Spring 2013 – A Comprehensive Stroke Center Patient Registry: Advantages, Limitations, and Lessons Learned

A Comprehensive Stroke Center Patient Registry: Advantages, Limitations, and Lessons Learned.
 
James E. Siegler1$, Amelia K. Boehme2,3$, Adrianne M. Dorsey1, Dominique J. Monlezun1, Alex J. George1, Amir Shaban4, H. Jeremy Bockholt5,6, Karen C. Albright2,3,7,8, Sheryl Martin-Schild4*.
 
Author Affiliations:
1Tulane University School of Medicine, New Orleans, LA, USA
2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
3Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
4Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, LA, USA
5Advanced Biomedical Informatics Group, LLC, Iowa City, IA, USA
6Department of Psychiatry, University of Iowa, Iowa City, IA, USA
7Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, Birmingham, AL, USA
8Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED), Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, Birmingham, AL, USA

 
$James E. Siegler and Amelia K. Boehme contributed equally to the production of this manuscript.

 

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Spring-2013-A-comprehensive-stroke-center-patient-registry-advantages-limitations-and-lessons-learned.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
*Corresponding Author: Sheryl Martin-Schild; smartin2[at]tulane.edu
 
Key Words: Stroke; Registries; Methodology; Epidemiological Methods; Common Data Elements; Source Data Verification.
 
Abstract:
There has been a trend to portray doctors as “all” - all knowing, all thinking, all seeing, all doing. We’re all brains, learning and memorizing, and all hands, cutting and suturing. Doctors can be any or none of these things, but sometimes we miss our greatest strength: we can be all Heart. And by being all Heart, we must be careful how our experiences affect us.

 
Published: May 31, 2013
 
 
Senior Editor: Kevin C. Patterson
 
Junior Editor: Jessica L. Wummel
 
DOI: Pending
 
Citation:
Siegler JE, Boehme AK, Dorsey AM, Monlezun DJ, George AJ, Shaban A, Bockckholt HJ, Albright KC, Martin-Schild S. A Comprehensive Stroke Center Patient Registry: Advantages, Limitations, and Lessons Learned. Medical Student Research Journal. 2013;2(Spring):21-29.
 
 
References:
1. Kunitz SC, Gross CR, Heyman A, et al. The pilot stroke data bank: definition, design, and data. Stroke. 1984; 15:740-6. http://dx.doi.org/10.1161/01.STR.15.4.740.

2. Mohr JP, Caplan LR, Melski JW, et al. The harvard cooperative stroke registry: a prospective registry. Neurology. 1978; 28(8):754-62. http://dx.doi.org/10.1212/WNL.28.8.754.

3. Rosati RA, McNeer JF, Starmer CF, Mittler BS, Morris JJ, Jr., Wallace AG. A new information system for medical practice. Arch Intern Med. 1975; 135(8):1017-24. http://dx.doi.org/10.1001/archinte.1975.00330080019003.

4. Ding D, Lu CZ, Fu JH, Hong Z. Predictors of vascular events after ischemic stroke: the China ischemic stroke registry study. Neuroepidemiology. 2010; 34:110-16. http://dx.doi.org/10.1159/000268823.

5. Turin TC, Kita Y, Rumana N, et al. Diurnal variation in onset of hemorrhagic stroke is independent of risk factor status: Takashima stroke registry. Neuroepidemiology. 2010; 34:25-33. http://dx.doi.org/10.1159/000255463.

6. Schwamm LH, Fonarow GC, Reeves MJ, et al. Get with the guidelines-stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation. 2009; 119:107-15. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.783688.

7. LaBresh KA. Quality of acute stroke care improvement framework for the paul coverdell national acute stroke registry: facilitating policy and system change at the hospital level. Am J Prev Med. 2006; 31(6):S246-50. http://dx.doi.org/10.1016/j.amepre.2006.08.012.

8. George MG, Tong X, McGruder H, et al. Paul coverdell national acute stroke registry surveillance – four states. 2005-2007. MMWR Surveill Summ. 2009; 58(SS07):1-23. http://origin.glb.cdc.gov/mmwr/preview/mmwrhtml/ss5807a1.htm.

9. Jakobsen E, Palshof T, Osterlind K, Pilegaard H. Data from a national lung cancer registry contributes to improve outcome and quality of surgery: Danish results. Eur J Cardiothorac Surg. 2009; 35(2):348-52. http://dx.doi.org/10.1016/j.ejcts.2008.09.026.

10. Larsson S, Lawyer P, Garellick G, Lindahl B, Lundstrom M. Use of 13 disease registries in 5 countries demonstrates the potential to use outcome data to improve health care’s value. Health Aff. 2012; 31(1):220-7. http://dx.doi.org/10.1377/hlthaff.2011.0762.

11. Maas AI. Traumatic brain injury: simple data collection will improve the outcome. Wien Klin Wochenschr. 2007; 119(1-2):20-2. http://dx.doi.org/10.1007/s00508-006-0759-y.

12. Xian Y, Fonarow GC, Reeves MJ, et al. Data quality in the American Heart Association get with the guidelines-stroke (gwtg-stroke): results from a national data validation audit. Am Heart J. 2012; 163(3): 392-8,e1. http://dx.doi.org/10.1016/j.ahj.2011.12.012.

13. Yoon SS, George MG, Myers S, et al. Analysis of data-collection methods for an acute stroke care registry. Am J Prev Med. 2006; 31(6):S196-201. http://dx.doi.org/10.1016/j.amepre.2006.08.010.

14. Braunschweig CA. Creating a clinical nutrition registry: prospects, problems, and preliminary results. J Am Diet Assoc. 1999; 99(4):467-70. http://dx.doi.org/10.1016/S0002-8223(99)00115-7.

15. Arts DG, De Keizer NF, Scheffer GJ. Defining and improving data quality in medical registries: a literature review, case study, and generic framework. J Am Med Inform Assoc. 2002; 9(6):600-11. http://dx.doi.org/10.1197/jamia.M1087.

16. Siegler JE, Martin-Schild S. Early neurological deterioration (end) after stroke: the end depends on the definition. Int J Stroke. 2011; 6(3):211-2. http://dx.doi.org/10.1111/j.1747-4949.2011.00596.x.

17. Albright KC, Martin-Schild S, Bockholt HJ, et al. No consensus on definition criteria for stroke registry common data elements. Cerebrovasc Dis Extra. 2011; 1(1):84-92. http://dx.doi.org/10.1159/000334146.

18. Davis FG, Bruner JM, Surawicz TS. The rationale for standardized registration and reporting of brain and central nervous system tumors in population-based cancer registries. Neuroepidemiology. 1997; 16(6):308-16. http://dx.doi.org/10.1159/000109703.

19. Leung LY, Albright KC, Boehme AK, et al. Short-term bleeding events observed with clopidogrel loading in acute ischemic stroke patients. J Stroke Cerebrovasc Dis. 2013; 22(7):1184-9. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.03.001.

20. Siegler JE, Boehme AK, Albright KC, Martin-Schild S. Ethnic disparities trump other risk factors in determining delay to emergency department arrival in acute ischemic stroke. Ethn Dis. 2013; 23(1):29-34. http://www.ncbi.nlm.nih.gov/pubmed/23495619.

21.Siegler JE, Boehme AK, Kumar AD, et al. Identification of modifiable and nonmodifiable risk factors for neurologic deterioration after acute ischemic stroke. J Stroke Cerebrovasc Dis. 2012; 22(7):e207-13. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.11.006.

22. Kumar AD, Boehme AK, Siegler JE, Gillette M, Albright KC, Martin-Schild S. Leukocytosis in patients with neurologic deterioration after acute ischemic stroke is
associated with poor outcomes. J Stroke Cerebrovasc Dis. 2012; 22(7):e111-7. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.08.008.

23. Saver JL, Warach S, Janis S, et al. Standardizing the structure of stoke clinical and epidemiological research data: the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Common Data Element (CDE) project. Stroke. 2012; 43:967-73. http://dx.doi.org/10.1161/STROKEAHA.111.634352.

24. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604-7. http://dx.doi.org/10.1161/01.STR.19.5.604.

25. Drolet BC, Johnson KB. Categorizing the world of registries. J Biomed Inform. 2008; 41(6):1009-20. http://dx.doi.org/10.1016/j.jbi.2008.01.009.

26. Bufalino VJ, Masoudi FA, Stranne SK, et al. The American Heart Association’s recommendations for expanding the applications of existing and future clinical registries: a policy statement from the American Heart Association. Circulation. 2011; 123:2167-79. http://dx.doi.org/10.1161/CIR.0b013e3182181529.

27. Jones EM, Albright KC, Fossati-Bellani M, Siegler JE, Martin-Schild S. Emergency department shift change is associated with pneumonia in patients with acute ischemic stroke. Stroke. 2011; 42:3226-30. http://dx.doi.org/10.1161/STROKEAHA.110.613026.

28. Johnson CM, Nahm M, Shaw RJ, et al. Can prospective usability evaluation predict data errors? AMIA Annu Symp Proc. 2010; 2010:346-50. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041437/?report=classic.

29. Reeves MJ, Mullard AJ, Wehner S. Inter-rater reliability of data elements from a prototype of the paul coverdell national acute stroke registry. BMC Neurol. 2008; 8:19. http://dx.doi.org/10.1186/1471-2377-8-19.

30. Paulsen A, Overgaard S, Lauritsen JM. Quality of Data Entry Using Single Entry, Double Entry and Automated Forms Processing–An Example Based on a Study of Patient-Reported Outcomes. PloS One. 2012; 7(4):e35087. http://dx.doi.org/10.1371/journal.pone.0035087.

31. Day S, Fayers P, Harvey D. Double data entry: what value, what price? Control Clin Trials. 1998; 19(1):15-24. http://dx.doi.org/10.1016/S0197-2456(97)00096-2.

32. Howard G. Why do we have a stroke belt in the southeastern united states? A review of unlikely and uninvestigated potential causes. Am J Med Sci. 1999; 317(3):160-7. http://journals.lww.com/amjmedsci/pages/articleviewer.aspx?year=1999&issue=03000&article=00005&type=abstract.

33. Lyden P, Raman R, Liu L, et al. NIHSS training and certification using a new digital video disk is reliable. Stroke. 2005; 36:2446-9. http://dx.doi.org/10.1161/01.STR.0000185725.42768.92.

34. Towfighi A, Saver JL. Stroke declines from third to fourth leading cause of death in the United States: historical perspective and challenges ahead. Stroke. 2012; 42:2351-5. http://dx.doi.org/10.1161/STROKEAHA.111.621904.

35. Hsieh FI, Lien LM, Chen ST, et al. Get with the guidelines-stroke performance indicators: surveillance of stroke care in the Taiwan stroke registry: get with the guidelines-stroke in Taiwan. Circulation. 2010; 122:1116-23. http://dx.doi.org/10.1161/CIRCULATIONAHA.110.936526.

36. California Acute Stroke Pilot Registry Investigators. The impact of standardized stroke orders on adherence to best practices. Neurology. 2005; 65(3):360-5. http://dx.doi.org/10.1212/01.wnl.0000171706.68756.b7.

37. Centers for Disease Control and Prevention (CDC). Use of a registry to improve acute stroke care-seven states, 2005-2009. MMWR. 2011; 60(07):206-10. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6007a2.htm.

Spring 2013 – All Heart

All Heart.
 
Brittney M. Benjamin.
 
Author Affiliations:
College of Human Medicine, Michigan State University, Grand Rapids, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Spring-2013-All-Heart.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
Corresponding author: Brittney M. Benjamin; brittneymichellebenjamin[at]gmail.com
 
Key Words: N/A

 
Abstract:
There has been a trend to portray doctors as “all” - all knowing, all thinking, all seeing, all doing. We’re all brains, learning and memorizing, and all hands, cutting and suturing. Doctors can be any or none of these things, but sometimes we miss our greatest strength: we can be all Heart. And by being all Heart, we must be careful how our experiences affect us.

 
Published: May 31, 2013
 
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Benjamin BM. All Heart. Medical Student Research Journal. 2013;2(Spring):20.
 
 
References:
N/A

Spring 2013 – Letter From the Editors

Letter From the Editors.
 
Chad Klochko.
 
Author Affiliations:
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Spring-2013-Letter-from-the-Editors.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding Author: Chad Klochko; Chad[at]msrj.chm.msu.edu
 
Key Words: N/A
 
Abstract:
It has been a pleasure to work as an editor over the past year. I believe that this can be a significant outlet for medical students to publish their research work, enabling them to receive credit for publishing, but even more importantly, contributing to the general body of medical knowledge and teaching valuable academic skills.

 
Published: May 31, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Klochko C. Letter From the Editors. Medical Student Research Journal. 2013;2(Spring):19.
 
 
References:
N/A

Winter 2013 – Too Small to Fail

Too Small to Fail.
 
Chad Klochko.
 
Author Affiliations:
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-Too-Small-to-Fail.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding Author: Chad Klochko; chad[at]msrj.chm.msu.edu
 
Key Words: N/A
 
Abstract:
On December 7, 2012, Nicholas Kristof, two-time Pulitzer Prize winning journalist, wrote a compelling article about people in poverty in the United States. The article, which appeared in the New York Times, describes the plight of young children who are failing in school and who are not acquiring the skills needed to move forward in their education, and tragically, in some cases, parents are allowing them to fail.

 
Published: February 27, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Klochko C. Too Small to Fail. Medical Student Research Journal. 2013;2(Winter):17-18.
 
 
References:
1. Kristof N. Profiting from a child’s illiteracy. The New York Times, 7 December 2012. Available from: http://www.nytimes.com/2012/12/09/opinion/sunday/kristof-profiting-from-a-childs-illiteracy.html?pagewanted=all&_r=0 [cited 23 January 2013].

2. Kathy R, Pavetti L. SSI and children with disabilities: just the facts. Center on Budget and Policy Priorities. Available from: http://www.cbpp.org/cms/index.cfm?fa=view&id=3875 [cited 23 January 2013].

3. U.S. House. Committee on ways and means. Supplemental security income for children hearing, 17, October 2011. Available from: http://waysandmeans.house.gov/news/documentsingle.aspx?DocumentID=270423 [cited 19 January 2013].

4. Social security administration. Annual statistical supplement report, 2012 (Table 7.e4). Available from: http://www.ssa.gov/policy/docs/statcomps/ssi_asr/2010/sect10.html#table69 [cited 17 January 2013].

5. Hemmeter J, Kauff J, Wittenburg D. Changing circumstances: experiences of child SSI recipients before and after their age-18 redetermination for adult benefits. J Vocat Rehabil. 2009; 30:201-21. http://dx.doi.org/10.3233/JVR-2009-0462.

6. DeCesaro A, Hemmeter J. Unmet health care needs and medical out-of-pocket expenses of SSI children. J Vocat Rehabil. 2009; 30:3. http://dx.doi.org/10.3233/JVR-2009-0461.

7. About Us. Save the Children. (2012, December). Available from: http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6146405/k.C7E9/About_Us.htm [cited 23 January 2013].

8. The Power and Promise of Education. Save the Children. (n.d.). Available from: http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6153015/k.E633/Education.htm [cited 23 January 2013].

9. What is Health Literacy? National Institutes of Health. (2012, March 5). Available from: http://www.nih.gov/clearcommunication/healthliteracy.htm [cited 23 January 2013].

10. Weir E. Illiteracy as a public health issue. CMAJ. 2001; 164:1486. http://www.cmaj.ca/content/164/10/1486.full.pdf+html

11. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics. Available from: http://nces.ed.gov/pubs2006/2006483.pdf [cited 23 January 2013].

Winter 2013 – Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report

Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report.
 
Lloyd D Hughes*, Emily McKay.
 
Author Affiliations:
Medical School, Liverpool University, Liverpool, England

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-Can-Donepezil-Hydrochloride-Reduce-the-Role-of-Neuroleptic-Drugs-in-Delirium-A-Case-Report.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
*Corresponding author: Lloyd D. Hughes; L.D.Hughes[at]dundee.ac.uk
 
Key Words: geriatrics; delirium; psychiatry; acetylcholinesterase inhibitors.
 
Abstract:
Background: Recent evidence shows that a confirmed diagnosis of delirium increases both patient morbidity and mortality. Importantly, these increases are independent of patient age, and presence of co-morbid disease. In the last few years, there has been evidence that acetylcholinesterase inhibitors may have a limited role in managing episodes of mild/moderate delirium. Methods: This case study reports a patient whose behavioral disturbances caused by delirium, responded well to donepezil hydrochloride in a nursing home in Dundee, United Kingdom. Results:Our clinical case focuses on a patient who was diagnosed with a mixed picture delirium after developing PUO. This case report notes that Mr A, a patient already prescribed donepezil hydrochloride, saw an improvement in his behavioral symptoms after an increase in his dose. This enabled the patient to avoid receiving neuroleptic or benzodiazepine medication, known to be particularly problematic in older patients.
Conclusion: The authors tentatively propose that patients in community care already prescribed acetylcholinesterase inhibitors, may benefit from an increased dose in cases of mild delirium (where there is no clear cause or requirement for hospital admission). In line with the significant impact that delirium has upon older patients in community care, we would call for further studies looking at the influence that these medications may have on the sequelae of delirium in patients in the community.

 
Published: February 27, 2013
 
Senior Editor: Skyler Johnson
 
Junior Editor: Bobby Gambhir
 
DOI: Pending
 

Citation:
Hughes LD, McKay E. Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report. Medical Student Research Journal. 2013;2(Winter):11-16.
 
 
References:
Can donepezil hydrochloride reduce the role of
neuroleptic drugs in delirium? A case report

1. Fields SD. Delirium predicts 12-month mortality independent of dementia status. ACP J Club. 2003; 139(3):80. http://www.ncbi.nlm.nih.gov/pubmed/14594431.

2. Alagiakrishnan K, Blanchette P. Delirium; 2012. Available from: http://emedicine.medscape.com/article/288890-overview [cited 28 October 2012].

3. Cerejeira J, Taylor JP. Diagnosing, treating and preventing delirium. Geriatr Med. 2011; 41(2):81-5. http://www.gmjournal.co.uk/uploadedfiles/redbox/pavilion_content/our_content/social_care_and_health/gm_archive/2011/february/feb2011p81.pdf

4. Curran S, Wattis J. Delirium and the elderly patient. Geriatr Med. 2007; 37(11):35-40. https://www.gmjournal.co.uk/uploadedFiles/Redbox/Pavilion_Content/Our_Content/Social_Care_and_Health/GM_Archive/2007/November/Nov07p35.pdf

5. Inouye SK. Delirium in older persons. NEJM. 2006; 345:1157-65. http://dx.doi.org/10.1056/NEJMra052321.

6. Boorsma M, Joling KJ, Frijters DH, Ribbe ME, Nijpels G, van Hout JP. The prevalence, incidence and risk factors for delirium in Dutch nursing homes and residential care homes. Int J Geriatr Psychiatry. 2011; 26(7):711-22. http://dx.doi.org/10.1002/gps.2770.

7. Hughes LD, Witham MD, MacLullich A. Delirium in older patients: important determinant of hospital outcome. J Indian Acad Geriatr. 2012; 8(2):92-4. http://sumj.dundee.ac.uk/data/uploads/delirium-jiag.pdf

8. Wass S, Webster PJ, Nair BR. Delirium in the elderly: a review. Oman Med J. 2008; 23(3):150-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282320/

9. McCusker J, Cole M, Dendukuri N, Han L, Belzile E. The course of delirium in older medical inpatients: a prospective study. J Gen Intern Med. 2003; 18:696704. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494920/

10. Tune LE, Egeli S. Acetylcholine and delirium. Dement Geriatr Cogn Disord. 1999; 10(5):342-4. http://dx.doi.org/10.1159/000017167.

11. Hughes LD, Mthembu M, Adams L. Diagnostic work-up and treatment of Dementia. Geriatr Med. 2011; 41(11):595-600. http://sumj.dundee.ac.uk/data/uploads/dementia.pdf

12. GP Training Website. Mini-mental state examination. Available from: http://www.gptraining.net/protocol/psychiatry/mini_mental_state.htm [cited 28 October 2012].

13. Waszynski CM. Confusion assessment method (CAM). Best practices in nursing care to older adults. Try This. 2001; 13(11):1-2. http://consultgerirn.org/uploads/File/trythis/try_this_13.pdf

14. NHS Tayside Website. Tayside area formulary. 2010. Available from: http://www.nhstaysideadtc.scot.nhs.uk/TAPG%20html/MAIN/Front%20page.htm [cited 28 October 2012].

15. National Institute for Health and Clinical Excellence (2010). Delirium: diagnosis, prevention and cure. London: National Institute for Health and Clinical Excellence. Available From http://www.nice.org.uk/

16. Litvin CB, Ornstein SM, Wessell AM, Nemeth LS , Nietert PJ. Adoption of a clinical decision support system to promote judicious use of antibiotics for acute respiratory infections in primary care. Int J Med Inform. 2012; 81(8):521-6. http://dx.doi.org/10.1016/j.ijmedinf.2012.03.002.

17. Posner JD. Particular problems of antibiotic use in the elderly. Geriatrics. 1982; 37(8):49-54. http://www.ncbi.nlm.nih.gov/pubmed/7095428

18. Guthrie B, Clark SA, McCowan C. The burden of psychotropic drug prescribing in people with dementia: a population database study. Age Ageing 2010; 39(5):637-42. http://dx.doi.org/10.1093/ageing/afq090.

19. Hughes LD, Hanslip J, Witham MD. Centrally active prescribing for nursing home residents how are we doing? Eur Geriatric Med. 2012; 3(5):304-7. http://dx.doi.org/10.1016/j.eurger.2012.04.008.

20. Banerjee S. Report for the minister of state for care services: the use of antipsychotic medication for people with dementia; 2009. Available from: http://www.nhs.uk/news/2009/10October/Pages/Antipsychotic-use-in-dementia.aspx
[cited 28 October 2012].

21. MacLullich AM, Beaglehole A, Hall RJ, Meagher DJ. Delirium and long-term cognitive impairment. Int Rev Psychiatry. 2009; 21(1):30-42. http://dx.doi.org/10.1080/09540260802675031.

22. Himmelheber AM, Sarter M, Bruno JP. Increases in cortical acetylcholine release during sustained attention performance in rats. Cogn Brain Res. 2000; 9(3):313-25. http://dx.doi.org/10.1016/S0926-6410(00)00012-4.

23. Ehrenstein G, Galdzicki Z, Lange GD. The choline-leakage hypothesis for the loss of acetylcholine in Alzheimer’s disease. Biophys J. 1997; 73(3):1276-80. http://dx.doi.org/10.1016/S0006-3495(97)78160-8.

24. Francis PT, Palmerb AM, Snapeb M, Wilcock GK. The cholinergic hypothesis of Alzheimer’s disease: a review of progress. J Neurol Neurosurg Psychiatry. 1999; 66:137-47. http://dx.doi.org/10.1136/jnnp.66.2.137.

25. Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev. 2006; 25(1):CD005593. http://dx.doi.org/10.1002/14651858.CD005593.

26. National Institute for Health and Clinical Excellence (2011). Dementia supporting people with dementia and their careers in health and social care’ [incorporating NICE technology appraisal of drugs for Alzheimer’s disease]. London: National Institute for Health and Clinical Excellence. Available from http://www.scie.org.uk/publications/misc/dementia/dementia-guideline.pdf

27. Moretti R, Torre P, Antonello RM, Cattaruzza T, Cazzato G. Cholinesterase inhibition as a possible therapy for delirium in vascular dementia: a controlled, open 24-month study of 246 patients. Am J Alzheimers Dis Other Demen. 2004; 19(6):333-9. http://dx.doi.org/10.1177/153331750401900607.

28. Oldenbeuving AW, de Kort PL, Jansen BP, Kappelle LJ, Roks G. A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurol. 2008; 8:34. http://dx.doi.org/10.1186/1471-2377-8-34.

29. Gamberini M, Bolliger D, Lurati B, et al. Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery – a randomized controlled trial. Crit Care Med. 2009; 37:1762-8. http://dx.doi.org/10.1097/CCM.0b013e31819da780.

30. Cerejeira J, Batista P, Nogueira V. Low preoperative plasma cholinesterase activity as a risk marker of post-operative delirium in elderly patients. Age Ageing. 2011; 40(5): 621-6. http://dx.doi/org/10.1093/ageing/afr053.

31. van Eijk MMJ, Roes KCB, Honing MLH, et al. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomized trial. Lancet. 2010; 376:1829-37. http://dx.doi.org/10.1016/S0140-6736(10)61855-7.

32. de Pont AC, van Geer MA, Schultz MJ. Cholinesterase inhibitor treatment in patients with delirium. Lancet. 2011; 377(9769):899. http://dx.doi.org/10.1016/S0140-6736(11)60342-5.

33. Frölich L, Forstl H. Cholinesterase inhibitor treatment in patients with delirium. Lancet. 2011; 377(9769):899. http://dx.doi.org/10.1016/S0140-6736(11)60341-3.

34. MacLullich AM, Hall RJ. Who understands delirium? Age Ageing. 2011; 40(4):412-4. http://dx.doi.org/10.1093/ageing/afr062.

35. MacLeod AD. Delirium: the clinical concept. Palliat Support Care. 2006; 4(3):305-12. http://dx.doi.org/10.1017/S147895150606038X.

36. British Geriatric Society. Guidelines for the prevention, diagnosis and management of delirium in older people in hospital; 2006. Available from: http://www.bgs.org.uk [cited 28 October 2012].

37. Mason N, Fletcher P. Assessment of a confused patient. Geriatr Med. 2012; 42(10):41-5. http://www.gmjournal.co.uk/uploadedfiles/redbox/pavilion_content/our_content/social_care_and_health/gm_archive/2012/october/gmoct2012p41.pdf

38. Maclullich AM, Ferguson KJ, Miller T, de Rooij SE, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008; 65(3):229-38. http://dx.doi.org/10.1016/j.jpsychores.2008.05.019.

39. Van der Mast RC, Fekkes D. Serotonin and amino acids: partners in delirium pathophysiology? Semin Clin Neuropsychiatry. 2000; 5(2):125-31. http://www.ncbi.nlm.nih.gov/pubmed/10837101

40. Pandharipande PP, Morandi A, Adams JR, et al. Plasma tryptophan and tyrosine levels are independent risk factors for delirium in critically ill patients. Intensive Care Med. 2009; 35(11):1886-92. http://dx.doi.org/10.1007/s00134-009-1573-6.

41. Shahid A, Milapkumar P, Shagufta J, et al. Insight into delirium. Innov Clin Neurosci. 2011; 8(10):25-34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225129/

Winter 2013 – The Role of Ultrasound Screening in Reducing AAA Mortality: A Review

The Role of Ultrasound Screening in Reducing AAA Mortality: A Review.
 
Kashif Imran Ahmad.
 
Author Affiliations:
Medical School, Liverpool University, Liverpool, England

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-The-Role-of-Ultrasound-Screening-in-Reducing-AAA-Mortality-a-Review.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
Corresponding author: Kashif Imran Ahmad; K.Ahmad[at]Lancaster.ac.uk
 
Key Words: population; screening; ultrasonography; abdominal aortic aneurysms; mortality; systematic review.
 
Abstract:
Men aged 65-79 are at the highest risk of having an abdominal aortic aneurysm (AAA) as well as a high incidence of rupture; this is treated as a surgical emergency, which has a total mortality of 75-90%. The diameter of an AAA proves to be the most useful risk factor in predicting mortality rates.

 
Published: February 27, 2013
 
Senior Editor: Emina Bajrovic
 
Junior Editor: Bobby Gambhir
 
DOI: Pending
 
Citation:
Ahmad KI. The Role of Ultrasound Screening in Reducing AAA Mortality: A Review. Medical Student Research Journal. 2013;2(Winter):3-10.
 
 
References:
1. Marshall G. Screening for abdominal aortic aneurysm – does it fulfill the criteria for mass screening? Radiography. 1996; 2:3-9. http://dx.doi.org/10.1016/S1078-8174(96)90029-2.

2. Scott R, Vardulaki K, Walker N, Day N, Duffy S, Ashton H. The long-term benefits of a single scan for abdominal aortic aneurysm (AAA) at age 65. Eur J Vasc Endovasc. 2001; 21:535-40. http://dx.doi.org/10.1053/ejvs.2001.1368.

3. Scott R, Bridgewater S, Ashton H. Randomized clinical trial of screening for abdominal aortic aneurysm in women. Brit J Surg. 2002; 89:283-5. http://dx.doi.org/10.1046/j.0007-1323.2001.02014.x.

4. Heronm M, Hoyert D, Murphy S, Xu J, Kochanek K,Tejada-Vera B. Deaths: final data for 2006. Natl Vital Stat Rep. 2009; 57(14):34-86. http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf

5. Bown M, Sutton A, Bell P, Sayers R. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Brit J Surg. 2002; 89:714-30. http://dx.doi.org/10.1046/j.1365-2168.2002.02122.x.

6. UK Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. NEJM. 2002; 346(19):1445-52. http://dx.doi.org/10.1056/NEJMoa013527.

7. Lederle F, Wilson S, Johnson G, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. NEJM. 2002; 346(19):1437-44. http://dx.doi.org/10.1056/NEJMoa012573.

8. NHS (2011). NHS evidence screening. Available from: http://www.library.nhs.uk/screening/SearchResults.aspx?catID=15441&tabID=289&pgIndex0& [cited 15 April 2011].

9. Darling R, Messina C, Brewster D, Ottinger L. Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circulation. 1977; 56(2):161-4.

10. Lederle F, Johnson G, Wilson S, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm detection and management veterans affairs cooperative study investigators. Arch Intern Med. 2000; 160:1425-30. http://dx.doi.org/10.1001/archinte.160.10.1425.

11. Lederle F, Johnson G, Wilson S. Abdominal aortic aneurysm in women. J Vasc Surg. 2001; 34:122-6. http://dx.doi.org/10.1067/mva.2001.115275.

12. Lindholt J, Henneberg E, Fasting H, Juul S. Hospital based screening of 65-73 year old men for abdominal aortic aneurysms in the county of Viborg, Denmark. J Med Screen. 1996; 3:43-6. http://dx.doi.org/10.1177/096914139600300111.

13. Vardulaki K, Pervost T, Walker N, et al. Incidence among men of asymptomatic abdominal aortic aneurysms: estimates from 500 screen detected cases. J Medl Screen. 1999; 6(1):50-4. http://dx.doi.org/10.1136/jms.6.1.50.

14. Earnshaw J, Shaw E, Whyman M, Poskitt K, Heather B. Screening for abdominal aortic aneurysms in men. Brit Med J. 2004; 328(7448):1122-4. http://dx.doi.org/10.1136/bmj.328.7448.1122.

15. Kochanek K, Xu J, Murphy S, Miniño A, Kung H. Deaths: preliminary data for 2009. Natl Vital Stat Rep. 2011; 59(11):1-69. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf

16. Gillum R. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol. 1995; 48:1289-98. http://www.jclinepi.com/article/PII0895435695000453/abstract.

17. Watson JE. Medical-surgical nursing and related physiology. 2nd ed. Philadelphia: W B Saunders; 1979, p. 351.

18. Adam D, Mohan I, Stuart W, Bain M, Bradbury A. Community and hospital outcome from ruptured abdominal aortic aneurysm within the catchment area of a regional vascular surgical service. J Vasc Surg. 1999; 30:922-8. http://dx.doi.org/10.1016/S0741-5214(99)70018-2.

19. Nusbaum J, Freimanis A, Thomford N. Echography in the diagnosis of abdominal aortic aneurysm. Brit J Surg. 1971; 102:385-8. http://dx.doi.org/10.1001/archsurg.1971.01350040147028.

20. Fleming C, Whitlock E, Beil T, Lederrle F. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. preventive services task force. Ann Intern Med. 2005; 142(3):203-11. http://dx.doi.org/10.7326/0003-4819-142-3-200502010-00012.

21. Williamson W, Nicoloff A, Taylor LJ, Moneta G, Landry G, Porter J. Functional outcome after open repair of abdominal aortic aneurysm. J Vasc Surg. 2001; 33:913-20. http://dx.doi.org/10.1067/mva.2001.115164.

22. Huber T, Wang J, Derrow A, et al. Experience in the United States with intact abdominal aortic aneurysm repair. J Vasc Surg. 2001; 33:304-10. http://dx.doi.org/10.1067/mva.2001.112703.

23. Lindholt J. Considerations and experiences of screening for abdominal aortic aneurysms. Copenhagen: Fadl’s Forlag; 1998.

24. Wilmink A, Quick C. Epidemiology and potential for prevention of abdominal aortic aneurysm. Brit J Surg. 1998; 85(2):155-62. http://dx.doi.org/10.1046/j.1365-2168.1998.00714.x.

25. Ferket B, Grootenboer N, Colkesen E, et al. Systematic review of guidelines on abdominal aortic aneurysm screening. J Vasc Surg. 2011; http://dx.doi.org/10.1016/j.jvs.2010.10.118.

26. Health Departments of the United Kingdom (1998). First Report of the National Screening Committee. National
Screening Committee, pp. 145. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/
documents/digitalasset/dh_084456.pdf
[cited 15 April 2011].

27. Health Departments of the United Kingdom (2000). Second Report of the UK National Screening Committee. National Screening Committee, pp. 1-29. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4014560.pdf [cited 15 April 2011].

28. McGregor JC, Pollock JG, Anton HC. The value of ultrasonography in the detection of abdominal aortic aneurysms. Scot Med J. 1975; 20:133-7.

29. Leger A, Spencely M, McCollum C, Mossa M. Screening for abdominal aortic aneurysms: a computer assisted cost-utility analysis. Eur J Vasc Endovasc. 1996; 11:183-90. http://www.ejves.com/article/S1078-5884%2896%2980049-9/abstract

30. Wilmink A, Forshaw M, Quick C, Hubbard C, Day N. Accuracy of serial screening for abdominal aortic aneurysms by ultrasound. J Med Screen. 2002; 9:125-7. http://dx.doi.org/10.1136/jms.9.3.125.

31. Lindholt J, Vammen S, Juul S, Henneberg E, Fasting H. The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc. 1999; 17(6):472-5. http://dx.doi.org/10.1053/ejvs.1999.0835.

32. Greenhalgh T. How to read a paper – the basics of evidence-based medicine. 4th ed. BMJ Books. London: Wiley-Blackwell; 2010.

33. NHS (2011). CASP tools – RCT appraisal tool. Available from: http://www.sph.nhs.uk/sph-files/casp-appraisal-tools/rctap9-praisaltool.pdf/view [cited 17 April 2011].

34. NHS (2011). Critical appraisal skills programme. Available from: http://www.sph.nhs.uk/what-we-do/public-health-workforce/resources/critical-appraisals-skills-programme/ [cited 17 April 2011].

35. Scott R, Wilson N, Ashton H, Kay D. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Brit J Surg. 1995; 82(8):1066-70. http://dx.doi.org/10.1002/bjs.1800820821.

36. Ashton H, Buxton M, Day N, et al. The multicentre aneurysm screening study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002; 360(9345):1531-39. http://dx.doi.org/10.1016/S0140-6736(02)11522-4.

37. Norman P, Jamrozik K, Lawrence-Brown M, et al. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. Brit Med J. 2004; 329:1259-62. http://dx.doi.org/10.1136/bmj.330.7491.596.

38. Lindholt J, Juul S, Fasting H, Henneberg E. Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial. Eur J Vasc Endovasc. 2002; 23(1):55-60. http://dx.doi.org/10.1053/ejvs.2001.1534.

Winter 2013 – The Color of Medicine

The Color of Medicine.
 
Diana Salinas.
 
Author Affiliations:
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-The-Color-of-Medicine.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding Author: Diana Salinas; email not available.
 
Key Words: N/A
 
Abstract:
’I will not permit considerations of religion, nationality, race, gender, politics, socioeconomic standing, or sexual orientation to intervene between my duty and my patient.’ This bullet point from the physician’s oath is engraved around the margins to remind us that as physicians we should treat and care for each patient equally and in an unbiased manner, but at the same time understand that a universal treatment plan will not apply to all patients.

 
Published: February 27, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Salinas D. The Color of Medicine. Medical Student Research Journal. 2013;2(Winter):2.
 
 
References:
N/A

Winter 2013 – Letter From the Editors

Letter From the Editors.
 
Chad Klochko, David Ortiz.
 
Author Affiliations:
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-Letter-from-the-Editors.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding Author: Chad Klochko; Chad[at]msrj.chm.msu.edu
 
Key Words: N/A

 
Abstract:
The year 2013 is going to be a very exciting year for the Medical Student Research Journal (MSRJ). MSRJ has made great strides in the past 12 months and can look forward to a bright furture in the year ahead. We have more than tripled our editoral staff, which now consists of 12 second – through fourth – year medical students.

 
Published: February 27, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Klochko C, Ortiz D. Letter From the Editors. Medical Student Research Journal. 2013;2(Winter):1.
 
 
References:
N/A

Winter 2011 – 10 Minutes with Paul Hebert, Editor-in-Chief of the Canadian Medical Association Journal

10 Minutes with Paul Hebert, Editor-in-Chief of the Canadian Medical Association Journal.

Pamela Verma, Diane Wu.

Author Affiliations:
University of British Columbia, Vancouver, BC, Canada
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Spring-2011-10-minutes-with-Paul-Hebert-Editor-in-Chief-of-the-Canadian-Medical-Association-Journal.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

*Corresponding Author: Pamela Verma; pamverma[at]interchange.ubc.ca

Key Words: N/A

Abstract:
Background: Most medical students, at some point in their career, aspire to publish a research paper of enough significance to join the pages of the major international medical journals. At the helm of these journals are physicians renowned for their academic and research acumen; in Canada, one of these physicians is Dr. Paul Hebert. We sat down with Dr. Hebert to talk about submission tips, becoming a journal editor, and how he got the job. This feature is part of Editors in Medicine, an ongoing series within student medical journals. Other interviews will be published periodically in various student journals internationally.
Published: June 30, 2011

Senior Editor: Andrew Wyman

Junior Editor: Steven Plato

DOI: http://dx.doi.org/10.15404/msrj.001.001.winter/03

Citation:
Verma P, Wu D. 10 Minutes with Paul Hebert, Editor-in-Chief of the Canadian Medical Association Journal. Medical Student Research Journal. 2011;1(Spring):8-9.

References:
N/A

Winter 2011 – Pregnant Patient Presenting with Syncope and a Medulloblastoma: A Case Report

Pregnant Patient Presenting with Syncope and a Medulloblastoma: A Case Report.

Mark Ishak.

Author Affiliations:
New York College of Osteopathic Medicine of NYIT, Old Westbury, NY, USA
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Spring-2011-Pregnant-patient-presenting-with-syncope-and-a-medulloblastoma-a-case-report.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

*Corresponding Author: Mark Ishak, mishak[at]nyit.edu

Key Words: Adult medulloblastoma; pregnant; syncope.
Abstract:
Medulloblastoma is a primary cerebellar tumor seen most commonly in the pediatric population. In adults, it represents about 1% of cancer found in the central nervous system. In adult medulloblastoma, only one third of cases occur in women and even less in pregnant women. This case describes a 34-year-old pregnant woman who presented to the emergency department with the syncope, which was found to be secondary to a medulloblastoma.
Published: June 25, 2011

Senior Editor: Steven Plato

Junior Editor: David Hobbs

DOI: http://dx.doi.org/10.15404/msrj.001.001.winter/02

Citation:
Ishak M. Pregnant Patient Presenting with Syncope and a Medulloblastoma: A Case Report. Medical Student Research Journal. 2011;1(Spring):5-7.

References:
1. Adult medulloblastomas. Holland-Frei cancer medicine. Hamilton, ON: BC Decker; 2003. Available from: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book_cmed6&part_ A19676. [cited July 2010].

2. Oliver TG, Grasfeder LL, Carroll AL, Kaiser C, Gillingham CL, Lin SM, et al. Transcriptional profiling of the sonic hedgehog response; a critical role for N-myc in proliferation of neuronal precursors. Proc Natl Acad Sci. 2003; 100(12):7331-36. http://dx.doi.org/10.1073/pnas.0832317100.

3. Sasai K, Romer JT, Lee Y, Finkelstein D, Fuller C, McKinnon PJ, et al. Shh pathway is down-regulated in cultured medulloblastoma cells: implications for preclinical studies. Cancer Res. 2006; 66(8): 4215-22. http://dx.doi.org/10.1158/0008-5472.CAN-05-4505.

4. Belcher SM, Ma X, Le HH. Blockade of estrogen receptors signaling inhibits growth and migration of medulloblastoma. Endocrinology. 2009; 150(3):1112-21. http://dx.doi.org/10.1210/en.2008-1363.

5. Pregnancy and Dizziness. 2007. Available from: http://www.americanpregnancy.org/pregnancyhealth/dizziness.html. [cited July 2010].

6. Morag R, Brenner B. Syncope: differential diagnosis & workup. eMedicine 2010. http://emedicine.medscape.com/article/811669-differential. [cited 13 April 2011].

7. Ismail K, Coakham HB, Walters JM. Intracranial meningioma with progesterone positive receptors in late pregnancy. Eur J Anaesthesiol. 1998; 15(1):106-9. http://dx.doi.org/10.1046/j.1365-2346.1998.00225.x.