Digital Commons Network^™

Preventing The Conversion From Prediabetes To Type 2 Diabetes Mellitus: Lifestyle Modification Versus Metformin Therapy, Kirsten Anderson

Physician Assistant Capstones

A 42-year-old mildly obese female returns to her primary care provider for lab results. Her screening comprehensive metabolic panel reveals an impaired fasting glucose of 120 mg/dL and her glycosylated hemoglobin A1c (HbA1c) is 6.3 – squarely in the prediabetic range, bordering on conversion to type 2 diabetes mellitus (T2DM). At this point, should the clinician recommend lifestyle modifications alone? Lifestyle modifications and metformin? Would those recommendations necessarily vary if she was 65 years old or had a history of gestational diabetes (GDM)?

Effects Of Antibiotics On Exacerbations For Patients With Chronic Obstructive Pulmonary Disease (Copd), Cierra Coffman

Physician Assistant Capstones

The use of antibiotics for treating exacerbations in patients with chronic obstructive pulmonary disease (COPD) has been a topic of controversy since first studied in the 1950s and 1960s. This paper analyzes the effects of a course of antibiotics on time until next exacerbation in patients with COPD. Five recent randomized control trials were examined. The antibiotic most often studied was azithromycin, a macrolide. Azithromycin decreased the length of time to first exacerbation compared to placebo in three studies; two other studies depicted sub analyses to support azithromycin as superior to placebo. Overall, antibiotics decreased the length of time between …

Is More Always Better? Efficacy Of Hctz, Low Versus High Dose Therapy In Dual Combination Treatment For Hypertension, Amanda Amy Diep

Physician Assistant Capstones

Currently, 1 in 5 U.S. adults are not aware that they have HTN; thus, a minimum of 20% of patients have BPs that are not at goal.7 With such a large number of patients untreated and uncontrolled, efforts have been made to improve patient attainment of these BP goals. Single-pill fixed-dose combination drugs were made available for this purpose. This option reduces medical costs for patients, increases medication compliance, and provides greater therapeutic results. Looking at trends for fixed-dose combination antihypertensive therapy, a commonly used formulation is a thiazide diuretic combined with an ARB.

Per the European Society of Hypertension-European …

Chronic Migraine Prophylaxis: A Comparison Between Botox And Topiramate, Brenda De La Torre

Physician Assistant Capstones

This is a review of two prophylactic medications for chronic migraine prophylaxis, Botox and topiramate. Three articles were selected that reviewed the efficacy of topiramate and regarding the effectiveness of Botox. These articles measured quality of life through a Migraine Specific Quality of Life Questionnaire. Inclusion criteria for choosing these articles is as follows; articles must be published within the last 15 years, focus must be adults excluding pediatric populations, primary focus of the articles is chronic migraines, research studies must follow patients for at least 12 weeks.

Are Sexual Minorities At An Increased Risk For Cardiovascular Disease?, Blake Beck

Physician Assistant Capstones

Among noncommunicable diseases, cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for 17.9 million deaths in 2016.1 In the United States the incidence of CVD deaths declined steadily from 1970 to 2014 but halted at 800,000 deaths a year in 2014 and since then has been trending upward.2 Due to an aging population and a dramatic rise in obesity over the past 25 years, the prevalence of CVD in the US is expected to increase by 10% between 2010 and 2030.3 Cardiovascular disease is a broad term that includes coronary heart disease, cerebrovascular disease, and peripheral vascular …

The Effects Of Bariatric Surgery On Obese Patients With Type 2 Diabetes, Nwanneka Dike

Physician Assistant Capstones

Bariatric surgery including Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric band may play a role in glycemic control by improving insulin secretion and sensitivity, specifically through improvement in the main incretin hormones known as glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP). These surgical interventions have been shown to provide effective long-term treatment for patients by providing durable weight loss, improving obesity-related comorbidities and fostering better health outcomes.

Achieving glycosylated hemoglobin levels below 7% can be very challenging in obese diabetic patients. Therefore, the effect of bariatric surgery compared to standard medical therapy alone in attaining this goal and …

Postmenopausal Women With Osteoporosis, Comparing Treatment Of Oral Bisphosphonates To Denosumab, Marissa Cadena

Physician Assistant Capstones

For postmenopausal women with osteoporosis, initiating treatment is vital to increasing bone mineral density and avoiding bone fragility, which can lead to fractures. Long-term treatment of osteoporosis in postmenopausal women with bisphosphonates increases bone mineral density. Even though oral bisphosphonates are the most commonly prescribed medication for osteoporosis, a majority of postmenopausal women discontinue bisphosphonate therapy within the first year of treatment due to cost, dose schedules, and side effects, thus, causing poor drug adherence. Evaluation of pharmaceutical treatments for newly diagnosed osteoporosis in postmenopausal women requires comparison of oral bisphosphonates to denosumab in order to assess which pharmacological treatment …

Knee Osteoarthritis: Efficacy Of Platelet-Rich Plasma Injections Are Non-Inferior To Conventional Joint Injection Treatments, John Riley Clark

Physician Assistant Capstones

Platelet-Rich Plasma (PRP) has emerged as a promising treatment of OA, particularly in large joints. For the treatment of knee OA PRP is non-inferior to the traditional methods, in improving function, pain, and ADLs. PRP is promising due to its autologous nature and appeal with the ever-increasing push for holistic or “natural” options in therapeutics. The patient will utilize properties of their own body to bolster an anti-inflammatory response and potentially improve the function of the knee cartilage. Although it requires fluid collection from a patient and processing which may be slightly time intensive, it offers an alternative to synthetic …

The Effect Of Meat Vs Non-Meat Diets On Cardiovascular Disease Risk Factors, Including Hypertension, Diabetes, And Obesity, Alyssa Coleman

Physician Assistant Capstones

Hyperlipidemia, hypertension, diabetes, family history, gender, and obesity are all well-established cardiovascular disease risk factors. Advancements are being made to investigate the role of diet as a modifiable risk factor, and to determine if adults who consume meat compared to those who do not consume meat are at higher risk for hypertension, obesity, and diabetes, thus increasing their cardiovascular disease risk. Because animal protein is ubiquitous in the modern diet, it is imperative that determinations are made in regard to either its benefits or its contribution to the burden of chronic disease. The clinical application of this research is to …

The Consequences Of Adverse Childhood Experiences On Health And Implications For The Future, Alison Dutton

Physician Assistant Capstones

One of the most significant aspects of healthcare that is interwoven among complaints and their management, no matter the specialty, is mental health. The full spectrum and severity of mental health conditions is important, but one area that every member of society can relate to is stress. The mere existence of being a human confounded with the everyday demands of society creates a recipe for people of all ages and backgrounds to feel stress and anxiety at some point in their lives. Stress can evolve from an individual’s family dynamic, demands of one’s profession, societal position, sexuality, among many other …

Field-Directed Therapy Options For Diffuse Actinic Keratoses, Sylwia Anna Cachro

Physician Assistant Capstones

In recent years, climate change has rapidly become an international focus and with it, its economic and environmental consequences. Less attention has been given to its effect on human health. A byproduct of climate change includes higher levels of ultraviolet or UV light exposure.1 UV light has long been associated with the development of skin cancer and pre-cancerous lesions known as actinic keratoses or solar keratoses.1 Given these changes, providers will begin to see more malignant or pre-malignant skin lesions on their patients and will need to confidently determine the best course of treatment for them. What constitutes good treatment? …

Are Prescription Opioids Increasing The Addictive Behavior And Death Rate In The United States Over The Last 20 Years?, Armeghan Bagherpour

Physician Assistant Capstones

The United States is in an opioid crisis. Of all the opioids that are marketed in the United States the most popular is Oxycontin, containing the active ingredient oxycodone, the chemical equiv-alent of heroin which is more powerful than morphine. Along with heroin and fentanyl, Oxy-contin has become one of the great killers of this era. It is estimated that in 2016 there were over 20,000 overdose deaths related to prescription pain relievers, as opposed to 12,990 over-dose deaths related to heroin in 2015. The state of West Virginia has been the one that has suf-fered the most. The rate …

In Patients Presenting To The Emergency Department With Atrial Fibrillation With Rapid Ventricular Response, Are Calcium Channel Blockers More Effective Than Beta-Blockers For Acute Management Of Rate Control?, Jennifer Dang

Physician Assistant Capstones

The evidence on the efficacy of nondihydropyridine calcium channel blockers (CCBs) compared to beta-blockers (BBs) for acute atrial fibrillation (AF) rate control in the emergency department setting was examined. Twelve studies were relevant and revealed that CCBs, specifically diltiazem, were superior to BBs because of their rapid onset of action and the lower number of doses they required to sustain ventricular rate control compared to BBs. However, given the small sample sizes in these studies and the limited number of randomized, double-blinded trials, more research is needed to increase the generalizability and to confirm the significance of these findings.

Advancements In The Treatment For Classic Hodgkin Lymphoma, R. Todd Budenz

Physician Assistant Capstones

In the United States, between the years 2011 and 2015, 42,490 cases of classical Hodgkin Lymphoma (cHL) were reported, and 5,585 people died.1 While the response rate to initial treatment leading to remission for those diagnosed with cHL has increased, a portion of patients with remitting or refractory Hodgkin Lymphoma (RRHL) continue to require attention. Currently, the Centers for Disease Control and Prevention estimates a 5-year survival rate for those with Hodgkin lymphoma of 83.5%, leaving 16.5% either in relapse or remitting disease.1 As research surrounding the treatment of cHL increases, there has been an emergence of utilizing novel treatments …

Efficacy Of Placebo Analgesia Treatment In The Management Of Chronic Non-Cancer Pain Compared To Opioids A Review, Robert Hill

Physician Assistant Capstones

Little is known regarding how the use of placebo analgesia compares to opioids affect long-term treatment efficacy in patients with chronic non-cancer pain over the first two years of treatment. To best answer this question, one must understand the transition from acute to chronic pain along nociceptive signaling pathways. This literature review aims to describe the major nociceptive signaling pathways involved in opioid and placebo analgesia and to discuss how placebo treatment affects chronic pain undergoing central sensitization. It will also review the current understanding of placebo effect and discuss the effects of dose-extending placebo use of opioid tolerance.

Type 2 Diabetes: Cardiovascular Outcomes With Metformin And Incretin Combination Therapy Compared To Metformin And Sulfonylureas, Brendan K. Lucas

Physician Assistant Capstones

Type 2 diabetes is a disease plaguing the American population, bringing along with it a number of complications. With millions of dollars spent annually to care for diabetic patients and the complications of diabetes, much remains to be known regarding newer medications and the effects of those complications. Two sodium glucose co-transporter 2 inhibitors, canagliflozin and empagliflozin, and one glucagon-like peptide-1 receptor agonist, liraglutide, have proven cardiovascular benefit; however, their use in combination with metformin has not been well studied when compared to metformin and sulfonylurea therapy. While there are studies underway evaluating such outcomes, a critical review of current …

The Screening And Management Of Comorbid Depression In Type 1 Diabetes For Improved Compliance, Rebecca N. Evans

Physician Assistant Capstones

Advanced practice and primary care providers are increasingly managing the ever-growing population of patients with diabetes—with a 2016 American Academy of Family Physicians (AAFP) study from the Medical Expenditures Panel Survey (MEPS) finding that a full 48 percent of medical encounters for the subset of patients with diabetes but no other chronic health conditions were in fact managed by general clinicians.1 Patients with diabetes face chronic, severe sequelae of their disease, often suffering comorbid conditions as well, including mental health diagnoses. Physician assistants (PAs) are likely to face increased diabetic patient caseloads—frequently including patients with unmet mental healthcare needs, and …

Is Cesarean Birth A Risk Factor For Childhood Obesity?, John Hosley

Physician Assistant Capstones

Most would agree that obesity is among one of the greatest challenges that providers face in healthcare. Most often the focus is on diet and activity as the primary factors responsible for weight management. Is it possible that the type of birth method predisposes a child to a life of uphill battles in management of weight and comorbidities? Overweight and obese children likely develop into obese adults increasing the likelihood of developing diabetes and cardiovascular disease at a younger age.4 Is there global evidence that otherwise healthy babies, who have been born by c-section compared with those born naturally, are …

Can Measuring Levels Of Serum Adhesion Proteins Replace The Ankle Brachial Index In The Fight Against Peripheral Artery Disease?, Mark K. Massey

Physician Assistant Capstones

If you knew that you were going to have one of both of your legs amputated due to a preventable medical condition in the future, then any sane person would want to find a way of preventing such a disabling and life changing event. Currently peripheral artery disease (PAD) is a growing threat to health in modern times, which can lead to the situation mentioned above. Due to diet and lifestyle risk factors, PAD incidence has increased as the world has become more developed.1 Mankind is unlikely to stop its march onward towards ever more developed states of living, which …

Does Living In A Rural Vs An Urban Environment During Childhood Increase The Risk Of Developing Or Exacerbating Asthma?, Lyndsay Garner

Physician Assistant Capstones

Medical literature that explored the relationship between asthma and differing environments was reviewed. The majority of the studies available involved case-control, cross-sectional studies and systematic reviews. Evidence revolving around this topic is contradictory, including the effects of rural and urban environment on asthma as well as the effects of air pollution on asthma exacerbations, was inconclusive.

Effect Of External Beam Radiation Versus Radical Prostatectomy On Patient Mortality And Quality Of Life, Jordan Jepson

Physician Assistant Capstones

Since prostate cancer prevalence is so high, multiple treatment modalities have been developed, with a curative goal. The most common prostate cancer treatments include radical prostatectomy (RP), which is simple removal of the prostate; and external beam radiation therapy (EBRT), which is destruction of the cancer cells via direct focused beams of radiation aimed at the tumor from outside the body.2 Other treatment modalities for prostate cancer exist, but these two particular modalities are the subject of this literary review. Both treatments have different cancer related mortality outcomes; and both have varying side effects, which can affect the patient’s quality …

Moderate To Severe Crohn's Disease: Are We Treating Successfully?, Valarie M. Kane

Physician Assistant Capstones

There are many medications indicated for the treatment of CD. Selection should aim to balance side-effects and long-term complications. The initial choice in medication treatment should also incorporate the individual profile of the patient as well making more potent medications available to higher risk patients instead of the standard stepwise approach.6 While the immunosuppressive medications azathioprine, 6-mercaptopurine and methotrexate are corticosteroid-sparing, they are not highly effective at mucosal healing or disease prevention. Because of this factor, immunosuppressive medications were not directly compared in this review.

The Effects Of Hyperbaric Oxygen Therapy On Chronic Diabetic Ulcer Healing, Breann Kinsey

Physician Assistant Capstones

Current wound management for chronic diabetic ulcers is unreliable and frequently fails. Due to this unsatisfactory outcome, many diabetic patients are at risk for further complications such as amputations or death. Hyperbaric oxygen therapy (HBOT) has the potential to promote chronic diabetic ulcer healing as an adjunct treatment tool by reducing tissue hypoxia and ischemia. The purpose of this medical literature review is to examine the effect of HBOT, compared to standard wound care alone, on chronic diabetic lower extremity ulcer healing. Unfortunately, limitations of existing medical evidence hinder the use of HBOT as a conventional treatment modality for non-healing …

Long-Term Outcomes Of Single Vs. Multiple Courses Of Antenatal Corticosteroids In Mothers At Risk For Preterm Delivery, Ellen K. Lee

Physician Assistant Capstones

Although it is well-known that the administration of antenatal corticosteroids to mothers at risk of preterm birth improves outcomes in premature infants, premature births and associated morbidity and mortality are still prevalent. Typical mortality associated with premature births account for approximately one-third of all infant deaths in the United States. Infants born before 25 weeks gestation have the highest mortality rate, and if they survive, are at the greatest risk for severe morbidity, which translate into higher risk of hospital readmission and significant medical costs. Premature neonates are at a higher risk for acute complications, including necrotizing enterocolitis, growth difficulties, …

Combined Oral Contraception And Ovarian Cancer Risk Prediction, Tara Grayson

Physician Assistant Capstones

This paper specifically examines whether women ages 25-50 who have taken oral contraceptives for at least 5 years are at a reduced risk for developing ovarian cancer over their lifetime compared to women ages 25-50 who have never used oral contraceptives. The answer to this question is particularly important in clinical practice in order to implement risk prediction and preventative counseling strategies, particularly for women with BRCA mutations, a strong family history of ovarian cancer, or personal history of breast cancer.

Gastric Bypass Surgery As An Alternative Treatment To Pharmacologic Therapy For Lowering Hba1c In Obese Type 2 Diabetic Patients, Pooja Kachhia

Physician Assistant Capstones

Focusing on therapy, many options are available for treating T2DM; however, of the numerous treatment choices, determining the most effective disease control is paramount. T2DM therapeutic measures includes lifestyle modifications, such as eating healthfully, exercising regularly, and losing excess weight. In addition, medicines are also prescribed to lower blood sugar to help prevent and delay complications. While the use of prescription medications to treat T2DM is a widely accepted and effective intervention, recent studies have shown that Roux-en-Y gastric bypass procedure can be an alternate and potentially more effective treatment. Although it is primarily used for bariatric therapy, Roux-en-Y gastric …

Nonpharmacologic Treatment Of Generalized Anxiety Disorder: Put Your Mind To It, Roseanna M. Pauli

Physician Assistant Capstones

Since GAD is usually a life-long disorder, selecting a therapy that is both effective and safe is essential. The relative safety of nonpharmacologic therapies compared to drug therapy, coupled with the preference to avoid medications, are factors favoring nonpharmacologic means for control of GAD. Whether one form of nonpharmacologic therapy is superior in efficacy to another, specifically whether CBT is better in adult patients, is worth examining. In addition, because this disorder is chronic, the durability of therapeutic actions is important, for which reason evidence confirming symptom control for at least one year’s duration is preferable.

Are Smoking Cessation Methods As Successful In Reaching Long Term Abstinence Rates When Used By Smokeless Tobacco Users In The United States, Lorissa Lorenzo-Trujillo

Physician Assistant Capstones

The three main cigarette cessation methods used in the US include nicotine replacement therapy (NRT), non-nicotine pharmacotherapies (varenicline and bupropion) and behavioral therapies. Smokeless tobacco specific recommendations are not currently available for health care providers in the US. This article examines whether the listed cigarette cessation methods are equally effective in reaching long-term abstinence rates when used by ST users, for which long-term abstinence is defined as zero ST consumption for 6 months or more.

The Use Of Probiotics In Diverticular Disease, Amanda M. Neri

Physician Assistant Capstones

Probiotics are becoming an important source of preventative treatment, due to their possible mechanism of action in modulating the immune system in the gut. Probiotics are also cost effective and have easy accessibility, which can play a role in treatment for gut related diseases. One disease that affects many people in society is diverticular disease, which has been shown to have inflamed and altered gut microbiota. Not only does this disease reduce the quality of life for patients, but also has an increased mortality rate.1 This increase in mortality is mainly due to complications of the disease process.1Obesity has also …

A Literature Review Of Type 2 Diabetes Mellitus & The Prevalence Of New Onset Atrial Fibrillation, John B. Mills Jr.

Physician Assistant Capstones

Atrial fibrillation (AF) is one of the most commonly diagnosed cardiac arrhythmias; however, details regarding the risk factors of AF are not necessarily well identified.1,2 This literature review will investigate the likelihood of a direct correlation between pre-existing type 2 diabetes mellitus (T2DM) and new-onset AF. Highlighting a definitive association between AF and T2DM has been a perplexing pursuit in research studies of epidemiology.2 The literature review will examine multiple studies and investigate the extent and significance to which T2DM and AF are related. The specific goal will be to assess whether T2DM patients over the age of 55, with …