This assignment was between 1800 to 2700 words (approximately 6 to 9 pages) and included three major parts. Using models discussed in class, students were asked to choose between:
- Position paper. In this sort of paper, you’ll use research to present an argument for or against a particular position relevant to your field of study.
- Research proposal/grant proposal model paper. In this paper, you’d make a case for the value of a particular sort of program for research or line of inquiry in your field, or advocate for an approach to research relevant to your field.
- Argument to Action. In this paper, you’d want to present a case for a specific plan of action to address a concern relevant to an issue in the your field.
The first component of this assignment was the proposal. This served as a declaration of a topic, a plan of execution and an explanation as to why the student chose this topic. It then included a progress report of research and data collected thus far and a plan of action for the development of the paper with a minimum of two annotated bibliography entries.
Self-Reflection
This is the assignment that we were preparing for from the beginning of the semester. We were allowed to draw from our previous research and writings in order to construct a topic that either continued from our literature review or was a new topic entirely. I opted to combine both papers since I had already done extensive research on a topic I had selected earlier in the semester. Throughout the drafting and peer reviews I had decided to write a research grant proposal in a specific hospital with a specific sample size and patient in mind with a specific procedure to treat those patients. Although this was my approach, with guidance I learned not to include such specific details. Drawing from research already done on the topic, this paper was to reflect my argument or proposal using references from studies already done. I also learned to organize my work and use previous studies as support for my own idea or argument. Welcome to my final research grant proposal.
Women Present Nontraditional Symptoms during Cardiovascular Complications than Men: A Study to Manage a Gender Bias Epidemic
According to the Center for Disease Control and Prevention (CDC), Heart Disease has been the leading cause of death in the United States dating back to 1998 when medical records were first digitally recorded. In fact, it continues to be a major leading cause of death in both men and women. 1 in every 4 deaths in the United states every year is due to heart disease, meaning approximately 610,000 people die every year. Unfortunately, vascular complications present differently in men and women. “Heart disease in women is often underestimated in the medical community, leading to less aggressive treatments” (Maas). Since cardiovascular diseases develop seven to ten years later in women compared to men, there are numerous misinterpretations and misconceptions about vascular complications in women; an estimated sixty-two percent (62%) of deaths linked to vascular complications occur in women (Nivedita).
The strongest correlation to such a high mortality rate is due to long “door-to-doctor” times, meaning upon presentation of symptoms, women are more likely to be misdiagnosed or not diagnosed at all (Nivedita).Therefore, although heart disease is the number one serial killer in the United States, science and medicine have not yet been able to predict its’ behavior when presented in women. This is a problem that continues to heavily affect past, present and future generations of both men and women. This research grant proposal raises awareness for the mistreatment and misconceptions in the medical community when treating women experiencing cardiovascular diseases. It also calls for a diagnostic test specifically built to monitor the presentation of vascular complications in women to create a base guideline distributed throughout the medical community used to prevent fatal “door-to-doctor” wait times. Aside from raising awareness, this proposal recommends percutaneous coronary intervention (PCI) as a first response to immediately containing any vascular complications as well as preventing future complications. By broadening a diagnostic for women, and using PCIs as the first line of defense for combating the high mortality rates in women, the medical community can use the data collected to improve the cardiac treatment of women in the long run and formulate a permanent basis to diagnose the various presentations.
Being a woman carries independent risk factors when discussing cardiovascular disease such as, low body weight, smaller vessels, greater risk profiles and later presentation (Lansky). Using Reviews conducted in PubMed, medical literature analysis and retrieval system online (MEDINE) and articles published by the American Heart Association (AHA) and Center for Disease Control and Preventions (CDC) and data collected by each publication respectively, to present statistical evidence and current misconceptions in the medical field as well as solutions to disclaim them. After establishing a cause and effect relationship, this paper will use collected data that reflects percutaneous coronary intervention is one of the safer minimally invasive procedures that would help solve the previously mentioned problem with a smaller recovery time and less post-procedural complications. Simply put, PCIs in women, compared to other cardiovascular interventions, are safer and have a higher survival rate leading to better results after a cardiac event.
For Cardiological policies to change and acknowledge the mistreatment of women, it is first important to raise awareness in the community. By conducting an impromptu survey, ten males and females were asked “What would you expect a heart attack to look like, if it happened right in front of you?” The answers were unanimous in stating the stereotypical “gripping of the chest and falling to the ground” scene portrayed in the media. This is a problem that contributes to the high mortality rates in both sexes but is detrimental to women. According to the AHA, chest pain is the most common symptom in both men and women as well as uncomfortable pressure, but women experience shortness of breath, fainting, back and jaw pain. According to Nieca Goldberg, M.D., medical director at NYU’s Langone Medical Center for Women’s Health, “women can experience a heart attack without chest pressure and instead feel upper back pressure or extreme fatigue…You could feel so short of breath as thought you ran a marathon, but you haven’t made a move”. The lack of a realistic grasp of heart attack symptoms in the community, correlates to the delayed treatment in women. Apart from being misdiagnosed by doctors, women take longer to obtain medical care since their symptoms do not adhere to the stereotypical presentation of a heart attack or vascular event (Regitz-Zagrosek). In order to diagnose vascular complications early, doctors should first raise awareness in their female patients of the risks and symptoms from the age of thirty. This will lead to appropriate diagnostic and therapeutic intervention.
Awareness is a front-end solution that encourages and expedites the diagnosing and treatment but is only the first prong to a three-step system. The second prong consists of formulating a basis for diagnosing the various presentation of symptoms. The scarcity of gender differences in vascular complication generates discrimination in the treatment and diagnosis of complications. Cardiac Catheterization Diagnostic is a minimally invasive diagnostic and treatment option that involves passing a thin flexible tube through the vessels that supply blood to the heart in order to diagnose any possible cardiac complications and monitor how the heart is functioning. Although this test is in place to prevent major cardiac events, only ten percent of women are referred to receive this procedure leading to worse outcomes (Lasky). The misdiagnosing of women is due to the later presentation of cardiovascular events in women. According to the AHA women are far more likely to experience vascular complications ten to fifteen years later.
Three studies were performed to observe gender differences in acute stroke presentation to provide discriminators for recognition, diagnostic testing and treatment. The first study Labiche et al in 2002 examined 1,189 stroke victims and concluded that women present with nontraditional symptoms that included pain and loss of consciousness as well as disorientation. The second study including both men and women occurred in 2009 by Stuart Shor et al who concluded one nonspecific symptom found in women were headaches and fatigue. The third study consisting of 461 patients also in 2009 by Lisabeth et al, inferred women present with altered mental status (Nivedita). These three studies recognize the nontraditional symptoms present in women compared to men, but the research cannot pinpoint a specific marker that is universal to all females. To create a new Cardiological guideline, the proposal is for the medical community to first collect patient medical record data with respect to women who presented with any kind of pain, fainting, numbness and any other nontraditional symptom that may occur during a cardiac event. After collecting the data and creating a registry, they should compare initial complaints of pain tracking to major diagnoses of vascular complications and death. By tracking the beginning of concern, doctors may be able to compile a list of key symptoms, age groups, area of pain as well as paralysis or neurological changes. This form of data collection would create a “red-yellow-green” category system that would not only distinguish symptoms but categorize their importance to avoid under or overtreatment. Thus, satisfying the second prong in the three-prong solution in this grant proposal.
Creating a registry and later a guideline that would be used to diagnose cardiovascular complications in women would drastically reduce the mortality rates in women. The Rochester Epidemiology Project Medical Record Linkage System was a system created to virtually identify every new case of stroke for residents of Rochester, Minnesota. By collecting data from five hospitals, the diagnoses were entered into a master sheet and translated into a central computer index to create a Rochester Stroke Registry (RSR). The project was approved by the Mayo Foundation Institutional Review Board and identifies over four hundred and forty-nine patients who experienced ischemic strokes during 1985-1989 (Nivedita). They reviewed patient medical records to create a sheet with greater than eighty symptoms and were placed in multiple categories and compared between men and women using Chi’s Square and t-test. Chi Square and t-tests are calculations used to measure how close two or more variables are to each other and whether the differences are significant or not. Using these systems of measure, it was found men and women had significantly different trends in symptoms (Nivedita). Creating a system such as the RSR to observe multiple vascular complications in women, would collect data that would be used by doctors, scientists and researchers around the world in combatting the number one killer in women.
By funding the creation of a registry, it would launch awareness campaigns that would promote National Attention as well as benefits to the medical community such as lower mortality rates. The initiation of this Project would also encourage the community to fund further research and self-diagnose their symptoms leading to early detection. The underlying conclusion in most research pertaining to gender differences in cardiovascular complications is, there needs to be more research done. Although detection of nontraditional and traditional symptoms are made, small sample sizes, dependent and independent variables and time are all factors that affect the results. In order to reduce some of those obstacles, creating a registry or multiple registries would be universal solutions that would provide the data for analysis. Once analyzes, it would serve as a basis for a diagnostic test that would determine whether a woman is experiencing a cardiac event. A problem that may arise from this would be false positives, but with proper medical practice, patients would gain awareness of possible vascular complications and continue to self-monitor and diagnose.
The research from previous studies and Reviews conclusively agree, the misconceptions about vascular complications are what categorize Heart Disease as the leading cause of death in both men and women. Women are at a much greater risk to be misdiagnosed, undertreated, or sent home when presenting with vascular complications (Lansky). Although there is a Cardiac Catheterization Diagnostic Procedure, doctors are less likely to refer women to get the procedure due to the misconceptions and lack of insight in signs and symptoms in women. Therefore, this research grant proposal is the response to a call for action. With multiple minor and major procedures in place to treat cardiovascular events, lack of diagnosis should not be the greatest contributor to such a high mortality rate.
In the event women are properly diagnosed, there would still be concern about mistreatment. By establishing a Cardiological Registry and guideline to treat women who present various cardiovascular complications, this proposal calls to action a strict symptom-treatment protocol that prevents the treatment of minor complications using major procedure. With the raw collected data, doctors will not only be able to track symptoms to specific complications, they would also be able to track which treatments provided the highest survival rates at what stage of vascular complication. By using the registry to create new treatment protocols, women would avoid being overcharged, over treated and receive the best care that would provide the best outcome post-procedure. Thus, initiating the third prong to reducing the mortality rate in women and ultimately creating a system that would benefit future generations of women.
References
Ahmed, B., Piper, W. D., M.D., Malenka, D., M.D., VerLee, P., M.D., Robb, J., M.D, Ryan, T., M.D., . . . Dauerman, H. L., M.D. (2009, October 1). Significantly Improved Vascular Complications Among Women Undergoing Percutaneous Coronary Intervention. Retrieved May 1, 2019, from https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.109.860494
University of Vermont College of Medicine, Burlington, Vt; Section of Cardiology (W.D.P., D.M., J.R.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Division of Cardiology (P.V.), Eastern Maine Medical Center, Bangor, Me; Division of Cardiology (T.R.), Maine Medical Center, Portland, Me; Catholic Medical Center (M.H.), Manchester, NH; and Central Maine Medical Center (W.P.), Lewiston, Me.
Cardiac Catheterization Diagnostic Procedures and Treatments. (n.d). Retrieved May 1, 2019, from https://www.medstarwashington.org/our-services/medstar-heart-vascular-institute/treatments/cardiac-catheterization/cardiac-catheterization-diagnostic-procedures-and-treatments/
Harvard Health Publishing. (2014, April). Heart attack and stroke: Men vs. women. Retrieved May 1, 2019, from https://www.health.harvard.edu/heart-health/heart-attack-and-stroke-men-vs-women
American Heart Association. (2015, July 31). Heart Attack Symptoms in Women. Retrieved May 1, 2019, from https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women
Nivedita, Jerath. U., Reddy, C., Freeman, W. D., Jerath, A. U., & Brown, R. D. (2011). Gender differences in presenting signs and symptoms of acute ischemic stroke: a population-based study. Gender medicine, 8(5), 312–319. doi:10.1016/j.genm.2011.08.001
Lansky, A. J., MD, Hochman, C. J., MD, Ward, P. A., MD, Mintz, G. S., MA, Fabunmi, R., PhD, Berger, P. B., MD, . . . Jacobs, A. K., MD. (2005, February 22). Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women. Retrieved from https://www.ahajournals.org/doi/10.1161/01.CIR.0000155337.50423.C9
and endorsed by the American College of Cardiology Foundation
Regitz-Zagrosek, Prescott, Eva, Gerdts, Anna, Maas, . . . Verena. (2015, November 03). Gender in cardiovascular diseases: Impact on clinical manifestations, management, and outcomes. Retrieved May 1, 2019, from https://academic.oup.com/eurheartj/article/37/1/24/2398374
CDC, NCHS. Underlying Cause of Death 1999-2013 released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Retrieved May 1, 2019, from https://www.cdc.gov/heartdisease/facts.htm
