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   2019| May-August  | Volume 5 | Issue 2  
    Online since August 29, 2019

 
 
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EXPERT COMMENTARY
The use of distributed consensus algorithms to curtail the spread of medical misinformation
Mateusz Plaza, Lorenzo Paladino, Ijeoma Nnodim Opara, Michael S Firstenberg, Benjamin Wilson, Thomas J Papadimos, Stanislaw P Stawicki
May-August 2019, 5(2):93-99
DOI:10.4103/IJAM.IJAM_47_19  
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REVIEW ARTICLE
A novel treatment option for patients suffering from migraine: Erenumab
Dhruva Sharma, Neha Sharma, Uma Advani, Preksha Sharma, Ravi Prakash
May-August 2019, 5(2):100-104
DOI:10.4103/IJAM.IJAM_42_18  
Migraine is one of the common disabling neurological disorders. It is conventionally treated by antihypertensives, antidepressants, and antiepileptics for prophylaxis. In spite of all these treatment options available, physicians were always in search of an ideal drug molecule with more target-specific drug action with lesser side effects and which may improve patient compliance. This exhaustive search led to the discovery of a new molecule in the pathophysiology of migraine that is calcitonin gene-related peptide (CGRP) and which in turn led to discovery of specific CGRP antagonists such as gepants and monoclonal antibodies such as erenumab. A systematic literature search was carried out on the internet using databases such as PubMed, Cochrane Reviews, Google Scholar, and Wikipedia using keywords such as migraine, erenumab, and CGRP receptor. Detailed information about pathophysiology of migraine, CGRP, and erenumab was gathered. Erenumab is the first human monoclonal antibody approved by the Food and Drug Administration in May 2018. It is marketed under the trade name “Aimovig.” It acts as an antagonist of CGRP receptors, which plays a key role in the pathophysiology of migraine. In spite of being macromolecular human monoclonal antibodies, it has very few side effects as compared to gepants. Erenumab may offer promising role in the preventive treatment of episodic and chronic migraine. The present study describes the mechanism of action, efficacy, and side effects as documented in three completed clinical trial findings of erenumab. The following core competencies are addressed in this article: Medical knowledge, Patient care and procedural skills.
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EDITORIAL
What's new in academic International medicine? The evolving terrain of American academic medicine
Anish Bhardwaj
May-August 2019, 5(2):85-92
DOI:10.4103/IJAM.IJAM_25_19  
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ORIGINAL ARTICLES
Stop the Bleed: A nurse-driven community outreach initiative
Susan I Liu, Jeffrey Curren, Kathryn Sobocinski, Danielle Zambardino, Lindsay A Smith, Jay O Rosenberg, Nicole E Leahy, Robert J Winchell, Mayur Narayan
May-August 2019, 5(2):105-109
DOI:10.4103/IJAM.IJAM_6_19  
Introduction: As part of a national public health initiative, our Level I Trauma Center has committed to training the public in bleeding control (B-Con) as part of the Stop the Bleed (StB) campaign. Our primary objectives were for nurse-led teams to present course materials to people with no healthcare background and to evaluate the impact of this training by participants' perceived ability to respond to life-threatening bleeding. Methods: We initially launched trainings for hospital medical staff, followed by courses for community members, business entities, and academic institutions. Trainings consisted of a 30-minute lecture, followed by a skills session during which participants practiced wound compression, wound packing, and tourniquet application. Participants completed pre- and posttraining questionnaires to assess learning. Answers were scored on a five-point Likert scale. Results were entered into Qualtrics (Provo, UT). Results: A total of 345 laypersons attended 43 StB training sessions. Nurses participated as skills' instructors at 100% of the trainings. Sixty-one percent of participants had previous cardiopulmonary resuscitation (CPR) or first aid training, while 9% reported prior B-Con training. Seventy-three percent of participants reported increased confidence in responding to an emergency medical situation after training, and 86% reported increased confidence in their ability to stop someone from bleeding. Conclusion: Nurses are well equipped to teach healthcare topics in a community-based setting and represent an ideal instructor pool for the large-scale implementation of StB. Given the positive impact of this program, nurses should continue to play a crucial role in growing this nationwide hemorrhage control campaign. The following core competencies are addressed in this article: Practice-based learning and improvement, Communication skills, and Medical knowledge.
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Assessing knowledge gaps regarding end-of-life issues in patients admitted to the hospital through the emergency department
Vamsi Balakrishnan, Mayank Mehrotra, Marissa Zwiebel, Nick Brandon, Luis Vera, Rebecca Jeanmonod
May-August 2019, 5(2):110-117
DOI:10.4103/IJAM.IJAM_53_18  
Introduction: United States law requires hospitals to document advanced directives for patients on admission with no provision for assessment of their understanding. Aim: We sought to assess patients' knowledge gaps regarding end-of-life care, including do-not-resuscitate and do-not-intubate orders, physician orders for life-sustaining treatment, outcomes after cardiopulmonary resuscitation, and preferences regarding end-of-life care Methods: This is a cross-sectional survey-based study of adult patients aged 55 and older who were being admitted to a large community hospital from the emergency department (ED). Patients were not excluded based on acuity or reason for admission. The survey questioned patients regarding age, primary care provider status, ED visits and hospitalization within the prior year, prior discussions with family, primary care, or inpatient care physicians regarding advanced medical directives, prior completion of advanced medical directives paperwork, knowledge of outcomes after cardiac arrest, and general attitudes regarding priorities related to a “good death”. Results: Although 98% of patients had primary care physicians, only one-fourth recalled discussing advanced directives with their doctors. About half of patients had discussed their wishes with their families, and 52% had signed advanced directive paperwork. Patients overestimated survival after cardiac arrest. The most common elements reported by patients as being important to a “good death” were the absence of pain (26%), the presence of family (24%), and death at home (16%). Conclusion: Patients have clear ideas for what makes a good death but have inadequate knowledge regarding resuscitative outcomes and do not make use of advanced directives. Physicians miss opportunities to educate patients and assist with these difficult decisions. Closing the gap between providers' understanding of patients' desires, and patients' understanding of end-of-life care is an opportunity for improvement. The following core competencies are addressed in this article: Patient care and procedural skills and Systems-based practice.
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Pattern of mobile phone usage among medical students
Neha Sharma, Uma Advani, Lokendra Sharma, Monika Jain, Kopal Sharma, Anand Mohan Dixit
May-August 2019, 5(2):118-123
DOI:10.4103/IJAM.IJAM_61_18  
Aims and Objectives: The aim is to study the pattern of mobile phone usage among medical students. Materials and Methods: A cross-sectional study was conducted among medical students of 2nd year MBBS at SMS Medical College, Jaipur, Rajasthan, India. A preformed, pretested questionnaire was used. Data were analyzed statistically by simple proportions. Results: The response rate was 92.13%. Of 164 students, 96 were male and 68 were female. The mean age of students was 20.04 ± 0.67. Almost 100% of respondents had smartphones. Nearly 48% of students had downloaded medical apps on their mobile phones. The most common age group of starting internet use among the respondents was 11–20 years. Daily use of the internet was 3–6 h/day by most of the medical students. Most of the students used mobile phones for the purpose of social networking (n = 76) followed by online shopping (n = 56). About 32.92% of students used mobile for academic purpose. Nearly 59.75% of students obtained 41%–60% of marks in spite of extensively using smartphones which shows that they are rationally using their phones in improving their academic performance. The association between time in hours spent on mobile phones and marks obtained in the examination held in the past 3 months was statistically nonsignificant (χ2 = 10.369, degree of freedom = 9,P= 0.321). About 57.29% of students were suffering from nomophobia (NMP), 26.82% of students were at risk of NMP, and only 13.20% of students were having no NMP. Nearly 58.53% of students had ringxiety. Conclusion: Our study gives a brief idea about the addiction of mobile phones among medical students. There is a definite need of further studies in this field. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Interpersonal and communication skills, Professionalism.
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CONFERENCE ABSTRACTS AND REPORTS
The 2019 St. Luke's university health network annual research symposium: Event highlights and scientific abstracts

May-August 2019, 5(2):135-149
DOI:10.4103/IJAM.IJAM_43_19  
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LETTERS TO EDITOR
Acute heart failure within 10 days of dual-chamber pacemaker implantation: A novel etiology
Joseph G Noto, Jesse A Johnson, Santo Longo, Sudip Nanda
May-August 2019, 5(2):132-134
DOI:10.4103/IJAM.IJAM_10_19  
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IMAGES IN ACADEMIC MEDICINE
Ribbing disease
Ganesh Singh Dharmshaktu, Tanuja Pangtey
May-August 2019, 5(2):124-126
DOI:10.4103/IJAM.IJAM_23_18  
Ribbing disease is an uncommon cause of localized pain and presents as a region of diaphyseal sclerosis sparing the epiphyseal area. Clinical features are to be correlated with advanced imaging modalities to rule out other differentials. Knowledge of this lesion is important to avoid inappropriate management and a case of Ribbing disease affecting tibia of a 52-year- old male is presented. The following core competencies are addressed in this article: Medical Knowledge, Patient care and procedural skills.
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LETTERS TO EDITOR
A conversation with a refugee Lesvos, Greece
Courtney L Shay
May-August 2019, 5(2):127-129
DOI:10.4103/IJAM.IJAM_58_18  
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Scope of the aptitude tests and their validation in medical education
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-August 2019, 5(2):130-131
DOI:10.4103/IJAM.IJAM_80_17  
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