Fall 2013 – Direct Access to Physical Therapy in Michigan is Overdue

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Direct Access to Physical Therapy in Michigan is Overdue.
 
Kevin C. Patterson1*, Rachel A. Patterson2
 
1College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
2College of Health Professions, Grand Valley State University, Grand Rapids, MI, USA

 

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Fall-2013-Direct-Access-to-Physical-Therapy-in-Michigan-is-Overdue.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
*Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com
 
Key Words: Direct Access; Physical Therapy; Primary Care; Healthcare; Utilization
 
Abstract:
Direct access to physical therapists (PTs), the ability for a patient to seek care from a PT without physician referral, has been contested for many years. The traditional gatekeeper model of access to physical therapy has changed throughout the nation and only two states remain without direct access. Michigan is one of those states, and the state legislature has not advanced direct access legislation despite numerous opportunities over the past 12 years. However, no evidence exists to show that direct access causes harm to patients and the healthcare system and, on the contrary, easy and early access to physical therapy by patients has been shown to improve outcomes and decrease costs of care. Direct access to physical therapy is long overdue in Michigan and should be reconsidered in order to better serve our patients and the healthcare system.
 
Published: September 30, 2013
 
 
Senior Editor: N/A
 
Junior Editor: N/A
 
Citation:
Patterson KC, Patterson RA. Direct Access to Physical Therapy in Michigan is Overdue. Medical Student Research Journal. 2013;3(Fall):13-16.
 
 
References:
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2. American Physical Therapy Association (2013). Direct access at the state level. Available from: http://www.apta.org/ StateIssues/DirectAccess. [cited 20 September 2013].

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5. Shah N, Nakamura Y. Case report: schizophrenia discovered during the patient interview in a man with shoulder pain referred for physical therapy. Physiother Can. 2010; 62:308-15. http://utpjournals.metapress.com/content/31rt02094252713t/.

6. Stowell T, Cioffredi W, Greiner A, Cleland J. Abdominal differential diagnosis in a patient referred to a physical therapy clinic for low back pain. J Orthop Sports Phys Ther. 2005; 35(11):755-64. http://dx.doi.org/10.2519/jospt.2005.35.11.755.

7. Boissonnault WG, Ross MD. Physical therapists referring patients to physicians: a review of case reports and series. J Orthop Sports Phys Ther. 2012; 42(5):446-54. http://dx.doi.org/10.2519/jospt.2012.3890.

8.Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists’ knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord. 2005; 6:7. http://dx.doi.org/10.1186/1471-2474-6-32.

9. Davenport TE, Watts HG, Kulig K, Resnik C.
Current status and correlates of physicians’ referral diagnoses for physical therapy. J Orthop Sports Phys Ther. 2005; 35(9):572-9. http://dx.doi.org/10.2519/jospt.2005.35.9.572.

10. Davenport TE, Sebelski CA. The physical therapist as a diagnostician: how do we, should we, and could we use information about pathology in our practice? Phys Ther. 2011; 91(11):1694-5. http://dx.doi.org/10.2522/ptj.2011.91.11.1694.

11. Moore JH, McMillian DJ, Rosenthal MD, Weishaar MD. Risk determination for patients with direct access to physical therapy in military health care facilities. J Orthop Sports Phys Ther. 2005; 35(10):674-8. http://dx.doi.org/10.2519/jospt.2005.35.10.674.

12. Pinnington MA, Miller J, Stanley I. An evaluation of prompt access to physiotherapy in the management of low back pain in primary care. Fam Pract. 2004; 21(4):372-80. http://dx.doi.org/10.1093/fampra/cmh406.

13. Hendriks EJM, Kerssens JJ, Dekker J, Nelson RM, Oostendorp RAB, van der Zee J. One-time physical therapist consultation in primary health care. Phys Ther. 2003; 83(10):918-31. http://www.physther.org/content/83/10/918.short.

14. Nordeman L, Nilsson B, Moller M, Gunnarsson R. Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial. Clin J Pain. 2006; 22(6):505-11. http://dx.doi.org/10.1097/01.ajp.0000210696.46250.0d.

15. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy impact on future health care utilization and costs. Spine. 2012; 37(25):2114-121. http://dx.doi.org/10.1097/BRS.0b013e31825d32f5.

16. Donato EB, DuVall RE, Godges JJ, Zimmerman GJ, Greathouse DG. Practice analysis: defining the clinical practice of primary contact physical therapy. J Orthop Sports Phys Ther. 2004; 34(6):284-304. http://dx.doi.org/10.2519/jospt.2004.34.6.284.

17. Mitchell JM, deLissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997; 77(1):10-18. http://www.physther.org/content/77/1/10.short.

18. Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Serv Res. 2012; 47(2):633-54. http://dx.doi.org/10.1111/j.1475-6773.2011.01324.x.

19. Holdsworth LK, Webster VS, McFadyen AK, Scottish Physiotherapy Self R. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy. 2007; 93(1):3-11. http://dx.doi.org/10.1016/j.physio.2006.05.005.

20. Holdsworth LK, Webster VS. Direct access to physiotherapy in primary care: now and into the future? Physiotherapy. 2004; 90(2):64-72. http://dx.doi.org/10.1016/j.physio.2004.01.005.

Fall 2013 – Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms

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Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms.
 
Zachary Jarou*, Nathaniel Harris, Liza Gill, Meena Azizi, Shayef Gabasha, Robert LaBril.
 
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Fall-2013-Public-Stroke-Knowledge-Those-Most-at-Risk-Least-Able-to-Identify-Symptoms.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
*Corresponding author: Zachary Jarou; zachjarou[at]gmail.com
 
Key Words: Stroke; CVA; Risk Factors; Warning Signs; Patient Education; Public Health.
 

Abstract:
Background and purpose: Fewer than 1 in 20 patients with acute ischemic stroke are treated with thrombolytic drugs, with three quarters of otherwise eligible patients being excluded secondary to delay in seeking medical treatment. Lack of symptom recognition may contribute to low treatment rates and is an important focus of public health education. The purpose of this study was to determine if an individual’s cumulative number of stroke risk factors correlated with their ability to identify stroke symptoms. Methods: We surveyed adults about their stroke risk factors and knowledge of stroke symptoms at grocery stores and malls in a medium-sized university town in the Midwestern US. Results: In total, 245 adults completed surveys. Self-reported risk factors included high blood pressure (25%), high cholesterol (22%), diabetes (12%), tobacco use (11%), alcohol use (7%), heart disease (7%), and prior stroke (3%). Cumulatively, 56% of respondents had no risk factors, 41% had 13 risk factors, and 4% had 4risk factors. When administered a six-point stroke symptom knowledge test, respondents with 4 risk factors were significantly less knowledgeable, receiving a mean score of 3.2, compared to those with 13 risk factors, who scored a mean of 4.6. Those with four or more years of college were significantly more knowledgeable than those with only a high-school education, receiving mean scores of 4.6 and 3.9, respectively. There was no association between stroke knowledge and use of a primary care physician. Conclusions: Although it is known that individuals with more risk factors are more likely to have a stroke, in our study these respondents were less able to recognize stroke symptoms compared to respondents with fewer risk factors. Future public stroke awareness campaigns should be targeted toward those most at risk so they learn to recognize stroke symptoms and thus seek treatment in a timely manner.
 
Published: September 30, 2013
 
Senior Editor: Jack Mettler
 
Junior Editor: Tim Smith
 
DOI: Pending
 
Citation:
Jarou Z, Harris N, Gill L, Azizi M, Gabasha S, LaBril R. Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms. Medical Student Research Journal. 2013;3(Fall):3-8.
 
 
References:
1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics-2011 update a report from the American Heart Association. Circulation. 2011; 123:e18-e209. http://dx.doi.org/10.1161/CIR.0b013e3182009701.

2. Wechsler LR. Intravenous thrombolytic therapy for acute ischemic stroke. N Engl J Med. 2011; 364:2138-46. http://dx.doi.org/10.1056/NEJMct1007370.

3. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359:1317-29. http://dx.doi.org/10.1056/NEJMoa0804656.

4. California Acute Stroke Pilot Registry (CASPR) Investigators. Prioritizing interventions to improve rates of thrombolysis for ischemic stroke. Neurology 2005; 64(4):654-9. http://dx.doi.org/10.1212/01.WNL.0000151850.39648.51.

5. Barber PAM, Zhang J, Demchuk AM, Hill MD, Buchan AM. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001; 56(8):1015-20. http://dx.doi.org/10.1212/WNL.56.8.1015.

6. Katzan IL, Hammer MD, Hixson ED, et al. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol. 2004; 61(3):346-50. http://dx.doi.org/10.1001/archneur.61.3.346.

7. Kleindorfer D, Khoury J, Broderick JP, et al. Temporal trends in public awareness of stroke warning signs, risk factors, and treatment. Stroke. 2009; 40:2502-6. http://dx.doi.org/10.1161/STROKEAHA.109.551861.

8. Reeves MJ, Rafferty AP, Aranha AAR, Theisen V. Changes in knowledge of stroke risk factors and warning signs among Michigan adults. Cerebrovasc Dis. 2008; 25:385-91. http://dx.doi.org/10.1159/000121338.

9. Kothari R, Sauerbeck L, Jauch E, et al. Patients’ awareness of stroke signs, symptoms, and risk factors. Stroke. 1997; 28:1871-5. http://dx.doi.org/10.1161/01.STR.28.10.1871.
10. American Stroke Association. Stroke warning signs and symptoms. 2013. Available from: http://strokeassociation.org [cited 10 August 2013].

11. Centers for Disease Control and Prevention. 2011 behavioral risk factor surveillance system questionnaire. 2011. Available from: http://www.cdc.gov/brfss/questionnaires.htm [cited 10 August 2013].

12. National Institute of Neurological Disorders and Stroke (NINDS). Stroke information page. 2013. Available from: http://www.ninds.nih.gov/disorders/stroke/stroke.htm [cited 10 August 2013].
13. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006; 60:7-12. http://dx.doi.org/10.1136/jech.2004.023531.

14. Schneider AT, Pancioli AM, Khoury JC, et al. Trends in community knowledge of the warning signs and risk factors for stroke. JAMA. 2003; 289(3):343-6. http://dx.doi.org/10.1001/jama.289.3.343.

15. Reeves MJ, Hogan JG, Rafferty AP. Knowledge of stroke risk factors and warning signs among Michigan adults. Neurology. 2002; 59(10):1547-52. http://dx.doi.org/10.1212/01.WNL.0000031796.52748.A5.

16. Yoon SS, Heller RF, Levi C, Wiggers J, Fitzgerald PE. Knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population. Stroke. 2001; 32:1926-30. http://dx.doi.org/10.1161/01.STR.32.8.1926.

17. Greenlund KJ, Neff LJ, Zheng ZJ, et al. Low public recognition of major stroke symptoms. Am J Prev Med. 2003; 25(4):315-19. http://dx.doi.org/10.1016/S0749-3797(03)00206-X.

18. Pancioli AM, Broderick J, Kothari R, et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998; 279(16):1288-92. http://dx.doi.org/10.1001/jama.279.16.1288.

19. Wolf P, D’Agostino R, Belanger A, Kannel W. Probability of stroke: a risk profile from the Framingham study. Stroke. 1991; 22:312-18. http://dx.doi.org/10.1161/01.STR.22.3.312.

Fall 2013 – A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis

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A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis.
 
Megan C. Hamre1*, Jennifer M. Eschbacher2, Frances Hahn2, Tilina Hu2
 
1School of Medicine, Creighton University, Omaha, NE, USA
2St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

 

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Fall-2013-A-Rare-Case-of-Breast-Carcinosarcoma-with-Lymphatic-Metastasis.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
*Corresponding Author: Megan C. Hamre; Meganhamre1[at]creighton.edu
 
Key Words: Breast Cancer; Carcinosarcoma; Clinical Protocols; Treatment Protocols; Lymphatic Metastasis.
 
Abstract:
Introduction and Patient Profile: Carcinosarcoma of the breast is a rare malignancy composed of two cell lines described as a ductal-type carcinoma with a sarcoma-like component. It is an aggressive neoplasm that is usually larger in size than epithelial breast cancers and characterized by a rapid increase in size. A 32-year-old woman presented with a palpable lump in the left upper outer breast. Imaging findings and an ultrasound-guided biopsy demonstrated a malignant neoplasm with chondroid differentiation. Interventions and Outcomes: The patient underwent a modified radical left breast mastectomy with sentinel node biopsy. Pathology report from the mastectomy demonstrated an infiltrating metaplastic carcinoma (MPC) with positive lymph nodes. Discussion: The most unusual feature of this case is the lymph node positivity, as lymphatic spread is uncommonly associated with carcinosarcoma or any subtype of metaplastic carcinoma of the breast. This case is important because it illustrates the potential future need for treatment guidelines for this uncommon tumor.
 
Published: September 30, 2013
 
Senior Editor: Skyler Johnson
 
Junior Editor: Alex Golec
 
DOI: Pending
 
Citation:
Hamre MC, Eschbacher JM, Hahn F, Hu T. A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis. Medical Student Research Journal. 2013;3(Fall):9-12.
 
 
References:
1. Beatty JD, Atwood M, Tickman R, Reiner M. Metaplastic breast cancer: clinical significance. Am J Surg. 2006; 191(5):657-64. http://dx.doi.org/10.1016/j.amjsurg.2006.01.038.

2. Esses KM, Hagmaier RM, Blanchard SA, Lazarchick JJ, Riker AI. Carcinosarcoma of the breast: two case reports and review of the literature. Cases J. 2009; 2:15. http://dx.doi.org/10.1186/1757-1626-2-15.

3. SEER Cancer Statistics Factsheets: Breast Cancer. National Cancer Institute. Bethesda, MD, Available from: http://seer.cancer.gov/statfacts/html/breast.html [cited 8 September 2013].

4. Leddy R, Irshad A, Rumboldt T, Cluver A, Campbell A, Ackerman S. Review of metaplastic carcinoma of the breast: imaging findings and pathologic features. J Clin Imaging Sci. 2012; 2:21. http://dx.doi.org/10.4103/2156-7514.95435.

5. Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast clinical presenta- tion, treatment results and prognostic factors. Acta Oncol. 2006; 45(2):188-95. http://dx.doi.org/10.1080/02841860500513235.

6. Shin HJ, Kim HH, Kim SM, Kim DB, Kim MJ, Gong G, et al. Imaging features of metaplastic carcinoma with chon- droid differentiation of the breast. AJR Am J Roentgenol. 2007; 188(3):691-6. http://dx.doi.org/10.2214/AJR.05.0831.

7. Smith TB, Gilcrease MZ, Santiago L, Hunt KK, Yang WT. Imaging features of primary breast sarcoma. AJR Am J Roentgenol. 2012; 198(4):W386-93. http://dx.doi.org/10.2214/AJR.11.7341.

Fall 2013 – Incomplete Storytelling

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Incomplete Storytelling.
 
Alexander S. Golec.
 
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Fall-2013-Incomplete-Storytelling.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding Author: Alexander S. Golec; golec@msu.edu
 
Key Words: N/A
 
Abstract:
Our interviews, physical exams, and laboratory tests only uncover select words of a patient’s story. Some days we may be lucky enough to stumble upon a phrase or complete sentence in their life’s tome. We base our diagnoses on these incomplete discoveries and hope for the best. Some of us may act like we have the Rosetta Stone in our pocket, granting us the ability to translate everything into our noble medical language. Others may focus too much time on the details of the letters and completely miss the story behind them. Deciphering the story of each patient requires not only a stellar medical acumen but also an ability to comprehend stories in languages that may seem foreign to us.

 
Published: September 30, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Golec AS. Incomplete Storytelling. Medical Student Research Journal. 2013;3(Fall):2.
 
 
References:
N/A

Fall 2013 – Letter From the Editors

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Letter From the Editors.
 
Kevin C. Patterson, Jessica L. Wummel.

 

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

 

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

 
Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com
 
Key Words: N/A
 
Abstract:
In the third MSRJ issue of 2013 and the first of the 2013-2014 academic year, we are very excited to present enlightening and thought-provoking articles. We are publishing the work of students from Michigan State University’s College of Human Medicine and Creighton University School of Medicine. This journal has seen large growth since the Spring 2013 issue, and we have bigger plans for the future.

 
Published: September 30, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Patterson KC, Wummel JL. Letter from the Editors. Medical Student Research Journal. 2013;2(Fall):1.
 
 
References:
N/A

MSRJ Contest

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Medical Student Research Journal Submission Contest

We at the MSRJ want to encourage student publications, so we’ve decided to organize a contest for a cash reward! We are pleased to announce the introduction of the MSRJ Submission Contest! $300 goes to the winner of each of four categories: Best Case Report, Best Reflection, Best Original Research or Brief Report, and Best Review to be submitted for possible publication. We will be voting for the best manuscript submitted in each of these categories. Submissions are due by October 1st, 2013 and you can learn more about the contest rules and guidelines here.

 

 MSRJ Contest Flyer - 6-4-13

 

 

 

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Spring 2013 – Funding the Future

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Funding the Future.
 
David L. 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-Spring-2013-Funding-the-Future.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding author: David Ortiz; ortizdav[at]msu.edu
 
Key Words: N/A

 
Abstract:
The problems facing healthcare training today are not simple. Predictions about future demand for physicians have a poor track record, as the GMENAC studies of the 1980s showed. Even if one could predict perfectly the demand for physicians in the future, history has shown that it takes 10-40 years for the full effects of increased medical school enrollment to be felt. The rate of GME must rise. In its present state, GME could sustain reductions as great as 10% of funding without the loss of total residency slots, but any decrease in GME funding will undoubtedly perpetuate the inadequacy of the physician workforce. By 2016, without increased GME funding, there will be a substantial increase in the number of unmatched US seniors and a substantial decrease in the number of foreign medical grads.

 
Published: May 31, 2013
 
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Ortiz DL. Funding the Future. Medical Student Research Journal. 2013;2(Spring):36-39.
 
 
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