Alexandra K. Feiertag, B.A.1*, Catherine A. Martin, M.D.1,2, Gregory E. Guenthner, M.L.I.S.2
1College of Medicine, University of Kentucky, Lexington, KY, USA
2Department of Psychiatry, University of Kentucky, Lexington, KY, USA
*Corresponding Author: Alexandra K. Feiertag; email@example.com
Key Words: opioid; overdose; safety; education; adolescent
Purpose: Opioid overdoses profoundly impact thousands of families across the United States. Behind this issue lies the accessibility of opioid prescriptions right inside our medicine cabinets. Our goal was to educate adolescent students in Kentucky schools about this matter because they comprise a vulnerable population.
Methods: Pre- and posttestings were used to analyze 26 adolescents’ knowledge, attitudes, and awareness regarding opioid overdoses pre- and post-intervention.
Results: Adolescents displayed significantly improved results from pre-test to post-test. Overdose Knowledge scores improved by 16% from pre- to post-intervention (p = 0.01). Attitude to Act scores improved by 35% (p = 0.03). Drug Disposal Awareness scores improved by 54% (p < 0.01).
Conclusions: This study demonstrates that education improves adolescents’ opioid overdose knowledge, attitudes, and awareness. The evidence shows that there are educational gaps that should be filled by teaching adolescents about the opioid epidemic and providing them with resources.
Published: Spring, 2019
1. Overdose death rates. National Institute on Drug Abuse. August 2018. Available from: https://www.drugabuse.gov/ related-topics/trends-statistics/overdose-death-rates [cited 10 August 2018].
2. Drugs of abuse. U.S. Department of Justice Drug Enforcement Administration. June 16, 2017. Available from: https://www.dea.gov/sites/default/files/sites/ getsmartaboutdrugs.com/files/publications/DoA_2017Ed_ Updated_6.16.17.pdf#page=40 [cited 10 August 2018].
3. Curtin SC, Tejada-Vera B, Warner M. Drug overdose deaths among adolescents aged 15–19 in the United States: 1999– 2015. Centers for Disease Control and Prevention. August 16, 2017; Available from: https://www.cdc.gov/nchs/products/ databriefs/db282.htm [cited 10 August 2018].
4. Slavova S, Bunn TL, Gao W. Drug overdose deaths in Kentucky, 2000–2013. Kentucky Injury Prevention and Research Center. March 6, 2015; Available from: http:// www.mc.uky.edu/kiprc/projects/ddmarpdak/pdf/ KyDrugOverdoseDeaths-2000-2013.pdf [cited 10 August 2018].
5. Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the epidemic of prescription opioid overdose deaths. Am J Public Health 2018; 108(4): 500–2. doi: 10.2105/ AJPH.2017.304265
6. Williams AV, Strang J, Marsden J. Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales for take-home naloxone training evaluation. Drug Alcohol Depend 2013; 132(1–2): 383–6. doi: 10.1016/j. drugalcdep.2013.02.007
7. Whiteside LK, Walton MA, Bohnert ASB, Blow FC, Bonar EE, Ehrlich P, et al. Nonmedical prescription opioid and sedative use among adolescents in the emergency department. Pediatrics 2013; 132(5): 825–32. doi: 10.1542/peds.2013-0721 8. Frank D, Mateu-Gelabert P, Guarino H, Bennett A, Wendel T, Jessell L, et al. High risk and little knowledge: overdose experiences and knowledge among young adult nonmedical prescription opioid users. Int J Drug Policy 2015; 26(1): 84–91. doi: 10.1016/j.drugpo.2014.07.013
9. Tilley JC, Ingram V. 2016 overdose fatality report. Kentucky Office of Drug Control Policy. 2016. Available from: https:// odcp.ky.gov/Documents/2016%20ODCP%20Overdose%20 Fatality%20Report%20Final.pdf [cited 10 August 2018].
The Medical Student Research Journal is hosting its first cover art competition! This is a competition to have your art featured in the Fall 2019 edition of the Medical Student Research Journal. This is a great opportunity to showcase humanism in medicine and earn a CITATION that you can add to your curriculum vitae!
• Competition Dates? June 1 to August 31, 2019
• Theme? Medicine
• Who is eligible? All MSU graduate and undergraduate students, KCAD students.
• How to compete? Please submit artwork in PDF or JPEG format by 11:59pm, August 31 2019.
Please send submissions to:
Check out the official flyer and last years cover art below:
Fall 2018 publication cover
The Fall 2018 Issue (click for PDF) is finally here! A big thank you to our authors, and especially to our Junior and Senior student editors who made this edition possible:
Francesca Cazzulino MS4, Larissa Georgeon MS4, Marten Hawkins MS4, Mariam Khan MS4, Jessica Martín MS4, Rohit Nallani MS4, Monica Pomaville M.D., Caitlin McCarthy MS3, Genevieve Pourzan MS3, Aiden Tan MS5, Sara Rosenblum MS4, Amina Ramadan MS3, Kathleen Louis MS3, Kyle Hildebrandt MS4, Alex Chavez-Yenter M.D., Kevin Lutley M.D., Amanda Witte M.D., and Nadine Talia M.D.
*If you would like a print copy of the Fall 2018 edition, please inquire via email @: firstname.lastname@example.org
by Andrew Albert
Layers of dirt, rock and bone,
dark, damp, days of carefully peeling off one by one with a fine-tooth comb.
Focus, hope, patience, needed to defend against anticipation.
The agitation can become overwhelming in the mine, I’ve seen it happen ore’ again.
When digging too deep without repose
this awakens the earth, protecting what is trying to be exposed.
One can put their whole being into this purpose, scars and ache to tell.
Know well that under dirt, rock and bone there may be gold.
Folding layers of hardship and worn nerve can hide a soul.
Life like gold.
Just as the treasures of the earth are hidden.
Let then, the miner and physician know,
that below the surface there is true color to show.
For how much more precious is a life than metal?
We must persist in uncovering the layers.
The central theme of this poem was to describe the persistence required of physicians when working with patients that may be difficult to understand, and how that could connect to the process of gold mining. They both share a persistence in the act of uncovering, whether uncovering a precious metal in mining, or removing individual barriers to get to know a patient (alternative: person). Structurally the poem includes two lines of true rhyming followed by two lines of dissidence to build tension. Every new paragraph begins with an early connecting rhyme to attempt to bring relief to the previous paragraph’s tension. This echoes the fact that the physician’s process of uncovering is an ebb and flow of tension and resolve. The poem was designed to end without a resolve with a reference to the title. This was meant to prompt the reader to look inward, contemplate the theme as a whole and connect the weight of how much time and effort should be invested in people. It may be difficult to appreciate the complete meaning throughout the lines, so this next section is meant to address some of those nuances.
Lines 1-4: The poem begins with a vague reference to mining that may be unfamiliar to most. In placer mining, many days are spent in machinery peeling back the earth, slowly descending towards the layers in which gold can be found. This mystery to which the poem is initially referring, was meant to draw the reader in and promote a moment of wonder. The type of wonder that is defined as “a moment of admiration, caused by something unexpected, unfamiliar, or inexplicable.” This wonder and curiosity can be the same way students and physicians may feel initiating a connection with a new patient. Line 3 describes how gold mining can feel like an endless process. You may find yourself asking, “Will this be worth it; are we going to find gold? What does it even look like”? The anticipation is unbearable, and one needs a strong sense of hope and vision to keep going. The same concept must be applied to patients. It may be easy to give up on someone, and believe there is nothing worth digging for. Sometimes all you want to do is give up, and the anticipation and waiting can seem overwhelming, but hope helps you persist.
Lines 5-8: Mining can be a dangerous process. If you are not careful with maintaining the angle of repose (defined as, “the steepest angle at which a sloping surface formed of a particular loose material is stable.”) when excavating the earth, the walls can cave in. Mistakes like this happen when the miner gets impatient or greedy. Just like the earth can protect its precious metals, so too patients cover themselves and hide if “rubbed” the wrong way. The process requires great care and patience, but if done in a careful manner there may be a reward at the end.
Lines 9-11: The next section reveals and confirms the connection between gold mining and humanity, with layers of hardship being the experiences that may need to be uncovered to find what is beneath. The gold in humanity is not meant to be a specific human trait, but rather the unique good in each individual. Also, a fascinating characteristic about gold is that every piece is highly unique in color and shape, and you do not need to be an expert to find a piece of it in an inconceivably large mess of dirt. You always know when you see it.
Lines 12-15: The last section alludes to “true colors.” This makes an important distinction of neutrality because what is revealed may in fact not be beautiful or precious, but they are true colors none the less. Sometimes, even after the long hours, days, and years of trying to uncover this treasure, there may not be any gold at the end of your pursuit. It is a sad truth, but both the miner and the physician must continue on in hope regardless. In regard to the line “life more precious than metal,” one must consider how vigorously we seek and sacrifice for our worldly desires, and question whether we ought to give an even more significant effort in caring for our patients.
“What I hope the reader takes from this poem is that people and situations can be complex and difficult to work with, but one must persist in hope of finding the value in a person. Physicians, after all, are just like miners, and despite major setbacks, wall cave ins, bankruptcy, or hardship, they will be back to continue digging with a renewed vigor and hope for treasure.”
The author is currently in his fourth year of medical school. Prior to committing to a career in medicine he worked for six summer seasons, gold mining in the Alaska Range.
Publication DOI: 10.15404/msrj/10.2018.0159
Corresponding author: Andrew Albert
College of Human Medicine, Michigan State University, East Lansing, MI, USA
Visit another recent post to meet our Executive Editorial Board: http://msrj.chm.msu.edu/2018-2019-msrj-executive-editorial-board/
Olivia Hudson- Olivia is a 4th year medical student serving as Senior Editor for the MSRJ. She is originally from Okemos, MI. She studied Human Biology at Michigan State University and played club lacrosse prior to medical school. She is interested in pursuing a career Interventional Cardiology. In her spare time, she enjoys biking, cooking and competitive sports.
James Parkkonen is a 4th year medical student serving as Senior Editor for the MSRJ. He hails from Negaunee, MI and majored in Psychology and Criminal Justice at the University of Michigan. He is a future Emergency Medicine physician whose hobbies include basketball, sitcoms, reading and kittens.
Aidan Tan is a 5th year medical student studying at the University of New South Wales and serving as a Senior Editor for the MSRJ.
Daniel Havlichek- Dan is a 4th year student at MSU-CHM serving MSRJ as a senior editor. He is an alumnus of the University of Michigan with a degree in microbiology. Career interests include Gastroenterology and general internal medicine. He is still seeking the perfect chicken tikka masala recipe.
Meghan Hill – Meghan is a 4th year medical student serving as Senior Editor for MSRJ. She is from Caledon, Ontario and received her Bachelors in Pharmacology at McGill University in Montreal, Quebec prior to starting medical school at MSU CHM. She is pursuing a career in Internal Medicine with potential specialization in Pulmonology and Critical Care.
Larissa Georgeon is a 4th year medical student at Michigan State University College of Human Medicine. She received her B.A. in Biology from Clark University and her M.P.H. in Epidemiology from Texas A&M University. Prior to medical school, she was an Epidemiological Fellow at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. She is interested in Global Health and has gained international experience through her public health internship in Mumbai, India and volunteering at a rural clinic in Surin, Thailand. Her passion is to pursue a career in women’s health and help alleviate domestic and global health disparities.
Francesca Cazzulino is a 4th year medical student serving as a Senior Editor for MSRJ. She is from Pasadena, CA and received her Bachelors of the Arts in Biology from Oberlin College and a Masters in Public Health in Epidemiology from UCLA Fielding School of Public Health. She is interested in pursuing a career in Internal Medicine.
Maria Rich – Maria is a 2nd year medical student at Michigan State University College of Human Medicine. She grew up in Grand Rapids, Michigan and received her B.A. in Biology from Kalamazoo College where she enjoyed studying abroad in Quito, Ecuador and playing varsity soccer. Prior to starting medical school, she worked as a Clinical Research Coordinator with the BeatCC Pediatric Oncology Research Team. At this point in her medical education, she is excited about pediatrics, genetics, and palliative care.
Ninette Musili – Ninette is a 2nd year medical student at Michigan State College of Human Medicine. She grew up in Ann Arbor, Michigan and attended the University of Michigan for a Bachelor of Science in Biomolecular Science. She is strongly interested in Global Health disparities and how they affect women and children healthcare. At this point in her education she has a strong interest in Surgery and Obstetrics/Gynecology.
Mutinta Chisowa- Mutinta is a 3rd year medical student Michigan State University College of Human Medicine. She grew up in Kalamazoo, Michigan and attended Oakwood University and recieved a B.S in Biology. She is interested in pursuing Emergency Medicine.
Baiju Patel – Baiju is a 3rd year medical student at Michigan State University College of Human Medicine. I grew up in Macomb, Michigan after arriving from India when I was a child. Attended Wayne State University and received BA in Biology. At this point in my education I have an interest to various fields ranging from Pediatrics, Psych, Neuro and Emergency Medicine.
Maddie Hulse – Maddie is a 3rd year medical student at Michigan State University College of Human Medicine. She grew up in East Lansing, Michigan and attended the University of Michigan and received a BS in Molecular and Cellular Biology. She is interested in pursuing a career in Internal Medicine or Family Medicine.
Emma Herrman – Emma is a 3rd year medical student at Michigan State University College of Human Medicine. She grew up in Shelby Twp,. MI and attended the University of Michigan, receiving a BS in biomolecular science with a minor in sociocultural anthropology. She is unsure what area of medicine she wants to pursue at this point, but is interested in emergency medicine, pediatrics and heme/onc.
Caitlin McCarthy – Caitlin is a 3rd year medical student at Michigan State University College of Human Medicine. She received her Bachelor of Arts in Chemistry and Psychology in 2013 from Kalamazoo College. After college graduation, she taught high school chemistry at University Prep High School in Detroit for three years. Outside of medical school, Caitlin is a registered yoga teacher and teaches vinyasa weekly at a studio in Grand Rapids. Her professional interests include preventive health, public and community health, women’s health, and education. She hopes to ultimately go into a field of medicine that affords her opportunities in advocacy, continuity of care, and meaningful relationships with patients.
Megan Kechner – Megan is a 3rd year medical student at Michigan State University College of Human Medicine. She received her Bachelor of Science in Neuroscience and Psychology in 2015 from Michigan State University. Her past research experience includes the study of molecular mechanisms underlying neuropsychiatric disorders such as depression and addiction. She has also conducted research at Vanderbilt University exploring the genetic variation in the human dopamine transporter gene and its role in Attention Deficit Hyperactivity Disorder. At CHM, Megan is currently using a pre- and post-test model to assess outcomes of the ThinkFirst injury prevention program. She is spending her clinical years in Flint, MI and is in the Medical Partners in Public Health Certificate program. Her professional interests include injury prevention, mental health, public health, and academic medicine. Ultimately, she is interested in pursuing a career in pediatrics, PM&R, or neurology.
Danielle Sethi – Danielle is a 3rd year medical student at Michigan State University College of Human Medicine. She received her Bachelor of Science in Architecture in 2012 from University of Michigan and her Master of Science in Physiology and Biophysics in 2014 from Georgetown University. After graduate school, she helped implement and manage the scribe program at the University of Michigan. She is in Flint, MI for her clinical years and she is in the Public Health Certificate program. Her professional interests include women’s health, public health, infectious diseases, and global medicine. She is interested in pursuing a career in Surgery or Emergency Medicine.
Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population
Author: Kelsey Grace , Michelle Carson MD, August Grace, David Betten MD
Author Affiliations: Sparrow Hospital Department of Emergency Medicine
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2018/02/ADirectiveEpub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]
Corresponding Author: Kelsey Grace, email@example.com
Advance directives are an important aspect of medical care for the elderly given the uncertainty of health and longevity. In their absence, family and physicians are often left with questions regarding what patient’s wishes would entail if they become incapacitated. Individuals >65 years presenting to the ED were surveyed during the months of June-September 2015 by study investigators regarding their knowledge and utilization of advance directives. 168 patient surveys were completed with a mean age of 77.2 (SD ±7.45 years; range 65-97). Of those, 91% were either ―very familiar‖ or ―somewhat familiar‖ with Advance Directives with 76.1% having some form of documented advance directives in place. Of those who felt family were aware of their wishes, 84.9% had assigned a Medical Durable Power of Attorney. Only a small minority had developed advance directives with their physician’s assistance (6.8%). The majority of patients stated that they had prepared their end of life documents with a Lawyer (72%). Only 35.8% of patients sampled had even mentioned the topic or their specific wishes with their primary care or ED physician. Overall rates of formalized advance directives would appear to be highly utilized in this patient population with little variation based upon respondents’ self-assessment of physical health. A surprising finding was how minor of a role physicians appear to play in the development of ADs. This provides an opportunity to enhance the physician-patient relationship and improve patient education regarding end of care discussions. Physicians should take initiative and begin having these conversations, in order to ensure that patients are making educated decisions and that proper documentation is occurring.
Published on date: February, 2018
Citation: Grace, K., Carson, M., Grace, A. et al. Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population, Medical Student Research Journal (2018). doi:10.15404/msrj/02.2018.0152
1. Koch, K. Patient Self-Determination Act. J Fla Med Assoc. 1992. 79:240–243.
2. O’Sullivan, R., Malio, K., Angeles, R., Agarwal, G. Advance directives: survey of primary care patients. Can Fam Physicians. 2015. 61(4):353-356.
3. Oulton, J., Rhodes, S., Howe, C., et al. Advanced directives for older adults in the emergency department: a systematic review. J Pallait Med. 2015. 18(6):500-505.
4. Llovera, I., Ward, M., Ryan, J., et al. Why don’t emergency department patients have Advanced directives? Academic Emergency Medicine. 1999. 6(10):1054-1060.
5. Ishihara KK, Wrenn K, Wright SW, Socha CM, Cross M. Advance directives in the emergency department: too few, too late. Acad Emerg Med. 1996. 3:50–53.
6. Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care—a case for greater use. New Engl J Med. 1991;324(13):889–895.
7. Spoelhof GD, Elliott B. Implementing Advance directives in office practice. Am Fam Physician. 2012. 85(5):461–466.
8. Edinger W, Smucker DR. Outpatients’ attitudes regarding Advance directives. J Fam Pract. 1992. 35(6):650–653.
9. Tierney WM, Dexter PR, Gramelspacher GP, Perkins AJ, Zhou XH, Wolinsky FD. The effect of discussions about Advance directives on patients’ satisfaction with primary care. J Gen Intern Med. 2001;16(1):32–40. (Patient satisfaction with physicians increases if directives are discussed).
MSRJ – Volume 5 – Fall 2017
We at MSRJ are working hard to streamline the manuscript review process to reduce the time between submission date and when a decision is made on final publication. One of the numerous barriers to fast and efficient manuscript review is something that is under author control – the quality of the submitted manuscript. In this post, I will describe an indispensable tool all authors should use in preparing a manuscript for publication.
The resource I am referring to is the “Reporting Guideline”. A reporting guideline is a document that outlines the minimum required content for your manuscript. It is like a checklist of what information should be included in your manuscript. The purpose of a guideline is to ensure authors provide required information such that a reader knows exactly what you did in your study, and if so desired, they could repeat your study using only your manuscript as a guide. The goal is to ensure all published research papers have proper reporting of details to ensure they can be critically appraised, utilized in systematic reviews, or repeated.
Use of a reporting guideline when writing your manuscript will also help shorten the time it takes from manuscript submission to journal decision. One of the major delays in the review process occurs when submitted manuscripts have missing information. This requires the journal to request a resubmission of the manuscript with the missing information, often requiring a second review. To avoid such a needless delay, we strongly recommend using a reporting guideline when submitting a manuscript to MSRJ.
So what should MSRJ authors do?
(1) Go to The Equator Network website (http://www.equator-network.org/). The Equator Network hosts hundreds of reporting guidelines on many different study design types. There are reporting guidelines for randomized trials, observational studies, systematic reviews, qualitative research, and case reports, among many others.
(2) On the Equator Network website, find the guideline appropriate to your study type.
(3) Once you have found the appropriate guideline, use the associated checklists to ensure you report all required information.
(4) Finally, cite the guideline you used in your manuscript.
By utilizing the appropriate guideline and adhering to its recommendations, you will ensure a smooth initial review and help improve the quality of research reporting in general.
Mark Trottier, Ph.D.
MSRJ Faculty Advisor
Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia
Author: Ahmed Al Wahab1 , Alaa Nugud, M.D.2 , Shomous Nugud M.D.3, Zahran Alras1
1College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
2Department of Pediatrics, Dubai Health Authority, Dubai, United Arab Emirates
3Department of Research, Sharjah Institute for Medical Research, Sharjah, United Arab Emirates
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2017/09/GlanzmannEPub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]
Corresponding Author: Ahmed Al Wahab, firstname.lastname@example.org
Key Words: Glanzmann Thrombasthenia, inherited platelet disorder, the disorder of hemostasis
Glanzmann Thrombasthenia (GT) is a rare inherited genetic platelet disorder characterized by a qualitative, or quantitative mutation in GPIIb/IIIa receptor; which results in defective platelet aggregation and diminished clot retraction.
A 19-year-old Arab descent female presented to emergency department with severe menorrhagia. On examination an ill looking pale patient in addition to generalized fatigue of one-week duration.
Acquired platelet disorders are more frequently encountered in practice than inherited ones, usually due to medical therapy or an underlying medical condition. GT, was previously known as hereditary hemorrhagic thrombasthenia, is an autosomal recessive disorder that is often disregarded as it has many clinical and laboratory findings similar to some acquired platelet disorders.
Published on date: September, 2017
Citation: Al Wahab, A., Nugud, A., Nugud, S., & Alras, Z. Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia, Medical Student Research Journal (2017). doi:10.15404/msrj/09.2017.0127
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Are medical students becoming less altruistic and more money-oriented? A three wishes survey
Author: Anna I. Perera MSc1, Anna Serlachius PhD1, Roger J. Booth PhD2 & Keith J. Petrie PhD1
1Department of Psychological Medicine, University of Auckland, NZ
2Department of Molecular Medicine and Pathology, University of Auckland, NZ
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2017/09/MedAltruismEpub-1.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]
Corresponding Author: Anna I. Perera, email@example.com
Key Words: undergraduate, motivations, altruism, money, specialization
In this study we assessed the underlying values and goals of current medical students by examining personal wishes. The authors also aimed to determine the impact of the increased financial burden of medical training on students‟ motivations by comparing current wishes to those of students from 1999. We also examined the relationships between types of wishes, choice of future medical specialty, and demographic characteristics.
An anonymous survey with the question: “If you had three wishes, what would you wish for?”, and items pertaining to specialization choice and demographics was completed by 418 medical students. Wishes were coded into seventeen categories. Results were compared to a previous survey conducted in 1999.
The largest category of wishes was altruism (40% of students) followed by achievement (36%), and money (34%). Significantly more medical students in 2015 had altruistic and achievement wishes compared to 1999. However, there was no significant increase in money-related wishes in the 2015 cohort compared to students from 1999. Final year students were more likely to report power-related wishes and male medical students had significantly more wishes related to power, money, and self-esteem. Students who aspired to be surgeons had more affiliation wishes and fewer knowledge-related aspirations. Conversely, medical students planning to enter internal medicine training were more likely to have wishes related to power and self-esteem. Achievement wishes were more common among individuals wanting to enter family medicine.
There was no evidence that medical students are becoming less altruistic and more money-orientated. Further, individuals did not appear to become less altruistic or increasingly financially driven as they progressed through the medical course.
Published on date: September, 2017
Citation: Perera, A., Serlachius, A., Booth, R., & Petrie K. Are Medical Students becoming Less Altruistic and More Money-Oriented? A Three Wishes Study, Medical Student Research Journal (2015). doi:10.15404/msrj/09.2017.0145
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