Alzheimer’s Disease: A Clinical and Basic Science Review. 

Author: Igor O. Korolev

Author Affiliations: College of Osteopathic Medicine and Neuroscience Program, Michigan State University, East Lansing, MI, USA

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Corresponding Author: Igor O. Korolev; korolevi[at]msu.edu

Key Words: Alzheimer’s disease; mild cognitive impairment; dementia; neurodegeneration; neuroimaging; biomarkers.

Abstract: Alzheimer’s disease (AD) is the most common cause of dementia in older adults and an important public health problem. The purpose of this review article is to provide a brief introduction to AD and the related concept of mild cognitive impairment (MCI). The article emphasizes clinical and neurobiological aspects of AD and MCI that medical students should be familiar with. In addition, the article describes advances in the use of biomarkers for diagnosis of AD and highlights ongoing efforts to develop novel therapies.

Published on date: September 31, 2014

Senior Editor: Liza Gill

Junior Editor: Timothy Smith

DOI: Pending

Citation: Korolev IO. Alzheimer’s Disease: A Clinical and Basic Science Review.  Medical Student Research Journal. 2014;4(Fall):24-33.

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A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot.

Author: Joseph B. Meleca¹, Maria Tecos¹, Abigail L. Wenzlick¹, Rebecca Henry², Patricia A. Brewer³.

Author Affiliations:

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

²Office of Medical Education, Research and Development, College of Human Medicine, Mighigan State University, East Lansing, MI, USA

³Office of Preclinical Curriculum, College of Human Medicine, Michigan State University, East Lansing, MI, USA

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

Corresponding Author: Joseph B. Meleca; melecajo[at]msu.edu

Key Words: curriculum reform; medical business; medical finance; student-led; course; elective; module; student debt.

Abstract: Background:  As the knowledge needed by physicians expands past basic science and patient care, students are calling for their medical school education to do the same. At Michigan State University College of Human Medicine, students addressed this concern by developing a pilot elective, Medical Business and Finance (MBF). The goal of this student-led elective was to provide a basic understanding of personal finance, student debt handling, business management, and insurance reimbursement issues. Methods:  A preliminary needs assessment was conducted to discern if students wanted medical business and finance supplementation to the medical school curriculum.  Ninety percent of students reported interest in a business and finance elective. Once the course was instated, student satisfaction and knowledge-base in medical business and finance was analyzed through pre-elective, pre-session and post-elective survey. Results:  Results were analyzed on forty-eight students’ pre-survey and post-survey responses.  After the course, self-assessed student knowledge regarding finance and business nearly doubled.  The average pre-elective self-assessed knowledge of finance was 3.02 on a ten-point scale and knowledge of business was 2.61. This was compared to an average post-elective self-assessed knowledge of 5.75 and 5.44, respectively. Satisfaction in MSU CHM business and finance resources also slightly increased at the completion of the course.  Nearly 85% of students felt they benefited from participating in the elective.  Similarly, 85% felt that incoming students would also benefit from taking the course. Almost 30% of students believed the material covered in the MBF Elective should be in the required medical school curriculum. Conclusion:  A student led elective can be an effective way to introduce students to an array of topics related to medical business and finance. Students felt that their knowledge of these topics increased and they valued the addition of medical business and finance education to their curriculum. A student-led elective is one potential way for others to successfully incorporate these topics into medical school curricula across the country.

Published on date: September 31, 2014

Senior Editor: Jon Zande

Junior Editor: Ghadear Shukr

DOI: Pending

Citation: Meleca JB, Tecos M, Wenzlick AL, Henry R, Brewer PA. A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot. Medical Student Research Journal. 2014;4(Fall):18-23.

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A Case of Severe, Refractory Antipsychotic-induced Orthostatic Hypotension.

Author: ¹Sahil Gambhir, ²Nicholas Sandersfeld, DO, ²Dale D’Mello, MD

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

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Corresponding Author: Sahil Gambhir, Gambhir1[at]msu.edu

Key Words: Orthostatic hypotension; antipsychotics; refractory; side effects; schizophrenia; management guidelines.

Abstract: Introduction: Antipsychotics have many adverse effects including orthostatic hypotension. Orthostatic hypotension is ideally treated with non-pharmacological strategies; however, these often fail leading to utilization of pharmacological methods. Currently, there is no agreed upon management or protocol for addressing antipsychotic-induced orthostatic hypotension and research in this area is limited. Patient profile: A 60-year-old man with a long history of schizophrenia who was receiving Haldol† Deconoate 200 mg injections every 4 weeks due to previous non-compliance. He was admitted to the inpatient psychiatric service due to worsening psychosis and suicidal behavior. Intervention: Despite use of medications, the patient was switched to risperidone with a goal of transition to an atypical long-acting injectable. The psychosis improved, but the patient developed orthostatic hypotension. After his medications were held, his blood pressure continued to be grossly abnormal. A number of different tests were completed followed by standard non-pharmacological treatment, which proved unsuccessful. Despite receiving intravenous fluid boluses to maintain his blood pressure, the patient required pharmacological treatment. This included midodrine and fludrocortisones, and concluded with Adderall† as his blood pressure stabilized. Conclusion: This case of a 60-year-old man with antipsychotic-induced orthostatic hypotension elucidates the frustration healthcare professionals and patients face with this common treatment-resistant condition. A treatment algorithm for managing drug-induced orthostatic hypotension is proposed and is a nidus for development of future protocols.

Published on date: September 31, 2014

Senior Editor: Kaitlyn Vitale

Junior Editor:Mike Klinger

DOI: Pending

Citation: Gambhir S, Sandersfeld N, D’Mello D. A Case of Severe, Refractory Antipsychotic-Induced Orthostatic Hypotension. Medical Student Research Journal. 2014;4(Fall): 15-7.

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Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome

Author: Stacie L. Clark

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

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Corresponding Author: Stacie L. Clark, clarkst[at]msu.edu

Key Words: sebaceous gland; sebaceous carcinoma; abdominal wall; Muir-Torre syndrome; colorectal cancer; HNPCC.

Abstract: Introduction: Sebaceous carcinoma is a rare dermatologic tumor affecting the pilosebaceous apparatus of the skin. While the majority of sebaceous carcinomas arise from sebaceous glands in the ocular area, extraocular sebaceous carcinomas, arising from any region populated with sebaceous glands have also been reported. Sebaceous carcinoma can present as a single lesion or in association with secondary malignancies, most commonly with those found in Muir Torre syndrome (MTS), an autosomal dominant condition associated with several types of sebaceous neoplasms as well as a variety of visceral malignancies. The most common form of MTS has been described as a variant of hereditary non polyposis colorectal cancer (Lynch syndrome). Patient profile: Here, we describe the case of a 55-year-old male, with a known history of colorectal cancer, presenting with a rapidly enlarging abdominal wall mass. Interventions and outcomes: Surgical excision of the mass histologically demonstrated sebaceous carcinoma. This diagnosis, the incidental discovery of a papillary thyroid carcinoma and the patient’s history of colorectal cancer, prompted referral for genetic counseling, the results of which are still pending. Discussion: Sebaceous carcinoma is one of several diagnostic criteria of MTS and its presence should prompt a complete evaluation for underlying internal malignancies.

Published on date: September 31, 2014

Senior Editor: Timothy Smith

Junior Editor: Joginder Singh

DOI: Pending

Citation: Clark SL. Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome. Medical Student Research Journal. 2014;4(Fall):12-4.

References:

1. Nelson BR, Hamlet KR, Gillard M, Railan D, Johnson TM. Sebaceous carcinoma. Journal of the American Academy of Dermatology. July 1995;33(1):1-15. doi: 10.1016/0190-9622(95)90001-2
2. Ponti G, Ponz de Leon M. Muir-Torre Syndrome. The Lancet Oncology. Dec 2005;6(12):980-987. doi:10.1016/S1470-2045(05)70465-4
3. Dores GM, Curtis RE, Toro JR, Devesa SS, Farumeni JF. Incidence of cutaneous sebaceous carcinoma and risk of associated neoplasms: insight into Muir-Torre Syndrome. Cancer. July 2008;113(12):3372-3381. doi: 10.1002/cncr.23963
4. Schwartz RA, Torre DP. The Muir-Torre syndrome: a 25-year retrospect. Journal of the American Academy of Dermatology. July1995;33(1):90-104. doi:10.1016/0190-9622(95)90017-9
5. Cohen PR, Kohn SR, Kurzrock R. Association of sebaceous gland tumors and internal malignancy: the Muir-Torre syndrome. The American Journal of Medicine. May 1991;90:606-613. doi:10.1016/S0002-9343(05)80013-0
6. Srivastava D, Taylor R. Appendage Tumors and Hamartomas of the Skin. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. eds. Fitzpatrick’s Dermatology in General Medicine, 8e. New York, NY: McGraw-Hill; 2012:1337-1362.
7. Dasgupta T, Wilson LD, Yu JB. A retrospective review of 1349 cases of sebaceous carcinoma. Cancer. July 2008;115(1):158-165. doi: 10.1002/cncr.23952

Acute Bronchiolitis – Case Report and Review of Management Guidelines.

Author: Neil D. Dattani, Clare M. Hutchinson

Author Affiliations: Norwich Medical School, Faculty of Medicine and health Sciences, University of East Anglia, Norwich, United Kingdom

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

Corresponding Author: Clare M. Hutchinson, claremhutchinson[at]gmail.com

Key Words: Bronchiolitis; Case reports; Pediatrics; Practice guidelines; Therapeutics.

Abstract: Introduction: The treatment of acute bronchiolitis is controversial, despite the fact that several well-designed trials have been conducted on the subject. Patient profile: A 10-month-old boy presented to the emergency department with a 3-day history of upper respiratory tract symptoms and an expiratory wheeze. Chest X-ray showed right upper lobe atelectasis. He was diagnosed with acute bronchiolitis. Interventions: He received nebulized salbutamol (albuterol) and oral dexamethasone in the emergency department. He was admitted to hospital overnight for continued salbutamol treatment via a metered-dose inhaler. Discussion: Five main treatment regimens exist for acute bronchiolitis nebulized epinephrine (adrenaline), other bronchodilators, nebulized hypertonic saline, glucocorticoids, and combinations of these. Nebulized epinephrine decreases the rate of hospitalization, other bronchodilators improve symptoms, and nebulized hypertonic saline reduces the length of hospitalization. There is no strong evidence for glucocorticoids or combinations of these treatments. Combined treatment with epinephrine and dexamethasone reduces rate of hospitalization.

Published on date: September 31, 2014

Senior Editor: Kevin Patterson

Junior Editor: Patrick Roach

DOI: Pending

Citation: Dattani ND, Hutchinson CM. Acute Bronchiolitis – Case Report and Review of Management Guidelines. Medical Student Research Journal. 2014;4(Fall):8-11.

References:

1. Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010 Feb;125(2):342-9. doi: 10.1542/peds.2009-2092
2. Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen TP, Patel H, Fernandes RM. Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD003123. doi: 10.1002/14651858.CD003123.pub3
3. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. New England Journal of Medicine2013 June 13;368(24):2286-93. doi: 10.1016/j.jemermed.2013.10.022
4. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD001266. doi: 10.1002/14651858.CD001266.pub4
5. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD006458. doi: 10.1002/14651858.CD006458.pub3
6. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson DW, Klassen TP, Hartling L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004878. doi: 10.1001/jama.2013.284921
7. Ducharme FM. Management of acute bronchiolitis. British Medical Journal 2011 Apr 6;342:d1658. doi: 10.1136/bmj.d1658
8. Plint AC, Johnson DW, Patel H, et al. Epinephrine and Dexamethasone in Children with Bronchiolitis. New England Journal of Medicine 2009 May 14;360(20):2079-89. doi: 10.1056/NEJMoa0900544
9. Enriquez A, Chu IW, Mellis C, Lin WY. Nebulised deoxyribonuclease for viral bronchiolitis in children younger than 24 months. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008395. doi: 10.1002/14651858.CD008395.pub2

9. Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004873. doi: 10.1002/14651858.CD004873.pub4
10. Beggs S, Wong Z, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD009609. doi: 10.1002/14651858.CD009609.pub2
11. Umoren R, Odey F, Meremikwu MM. Steam inhalation or humidified oxygen for acute bronchiolitis in children up to three years of age. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD006435. doi: 10.1002/14651858.CD006435.pub2
12. Liet J, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD006915. doi:  10.1002/14651858.CD006915.pub2
13. Spurling GKP, Doust J, Del Mar CB, Eriksson L. Antibiotics for bronchiolitis in children. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD005189. doi: 10.1002/14651858.CD005189.pub3
14. American Academy of Pediatrics Committee on Infectious Diseases; American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014 Aug;134(2):415-20. doi: 10.1542/peds.2014-1665

A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners.

Author: Dane E. Klett

Author Affiliations: School of Medicine, Creighton University, Phoenix, AZ, USA

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

Corresponding Author: Dane E. Klett

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

Abstract: Howard L. Harrod on his struggles with prostate cancer (PCa): ‘Not only had I a sense of having been mutilated, but I had lost the very capacities that were symbolically associated with manhood’.¹ Many patients with PCa experience this jolt to their sense of manhood, thus making PCa unique among the various cancer diagnoses and worthy of independent discussion.
In addition, PCa remains the most common male cancer and the third leading cause of all male cancer deaths.² Most physicians are aware of the link between cancer and mental health issues, but many forget or overlook just how important it is to address a patient’s state of mental health.

Published on date: September 31, 2014

Senior Editor: Caela Hesano

Junior Editor: Regina Mater

DOI: Pending

Citation: Klett DE. A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners. Medical Student Research Journal. 2014;4(Fall):4-7.

References:

1. Harrod HL. A piece of my mind. An essay on desire. JAMA. Feb 19 2003;289(7):813-814.
2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J. Clin. Jan 2013;63(1):11-30. doi:10.3322/caac.21166
3. Watts S, Leydon G, Birch B, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4(3):e003901. doi: 10.1136/bmjopen-2013-003901
4. Jayadevappa R, Malkowicz SB, Chhatre S, Johnson JC, Gallo JJ. The burden of depression in prostate cancer. Psychooncology. Dec 2012;21(12):1338-1345. doi: 10.1002/pon.2032
5. Sharpley CF, Bitsika V, Christie DR. Diagnosing ‘male’ depression in men diagnosed with prostate cancer: the next step in effective translational psycho-oncology interventions? Psychooncology. Apr 3 2014. doi: 10.1002/pon.3530
6. Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J. Urol. Feb 2001;165(2):445-454. doi: 10.1016/S0022-5347(05)65543-7
7. Lintz K, Moynihan C, Steginga S, et al. Prostate cancer patients’ support and psychological care needs: Survey from a non-surgical oncology clinic. Psychooncology. Dec 2003;12(8):769-783. doi: 10.1002/pon.702
8. Kunkel EJ, Bakker JR, Myers RE, Oyesanmi O, Gomella LG. Biopsychosocial aspects of prostate cancer. Psychosomatics. Mar-Apr 2000;41(2):85-94. doi: 10.1176/appi.psy.41.2.85
9. Bergman J, Litwin MS. Quality of life in men undergoing active surveillance for localized prostate cancer. J. Natl. Cancer Inst. Monogr. Dec 2012;2012(45):242-249. doi: 10.1093/jncimonographs/lgs026
10. Chipperfield K, Fletcher J, Millar J, et al. Predictors of depression, anxiety and quality of life in patients with prostate cancer receiving androgen deprivation therapy. Psychooncology. Mar 11 2013(22):2169-2176. doi: 10.1002/pon.3269
11. Couper J, Bloch S, Love A, Duchesne G, Macvean M, Kissane D. Coping patterns and psychosocial distress in female partners of prostate cancer patients. Psychosomatics. Jul-Aug 2009;50(4):375-382. doi: 10.1176/appi.psy.50.4.375
12. Lilleby W, Fossa SD, Waehre HR, Olsen DR. Long-term morbidity and quality of life in patients with localized prostate cancer undergoing definitive radiotherapy or radical prostatectomy. Int. J. Radiat. Oncol. Biol. Phys. Mar 1 1999;43(4):735-743. doi: 10.1016/S0360-3016(98)00475-1
13. Dahn JR, Penedo FJ, Gonzalez JS, et al. Sexual functioning and quality of life after prostate cancer treatment: considering sexual desire. Urology. Feb 2004;63(2):273-277. doi: 10.1016/j.urology.2003.09.048
14. Kissane DW, McKenzie M, Bloch S, Moskowitz C, McKenzie DP, O’Neill I. Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement. Am. J. Psychiatry. Jul 2006;163(7):1208-1218. doi: 10.1176/appi.ajp.163.7.1208
15. Couper JW, Love AW, Dunai JV, et al. The psychological aftermath of prostate cancer treatment choices: a comparison of depression, anxiety and quality of life outcomes over the 12 months following diagnosis. Med. J. Aust. Apr 6 2009;190(7 Suppl):S86-89.
16. Kornblith AB, Herr HW, Ofman US, Scher HI, Holland JC. Quality of life of patients with prostate cancer and their spouses. The value of a data base in clinical care. Cancer. Jun 1 1994;73(11):2791-2802.
17. Couper JW. The effects of prostate cancer on intimate relationships. The Journal of Men’s Health & Gender. 9// 2007;4(3):226-232. doi: 10.1016/j.jmhg.2007.04.008
18. Singer PA, Tasch ES, Stocking C, Rubin S, Siegler M, Weichselbaum R. Sex or survival: trade-offs between quality and quantity of life. J. Clin. Oncol. Feb 1991;9(2):328-334.
19. Tavlarides AM, Ames SC, Diehl NN, et al. Evaluation of the association of prostate cancer-specific anxiety with sexual function, depression and cancer aggressiveness in men 1 year following surgical treatment for localized prostate cancer. Psychooncology. Jun 2013;22(6):1328-1335. doi: 10.1002/pon.3138
20. Hyun JS. Prostate cancer and sexual function. World J Mens Health. Aug 2012;30(2):99-107. doi: 10.5534/wjmh.2012.30.2.99
21. Llorente MD, Burke M, Gregory GR, et al. Prostate cancer: a significant risk factor for late-life suicide. Am. J. Geriatr. Psychiatry. Mar 2005;13(3):195-201. doi: 10.1097/00019442-200503000-00004
22. Dale HL, Adair PM, Humphris GM. Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancer. Psychooncology. Mar 2010;19(3):227-237. doi: 10.1002/pon.1598
23. Tyson MD, Andrews PE, Etzioni DA, et al. Marital status and prostate cancer outcomes. Can J Urol. Apr 2013;20(2):6702-6706. doi: 10.1016/j.juro.2012.02.222

Broken.

Author:  Timothy DeKoninck

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

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/11/MSRJ-Fall-2014-Broken.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding author: Timothy DeKoninck; dekonin4[at]msu.edu

Key Words: N/A

Abstract: There are several elements symbolized in the mosaic that represent a doctor-patient relation- ship. This piece of work strives to piece together and serve as a reminder of the elements that make for a successful and impactful relationship.

Published on date: September 31, 2014

Senior Editor: N/A

Junior Editor: N/A

DOI: pending

Citation: DeKoninck T. Broken. Medical Student Research Journal. 2014;4(Fall):2-3.

References: N/A

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/2014/11/MSRJ-Fall-2014-Letter-from-the-Editors.pdf” type=”icon” icon=”download” color=green] 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 Fall 2014 issue, the first issue of the new academic year. We have been overwhelmed with amazing articles from medical students around the world and this has allowed us to publish our largest issue yet! This issue includes stimulating articles written by students from the University of Toronto, Creighton University School of Medicine, Saba University School of Medicine, Michigan State University College of Osteopathic Medicine, and Michigan State University College of Human Medicine.

Published on date: September 31, 2014

Senior Editor: N/A

Junior Editor: N/A

DOI: Pending

Citation: Wummel JL, Mettler JC. Letter From the Editors. Medical Student Research Journal. 2014;4(Fall):1.

References: N/A