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Does Traditional Chinese Medicine Matter?

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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

 

Abstract:

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

References:

  1. Hesketh T, Zhu WX. Traditional Chinese medicine: One country, two systems. BMJ: British Medical Journal (International Edition). 1997;315(7100):3p.
  2. Covington MB. Traditional Chinese medicine in the treatment of diabetes. Diabetes Spectrum. 2001;14(3):154-159.
  3. Yu H, Wang S, Liu J, Lewith G. Why do cancer patients use Chinese Medicine?-A qualitative interview study in China. European Journal of Integrative Medicine. 2012;4:c197-c203.
  4. Lee GBW, Charn TC, Chew ZH, Ng TP. Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Fam Pract. Dec 2004;21(6):654-660.
  5. Yang WY, Lu JM, Weng JP, et al. Prevalence of Diabetes among Men and Women in China. New Engl J Med. Mar 25 2010;362(12):1090-1101.
  6. Wang WB, McGreevey WP, Fu CW, et al. Type 2 Diabetes Mellitus in China: A Preventable Economic Burden. Am J Manag Care. Sep 2009;15(9):593-601.
  7. Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS. Systematic Review of Herbs and Dietary Supplements for Glycemic Control in Diabetes. Diabetes Care. 2003;26(4):18p.
  8. Liu JP, Zhang M, Wang WY, Grimsgaard S. Chinese herbal medicines for type 2 diabetes mellitus. Cochrane Database Systemic Review. 2004;3:CD003642.
  9. Li WL, Zheng HC, Bukuru J, De Kimpe N. Natural medicines used in the traditional Chinese medical system for therapy of diabetes mellitus. J Ethnopharmacol. May 2004;92(1):1-21.
  10. Donnelly R, Wang B, Qu X. Type 2 diabetes in china: Partnerships in education and research to evaluate new antidiabetic treatments. British Journal of Clinical Pharmacology. 2006;61(6):702-705.
  11. He J, Gu D, Wu X, et al. Major Causes of Death among Men and Women in China. New Engl J Med. 2005;353(11):1124-1134.
  12. Weil A. The state of the integrative medicine in the U.S. and Western World. Chinese journal of integrative medicine. Jan 2011;17(1):6-10.
  13. Xu W, Towers AD, Li P, Collet JP. Traditional Chinese medicine in cancer care: perspectives and experiences of patients and professionals in China. European journal of cancer care. Sep 2006;15(4):397-403.
  14. Liu Y, Rao K, Hsiao WC. Medical expenditure and rural impoverishment in China. Journal of health, population, and nutrition. Sep 2003;21(3):216-222.
  15. Health in rural China worsening, costs rising-WHO. 2007. http://www.reuters.com/article/2007/11/01/idUSPEK281625. Accessed Feb 7, 2012.
  16. Hui J, Xiao S, Xu H. Community-based screening for type 2 diabetes mellitus. Chinese Journal of Social Medicine. 2011;28(6):415-417.
  17. Lei X, Lin W. The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health? Health economics. Jul 2009;18 Suppl 2:S25-46.
  18. Hung JC, CJ; Chang, HY. Relationships between medical beliefs of superiority of Chinese or western medicine, medical behaviours and glycaemic control in diabetic outpatients in Taiwan. Health and Social Care in the Community. 2012;20(1):80-86.

Combating Obstacles to Empathy

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

Author: Francesca P. Kingery, M.S.1*, Alexander Bajorek, M.D. M.A.2, Amber Zimmer Deptola, M.D.3 Karen Hughes Miller, Ph.D.4, Craig Ziegler Ph.D.5, Pradip D. Patel M.D.6

Author Affiliations:

1School of Medicine, University of Louisville, Louisville, KY, USA.

2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA, USA.

3Washington University School of Medicine, St. Louis, MO, USA.  

4Graduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.

5Office of Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.

6Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.

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

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

 

Abstract:

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

References:

  1. Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine. October 2007;22(10):1434-8. http://dx.doi.org/10.1007/s11606-007-0298-x.
  2. Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine. September 2009;84:1182–1191.
  3. Mangione S, Kane GC, Caruso JW, Gonella JS, Nasca TJ, Hojat M. Assessment of empathy in different years of internal medicine training. Medical Teacher. July 2002;24:370–3.
  4. Newton BW, Barber L, Clardy J, et al. Is there hardening of the heart during medical school? Academic Medicine. March 2008;83:244–249. http://dx.doi.org/10.1097/ACM.0b013e3181637837.
  5. Rosenthal S, Howard B, Schlussel YR, et al. Humanism at heart: preserving empathy in third-year medical students. Academic Medicine. March 2011;86(3):350-8. http://dx.doi.org/10.1097/ACM.0b013e318209897f.
  6. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Academic Medicine. January 2006; 81(1):82-5.
  7. Gold A, Gold S. Humanism in medicine from the perspective of the Arnold Gold Foundation: challenges to maintaining the care in health care. Journal of Child Neurology. June 2006;21(6): 546-9.
  8. Mueller PS. Incorporating professionalism into medical education: the Mayo Clinic experience. Keio Journal of Medicine. September 2009;58(3):133-43.
  9. Shiau S, Chen CH. Reflection and critical thinking of humanistic care in medical education. Kaohsiung Journal of Medical Science. July 2008;24(7):367-72. http://dx.doi.org/10.1016/S1607-551X(08)70134-7.
  10. Swick HM. Viewpoint: professionalism and humanism beyond the academic health center. Academic Medicine. November 2007;82(11):1022-8.
  11. Bikker AP, Mercer SW, Rielly D. A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital. J Altern Complement Med. August 2005;11(4):591-600.
  12. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. The Lancet. March 2001;357(9258):757-762.
  13. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. September 2004;27(3):237-51.
  14. Wensing M, Jung HP, Mainz J, Olesen F, Grol R. A systematic review of the literature on patient priorities for general practice care, part 1: description of the research domain. Social Science & Medicine. November 1998;47(10):1573-1588.
  15. Schattner, A. The silent dimension: expressing humanism in each medical encounter. Archives of Internal Medicine. June 2009;169(12):1095-9. http://dx.doi.org/10.1001/archinternmed.2009.103.
  16. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor– patient relationship and malpractice: lessons from plaintiff depositions. Archives of Internal Medicine. June 1994; 154:1365–1370.
  17. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. The relationship with malpractice claims among primary care physicians and surgeons. Journal of the American Medical Association. February 1997;277:553–9.
  18. Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the “nature” and “specific effectiveness” of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Education and Counseling. March 2009;74(3):339-46. http://dx.doi.org/10.1016/j.pec.2008.11.013
  19. Association of American Medical Colleges Medical School Objectives Project. Learning Objectives for Medical Student Education: Guidelines for Medical Schools. Washington, DC: Association of American Medical Colleges. Available from: https://members.aamc.org/eweb/ upload/Learning%20Objectives%20for %20Medica l%20Student%20Educ%20Report%20I.pdf. Accessed December 28, 2014.
  20. Accreditation Council for Graduate Medical Education. General Competency and Assessment: Common Program Requirements. June 9, 2013; Available from: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed December 28, 2014.
  21. Medical professionalism in the new millennium: A physician’s charter. Project of the ABIM Foundation, ACP-ASIM Foundation and the European Federation of Internal Medicine. Annals of Internal Medicine. February 2002;136:243–246.
  22. Lehmann LS, Kasoff WS, Koch P, Federmann DD. A survey of medical ethics education at U.S. and Canadian medical schools. Academic Medicine. July 2004;79:682–689.
  23. Medical residency application to recognize student achievement in humanism in medicine [news release]. Englewood Cliffs, NJ: Arnold P. Gold Foundation; Nov 12, 2014. http://www.prnewswire.com/news-releases/medical-residency-application-to-recognize-student-achievement-in-humanism-in-medicine-282404131.html. Accessed January 10, 2015.
  24. Benbassat J, Baumal R, Borkan JM, Ber R. Overcoming barriers to teaching the behavioral and social sciences to medical students. Academic Medicine. April 2003;78(4):372-80.
  25. Wachtler C, Lundin S, Troein M. Humanities for medical students? A qualitative study of a medical humanities curriculum in a medical school program. BMC Medical Education. March 2006;6:16.
  26. Doukas DJ, McCullough LB, Wear S. Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Academic Medicine. March 2012;87(3):334-41. http://dx.doi.org/10.1097/ACM.0b013e318244728c.
  27. Patel PD, Kischnick DB, Bickel SG, Ziegler CH, Miller KH. Evaluating the Utility of Peer- Assisted Learning in Pediatrics. Medical Science Educator. December 2011;21(4):316-319.
  28. Pandit NR. The Creation of Theory: A recent application of the Grounded Theory Method. The Qualitative Report. December 1996;2(4):1-20.
  29. Moyer CA, Arnold L, Quaintance J, et al. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Academic Medicine. November 2010; 85(11):1800-7. http://dx.doi.org/10.1097/ACM.0b013e3181f526af.
  30. Reichert J, Bognar S, Greenberg LW, Godoy M, Durgans KY. New educational modules offer tough case studies around humanistic issues. Journal of Cancer Education. February 2011; 26(2):386-7. http://dx.doi.org/10.1007/s13187-011-0195-1.
  31. Wen LS, Baca JT, O’Malley P, Bhatia K, Peak D, Takayesu JK. Implementation of small-group reflection rounds at an emergency medicine residency program. Canadian Journal of Emergency Medicine. May 2013; 5(3):175-7.
  32. Misch, DA. Evaluating physicians’ professionalism and humanism: the case for humanism “connoisseurs”. Academic Medicine. June 2002;77(6):489-95.
  33. Self, DJ, Olivarez M, Baldwin DC Jr. The amount of small-group case- study discussion needed to improve moral reasoning skills of medical students. Academic Medicine. May 1998;3(5):521-3.

Medals 4 Mettle

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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

 

Abstract:

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

References:

  1. Dossett ML, Kohatsu W, Nunley W, Mehta D, Davis RB, Phillips RS, Yeh G. A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self care: an evaluation of the HEART program. Explore. 2013 Sep-Oct;9(5):292-8.
  2. Moyer CA, Arnold L, Quaintance J, Braddock C, Spickard A 3rd, Wilson D, Rominski S, Stern DT. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Acad Med. 2010 Nov;85(11):1800-7.
  3. Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. Acad Med. 2014 Sep;89(9):1252-8.
  4. Magnezi R, Bergman LC, Urowitz S. Would your patient prefer to be considered your friend? Patient preferences in physician relationships. Health Educ Behav. 2014 Aug 25.
  5. Branch WT Jr. Treating the whole patient: passing time-honored skills for building doctor-patient relationships to generations of doctors. Med Educ. 2014;48:67-74.
  6. Duong DV. Caregiving as good doctoring. Acad Med. 2013 Nov;88(11):1678-9.
  7. Williams GC, Frankel RM, Campbell TL, Deci EL. Research on relationship-centered care and healthcare outcomes from the Rochester biopsychosocial program: a self-determination theory integration. Fam Syst Health. 2000;18(1):79-90.
  8. Schaechter, JL, Canning EH. ‘Pals’ a medical student public service program. West J Med. 1994 Oct;161(4):390-2.
  9. Burks DJ, Kobus AM. The legacy of altruism in health care: the promotion of empathy, prosociality and humanism. Med Educ. 2012; 46:317-25.
  10. Eckenfels, EJ. The purpose of service learning. Fam Med. 2009; 41(9):659-62.
  11. Isenberg SF. Physician founds charity to honor collective ‘mettle.’ IBJ. 2006 Feb 6;26(49):A38.
  12. Center for Disease Control (CDC) Handbook on program Evaluation Available online at http://www.cdc.gov/eval/guide/CDCEvalManual.pdf
  13. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Systat Software, Released 2008 .
  14. Pandit, NR (1996) Creation of Theory: A Recent Application of the Grounded Theory Method. The Qual Repo 2(4). Available online at http://www.nova.edu/ssss/QR/QR2-4/pandit.html
  15. Cohen, Jacob. Statistical Power Analysis for the Behavioral Sciences. New Jersey: Lawrence Erlbaum Associates, 1988. Print

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

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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

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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.

References:

  1. Ghent A. Overcoming migrants’ barriers to health. Bull World Health Org 2008; 8: 583-4.
  2. Habarad J. Refugees and the structure of opportunity: transitional adjustments to aid among U.S. resettled Lao Iu Mien, 1980-1985. Center Migrat Stud Spec Issues 1987; 5: 66-87.
  3. Yeung B. We are the people: the history of the Iu-Mien. SF Weekly 2001; 20.
  4. Lum T. Laos: background and U.S. relations. Congressional Research Service Report for Congress 2008. Available from: http://www.fas.org/sgp/crs/row/RL34320.pdf [cited 20 December 2011].
  5. US Census Bureau, 2010 United States Census. 2010. Available from: http://www.census.gov/2010census [cited 20 December 2011].
  6. Catanzaro A. Health status of refugees from Vietnam, Laos, and Cambodia. JAMA 1982; 247: 1303-8.
  7. Laos overview. World directory of minorities and indigenous peoples. 2005. Available from: http://www.minorityrights.org/4014/laos/laos-overview.html [cited 20 January 2014].
  8. Depke J. Coalition building and the intervention wheel to address breast cancer screening in Hmong women. Clin Med Res 2011; 9: 1-6.
  9. Murphy-Thalacker K. Hypertension and the Hmong community: using the health belief model for health promotion. Health Promot Pract 2010; 13: 6.
  10. Johnson S. Hmong health beliefs and experiences in the western health care system. J Transcult Nurs 2002; 13: 126-32.
  11. Culhane-Pera K. ‘We are out of balance here’: a Hmong cultural model of diabetes. J Immigr Minor Health 2007; 9:179-90.
  12. BBC. Thai army deports Hmong to Laos. 2009. Available from: http://news.bbc.co.uk/2/hi/8432094.stm [cited 7 January 2013].
  13. de Boer H, Lamxay V. Plants used during pregnancy, childbirth and postpartum healthcare in Lao PDR: a comparative study of the Brou, Saek and Kry ethnic groups. J Ethnobiol Ethnomed 2009; 5: 25.
  14. Sydara K. Use of traditional medicine in Lao PDR. Complement Ther Med 2005; 13: 199_205.
  15. Douangphachanh X. Availability and use of emergency obstetric care services in public hospitals in Laos PDR: a systems analysis. Biosci Trend 2010; 4: 318-24.
  16. UN Committee on the Elimination of Racial Discrimination (CERD), UN Committee on the Elimination of Racial Discrimination. Concluding observations, Lao People’s Democratic Republic; 2005. Available from: http://www.unhcr.org/refworld/docid/42de64284.html [cited 23 December 2012].
  17. Kanashiro J, Hollaar G, Wright B, Nammavongmixay K, Roff S. Setting priorities for teaching and learning: an innovative needs assessment for a new family medicine program in Lao PDR. Acad Med 2007; 82: 231-7.
  18. Shirayama Y. Modern medicine and indigenous health beliefs: malaria control alongside ‘Sadsana-phee’. Southeast Asian J Trop Med Public Health 2006; 37: 622-9.
  19. Fadiman A. The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. New York: Noonday Press; 1998.
  20. Hmong American Partnership. Available from: http://www.hmong.org/page334122813.aspx [cited 27 November 2012].
  21. Reznik V. Hais cuaj txub kaum txub _ to speak of all things: a Hmong cross-cultural case study. J Immigr Health 2001; 3: 23-30.
  22. Michaud J. Handling mountain minorities in China, Vietnam and Laos: from history to current concerns. Asian Ethnicity 2009; 10: 25-49.
  23. Keomany S. Toad poisoning in Laos. Am J Trop Med Hyg 2007; 77: 850-3.
  24. Miles B. Qualitative data analysis: an expanded sourcebook. Thousand Oaks, CA: Sage; 1994.
  25. Dedoose web application for managing, analyzing, and presenting qualitative and mixed method data. Los Angeles, CA: Socio Cultural Research Consultants, LLC; 2012.
  26. Martin D. Refugees and Asylees: 2011 annual flow report. US Department of Homeland Security Office of Immigration Statistics. Available from: http://www.dhs.gov/refugees-andasylees-2011 [cited 1 November 2012].
  27. Bhutanese refugee health profile. CDC; 2012. Available from: http://www.cdc.gov/immigrantrefugeehealth/profiles/bhutanese/background/index.html [cited 22 December 2012].
  28. World Health Organization (2012). Country health profiles. Available from: http://www.who.int/countries/en/ [cited 22 December 2012].
  29. Wong C. Adherence with hypertension care among Hmong Americans. J Community Health Nurs 2005; 22: 143-56.

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

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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

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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.

References:

 

 

  1. Pilnick A, Dingwall R. On the remarkable persistence of asymmetry in doctor/patient interaction: a critical review. Soc Sci Med 2011; 72: 1374-82.
  2. Simkin P. Birth plans: after 25 years, women still want to be heard. Birth 2007; 34(1): 49-51.
  3. Namey EE, Lyerly AD. The meaning of ‘‘control’’ for childbearing women in the US. Soc Sci Med 2010; 71(4): 769-76.
  4. Miller AC, Shriver TE. Women’s childbirth preferences and practices in the United States. Soc Sci Med 2012; 75(4):709-16.
  5. Pennell A, Salo-Coombs V, Herring A, Spielman F, Fecho K. Anesthesia and analgesia_related preferences and outcomes of women who have birth plans. J Midwifery Women’s Health 2011; 56(4): 376-81.
  6. Horowitz ER, Yogev Y, Ben-Haroush A, Kaplan B. Women’s attitude toward analgesia during labor – a comparison between 1995 and 2001. Eur J Obstet Gynecol Reprod Biol 2004; 117(1): 30-32.
  7. Thompson R, Miller YD. Birth control: to what extent do women report being informed and involved in decisions about pregnancy and birth procedures? BMC Pregnancy Childbirth 2014; 14(1): 62.
  8. Toledo P, Sun J, Peralta F, Grobman WA, Wong CA, Hasnain-Wynia R. A qualitative analysis of parturients’ perspectives on neuraxial labor analgesia. Int J Obstet Anesth 2013; 22(2): 119-23.
  9. Fro¨ hlich S, Tan T, Walsh A, Carey M. Epidural analgesia for labour: maternal knowledge, preferences and informed consent. Irish Med J 2012; 104(10): 300-2.
  10. Pain relief during labor. ACOG committee opinion No 295. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004; 104: 213.
  11. Johnson DE. Getting off the GoldVarb standard: introducing Rbrul for mixed-effects variable rule analysis. Lang Linguist Compass 2009; 3: 359-83.
  12. R Development Core Team. R: A language and environment for statistical computing [Computer program]. Vienna, Austria: R Foundation for Statistical Computing; 2012.
  13. Hadar E, Raban O, Gal B, Yogev Y, Melamed N. Obstetrical outcome in women with self-prepared birth plan. J Matern Fetal Neonatal Med 2012; 25(10): 2055-7.
  14. Hidaka R, Callister LC. Giving birth with epidural analgesia: the experience of first-time mothers. J Perinat Educ 2012; 21: 24.
  15. Kannan S, Jamison RN, Datta S. Maternal satisfaction and pain control in women electing natural childbirth. Reg Anesth Pain Med 2001; 26(5): 468-72.
  16. Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186(5): S160-72.
  17. Lawrence HC III, Copel JA, O’Keeffe DF, Bradford WC, Scarrow PK, Kennedy HP, et al. Quality patient care in labor and delivery: a call to action. Am J Obstet Gynecol 2012; 207: 147-8.

 

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Winter 2015 – In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism

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In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism

Author: Virginia Corbett1, Houria Hassouna2, Reda Girgis3

Author Affiliations:

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

2Division of Thrombosis, Department of Internal Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA

3Department of Pulmonary Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA

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

Corresponding Author: Virginia Corbett, corbettv[at]msu.edu

Key Words: pulmonary embolism; in situ pulmonary artery thrombosis; deep vein thrombosis (DVT); pulmonary circulation; Virchow’s triad

Abstract: The annual incidence of pulmonary embolism(PE) in the United States is reported to be 0.69 per1,000 persons with mortality of up to 30% depending upon the size of the emboli.1 PE and deep venous thrombosis (DVT) are both considered manifestations ofthe same disease of venous thromboembolism. Virchowpostulated that dysfunction of vessel walls, alternationsin blood flow and hypercoagulability of theblood triggered inappropriate thrombus formation.2 DVT most commonly occurs as local clot formation in the deep calf veins. PE arises when clots break off from a peripheral DVT and become lodged within the pulmonary arterial vasculature. PE is routinely diagnosed when filling defects are found in the pulmonary arteries on computed tomography angiogram (CTA). Among the general population of patients presenting to emergency rooms, absence of DVT may occur in up to 57% of those diagnosed with PE.3 A high prevalence of isolated PE may suggest localized thrombus formation in the pulmonary arteries instead of embolization from peripheral clots.

Published on date: January 1, 2015

Senior Editor: Kailyne Van Stavern

Junior Editor: Garrett Roe

DOI: Pending

Citation: Corbett V. Hassouna H. Girgis R. In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism . Medical Student Research Journal. 2015;4(Winter):54-8.

References:

  1. Office of the Surgeon General (US); National Heart, Lung, and Blood Institute (US). The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44181/ [cited 15 February 2014].
  2. Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet 2005; 365(9465): 1163_74. doi: 10.1016/S0140-6736(05)71880-8
  3. Sohns C, Amarteifio E, Sossalla S, Heuser M, Obenauer S. 64-Multidetector-row spiral CT in pulmonary embolism with emphasis on incidental findings. Clin Imaging 2008; 32(5): 335_41. doi: 10.1016/j.clinimag.2008.01.028
  4. Van belle A, Bu¨ ller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295(2): 172_9. doi: 10.1001/jama.295.2.172
  5. Kumar NG, Clark A, Roztocil E, Caliste X, Gillespie DL,Cullen JP. Fibrinolytic activity of endothelial cells from different venous beds. J Surg Res 2015; 194(1): 297_303. doi: 10.1016/j.jss.2014.09.028
  6. Rosenhek R, Korschineck I, Gharehbaghi-schnell E, Jakowitsch J, Bonderman D, Huber K, et al. Fibrinolytic balance of the arterial wall: pulmonary artery displays increased fibrinolytic potential compared with aorta. Lab Invest 2003; 83(6): 871_6. doi: 10.1097/01.LAB.0000073127.46392.9D
  7. Ryan US. Metabolic activity of pulmonary endothelium: modulations of structure and function. Annu Rev Physiol 1986; 48(1): 263_77. doi: 10.1146/annurev.ph.48.030186.001403.
  8. Goodman LR. Small pulmonary emboli: what do we know? Radiology 2005; 234(3): 654_8. doi: 10.1148/radiol.2343041326
  9. Ryan US. Structural bases for metabolic activity. Annu Rev Physiol 1982; 44(1): 223_39. doi: 10.1146/annurev.ph.44.030182.001255
  10. Key NS, Bach RR. Tissue factor as a therapeutic target. Thromb Haemost 2001; 85(3): 375_6. doi: 10.1517/14728222.6.2.159
  11. Martinelli I. Unusual forms of venous thrombosis and thrombophilia. Pathophysiol Haemost Thromb 2002; 32(5_6): 343_5. doi: 10.1159/000073595
  12. Agarwal PP, Wolfsohn AL, Matzinger FR, Seely JM, Peterson RA, Dennie C. In situ central pulmonary artery thrombosis in primary pulmonary hypertension. Acta Radiol 2005; 46(7): 696_700. doi: 10.1080/02841850500215501
  13. Russo A, De luca M, Vigna C, De Rito V, Pacilli M, Lombardo A, et al. Central pulmonary artery lesions in chronic obstructive pulmonary disease: a transesophagealechocardiography study. Circulation 1999; 100(17): 1808_15. doi: 10.1161/01.CIR.100.17.1808
  14. Wechsler RJ, Salazar AM, Gessner AJ, Spirn PW, Shah RM, Steiner RM. CT of in situ vascular stump thrombosis after pulmonary resection for cancer. AJR Am J Roentgenol 2001; 176(6): 1423_5. doi: 10.2214/ajr.176.6.1761423
  15. Lundy JB, Oh JS, Chung KK, Ritter JL, Gibb I, Nordmann GR, et al. Frequency and relevance of acute peritraumatic pulmonary thrombus diagnosed by computed tomographic imaging in combat casualties. J Trauma Acute Care Surg 2013; 75(2 Suppl 2): S215_20. doi: 10.1097/TA.0b013e318299da66
  16. Knudson MM, Gomez D, Haas B, Cohen MJ, Nathens AB. Three thousand seven hundred thirty-eight posttraumatic pulmonary emboli: a new look at an old disease. Ann Surg 2011; 254(4): 625_32. doi: 10.1097/SLA.0b013e3182300209
  17. Schulz C, Engelmann B, Massberg S. Crossroads of coagulation and innate immunity: the case of deep vein thrombosis. J Thromb Haemost 2013; 11 (Suppl 1): 233_41. doi: 10.1111/jth.12261
  18. Drake TA, Morrissey JH, Edgington TS. Selective cellular expression of tissue factor in human tissues. Implications for disorders of hemostasis and thrombosis. Am J Pathol 1989; 134(5): 1087_97.
  19. Polgar J, Matuskova J, Wagner DD. The P-selectin, tissue factor, coagulation triad. J Thromb Haemost 2005; 3(8): 1590_6. doi: 10.1111/j.1538-7836.2005.01373.x
  20. Sevestre MA, Quashie´ C, Genty C, Rolland C, Que´re´ I, Bosson JL, et al. Clinical presentation and mortality in pulmonary embolism: the Optimev study. J Mal Vasc 2010; 35(4): 242_9. doi: 10.1016/j.jmv.2010.05.004
  21. Van langevelde K, Flinterman LE, Van hylckama vlieg A, Rosendaal FR, Cannegieter SC. Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as 2 sides of the spectrum. Blood 2012; 120(5):933_46. doi: 10.1182/blood-2012-02-407551
  22. De boer JD, Majoor CJ, Van’t veer C, Bel EH, Van der poll T. Asthma and coagulation. Blood 2012; 119(14): 3236_44. doi: 10.1182/blood-2011-11-391532
  23. Chung WS, Lin CL, Ho FM, Li RY, Sung FC, Kao CH, et al. Asthma increases pulmonary thromboembolism risk: a nationwide population cohort study. Eur Respir J 2014; 43(3):801_7. doi: 10.1183/09031936.00043313
  24. Majoor CJ, Kamphuisen PW, Zwinderman AH, Ten Brinke A, Amelink M, Rijssenbeek-Nouwens L, et al. Risk of deep vein thrombosis and pulmonary embolism in asthma. Eur Respir J 2013; 42(3): 655_61. doi: 10.1183/09031936.00150312
  25. Bertoletti L, Quenet S, Laporte S, Sahuquillo JC, Conget F, Pedrajas JM, et al. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry. Respir Res 2013; 14: 75. doi: 10.1186/1465-9921-14-75
  26. Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest 2009; 135(3): 786_93. doi:10.1378/chest.08-1516
  27. Konstantinides SV. Asthma and pulmonary embolism: bringing airways and vessels closer together. Eur Respir J 2014; 43(3): 694_6. doi: 10.1183/09031936.00009414
  28. Velmahos GC, Spaniolas K, Tabbara M, Abujudeh HH, de Moya M, Gervasini A, et al. Pulmonary embolism and deep venous thrombosis in trauma: are they related? Arch Surg 2009; 144(10): 928_32. doi:10.1001/archsurg.2009.97
  29. Van langevelde K, Sra´mek A, Vincken PW, Van rooden JK, Rosendaal FR, Cannegieter SC. Finding the origin of pulmonary emboli with a total-body magnetic resonance direct thrombus imaging technique. Haematologica 2013; 98(2):309_15. doi: 10.3324/haematol.2012.069195
  30. Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood 2014; 123(12): 1794_1801. doi: 10.1182/blood-2013-12-512681
  31. PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005; 112(3): 416_22. doi: 10.1161/CIRCULATIONAHA.104.512834
  32. Korkmaz A, Ozlu T, Ozsu S, Kazaz Z, Bulbul Y. Long-term outcomes in acute pulmonary thromboembolism: the incidence of chronic thromboembolic pulmonary hypertension and associated risk factors. Clin Appl Thromb Hemost 2012;18(3): 281_8. doi: 10.1177/1076029611431956

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Winter 2015 – White Coat Sparty

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White Coat Sparty.

Author:  Carter Anderson

Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA

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

Corresponding author: Carter Anderson; carterbanderson[at]yahoo.com

Key Words: N/A

Abstract: Professional responsibility, compassion, honesty, respect for others, competence, and social responsibility are the characteristics that the Michigan State University College of Human Medicine strives to instill in every student.

Published on date: January 1, 2015

Senior Editor: N/A

Junior Editor: N/A

DOI: pending

Citation: Anderson C. White Coat Sparty. Medical Student Research Journal. 2015;4(Winter):52-53.

References: N/A

 

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Winter 2015 – Letter from the Editors

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Letter From the Editors.

Author: Jessica L Wummel1, Jack C Mettler2

Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA, 2College of Human Medicine, Michigan State University, Flint, MI, USA

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

Corresponding Author: Jessica L Wummel; Jessica[at]msrj.org, Jack C Mettler; Jack[at]msrj.org

Key Words: N/A

Abstract: The editors of MSRJ are excited to announce our Winter 2015 issue. As always, we were incredibly impressed by the caliber of submissions. This issue includes interesting articles written by medical students from UC Davis College of Medicine and Michigan State University College of Human Medicine.

Published on date: January 1, 2015

Senior Editor: N/A

Junior Editor: N/A

DOI: Pending

Citation: Wummel JL, Mettler JC. Letter From the Editors. Medical Student Research Journal. 2015;4(Winter):51.

References: N/A

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Fall 2014 – The Growth of Medical Student Opportunities in Global Health

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The Growth of Medical Student Opportunities in Global Health.

Author: Johnathan Kao, MPH

Author Affiliations: College of Human Medicine, Michigan State University, Flint, MI, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/12/Fall-2014-Editorial-Global-Health.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Johnathan Kao; johnathan.kao[at]msrj.org

Key Words: sexual health; relationships; intimacy; radiotherapy; psycho-supportive treatment; hormone therapy.

Abstract: Since the establishment of the World Health Organization on April 7, 1948,1 global health has grown in prominence and popularity among health care workers at all levels of training. International clinical rotation electives have been available to students for over half a century2 and interest in these programs has risen steadily over the decades. During this period, many organizations established programs for students and faculty interested in global health research and service. In 2006, these organizations united under the WHO’s Global Health Workforce Alliance to assist students and faculty in becoming more involved in global health activities.3 Despite these Changes, in 2007, Drain et al recognized a lack of global health education in medical schools and growing student interest, calling for more opportunities to fill the gap.4

Published on date: September 31, 2014

Senior Editor: N/A

Junior Editor: N/A

DOI: Pending

Citation: Kao J. The Growth of Medical Student Opportunities in Global Health. Medical Student Research Journal. 2014;4(Fall):48-50.

References:

  1. World Health Organization. History of WHO. 2014. Accessed from: http://www.who.int/about/history/en/ [cited 21 June 2014].
  2. Bissonette R, Route C. The Educational Effect of Clinical Rotations in Nonindustrialized Countries. Fam Med 1994; 26(4):226-31.
  3. World Health Organization. Global Health Education Consortium. 2014. Accessed from: http://www.who.int/workforcealliance/members_partners/member_list /ghec/en/ [cited 21 June 2014].
  4. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global Health in Medical Education: A Call for More Training and Opportunities. Acad Med 2007; 82(3):226-30. doi: 10.1097/ACM.0b013e3180305cf9
  5. Hag C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A. New World Views: Preparing Physicians in Training for Global Health Work. Fam Med 2000; 32(8):566-72.
  6. Medical School Graduation Questionnaire: All School Summary Report. 2013. Accessed from: https://www.aamc.org/download/350998/data/2013 gqallschoolssummaryreport.pdf [cited 21 June 2014].
  7. Imperato PJ. A Third World International Health Elective for U.S. Medical Students: The 25-year Experience of the State University of New York, Downstate Medical Center. J Community Health 2004; 29(5):337-73. doi:10.1023/b:johe.0000038652.65641.0d
  8. Pust RE, Moher SP. A Core Curriculum for International Health: Evaluating Ten Years’ Experience at the University of Arizona. Acad Med 1992; 67(2):90-4. doi:10.1097/00001888-199202000-00007
  9. Haq C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A. New World Views: Preparing Physicians in Training for Global Health Work. Fam Med 2000; 32(8):566-72.
  10. Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E. A Model for Sustainable Short-Term International Medical Trips. Ambul Pediatr 2007; 7(4):317-20. doi: 10.1016/j.ambp.2007.04.003
  11. Montgomery LM. Short-Term Medical Missions: Enhancing or Eroding Health? Missiology 1993; 21(3):333-41. doi: 10.1177/009182969302100305
  12. Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and Best Practice Guidelines for Training Experiences in Global Health. Am J Trop Med Hyg 2010; 83(6):1178-82. doi: 10.4269/ajtmh.2010.10-0527
  13. AAMC GSA Steering Committee. Guidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences. AAMC 2011. Accessed from: https://www.aamc.org/download/181690/data/guidelinesforstudentsprovidingpatientcare.pdf [cited 21 June 2014].
  14. DeCamp M, Enumah S, O’Neill D, Sugarman J. Perceptions of a Short-Term Medical Programme in the Dominican Republic: Voices of Care Recipients. Glob Public Health 2014; 9(4):411-25. doi: 10.1080/17441692.2014.893368
  15. Accreditation Council of Graduate Medical Education. Common Program Requirements. ACGME 2013. Accessed from: https://www.acgme.org/ acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf [cited 21 June 2014].
  16. Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ. Educational Effects of International Health Electives on U.S. and Canadian Medical Students and Residents: A Literature Review. Acad Med 2007; 82(3):226-30. doi: 10.1097/00001888-200303000-00023

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Fall 2014 – Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice?

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Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice?

Author: Puneet K. Singh

Author Affiliations: Saba University School of Medicine, Saba, Dutch Caribbean

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/12/Fall-2014-CRC-Screening.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Puneet K. Singh; pun33t.singh[at]gmail.com

Key Words: Colonoscopy; colorectal neoplasms; sigmoidoscopy; CT colonography; mass screening.

Abstract: Colorectal cancer (CRC) is the third most common form of cancer and the second leading cause of cancer death in the Western world. Presently, screening tools such as colonoscopy, sigmoidoscopy, fecal occult blood test (FOBT) and computed tomographic colonography (CTC) are available for CRC screening. The debate over which screening tool is most effective in detecting CRC and precancerous lesions is ongoing. Many recent studies have identified colonoscopy as the most sensitive and specific screening modality for CRC. However, a number of factors have prevented colonoscopy from being widely accepted. Less invasive techniques such as sigmoidoscopy and CTC are growing in popularity among physicians and patients who are apprehensive about colonoscopy screening; although many still are yet to experience the procedure first-hand. This literature review will attempt to validate the growing theory that colonoscopy is superior to other modalities for the diagnosis and screening of CRC and reduces the risk of CRC mortality. In order to do so, the paper will compare the risks and benefits of colonoscopy to sigmoidoscopy and CTC. It will further look at the different aspects that encompass a patient’s decision to partake in screening, such as basic knowledge about CRC, history of CRC in the family, advice from physicians and individual beliefs about what screening entails. Finally, this paper will propose ways in which colonoscopy screening can be improved and thus surpass other screening modalities to universally become the first choice for CRC screening.

Published on date: September 31, 2014

Senior Editor: Jack Mettler

Junior Editor: David Carr

DOI: Pending

Citation: Singh PK. Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice? Medical Student Research Journal. 2014;4(Fall):34-47.

References:

  1. Holt PR, Kozuch P, Mewar S. Colon cancer and the elderly: from screening to treatment in management of GI disease in the elderly. Best Pract Res Clin Gastroenterol. 2009;23:889-907. doi: 10.1016/j.bpg.2009.10.010
  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10-29. doi:  10.3322/caac.20138
  3. Manne U, Shanmugam C, Katkoori VR, Bumpers HL, Grizzle WE. Development and progression of colorectal neoplasia. Cancer Biomark. 2010;9:235-265. doi: 10.3233/CBM-2011-0160
  4. Qaseem A, Denberg TD, Hopkins RH, Jr., et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156:378-386. doi: 10.7326/0003-4819-156-5-201203060-00010
  5. Centers for Disease C, Prevention. Vital signs: Colorectal cancer screening, incidence, and mortality–United States, 2002-2010. MMWR Morb Mortal Wkly Rep. 2011;60:884-889.
  6. Lieberman D. Colorectal cancer screening: practice guidelines. Dig Dis. 2012;30 Suppl 2:34-38. doi: 10.1159/000341891
  7. Centers for Disease C, Prevention. Vital signs: colorectal cancer screening test use – United States, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:881-888.
  8. Kahi CJ, Anderson JC, Rex DK. Screening and surveillance for colorectal cancer: state of the art. Gastrointest Endosc. 2013;77:335-350. doi: 10.1016/j.gie.2013.01.002
  9. Rabeneck L, Paszat LF, Saskin R, Stukel TA. Association between colonoscopy rates and colorectal cancer mortality. Am J Gastroenterol. 2010;105:1627-1632. doi: 10.1038/ajg.2010.83
  10. Manser CN, Bachmann LM, Brunner J, Hunold F, Bauerfeind P, Marbet UA. Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study. Gastrointest Endosc. 2012;76:110-117. doi: 10.1016/j.gie.2012.02.040
  11. Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010;139:1128-1137. doi: 10.1053/j.gastro.2010.06.052
  12. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1-8.
  13. Bretagne JF, Hamonic S, Piette C, et al. Variations between endoscopists in rates of detection of colorectal neoplasia and their impact on a regional screening program based on colonoscopy after fecal occult blood testing. Gastrointest Endosc. 2010;71:335-341. doi: 10.1016/j.gie.2009.08.032
  14. Adler A, Wegscheider K, Lieberman D, et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut. 2013;62:236-241. doi: 10.1136/gutjnl-2011-300167
  15. Baxter NN, Warren JL, Barrett MJ, Stukel TA, Doria-Rose VP. Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol. 2012;30:2664-2669. doi: 10.1200/JCO.2011.40.4772
  16. Ko CW, Dominitz JA, Green P, Kreuter W, Baldwin LM. Specialty differences in polyp detection, removal, and biopsy during colonoscopy. Am J Med. 2010;123:528-535. doi: 10.1016/j.amjmed.2010.01.016
  17. Graser A, Stieber P, Nagel D, et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut. 2009;58:241-248. doi: 10.1136/gut.2008.156448
  18. Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345-2357. doi: 10.1056/NEJMoa1114635
  19. Hoff G, Grotmol T, Skovlund E, Bretthauer M, Norwegian Colorectal Cancer Prevention Study G. Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial. BMJ. 2009;338:b1846. doi: 10.1136/bmj.b1846
  20. Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 18 2008;359:1207-1217. doi: 10.1056/NEJMoa0800996
  21. Zalis ME, Blake MA, Cai W, et al. Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation. Ann Intern Med. 2012;156:692-702. doi: 10.7326/0003-4819-156-10-201205150-00005
  22. Atkin W, Dadswell E, Wooldrage K, et al. Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet. 2013;381:1194-1202. doi: 10.1016/S0140-6736(12)62186-2
  23. von Wagner C, Ghanouni A, Halligan S, et al. Patient acceptability and psychologic consequences of CT colonography compared with those of colonoscopy: results from a multicenter randomized controlled trial of symptomatic patients. Radiology. 2012;263:723-731. doi: 10.1148/radiol.12111523
  24. de Wijkerslooth TR, de Haan MC, Stoop EM, et al. Reasons for participation and nonparticipation in colorectal cancer screening: a randomized trial of colonoscopy and CT colonography. Am J Gastroenterol. 2012;107:1777-1783. doi:  10.1038/ajg.2012
  25. de Wijkerslooth TR, de Haan MC, Stoop EM, et al. Burden of colonoscopy compared to non-cathartic CT-colonography in a colorectal cancer screening programme: randomised controlled trial. Gut.2012;61:1552-1559. doi:  10.1038/ajg.2012
  26. Courtney RJ, Paul CL, Sanson-Fisher RW, et al. Individual- and provider-level factors associated with colorectal cancer screening in accordance with guideline recommendation: a community-level perspective across varying levels of risk. BMC Public Health. 2013;13:248. doi: 10.1186/1471-2458-13-248
  27. Fenton JJ, Jerant AF, von Friederichs-Fitzwater MM, Tancredi DJ, Franks P. Physician counseling for colorectal cancer screening: impact on patient attitudes, beliefs, and behavior. J Am Board Fam Med. 2011;24:673-681. doi: 10.3122/jabfm.2011.06.110001