Pub Date : 2023-01-01DOI: 10.15404/msrj/02.2023.239
Christopher Keyes, Lodewijk van Holsbeeck, J. Kerver, Chi Chang
Purpose: Patient positioning plays a crucial role in the field of radiology. Lateral knee X-rays are a type of image that often has incorrect positioning of the angle of knee flexion. The ideal range is between 20 and 30 degrees. The goal of this study was to assess the angle of knee flexion at two different locations in a single hospital system while determining if several variables influence the angle. Method: This study is a retrospective chart review that assessed the angle of knee flexion in patients 18 years or older that underwent a lateral-mediolateral knee X-ray taken at an urgent care center and a general diagnostic center of a hospital within the same system between March 1 and December 1, 2021. Variables including age, sex, BMI, technologist, and location were collected from these patients’ charts and evaluated. MRI information was gathered for patients who underwent an MRI within 30 days of a lateral knee X-ray. The research team assessed effusions reported on X-ray compared to effusions reported on MRI for these patients. Results: Among patients included in the study (n = 665) the average angle of knee flexion was 51.28 degrees. Age, sex, BMI, and location were not significantly associated with the mean angle of knee flexion with p-values of 0.63, 0.13, 0.55, and 0.15 respectively. The radiology technologist taking the image did have an association with the angle of knee flexion with a p-value of 0.001. Differences in the mean angle of knee flexion between the groups of X-rays with effusions reported compared to the groups of X-rays where effusions were not reported but found on MRI resulted in a p-value of 0.83. Conclusions: The technologist taking the image was the only variable of this study that had a significant difference in mean angle of knee flexion. Additional studies are needed to determine what technologist factors are most important in determining the angle of knee flexion. Using MRI information to evaluate if effusions were not reported due to the angle of knee flexion was limited in this study due to small sample size.
{"title":"An Assessment of Knee Flexion in Lateral Knee X-rays","authors":"Christopher Keyes, Lodewijk van Holsbeeck, J. Kerver, Chi Chang","doi":"10.15404/msrj/02.2023.239","DOIUrl":"https://doi.org/10.15404/msrj/02.2023.239","url":null,"abstract":"Purpose: Patient positioning plays a crucial role in the field of radiology. Lateral knee X-rays are a type of image that often has incorrect positioning of the angle of knee flexion. The ideal range is between 20 and 30 degrees. The goal of this study was to assess the angle of knee flexion at two different locations in a single hospital system while determining if several variables influence the angle. Method: This study is a retrospective chart review that assessed the angle of knee flexion in patients 18 years or older that underwent a lateral-mediolateral knee X-ray taken at an urgent care center and a general diagnostic center of a hospital within the same system between March 1 and December 1, 2021. Variables including age, sex, BMI, technologist, and location were collected from these patients’ charts and evaluated. MRI information was gathered for patients who underwent an MRI within 30 days of a lateral knee X-ray. The research team assessed effusions reported on X-ray compared to effusions reported on MRI for these patients. Results: Among patients included in the study (n = 665) the average angle of knee flexion was 51.28 degrees. Age, sex, BMI, and location were not significantly associated with the mean angle of knee flexion with p-values of 0.63, 0.13, 0.55, and 0.15 respectively. The radiology technologist taking the image did have an association with the angle of knee flexion with a p-value of 0.001. Differences in the mean angle of knee flexion between the groups of X-rays with effusions reported compared to the groups of X-rays where effusions were not reported but found on MRI resulted in a p-value of 0.83. Conclusions: The technologist taking the image was the only variable of this study that had a significant difference in mean angle of knee flexion. Additional studies are needed to determine what technologist factors are most important in determining the angle of knee flexion. Using MRI information to evaluate if effusions were not reported due to the angle of knee flexion was limited in this study due to small sample size.","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67067301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.15404/msrj/09.2023.251
Claire McNary, Edward Rohn
{"title":"Impact of Imposter Phenomenon on Medical Learners and Clinicians: A Scoping Review","authors":"Claire McNary, Edward Rohn","doi":"10.15404/msrj/09.2023.251","DOIUrl":"https://doi.org/10.15404/msrj/09.2023.251","url":null,"abstract":"","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135496986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.15404/msrj/05.2023.234
M. Goodman, Wesley T. Richerson, D. Wolfgram
Diffusion-tensor imaging has become common practice in radiology and imaging research due to its many applications in brain connectivity and neurodevelopment as well as for pathologies including tumors, ischemia, trauma, and neurodegeneration. However, its novelty compared to other neuroimaging techniques has meant that graduate programs, particularly medical schools, have not included opportunities to learn how diffusion tensor imaging can visualize the brain and interpretation of the data clinically and in research. Diffusion tensor imaging can be a challenging utility to understand for newcomers and is subject to wide interpretation. We offer for medical and graduate students as well as residents a step-by-step guide in interpreting diffusion tensor imaging results for clinical analysis using simple explanations of physics and neuroscience and its application in clinical and translational research.
{"title":"Diffusion Tensor Imaging: A Step-by-Step Guide for Radiology and Neurology Clerkship Students, Residents, and Graduate Students Using Clinical Research Examples","authors":"M. Goodman, Wesley T. Richerson, D. Wolfgram","doi":"10.15404/msrj/05.2023.234","DOIUrl":"https://doi.org/10.15404/msrj/05.2023.234","url":null,"abstract":"Diffusion-tensor imaging has become common practice in radiology and imaging research due to its many applications in brain connectivity and neurodevelopment as well as for pathologies including tumors, ischemia, trauma, and neurodegeneration. However, its novelty compared to other neuroimaging techniques has meant that graduate programs, particularly medical schools, have not included opportunities to learn how diffusion tensor imaging can visualize the brain and interpretation of the data clinically and in research. Diffusion tensor imaging can be a challenging utility to understand for newcomers and is subject to wide interpretation. We offer for medical and graduate students as well as residents a step-by-step guide in interpreting diffusion tensor imaging results for clinical analysis using simple explanations of physics and neuroscience and its application in clinical and translational research.","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67067623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.15404/msrj/10.2022.219
Rohit Abraham, N. Ladaga, T. Sapp, L. Ouellette, Matt Singh, M. Emery, Jeffrey Jones
,
，
{"title":"Ethical Issues Confronting Medical Students During a Clerkship in Emergency Medicine","authors":"Rohit Abraham, N. Ladaga, T. Sapp, L. Ouellette, Matt Singh, M. Emery, Jeffrey Jones","doi":"10.15404/msrj/10.2022.219","DOIUrl":"https://doi.org/10.15404/msrj/10.2022.219","url":null,"abstract":",","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67067998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.15404/msrj/12.2022.224
A. Kashyap, J. Gandhi, P. Shinde
Introduction : This study aims to assess the impact of various teaching methods including role play, didactic lectures, and case studies on the history taking and communication skills of second-year Bachelor of Medicine and Surgery (MBBS) students. The goal is to help students become better doctors by arriving at diagnoses quicker by asking relevant questions in their history taking. A secondary goal is to improve the doctor–patient relationship through better communication skills. Methods : The students were assessed on their history taking and communication skills before and after the application of specific teaching methods. The teaching methods were chosen according to efficacy and impact as shown by other research articles, in addition to the convenience of applying them to our study and the curriculum of similar schools. The improvement was scored by the faculty at KEM Hospital in Mumbai, India, where the study was conducted, using a checklist that includes the main aspects of communication and general history taking. We tested the students on their communication skills, completeness of their history taking with regard to the history of the presenting illness, history of past illnesses, personal history, family history, and mental status report. The results of the pre-and post-intervention scores were analyzed using paired t-tests. Results : Fifteen students were assessed in this study. The results showed improvement in their mean scores after the teaching methods were applied. Using the student t-test, we statistically analyzed the students pre-and post-intervention. The p-value was found to be statistically significant (<0.05) in communication skills, completeness of their history taking with regard to the history of the presenting illness, history of past illnesses, family history, and mental status report. It was found to be non-significant with regard to personal history taking. Conclusions : The students benefited from the teaching sessions conducted during their surgical rotations. Applying these teaching tools helped students come to diagnoses better through history taking alone. Their communication skills were also found to be significantly improved, which has shown to positively impact physician–patient rapport and treatment compliance. We have concluded that it would be meaningful to incorporate these teaching tools in the curriculum of second-year undergraduate students with the goal of making them better physicians in the future.
{"title":"The Impact of Specific Teaching Methods on Communication and History Taking in Second Year Medical Students","authors":"A. Kashyap, J. Gandhi, P. Shinde","doi":"10.15404/msrj/12.2022.224","DOIUrl":"https://doi.org/10.15404/msrj/12.2022.224","url":null,"abstract":"Introduction : This study aims to assess the impact of various teaching methods including role play, didactic lectures, and case studies on the history taking and communication skills of second-year Bachelor of Medicine and Surgery (MBBS) students. The goal is to help students become better doctors by arriving at diagnoses quicker by asking relevant questions in their history taking. A secondary goal is to improve the doctor–patient relationship through better communication skills. Methods : The students were assessed on their history taking and communication skills before and after the application of specific teaching methods. The teaching methods were chosen according to efficacy and impact as shown by other research articles, in addition to the convenience of applying them to our study and the curriculum of similar schools. The improvement was scored by the faculty at KEM Hospital in Mumbai, India, where the study was conducted, using a checklist that includes the main aspects of communication and general history taking. We tested the students on their communication skills, completeness of their history taking with regard to the history of the presenting illness, history of past illnesses, personal history, family history, and mental status report. The results of the pre-and post-intervention scores were analyzed using paired t-tests. Results : Fifteen students were assessed in this study. The results showed improvement in their mean scores after the teaching methods were applied. Using the student t-test, we statistically analyzed the students pre-and post-intervention. The p-value was found to be statistically significant (<0.05) in communication skills, completeness of their history taking with regard to the history of the presenting illness, history of past illnesses, family history, and mental status report. It was found to be non-significant with regard to personal history taking. Conclusions : The students benefited from the teaching sessions conducted during their surgical rotations. Applying these teaching tools helped students come to diagnoses better through history taking alone. Their communication skills were also found to be significantly improved, which has shown to positively impact physician–patient rapport and treatment compliance. We have concluded that it would be meaningful to incorporate these teaching tools in the curriculum of second-year undergraduate students with the goal of making them better physicians in the future.","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67067639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.15404/msrj/10.2022.228
Brandon Ballane, Mark Berkowitz, Josselyn Galdamez, Olivia Gellerson, Sirajul Islam, Ami Merker, Catherine Morse, Nicholas Rich, Daniel Peters
We aim to add to the literature regarding Petit (inferior lumbar) hernias. The presence and location of lower back masses may have a deeper origin than initially apparent. We urge the surgical community to keep in mind the differential diagnosis of lumbar hernia, although rare, when evaluating subcutaneous masses and lipomata in this region. Simple excision may address the mass but not the cause and will lead to early recurrence of the presenting problem.
{"title":"A case of Petit's hernia presenting as bilateral lipomata of the back","authors":"Brandon Ballane, Mark Berkowitz, Josselyn Galdamez, Olivia Gellerson, Sirajul Islam, Ami Merker, Catherine Morse, Nicholas Rich, Daniel Peters","doi":"10.15404/msrj/10.2022.228","DOIUrl":"https://doi.org/10.15404/msrj/10.2022.228","url":null,"abstract":"We aim to add to the literature regarding Petit (inferior lumbar) hernias. The presence and location of lower back masses may have a deeper origin than initially apparent. We urge the surgical community to keep in mind the differential diagnosis of lumbar hernia, although rare, when evaluating subcutaneous masses and lipomata in this region. Simple excision may address the mass but not the cause and will lead to early recurrence of the presenting problem.","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67068055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.15404/msrj/02.2022.226
N. Nikroo, Michael Lee, E. Leach, L. Fomum-Mugri, A. Nelson, L. Ouellette, Jeffrey Jones
Background: In addition to the purposeful teaching of knowledge and skills to medical students, the ‘hidden curriculum’ (HC) refers to the inadvertent – and often unrecognized – transmission of implicit ideas, attitudes, and behaviors. One way to raise student and teacher understanding of the HC is to provide them concrete examples of how and when it occurs during medical school. The goal of this study was to investigate how the HC is depicted in popular medical television (TV) shows. Methods: A systematic content analysis of successive episodes of eight prime-time TV shows was completed using a standardized classification scheme. A complete season of each TV program was analyzed to identify and classify depictions of the HC as it pertains to medical students. Our classification scheme used four dominant themes: what students discovered about medicine, what students learned about becoming a physician, what students experienced, and what students realized about themselves. After coding, all incidents were classified as ‘negative’ if a rule or normal procedure was broken or ‘positive’ if they followed established professional values or provided patient-centered care. Results: A total of 137 episodes were viewed with 1,160 depictions of the HC portrayed. The TV shows with the most depictions were Code Black and Scrubs. Within the four dominant themes, 45 subthemes were identified. Most depictions (66.7%) were described as positive and included conflict resolution, sensitivity, respect, empathy, accountability, and role modeling. However, 33.3% (386/1,160) were negative and included unrealistic patient expectations, working in a chaotic environment, haphazard learning interactions, emotional detachment, loss of idealism, complex social situations, and dealing with uncertainty. Conclusions: Television dramas contain many positive and negative examples of the HC during undergraduate medical training. Short snippets from these incidents could be used in an educational setting to teach related issues including professionalism, ethics, role modeling, communication skills, and coping techniques.
{"title":"The Hidden Curriculum of Medicine Portrayed in Popular Television Medical Shows","authors":"N. Nikroo, Michael Lee, E. Leach, L. Fomum-Mugri, A. Nelson, L. Ouellette, Jeffrey Jones","doi":"10.15404/msrj/02.2022.226","DOIUrl":"https://doi.org/10.15404/msrj/02.2022.226","url":null,"abstract":"Background: In addition to the purposeful teaching of knowledge and skills to medical students, the ‘hidden curriculum’ (HC) refers to the inadvertent – and often unrecognized – transmission of implicit ideas, attitudes, and behaviors. One way to raise student and teacher understanding of the HC is to provide them concrete examples of how and when it occurs during medical school. The goal of this study was to investigate how the HC is depicted in popular medical television (TV) shows. Methods: A systematic content analysis of successive episodes of eight prime-time TV shows was completed using a standardized classification scheme. A complete season of each TV program was analyzed to identify and classify depictions of the HC as it pertains to medical students. Our classification scheme used four dominant themes: what students discovered about medicine, what students learned about becoming a physician, what students experienced, and what students realized about themselves. After coding, all incidents were classified as ‘negative’ if a rule or normal procedure was broken or ‘positive’ if they followed established professional values or provided patient-centered care. Results: A total of 137 episodes were viewed with 1,160 depictions of the HC portrayed. The TV shows with the most depictions were Code Black and Scrubs. Within the four dominant themes, 45 subthemes were identified. Most depictions (66.7%) were described as positive and included conflict resolution, sensitivity, respect, empathy, accountability, and role modeling. However, 33.3% (386/1,160) were negative and included unrealistic patient expectations, working in a chaotic environment, haphazard learning interactions, emotional detachment, loss of idealism, complex social situations, and dealing with uncertainty. Conclusions: Television dramas contain many positive and negative examples of the HC during undergraduate medical training. Short snippets from these incidents could be used in an educational setting to teach related issues including professionalism, ethics, role modeling, communication skills, and coping techniques.","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67067256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.15404/msrj/10.2022.222
Nathan DeBruine, Stephane Leung Wai Sang
Quadricuspid aortic valves (QAVs) are a rare congenital anomaly associated with increased risk of aortic insufficiency. This case presents the incidental finding of a QAV on intraoperative transesophageal echocardiography (TEE) after going undetected on transthoracic echocardiography multiple times, suggesting that TEE may be a superior imaging modality for the identification of this defect. This patient with a history of coronary artery disease presented with sudden onset moderate to severe aortic insufficiency and required subsequent aortic valve replacement (AVR).
{"title":"Quadricuspid Aortic Valve by Transesophageal Echocardiography","authors":"Nathan DeBruine, Stephane Leung Wai Sang","doi":"10.15404/msrj/10.2022.222","DOIUrl":"https://doi.org/10.15404/msrj/10.2022.222","url":null,"abstract":"Quadricuspid aortic valves (QAVs) are a rare congenital anomaly associated with increased risk of aortic insufficiency. This case presents the incidental finding of a QAV on intraoperative transesophageal echocardiography (TEE) after going undetected on transthoracic echocardiography multiple times, suggesting that TEE may be a superior imaging modality for the identification of this defect. This patient with a history of coronary artery disease presented with sudden onset moderate to severe aortic insufficiency and required subsequent aortic valve replacement (AVR).","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67068046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.15404/msrj/04.2022.223
Zachary Jodoin, S. Sims, T. Petsche
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Abstract Case: We present a case of acute idiopathic four-compartment syndrome of the leg, treated by four-compartment fasciotomy, and wounds left to heal by secondary intention due to persistent edema following surgery. Conclusion: This case highlights the importance of maintaining a high level of clinical suspicion for idiopathic spontaneous compartment syndrome presentation. This case also illustrates the variability of compartment syndrome treatment and recovery. The standard treatment for compartment syndrome is fasciotomy with delayed primary wound closure, but the patient elected to heal by secondary intention. The patient’s long term follow-up results showed positive outcomes.
{"title":"Idiopathic Acute Four-Compartment Syndrome of the Lower Leg","authors":"Zachary Jodoin, S. Sims, T. Petsche","doi":"10.15404/msrj/04.2022.223","DOIUrl":"https://doi.org/10.15404/msrj/04.2022.223","url":null,"abstract":"This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Abstract Case: We present a case of acute idiopathic four-compartment syndrome of the leg, treated by four-compartment fasciotomy, and wounds left to heal by secondary intention due to persistent edema following surgery. Conclusion: This case highlights the importance of maintaining a high level of clinical suspicion for idiopathic spontaneous compartment syndrome presentation. This case also illustrates the variability of compartment syndrome treatment and recovery. The standard treatment for compartment syndrome is fasciotomy with delayed primary wound closure, but the patient elected to heal by secondary intention. The patient’s long term follow-up results showed positive outcomes.","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67067414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.15404/msrj/08.2021.198
M. Sharobim
Introduction: Gliomas are neoplasms of the central nervous system (CNS). Despite aggressive treatment, median survival of malignant tumors remains poor at 12 - 18 months. Newer treatments allow delivery of therapeutic substances across the selectively permeable blood-brain barrier (BBB). This allows for chemotherapeutics to more easily reach their target location in the CNS. Drug eluting wafers made up of carmustine can be placed in the surgical resection cavity of a tumor and clinical trials to date have demonstrated their utility. Hypothesis: Bypassing the BBB to allow greater accumulation of chemotherapeutics in the CNS will improve clinical outcomes in glioma patients. Methods: Studies from medical literature databases describing trials using carmustine wafers implanted after glioma resection were obtained. To test our hypothesis, the available data using this therapy was compared to current first line treatment data for glioma as described by Stupp and colleagues. The inclusion criterion for efficacy analysis was histopathologically confirmed primary glioma. Exclusion criteria included presence of metastasis or pediatric tumors. Results: 10 studies describing wafer therapy use were initially gathered, encompassing over 500 patients. 6 studies met criteria for treatment efficacy analysis. 4 of 6 (75%) trials exhibited significant survival advantage as compared to control treatment. Furthermore, 3 of the 4 (75%) studies showing significance also demonstrated equal or higher percent increase in overall survival from control as compared to data generated from current first line therapy. Conclusion: Treatments bypassing the BBB are not currently standard-of-care for patients with glioma. We uncovered that most trials using carmustine implants post tumor resection describe increased overall survival, however in specific cohorts. Diverting the BBB in general may also have fewer side effects in contrast to classical routes of therapy. Future work is needed to develop similar therapeutics that improve outcomes in all age, gender, and prognostic risk factor populations.
{"title":"Bypassing the Blood-Brain Barrier to Treat Brain Cancer: A Systematic Review of the Efficacy of Carmustine Wafer Implant Therapy","authors":"M. Sharobim","doi":"10.15404/msrj/08.2021.198","DOIUrl":"https://doi.org/10.15404/msrj/08.2021.198","url":null,"abstract":"Introduction: Gliomas are neoplasms of the central nervous system (CNS). Despite aggressive treatment, median survival of malignant tumors remains poor at 12 - 18 months. Newer treatments allow delivery of therapeutic substances across the selectively permeable blood-brain barrier (BBB). This allows for chemotherapeutics to more easily reach their target location in the CNS. Drug eluting wafers made up of carmustine can be placed in the surgical resection cavity of a tumor and clinical trials to date have demonstrated their utility. Hypothesis: Bypassing the BBB to allow greater accumulation of chemotherapeutics in the CNS will improve clinical outcomes in glioma patients. Methods: Studies from medical literature databases describing trials using carmustine wafers implanted after glioma resection were obtained. To test our hypothesis, the available data using this therapy was compared to current first line treatment data for glioma as described by Stupp and colleagues. The inclusion criterion for efficacy analysis was histopathologically confirmed primary glioma. Exclusion criteria included presence of metastasis or pediatric tumors. Results: 10 studies describing wafer therapy use were initially gathered, encompassing over 500 patients. 6 studies met criteria for treatment efficacy analysis. 4 of 6 (75%) trials exhibited significant survival advantage as compared to control treatment. Furthermore, 3 of the 4 (75%) studies showing significance also demonstrated equal or higher percent increase in overall survival from control as compared to data generated from current first line therapy. Conclusion: Treatments bypassing the BBB are not currently standard-of-care for patients with glioma. We uncovered that most trials using carmustine implants post tumor resection describe increased overall survival, however in specific cohorts. Diverting the BBB in general may also have fewer side effects in contrast to classical routes of therapy. Future work is needed to develop similar therapeutics that improve outcomes in all age, gender, and prognostic risk factor populations.","PeriodicalId":91358,"journal":{"name":"Medical student research journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67067732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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