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

Author: Katherine Crabtree¹,Oanh L. Meyer², Tonya L. Fancher³

Author Affiliations:

¹UC Davis College of Medicine, Sacramento, CA, USA

²UC Davis School of Medicine, Alzheimer’s Disease Center, Department of Neurology, Sacramento, CA, USA

³UC Davis School of Medicine, Division of General Internal Medicine, Sacramento, CA, USA

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Corresponding Author: Katherine Crabtree, katcrabtree[at]gmail.com

Key Words: Hmong; Mien; Laos, refugees; cross-cultural healthcare; medical education.

Abstract: Background: In both the United States and Laos, Lao ethnic minority patients face cultural and linguistic challenges to adequate medical care. We may be able to learn from Lao experiences to improve care for patients in the United States. This study explored Laotian and American medical students’ experiences in care for these patients. Methods: Laotian and American medical students (n_19) participated in five interview groups discussing barriers to health care and strategies for addressing barriers for Laotian ethnic minority patients. Results: The students identified similar barriers to care. Laotian students identified unique strategies to address barriers to care. American students focused on general approaches to cross-cultural care. Discussion: The strategies that Laotian medical students learn in their training reflect their extensive exposure to Hmong and other Laotian ethnic minority patients, while American students learn broad strategies to care for many minority groups. Further work is needed to determine if their experience can be translated into the domestic context.

Published on date: January 1, 2015

Senior Editor: Ghadear Shukr

Junior Editor: Nadine Talia

DOI: Pending

Citation: Crabtree K, Fancher TL, Meyer TL. Care for Laotian Ethnic Minorities: A Cross-National Study of Medical Students in Laos and California. Medical Student Research Journal. 2015;4(Winter):66-70.

References:

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

Author: Lauren Ann Gamble¹, Ashley Hesson¹, Tiffany Burns².

Author Affiliations:

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

²Department of Family Medicine, Michigan State University, East Lansing, MI, USA

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Corresponding Author: Lauren Ann Gamble, gambleL2[at]msu.edu

Key Words: epidural; birth plan; labor analgesia; patient preference, decision making.

Abstract: Background: Women have been shown to value control in the labor experience, a desire that is often formalized into an explicit birth plan. Epidural preferences are a primary component of this plan. Despite this specification, women’s plans are not always carried out. This may be due to patient factors (e.g., dissatisfaction with labor), provider behaviors (e.g., frequent epidural offers), or situational variables (e.g., prolonged labor). Purpose: The current study investigates the relative impact of patient preference for epidural use as compared to provider suggestion and circumstances of labor. It hypothesizes that providing an epidural preference in a birth plan and receiving frequent epidural offers will predict epidural administration. Methods: Adult, postpartum women were surveyed about their labor experience at a high-volume obstetrics unit in a medium-sized community hospital. Responses to a structured survey instrument focused on prelabor preferences and labor characteristics. Descriptive statistics and multiple logistic regression modeling were used to analyze participant responses. Results: Eighty-three postlaboring women completed surveys, of which 79 surveys were analyzed. Eighty-four percent (N_66) received an epidural during their labor process, while 73% (N_58) desired an epidural as a part of their birth plan. Women were offered an epidural at a mean frequency of 0.2790.48 times per hour (median_0.14). The significant predictors of epidural administration were desire for an epidural in the birth plan (pB0.01) and the frequency of epidural offers (pB0.01). Wanting an epidural was associated with receiving an epidural. Conversely, increased frequency of being offered an epidural negatively correlated with epidural administration. Conclusions: Our findings indicate that personal preference is the most influential factor in determining whether or not a laboring woman will receive an epidural. Increasing provider attempts to offer an epidural – as represented by increased frequency of queries- decreased the likelihood that an epidural would be received.

Published on date: January 1, 2015

Senior Editor: Tina Chaalan

Junior Editor: Jennifer Monacelli

DOI: Pending

Citation: Gamble LA, Hesson A, Burns T. Sticking to the Plan: Patient Preferences for Epidural Use During Labor. Medical Student Research Journal. 2015;4(Winter):59-65.

References:

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5. Pennell A, Salo-Coombs V, Herring A, Spielman F, Fecho K. Anesthesia and analgesia_related preferences and outcomes of women who have birth plans. J Midwifery Women’s Health 2011; 56(4): 376-81.
6. Horowitz ER, Yogev Y, Ben-Haroush A, Kaplan B. Women’s attitude toward analgesia during labor – a comparison between 1995 and 2001. Eur J Obstet Gynecol Reprod Biol 2004; 117(1): 30-32.
7. Thompson R, Miller YD. Birth control: to what extent do women report being informed and involved in decisions about pregnancy and birth procedures? BMC Pregnancy Childbirth 2014; 14(1): 62.
8. Toledo P, Sun J, Peralta F, Grobman WA, Wong CA, Hasnain-Wynia R. A qualitative analysis of parturients’ perspectives on neuraxial labor analgesia. Int J Obstet Anesth 2013; 22(2): 119-23.
9. Fro¨ hlich S, Tan T, Walsh A, Carey M. Epidural analgesia for labour: maternal knowledge, preferences and informed consent. Irish Med J 2012; 104(10): 300-2.
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14. Hidaka R, Callister LC. Giving birth with epidural analgesia: the experience of first-time mothers. J Perinat Educ 2012; 21: 24.
15. Kannan S, Jamison RN, Datta S. Maternal satisfaction and pain control in women electing natural childbirth. Reg Anesth Pain Med 2001; 26(5): 468-72.
16. Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186(5): S160-72.
17. Lawrence HC III, Copel JA, O’Keeffe DF, Bradford WC, Scarrow PK, Kennedy HP, et al. Quality patient care in labor and delivery: a call to action. Am J Obstet Gynecol 2012; 207: 147-8.

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

Author: Virginia Corbett¹, Houria Hassouna², Reda Girgis³

Author Affiliations:

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

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

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

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

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

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

Published on date: January 1, 2015

Senior Editor: Kailyne Van Stavern

Junior Editor: Garrett Roe

DOI: Pending

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

References:

1. Office of the Surgeon General (US); National Heart, Lung, and Blood Institute (US). The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44181/ [cited 15 February 2014].
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4. Van belle A, Bu¨ ller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295(2): 172_9. doi: 10.1001/jama.295.2.172
5. Kumar NG, Clark A, Roztocil E, Caliste X, Gillespie DL,Cullen JP. Fibrinolytic activity of endothelial cells from different venous beds. J Surg Res 2015; 194(1): 297_303. doi: 10.1016/j.jss.2014.09.028
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15. Lundy JB, Oh JS, Chung KK, Ritter JL, Gibb I, Nordmann GR, et al. Frequency and relevance of acute peritraumatic pulmonary thrombus diagnosed by computed tomographic imaging in combat casualties. J Trauma Acute Care Surg 2013; 75(2 Suppl 2): S215_20. doi: 10.1097/TA.0b013e318299da66
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17. Schulz C, Engelmann B, Massberg S. Crossroads of coagulation and innate immunity: the case of deep vein thrombosis. J Thromb Haemost 2013; 11 (Suppl 1): 233_41. doi: 10.1111/jth.12261
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21. Van langevelde K, Flinterman LE, Van hylckama vlieg A, Rosendaal FR, Cannegieter SC. Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as 2 sides of the spectrum. Blood 2012; 120(5):933_46. doi: 10.1182/blood-2012-02-407551
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24. Majoor CJ, Kamphuisen PW, Zwinderman AH, Ten Brinke A, Amelink M, Rijssenbeek-Nouwens L, et al. Risk of deep vein thrombosis and pulmonary embolism in asthma. Eur Respir J 2013; 42(3): 655_61. doi: 10.1183/09031936.00150312
25. Bertoletti L, Quenet S, Laporte S, Sahuquillo JC, Conget F, Pedrajas JM, et al. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry. Respir Res 2013; 14: 75. doi: 10.1186/1465-9921-14-75
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29. Van langevelde K, Sra´mek A, Vincken PW, Van rooden JK, Rosendaal FR, Cannegieter SC. Finding the origin of pulmonary emboli with a total-body magnetic resonance direct thrombus imaging technique. Haematologica 2013; 98(2):309_15. doi: 10.3324/haematol.2012.069195
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32. Korkmaz A, Ozlu T, Ozsu S, Kazaz Z, Bulbul Y. Long-term outcomes in acute pulmonary thromboembolism: the incidence of chronic thromboembolic pulmonary hypertension and associated risk factors. Clin Appl Thromb Hemost 2012;18(3): 281_8. doi: 10.1177/1076029611431956

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White Coat Sparty.

Author:  Carter Anderson

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

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

Key Words: N/A

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

Published on date: January 1, 2015

Senior Editor: N/A

Junior Editor: N/A

DOI: pending

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

References: N/A

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Letter From the Editors.

Author: Jessica L Wummel¹, Jack C Mettler²

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

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

Key Words: N/A

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

Published on date: January 1, 2015

Senior Editor: N/A

Junior Editor: N/A

DOI: Pending

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

References: N/A