August 2012 Diary of an MSTAR Student
August 2012 Diary of an MSTAR Student

Kerry Bertke: Making Progress with Preventative Medicine

August 30, 2012

As I wrap up my time at UNC Chapel Hill and my on-site work at the Center for Health Promotion and Disease Prevention I realize how fast eight weeks can go. I remain extremely excited about prevention medicine and believe even more strongly that speaking to individuals about diet and exercise, and offering methods to change poor habits, is important. In addition, my visit to Lenoir County and my interaction with the participants demonstrated how determined and successful a group of people can be when all are motivated and supported in their efforts to change lifestyle habits. This is a group of people at high risk for cardio vascular disease (CVD) for many reasons, but they seem committed to making progress through dietary changes and consistent physical activity in order to reduce that risk and make a healthier life for themselves and their families. It is important to them and the health of their community.

My work with this project also revealed that the aging population, in particular, can benefit greatly from lifestyle advice and intervention. According to research literature, despite the onset of health concerns with age many aging patients are more likely to have healthier dietary practices than younger adults, like eating more fruit and vegetable servings per day. They also are more likely to make the necessary changes in habit according to advice from health care professionals. This evidence makes the work of my mentor and those in his field even more important and valuable to the future of health care and the efforts to reduce the prevalence of not only cardiovascular disease, but other chronic diseases as well.

I feel privileged to have experienced the MSTAR opportunity at my alma mater, and to have met so many inspired researchers and physicians. I hope to stay informed on the progress of the cardiovascular disease lifestyle intervention and the involved participants in Lenoir County, North Carolina, and I look forward to seeing the additional research and developments that come from this project. I’m also excited to apply what I’ve seen and learned through this opportunity during my second year of medical school. With all they have to teach us, medical schools do not focus enough on nutrition, or even preventative medicine as a whole, so I hope to share some of what I learned through this project with my peers and also further explore its application to the aging adult population. I know this is a population that will be continuously growing as the Baby Boomers age, and a cohort that I will see often once I become a physician.

Participating in the MSTAR summer program is a privilege and I’m grateful to have had the company of so many other interesting and motivated medical students and researchers.

Kerry Bertke
Ohio University Heritage College of Osteopathic Medicine

 


Ann Tukpah: Understanding the Significance of "Normal" vs. "Abnormal" Test Results

August 29, 2012

We are a few weeks into the MSTAR program and the summer days have been long but fleeting. Our most recent didactic session was truly dynamic; topics from prostate cancer screening, survey development and funding and grant writing were studied. It was an informative and lively session. I’m continuing my work at the Non-Invasive Cardiology unit at Mount Sinai, studying patient outcomes after a myocardial perfusion imaging (MPI) test. My project will investigate differences between patients over age 80 that have an “abnormal” MPI study and those that have a “normal” study. We will also explore the downstream actions (invasive procedure, medical management, further testing, no follow-up) taken after an MPI study has taken place. We would like to describe the patient population seen here, understand difference between them and determine what patients can expect after a study is completed. We anticipate this research will promote understanding of our geriatric population, impact clinical decisions on testing geriatric patients and contribute to the general body of knowledge. The team in the unit – attending, fellows, nurses, and technicians – have all been very welcoming and patient in answering all my questions and teaching me exciting things. I’m looking forward to continuing to learn more.

In addition to the didactic sessions and research, the shadowing at the Martha Stewart Center was a great experience. The patients were very interested in speaking with me and the attending explained many concepts and actions. It was a unique opportunity to interact with everyone involved and I am appreciative of the dedicated time to engage in this opportunity.

Ann Tukpah
Mount Sinai School of Medicine

 

 

Susanna O'Kula: Language Fluency & Care Transitions

August 24, 2012

The three weeks after my last post proved vastly different from the first few I spent at the Bronx VA: our patient recruitment jumped up to 5-7 a week! By now, I imagine I could administer the baseline questionnaire in my sleep. In addition to study enrollment and follow-up phone calls, I've spent a lot of time doing chart abstraction for the nearly 60 patients now enrolled in the study to better understand "my" population. Even within a geriatrics cohort, the range of the patients' health status amazes me—one chart might show thirteen active medications, six chronic conditions, and a 30-day rehospitalization for a 77 year-old, but the next might display only five medications and a few chronic conditions for an 85 year-old veteran.

When I look specifically at the responses to questions targeting English vs. Spanish fluency, I've found rather unusual responses. The overwhelming majority of patients are English-speaking, but some veterans, usually from Puerto Rico, say that “Spanish” is their primary language or what they mainly speak at home. They attribute their ability to get by in medical settings, however, to their spouse, child, or caregiver’s translating. When I asked one patient to explain why “English” was his primary language but “Spanish” was what was spoken at home, he smiled and explained that his Colombian wife speaks no English. They converse solely in Spanish, so he considers himself bilingual because he also speaks English well. The survey responses suggest "English fluency" and "Spanish fluency" are not black-and-white definitions; instead, the exercise has revealed a diversity of patient care transitions experiences.

This week and next I'm describing my data and testing hypotheses with STATA. Learning how to use this statistical package and write different codes and commands for the predictor and outcome variables I want to analyze has been one of the more humbling experiences of my summer project. I’m lucky to have a patient PI who can answer my many questions! A statistician I am not, but it's been enlightening to attempt to understand how the tables and graphics I see in abstract presentations are actually generated. In the last couple of weeks of my MSTAR project, I’m eager to synthesize the data collected thus far.

Susanna O'Kula
Mount Sinai School of Medicine

 

 

Elizabeth Pedowitz: Moving from Data Collection to Data Analysis

August 21, 2012

My research is continuing to go well. My project consists of looking at how much time physicians in the Mount Sinai Visiting Doctors (MSVD) program spend providing care outside of home visits. Physicians have been filling out research forms I’ve created for every interaction/event they have outside of the home visits related to patient care. I’m currently in the last week of data collection.

I’ve been entering data for the last couple of weeks and I’m nearing the end of it, thankfully. Entering the data has taken much more time than I thought it would. The number of research forms the physicians handed back to me is astounding.  I’m really relieved to see they were able to complete the forms despite their incredibly busy schedules. And despite the time commitment, I’d much rather have tons of data than not enough! On Monday I’m meeting with my PI so we can discuss how to analyze the data that I’ve collected and put in an excel spreadsheet.

One of my research questions is how the time spent providing care outside of home visits differs in the two different models of care that MSVD has. The team approach has a nurse practitioner take many of the calls that come in for the physicians, whereas the regular practice does not have this. It will be interesting to see how the time compares between physicians in each group. My PI and I hypothesize that if you take the time that the NP spends providing care for the team, it will end up equaling the extra combined time of the physicians in the regular practice.

Our weekly MSTAR classes have been going well. This week we talked about data analysis and last week we spoke about eye and ear issues in geriatrics patients. It was interesting learning what is and is not part of normal aging. We did both a hearing and vision exercise. The hearing exercise was called the “Unfair hearing test” and we had to listen to a bunch of words played out loud with different frequencies simulating hearing loss. We were supposed to write down what we thought the words were. We all had a lot of trouble figuring out the right words. The doctor teaching us explained that many elderly people have problems with high frequencies so when speaking with someone who is hard of hearing don’t speak louder but rather more slowly and with a lower tone.  The vision exercise involved a bunch of plastic glasses simulating different types of vision loss. It was really interesting to be put in the shoes of someone with vision loss or hearing loss.

I also have had some extremely interesting shadowing experiences. Last Wednesday I was with the Concurrent team doing rounds in the hospital. One patient spoke Spanish and the fellow I was with didn’t, so I had to translate while she assessed the patient’s mental capacity by asking such things as “Who is the president?”, “What year is it?”, “Can you please draw a clock that shows 2 o’clock?” etc. I then had to continue to translate when a cardiologist came by to tell her that she had three vessel coronary disease. I wasn’t 100% comfortable translating this because it was such upsetting news to the patient and her daughter. However, it showed me how important my Spanish knowledge is. One patient we saw had had a massage and meditation session the day before as part of the Geriatrics department’s services. She said that it had definitely calmed her down. I’m sure integrative medicine is underused and it was great to see it being given to patients here and to see them benefitting from it.

Elizabeth Pedowitz
Mount Sinai School of Medicine

 

 

Ranjith Babu: Reviewing Charts and Meeting Patients with Glioblastoma

August 20, 2012

My experience thus far in the MSTAR program has been both enlightening and motivating. I am currently doing glioblastoma (brain tumor) research at the Duke University Medical Center and have been making good progress. I have identified a cohort for the basis of my projects and am performing chart reviews to extract the necessary data for analysis. I am pretty excited to finish completing all of the data collection and begin analysis, which will surely provide insights for improving the management of glioblastoma in the elderly. Performing chart reviews has also vastly increased my knowledge in the treatments for glioblastoma, the side effects of medical and surgical therapy, and prognostic factors for survival.

In addition to my clinical research, I have been going to a brain tumor clinic every week. This has been a profoundly inspiring experience which has refreshed my motivation for becoming an academic neurosurgeon. Interviewing patients and hearing their stories reminds me of the hardships that patients go through after being diagnosed with aggressive and devastating diseases such as glioblastoma. Not only must they undergo craniotomies for surgical resection, a highly invasive and high-risk procedure, but they must also receive radiotherapy and prolonged courses of chemotherapy. It is heart breaking to see grandparents whose only request is to be able to attend their grandchild’s graduation, piano recital, or birthday, a promise we frequently cannot make.

These research and clinical experiences have been both professionally and personally enriching. While I continue to toil away at the computer to finish my data collection, I will have the memories of the brain tumor patients pushing me forward.

Ranjith Babu
Duke University School of Medicine

 

 

Derek Berglund: Conducting a Retrospective Chart Review

August 13, 2012

I am now near the midpoint of my retrospective chart review as part of the MSTAR program and the project has been an even greater learning tool than I originally anticipated. I have been looking at medical records for quite some time now and thus the daily process of reviewing them has become fairly automatic. However, I am still intrigued by the information I find while reading through cases. After looking through many records, I have begun to pick up on trends even before performing statistical analysis. For example, in my study on elderly patients undergoing surgery for hip fracture, I have noticed that a large number of these patients are discharged to nursing homes even if they originally lived at home, were independent, and had good health. I also enjoy reading through the clinical resumes on how the hip fracture injuries occur and what each patient’s hospital course consists of. I have encountered a range of different scenarios with some stories being simple and some absurd. This variety keeps my work interesting and my brain engaged.

I begin a typical day by biking to the hospital and taking the elevator to the floor where the medical records office is located. I head to the physician’s lounge where most of my work is done. The room contains computers but I usually prefer an empty desk so I may use my own laptop. I then locate and collect the charts I wish to review. I normally review about twenty-five charts per day but there are usually only about fifteen of these that meet the inclusion criteria for my study. Records from 2009 to the present are found through the online system and thus are easy to access. Records older the 2009 must be obtained in hard copy form and I order these from the medical records office several days before I plan to review them. I take each box back to the physician’s lounge and go through them one by one. One problem I have encountered when dealing with hard copies is that many records consist of several volumes. Many times, not all of the volumes for a given record are in the same box so I must go through many boxes looking for several parts of one record. Also, hard copies of charts are sometimes incomplete and I therefore cannot acquire all the information I need. For these reasons, it is usually more efficient to review charts in electronic form. At the conclusion of my day, I pack up the boxes with the records and mark the boxes I have finished so that they may be taken back into storage. I then bike back home and start again the following day.

Derek Berglund
Saint Louis University

 

 

Lalitha Kunduru: The Challenges of Patient Recruitment

August 7, 2012

I have completed over a month of research and have fallen into a daily routine. I have learned the difficulties of gaining approval from clinics to recruit patients there. I realize that it is a concern for clinics because patients with appointments are generally sick and do not want to be bothered by research studies. They may already be anxious about having to visit the doctor and don’t want to fill out any unnecessary paperwork, especially for a medical student who is not treating them directly. Although I have accepted that getting rejected is a part of patient recruitment in research, I have learned that others are very receptive to helping research and want to spend the time to talk to me and ask about my project. I have learned that some patients cringe at the word "research" so I have started to just use the word "study". So far, I have completed twenyt-two interviews. Some days provide better results than others and I have learned that this is just due to chance and there is not much that I can do about it.

My shadowing experiences have been incredibly useful. I’ve learned that geriatrics is a field where a lot of different sides of medicine overlap. It is a challenging field because patients usually come in with multiple problems and it is necessary to manage the patient as a whole. It is important to take into account how many medications a patient is taking and to make sure this list does not get unmanageable. The end goal is to improve the quality of life for the patient and sometimes this may include tradeoffs. One of the most inspiring things for me this summer has been seeing how devoted and caring some of the family members of the patients are. Because I had seen geriatrics patients in hospitals being neglected in the past, I was happy to see that this is not always true. I am very grateful for the experiences that I am gaining because I am extremely confident that they will be valuable for me regardless of the field that I pursue. Furthermore, with each day I am attracted more and more to the field of geriatrics. I want to play a role in taking care of elderly patients one day; and the physicians that I have gotten to shadow are some of the best role models that I have encountered in the medical field.

Lalitha Kunduru
University of North Carolina

 

 

 

Anne Richardson Wright: Drafting a Manuscript

August 3, 2012

Today marks the halfway point in my 8-week MSTAR experience here at the University of North Carolina (UNC). The week began with the usual 10 a.m. database meeting with the primary investigators (MDs and PhDs), statisticians, physical therapist, epidemiologists, and research students such as myself. This is a fantastic meeting to sit in on because it focuses on all aspects of data processing, from collection to analysis. It is an arena for brainstorming, organizing and clarifying the existing and/or potential databases maintained by the Thurston Arthritis Research Center. At this meeting I spent most of my time absorbing information on how to conduct sound and compelling research. At the end of the meeting, however, I had the opportunity to update everyone on the neck and shoulder data that I am currently analyzing. Our data is looking very strong and everyone at the meeting seemed to think that we would be able to publish a very interesting study.

This response was very encouraging, so after the meeting I sat down and drafted the introduction to my manuscript. This involved a literature review and careful consideration of the data: a process which allowed my to clarify the importance and aims of my MSTAR research project. I sent my draft to my mentors, Dr. Amanda Nelson and Dr. Joanne Jordan, who spent time giving my very constructive and positive feedback. This experience alone boosted my confidence in writing research papers and has fueled my enthusiasm for participating in research.

With my paper started, I then focused on getting more experience in the rheumatology clinic by shadowing one of my mentors. I was fortunate to go on a day when six patients came in with six different medical issues. These included gout, fibromyalgia, CREST syndrome, osteoarthritis, rheumatoid arthritis, and a seronegative spondyloarthropathy. It was interesting to witness the presentation of these illnesses and how each is treated, rather than simply reading about them in a textbook. However, what struck me most in this particular clinic was that every one of the patients had done extensive online research into their disease. Thus, much of the history taking was directed by the patient’s web-based information, whether correct or incorrect. It was educational to see how my mentor navigated the patients towards a better understanding of what they had read and away from erroneous information obtained from illegitimate websites. She never dismissed anything the patient said as "stupid", instead she validated their thoughts and then offered a counterargument that she used to persuade the patient to trust her over the Internet. I found this to be a wise approach and one that I will apply as a future physician.

With these valuable research and clinical experiences under my belt I am going to wrap up my week by writing more of my manuscript, attending rheumatology grand rounds and going to our MSTAR didactic session. I would count this as a very successful week in my MSTAR experience and I am glad to say that each one of the four weeks here has been equally as great. I can’t help but think to myself  "thank goodness I decided to participate in this program" because I have learned so much about clinical skills, the specialties of geriatrics and rheumatology, and executing reliable research projects.

Anne Richardson Wright
University of Hawaii



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