Merkuriusz Lek 2007;23(137):363-366.
  22. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 2003;88(5):879-903.
  23. McAdams DP, Olson BD. Personality development: continuity and change over the life course. Annu Rev Psychol. 2010;61:517-542 http://dx.doi.org/10.1146/annurev.psych.093008.100507.
  24. Petrie KJ, White GR, Cameron LD, Collins JP. Photographic memory, money, and liposuction: survey of medical students’ wish lists. BMJ 1999;319(7225):1593-1595.
  25. King L, Broyles SJ. Wishes, gender, personality and well-being. J Person 1997;65:49-76.
  26. Quince TA, Parker RA, Wood DF, Benson JA. Stability of empathy among undergraduate medical students: A longitudinal study at one UK medical school. BMC Med Ed 2011;11:90 http://dx.doi.org/10.1186/1472-6920-11-90.
  27. Albanese MA, Snow MH, Skochelak HE, Huggett KN, Farrell PM. Assessing personal qualities in medical school admissions. Acad Med 2003;78(3):313-321.
  28. Muller D, Kase N. Challenging traditional premedical requirements as predictors of success in medical school: The Mount Sinai School of Medicine humanities and medicine program. Acad Med 2010;85(8):1378-1383. http://dx.doi.org/10.1097/ACM.0b013e3181dbf22a.
  29. Poole P, Shulruf B, Boyle V. Influence of gender and other factors on medical student specialty interest. NZ Med J 2014;127(1402):78-87
  30. Tweed MJ, Bagg W, Child S, Wilkinson TJ, Weller J. How the trainee intern year can ease the transition from undergraduate education to postgraduate practice. N.Z. Med J 2010;123:81-91.
  31. Prka M, Danic A, Glavas E. What do medical students want from their professional and private life? Croat Med J 2002;43(1):80-83.
  32.  Buss DM. How can evolutionary psychology successfully explain personality and individual differences. Prospect Pscyhol Sci 2009;4(4):359-366. http://dx.doi.org/10.1111/j.1745-6924.2009.01138.x.
  33. Schwartz SH, Rubel T. Sex differences in value priorities: Cross cultural and multimethod studies. J Pers Soc Psychol 2005;89(6):1010-1028.
  34. Moyo M, Goodyear-Smith FA, Weller J, Robb G, Shulruf B. Healthcare practitioners‟ personal and professional values. Adv Hlth Sci Ed 2016;21(2):257-286. http://dx.doi.org/10.1007/s10459-015-9626-9.

Aerococcus Viridans

Posted on by

Aerococcus Viridans Infectious Endocarditis Complicated by Splenic Infarction

Author: Joshua Budhu M.S, Dorian Wood B.S, Marvin Crawford M.D, Khuram Ashraf M.D, Frederick Doamekpor M.D, Olufunke Akinbobuyi M.D

Author Affiliations: Morehouse School of Medicine, GA, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2017/09/AViridansEndocarditisEpubF.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: Joshua Budhu, jbudhu@gmail.com

Key Words: splenic infarct, infectious endocarditis, aercoccus viridans, HIV, immunocompromised, hemodialysis

Abstract:

In this case report we discuss splenic infarction as a presentation for infectious endocarditis. While not unheard of, splenic infarctions are usually incidental findings and are not usually used to diagnose infectious endocarditis. Since our patient was on hemodialysis, had AIDS and blood cultures tested positive for Aerococcus viridans and Streptococcus parasanguis, we propose that atypical presentations of IE should be considered in immunocompromised patients.

 

Published on date: September, 2017

DOI: 10.15404/msrj/07.2017.0002

Citation: : Budhu, J., Wood, D., Crawford, M., Ashraf, K., Doamekpor, F., & Akinbobuyi, O. Aerococcus Viridans Infectious Endocarditis Complicated by Splenic Infarction, Medical Student Research Journal (2017). doi:10.15404/msrj/07.2017.0002

References:

  1. Baddour M., Wilson  W.R., Bayer  A.S.; Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 111 2005:e394-e434.
  2. Sanfilippo AJ, Picard MH, Newell JB, Rosas E, Davidoff R, Thomas JD, Weyman AE. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications.J Am Coll Cardiol. 1991; 18:1191–1199. CrossRefMedline.
  3. Fauci, A.S., Braunwald, E., Kasper, D.L., Hauser, S.L., Longo, D.L., Jameson, J.L., Loscalzo, J. (Eds.). Harrison’s principles of internal medicine (18th ed.) (2011). New York: McGraw Hill.
  4. Vilacosta I, Graupner C, San Roman JA, Sarria C, Ronderos R, Fernandez C, Mancini L, Sanz O, Sanmartin JV, Stoermann W. Risk of embolization after institution of antibiotic therapy for infective endocarditis.J Am Coll Cardiol.2002; 39: 1489–1495.
  5. Nucifora G, Badano LP,Viale P,et al. Infective endocarditis in chronic haemodialysis patients: an increasing clinical challenge. Eur Heart J2007;28:2307-2312.
  6. Zhou W, Nanci V, Jean A, Salehi AH, Altuwaijri F, Cecere R, et al. Aerococcus viridans native valve endocarditis. Can J Infect Dis Med Microbiol. 2013;24(3):155-8.
  7. Uh, Y., J. S. Son, I. H. Jang, K. J. Yoon, and S. I. Hong. 2002. Penicillin-resistant Aerococcus viridans bacteremia associated with granulocytopenia. J. Korean Med. Sci. 17:113-115

 

MRI vs. CT in Diagnosing Acute Appendicitis in Children

Posted on by

Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomography

Author: Benjamin Whitt

Author Affiliations: Saba University School of Medicine, MA, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2017/09/Accuracy-MRI-FINAL-epub-formated.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: Benjamin Whitt, btwhitt22@gmail.com

Key Words: Appendicitis; Diagnostic Imaging; Sensitivity; Specificity; Children

Abstract:

Purpose

Computed tomography (CT) has emerged as the gold standard test for the evaluation of suspected appendicitis in pediatric patients. It has been shown to have excellent accuracy and to decrease negative appendectomy rates. However, CT scans expose patients to ionizing radiation, which is of especially high concern in children. Magnetic resonance imaging (MRI) is a potential alternative that could be used to evaluate children while eliminating exposure to radiation. This systematic review tests the hypothesis that the sensitivity and specificity of MRI are not inferior to that of CT in the evaluation of suspected appendicitis in children.

Methods

A search of the Medline database was conducted to identify articles that used MRI to evaluate children with suspected appendicitis. Articles that focused on pediatric subjects and reported sensitivity and specificity of MRI in these subjects were included. Data for the calculation of sensitivity, specificity, and 95% confidence intervals for each were extracted from each study included. Pooled data for sensitivity and specificity of MRI were calculated and tested for significance compared to sensitivity and specificity of CT using Fisher’s exact test.

Results

Nine studies were found to be relevant to the question posed by this systematic review and met the inclusion criteria. The pooled sensitivity and specificity of MRI for the diagnosis of appendicitis were 0.96 (95% CI: 0.94-0.98) and 0.97 (95% CI: 0.96-0.98) as opposed to values of 0.94 (95% CI: 0.92-0.97) and 0.95 (95% CI: 0.94-0.97) for CT. The difference between MRI and CT was not statistically significant for sensitivity (p=0.11) or specificity (p=0.06) in the evaluation of suspected appendicitis in children.

Conclusion

In children with suspected appendicitis, the sensitivity and specificity of MRI are comparable to those of CT in terms of sensitivity and specificity. MRI is a viable choice for imaging in these patients and limits exposure to radiation.

 

Published on date: September, 2017

DOI: 10.15404/msrj/07.2017.0001

Citation: Whitt, Benjamin. Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomography, Medical Student Research Journal (2015), 4(3), 54-58. doi:10.15404/msrj/07.2017.0001

References:

  1. Guthery, S.L., Hutchings, C., Dean, J.M., & Hoff, C. (2004). National estimates of hospital utilization by children with gastrointestinal disorders: analysis of the 1997 kids’ inpatient database. The Journal of Pediatrics, 144(5), 589-94. http://dx.doi.org/10.1016/j.peds.2004.02.029
  2. Addiss, D.G., Shaffer, N., Fowler, B.S., & Tauxe, R.V. (1990). The epidemiology of appendicitis and appendectomy in the United States. American Journal of  Epidemiology, 132 (5), 910-25.
  3. Seetahal, S.A., Bolorunduro, O.B., & Sookdeo, T.C. et al. (2011). Negative appendectomy: a 10-year review of a nationally representative sample. American Journal of Surgery, 201(4), 433-7. http://dx.doi.org/10.1016/j.amjsurg.2010.10.009
  4. Saito, J.M., Yan, Y., Evashwick, T.W., Warner, B.W., & Tarr, P.I. (2013). Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Pediatrics, 131(1), 37-44. http://dx.doi.org/10.1542/peds.2012-1665
  5. Fahimi, J., Herring, A., Harries, A., Gonzales, R., & Alter, H. (2012). Computed tomography use among children presenting to emergency departments with abdominal pain. Pediatrics, 130(5), 1069-75. http://dx.doi.org/10.1542/peds.2012-0739
  6. Hernanz-Schulman, M. (2010). CT and US in the diagnosis of appendicitis: an argument for CT. Radiology, 255(1), 3-7. http://dx.doi.org/10.1148/radiol.2553201003
  7. Raja, A.S., Wright, C., & Sodickson, A.D. et al. (2010). Negative appendectomy rates in the era of CT: an 18-year perspective. Radiology, 256(2), 460-65. http://dx.doi.org/10.1148/radiol.10091570
  8. Charfi, S., Sellami, A., Affes, A., Yaich, K., Mzali, R., & Boudawara, T.S. (2014) Histopathological findings in appendectomy specimens: a study of 24,697 cases. International Journal of Colorectal Disease, 29(8), 1009-12. http://dx.doi.org/10.1007/s00384-014-1934-7
  9. Doria, A.S., Moineddin, R., & Kellenberger, C.J. et al. (2006). US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology, 241(1), 83-94. http://dx.doi.org/10.1148/radiol.2411050913
  10. Brenner, D.J. & Hall, E.J. (2007). Computed tomography—an increasing source of radiation exposure. New England Journal of Medicine, 357(22), 2277-84. http://dx.doi.org/10.1056/NEJMra072149
  11. Mathews, J.D., Forsythe, A.V., & Brady, Z. et al. (2013). Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ, 346. http://dx.doi.org/10.1136/bmj.f2360
  12. Pearce, M.S., Salotti, J.A., & Little, M.P. et al. (2012). Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet, 380(9840), 499-505. http://dx.doi.org/10.1016/S0140-6736(12)60815-0
  13. Nash, K., Hafeez, A., & Hou, S. (2002). Hospital-acquired renal insufficiency. American Journal of Kidney Diseases, 39(5), 930-36. http://dx.doi.org/10.1053/ajkd.2002.32766
  14. Laroche, D., Aimone-Gastin, I., & Dubois, F. et al. (1998). Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology, 209(1), 183-90. http://dx.doi.org/10.1148/radiology.209.1.9769830
  15. Cogley, J.R., O’Connor, S.C., Houshyar, R., & Al Dulaimy, K. (2012). Emergent pediatric US: what every radiologist should know. Radiographics, 32(3), 651-65. http://dx.doi.org/10.1148/rg.323115111
  16. van Randen, A., Bipat, S., Zwinderman, A.H., Ubbink, D.T., Stoker, J., & Boermeester, M.A. (2008). Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology, 249(1), 97-106. http://dx.doi.org/10.1148/radiol.2483071652
  17. Lowe, L.H., Penney, M.W., & Stein, S.M. et al. (2001). Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography. American Journal of Roentgenology, 176(1), 31-35. http://dx.doi.org/10.2214/ajr.176.1.1760031
  18. Krishnamoorthi, R., Ramarajan, N., & Wang, N.E. et al. (2011). Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology, 259(1), 231-39. http://dx.doi.org/10.1148/radiol.10100984
  19. Poletti, P.A., Platon, A., & De Perrot, T. et al. (2011). Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT. European Radiology, 21(12), 2558-66. http://dx.doi.org/10.1007/s00330-011-2212-5
  20. Rosen, M.P., Ding, A., & Blake, M.A. et al. (2011). ACR Appropriateness Criteria® right lower quadrant pain—suspected appendicitis. Journal of the American College of Radiology, 8(11), 749-55. http://dx.doi.org/10.1016/j.jacr.2011.07.010
  21. Pedrosa, I. & Rofsky, N.M. (2003). MR imaging in abdominal emergencies. Radiologic Clinics of North America, 41(6), 1243-73.
  22. Barger Jr, R.L. & Nandalur, K.R. (2010). Diagnostic performance of magnetic resonance imaging in the detection of appendicitis in adults: a meta-analysis. Academic Radiology, 17(10), 1211-16. http://dx.doi.org/10.1016/j.acra.2010.05.003
  23. Dillman, J.R., Gadepalli, S., & Sroufe, N.S. et al. (2016). Equivocal Pediatric Appendicitis: Unenhanced MR Imaging Protocol for Nonsedated Children-A Clinical Effectiveness Study. Radiology, 279(1), 216-25. http://dx.doi.org/10.1148/radiol.2015150941
  24. Thieme, M.E., Leeuwenburgh, M.M., & Valdehueza, Z.D. et al. (2014). Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. European Radiology, 24(3), 630-37. http://dx.doi.org/10.1007/s00330-013-3044-2
  25. Herliczek, T.W., Swenson, D.W., & Mayo-Smith, W.W. (2013). Utility of MRI after inconclusive ultrasound in pediatric patients with suspected appendicitis: retrospective review of 60 consecutive patients. American Journal of Roentgenology, 200(5), 969-73. http://dx.doi.org/10.2214/AJR.12.10078
  26. Rosines, L.A., Chow, D.S., & Lampl, B.S. et al. (2014) Value of gadolinium-enhanced MRI in detection of acute appendicitis in children and adolescents. American Journal of Roentgenology, 203(5), 543-48. http://dx.doi.org/10.2214/AJR.13.12093
  27. Kulaylat, A.N., Moore, M.M., & Engbrecht, B.W. et al. (2015). An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis. Journal of Pediatric Surgery, 50(8), 1359-63. http://dx.doi.org/10.1016/j.jpedsurg.2014.12.012
  28. Moore, M.M., Gustas, C.N., & Choudhary, A.K. et al. (2012). MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatric Radiology, 42(9), 1056-63. http://dx.doi.org/10.1007/s00247-012-2412-4
  29. Orth, R.C., Guillerman, R.P., Zhang, W., Masand, P., & Bisset III, G.S. (2014). Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology, 272(1), 233-40. http://dx.doi.org/10.1148/radiol.14132206
  30. Bayraktutan, U., Oral, A., & Kantarci, M. et al. (2014). Diagnostic performance of diffusion-weighted MR imaging in detecting acute appendicitis in children: comparison with conventional MRI and surgical findings. Journal of Magnetic Resonance Imaging, 39(6), 1518-24. http://dx.doi.org/10.1002/jmri.24316
  31. Koning, J.L., Naheedy, J.H., & Kruk, P.G. (2014). Diagnostic performance of contrast enhanced MR for acute appendicitis and alternative causes of abdominal pain in Pediatric Radiology, 44(8), 948-55. http://dx.doi.org/10.1007/s00247-014-2952-x
  32. Cobben, L., Groot, I., Kingma, L., Coerkamp, E., Puylaert, J., & Blickman, J. (2009). A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. European Radiology, 19(5), 1175-83. http://dx.doi.org/10.1007/s00330-008-1270-9
  33. Heverhagen, J.T., Pfestroff, K., Heverhagen A.E., Klose, K.J., Kessler, K., & Sitter, H. (2012). Diagnostic accuracy of magnetic resonance imaging: a prospective evaluation of patients with suspected appendicitis (diamond). Journal of Magnetic Resonance Imaging, 35(3), 617-23. http://dx.doi.org/10.1002/jmri.22854
  34. Leeuwenburgh, M.M., Wiarda, B.M., & Jensch, S. et al. (2014). Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis. European Journal of Radiology, 83(1), 103-10. http://dx.doi.org/10.1016/j.ejrad.2013.09.022

Hardware Repair

Posted on by

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

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2016/12/HardwareRepairEpub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

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

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

 

Abstract:

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

References:

  1. Sebastin SJ, Chung KC. An Asian perspective on the management of distal radius fractures. Hand Clin. 2012;28(2):151-156.
  1. Kose A, Aydin A, Ezirmik N, Topal M, Can CE, Yilar S. Intramedullary nailing of adult isolated diaphyseal radius fractures. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2016;22(2):184-191.
  1. Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. The Journal of the American Academy of Orthopaedic Surgeons. 2009;17(6):369-377.
  1. Lattmann T, Meier C, Dietrich M, Forberger J, Platz A. Results of volar locking plate osteosynthesis for distal radial fractures. Journal of trauma. 2011;70(6):1510-1518.
  1. Harness NG. Fixation Options for the Volar Lunate Facet Fracture: Thinking Outside the Box. J Wrist Surg. 2016;5(1):9-16.
  1. Ezzat A, Baliga S, Carnegie C, Johnstone A. Volar locking plate fixation for distal radius fractures: Does age affect outcome? J Orthop. 2016;13(2):76-80.
  1. Dasari CR, Sandhu M, Wisner DH, Wong MS. Approaches to Distal Upper-Extremity Trauma: A Comparison of Plastic, Orthopedic, and Hand Surgeons in Academic Practice. Ann Plast Surg. 2016;76 Suppl 3:S162-164.
  1. Geissler WB, Clark SM. Fragment-Specific Fixation for Fractures of the Distal Radius. J Wrist Surg. 2016;5(1):22-30.
  1. Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J. [The volar locking plate for extension fractures of the distal radius]. Oper Orthop Traumatol. 2016;28(1):47-64.
  1. Korpelainen R, Korpelainen J, Heikkinen J, Vaananen K, Keinanen-Kiukaanniemi S. Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index–a population-based study. Bone. 2006;39(2):385-391.
  1. Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. The Journal of hand surgery. 2011;36(6):982-985.
  1. De Baere T, Lecouvet F, Barbier O. Breakage of a volar locking plate after delayed union of a distal radius fracture. Acta orthopaedica Belgica. 2007;73(6):785-790.
  1. Naito K, Zemirline A, Sugiyama Y, Obata H, Liverneaux P, Kaneko K. Possibility of Fixation of a Distal Radius Fracture With a Volar Locking Plate Through a 10 mm Approach. Tech Hand Up Extrem Surg. 2016;20(2):71-76.
  2. Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. The Journal of hand surgery. 2011;36(5):824-835 e822.
  1. Cao J, Ozer K. Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report. Patient safety in surgery. 2010;4(1):19.
  1. Yukata K, Doi K, Hattori Y, Sakamoto S. Early breakage of a titanium volar locking plate for fixation of a distal radius fracture: case report. The Journal of hand surgery. 2009;34(5):907-909.
  1. Wall LB, Brodt MD, Silva MJ, Boyer MI, Calfee RP. The effects of screw length on stability of simulated osteoporotic distal radius fractures fixed with volar locking plates. The Journal of hand surgery. 2012;37(3):446-453.
  1. Arora R, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of current management of distal radius fractures in the elderly individuals. Geriatric orthopaedic surgery & rehabilitation. 2011;2(5-6):187-194.
  1. Chung KC, Squitieri L, Kim HM. Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. The Journal of hand surgery. 2008;33(6):809-819.
  1. Sugun TS, Gurbuz Y, Ozaksar K, Toros T, Bal E, Kayalar M. A new complication in volar locking plating of the distal radius: longitudinal fractures of the near cortex. Acta Orthop Traumatol Turc. 2016;50(2):147-152.
  1. Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. The Journal of hand surgery. 2011;36(7):1135-1141.