Digital Commons Network^™

Effects Of Ketamine Versus Morphine In The Treatment Of Acute Pain In The Emergency Department, Dakoda Farrington, Amber Knowlton

Physician Assistant Capstones, 2016 to 2019

No abstract provided.

Effects Of Prehospital Vs. In Hospital Therapeutic Hypothermia On Neurological Status After Cardiac Arrest, Cassandra Johnson, Ingrid Brown

Physician Assistant Capstones, 2016 to 2019

Objective: To conduct an analysis of literature that examines whether the use of prehospital therapeutic hypothermia (TH) results in significant changes in neurologic outcomes that are in adults that experienced out of hospital cardiac arrest (OHCA). Methods: Systematic searches were conducted through PubMed at the James Madison University Library. The inclusion criteria included human adults who experienced out of hospital cardiac arrest and were treated by Emergency Medical Services (EMS) with and/or without prehospital TH by means of intravenous cold fluids and surface cooling. Results: Three studies involving 2180 cases were included. This review indicated that prehospital TH after …

Chlorhexidine Gluconate Vs Povidone-Iodine In The Prevention Of Clean-Contaminated Surgical Site Infections, Erin Layne, Abigail Stone

Physician Assistant Capstones, 2016 to 2019

Abstract

Background:

A patient’s skin is the major source of pathogens that can cause post-operative complications such as surgical site infections (SSIs). Optimization of pre-operative skin antisepsis is obtained with chlorhexidine gluconate (CG) and povidone-iodine (PI). These two solutions are the most widely used antiseptics for pre-operative purposes.

Objective:

Among surgical patients greater than 18 years of age undergoing clean-contaminated surgery, which antiseptic, iodophors or chlorhexidine gluconate, is more effective at reducing postoperative surgical site infections?

Methods:

A search was done in PubMed utilizing the terms chlorhexidine, infection control, iodophors, and surgical site infection. The limits applied included randomized …

The Use Of Probiotics To Prevent Ventilator-Associated Pneumonia In Adults, Michael Roper, Paige Douthett

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the efficacy and safety of preventing the acquisition of ventilator- associated pneumonia with the use of probiotic supplementation, as compared to a placebo, among hospitalized adult men and women receiving more than 24 hours of mechanical ventilation. Design: Systematic Literature Review. Methods: Systematic searches were conducted through PubMed and Scopus using the search terms “ventilator”, “probiotics”, and “prevention”. Records were excluded from the analysis if they were published before 2015, full text was not available, studies other than randomized control trial or cohort studies, and if the study population was less than 18 years old. Results: Of …

Effects Of Stem Cell Therapy On 6-Minute Walk Test Distance And Left Ventricular Ejection Fraction In Patients With Nonischemic Cardiomyopathy, Kayleigh Hunt, Alexa Maziuk

Physician Assistant Capstones, 2016 to 2019

Objective

To assess the efficacy of stem cells in the improvement of functional capacity and quality of life in the setting of nonischemic dilated cardiomyopathy.

Design

Systematic literature review

Methods

A literature search of PubMed was conducted utilizing the following search terms: “stem,” “cell,” “nonischemic,” and “cardiomyopathy.” The following limits were used: “2015-2018,” nonischemic cardiomyopathy, results of LVEF and 6MWT, randomized controlled trials, pilot studies, and sample size >22.

Results

Butler et al. found that within the itMSC group, 6MWD increased by an average of 27.40 m (95% CI 0.28–54.52; P=0.05), but it decreased by an average of 10.83 m …

Corticosteroid Vs Platelet Rich Plasma Injections In The Treatment Of Chronic Plantar Fasciitis, Elizabeth J. Meaney, Emma W. Adelman

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the effectiveness of platelet rich plasma (PRP) injections in the treatment of chronic plantar fasciitis compared to traditional corticosteroid injections. Design: Systematic literature review. Methods: A literature search was performed in Pubmed using the search terms “plantar fasciitis” and “platelet rich plasma”. Inclusion criteria included publication within 10 years, randomized control trial, human study, and containing the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scoring system. Results: Our literature search resulted in the review of three randomized- control trials. Mahindra et al. showed that PRP was superior to corticosteroid injections in the treatment of chronic plantar …

Crystalloids Or Colloids… What’S In Your Iv? Determining Fluid Type For Septic Shock Resuscitation, Eleanor L. Jordan, Amy K. Lansing

Physician Assistant Capstones, 2016 to 2019

Objective: To compare the efficacy of crystalloid versus colloid solutions, specifically normal saline versus albumin, in decreasing mortality among patients with septic shock requiring resuscitation fluids in the intensive care unit (ICU) setting. Design: Systematic literature review. Methods: Research was conducted in PubMed and UpToDate, utilizing the search terms sepsis, septic shock, fluid resuscitation, colloids and crystalloids. Specifically, in PubMed, the following limits and terms were used: randomized control trial, human subjects, English, and within the last 7 years. Results: The Annane et al study found no significant difference in colloid fluid resuscitation versus crystalloid fluid resuscitation in the decreasing …

Subanesthetic Iv Ketamine Reduces Acute Suicidal Ideation In Patients With Mood Disorders, Kimberly Jenko, Jack Anzilotti

Physician Assistant Capstones, 2016 to 2019

Background. Depression and suicide are common in the United States and present a significant problem in the healthcare landscape. Currently, there are few options that can rapidly reduce suicidal ideation in patients with depression. Ketamine, a glutamate N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to reduce acute suicidality in patients with depression. Previous studies have a reduction of suicidal ideation compared to saline placebo, but few studies have shown a significant effect compared to a similar psychoactive drug such as midazolam.

Method. A search of PubMed and PsychNET was performed in September 2018 using the terms “ketamine,” “suicide,” …

Comparing Effectiveness Of Colonoscopy Versus Fecal Immunochemical Testing In Screening For Colorectal Cancer, Hannah Vanrooyen, Lindsay Burns

Physician Assistant Capstones, 2016 to 2019

Introduction: Colorectal cancer (CRC) is deadly neoplasm that takes many lives in the United States and is a leading cause of cancer worldwide. If CRC is detected early through screening, there is a higher chance of remission which makes screening an important tool in CRC prevention. Currently, colonoscopy is the gold standard, but due to the undesirable preparation needed for a colonoscopy, patient compliance is low. Giving patients a screening option that requires less preparation may help to increase the compliance for CRC screening. Fecal Immunological testing has been shown to have higher compliance rates among patients as compared to …

Effect Of Metformin On Adolescent Obesity, Mackenzie Mcnamee, Victoriya Eggen

Physician Assistant Capstones, 2016 to 2019

Objectives: Metformin is the first line treatment for type 2 diabetes mellitus (T2DM) in both adults and children and has been shown to result in weight loss. Pediatric obesity is a major risk factor for the development of T2DM as well as several other diseases. Recently, physicians have reported using Metformin off-label to treat obesity in adolescent patients. The purpose of this study is to investigate whether Metformin is effective in reducing BMI in obese adolescents.

Methods: Studies were found using PubMed, MeSH, Medline, and CINAHL. The search terms used were: “obesity,” Metformin,” “adolescents,” “children,” “metformin and weight,” …

Effect Of Postpartum Protocols On Maternal Outcomes, Kelsey Grimm, Emily Harnish

Physician Assistant Capstones, 2016 to 2019

Objective: To determine whether postpartum hemorrhage (PPH) protocols lead to decreases in maternal morbidity and mortality.

Design: Systemic literature review.

Methods: The clinical question investigated is whether the implementation of PPH protocols has measurable impact on maternal morbidity and mortality. Searches were done through PubMed using the keywords: “maternal hemorrhage postpartum protocol.” Studies were eliminated if they were more than 10 years old, conducted outside the United States, published in a non-English language, used other animal subjects besides humans, used non-female subjects, if they did not answer the clinical question, or were review articles. Eventually, three cohort …

Exclusive Enteral Nutrition And Corticosteroids: Two Effective Methods Of Induction Treatment In Crohn’S Disease, Sarah E H Hutchison, Rachel L. Stottlar

Physician Assistant Capstones, 2016 to 2019

Objective: To compare the effectiveness of corticosteroids (CS) versus exclusive enteral nutrition (EEN), as induction therapy of Crohn’s disease to induce remission. Design: Systematic literature review. Methods: Searches were done in PubMed utilizing the terms: enteral nutrition therapy, exclusive enteral nutrition, inflammatory bowel disease, Crohn’s disease, corticosteroids, pediatric, nutrition, and steroids. Articles were excluded with patients > 18 years of age, confounding variables, inclusion of other treatment options, or physician discretion bias in selecting a treatment option. Results: Ultimately, three articles were included in our review. Two of three studies examined showed a statistically significant improvement in remission rates in …

The Effect Of Yoga On Fatigue In Breast Cancer Patients Undergoing Radiotherapy, Magdalene Bredehoeft, Karli Ribsam

Physician Assistant Capstones, 2016 to 2019

Objective: Assess the effect of yoga on levels of fatigue among women with breast cancer currently undergoing radiotherapy. Design: Systematic literature review. Methods: Searches were done on PubMed, utilizing the terms “yoga,” “fatigue,” “breast cancer,” and “radiotherapy.” Limits that led to inclusion of studies included: published after 2008, studies researching breast cancer, and studies that were randomized controlled trials. Results: Randomized controlled trials studied were by Chandwani et al. (2010), Chandwani et al. (2014), and Vadiraga et al. (2009). Conclusion: Yoga can improve quality of life among women with breast cancer undergoing radiotherapy, specifically by decreasing levels of fatigue. We …

Effects Of Equine Assisted Activity On Children And Adolescents With Autism Spectrum Disorder, Briana Ciampi, Jeffrey M. Roy

Physician Assistant Capstones, 2016 to 2019

Background: Autism spectrum disorder (ASD) encompasses a spectrum of disorders which are characterized as having impaired communication skills, social skills and repetitive behaviors or body movements.^1,2 Since every individual with ASD presents with different challenges, treatment modalities for ASD are quite diverse. Equine Assisted Activities (EAA) to include therapeutic horseback riding (THR) is a treatment modality that has been utilized more in recent years for children and adolescents with ASD, as it is thought the connection between the individual and the horse can facilitate emotional, behavioral, and cognitive growth.³ Objective: To determine the effectiveness of Equine Assisted Activity …

Effect Of Npo Status On Aspiration Risk In Pediatric Patients Undergoing Procedural Sedation, Stacey Waldron, Kelsey Woycik

Physician Assistant Capstones, 2016 to 2019

Objective:To conduct a review of literature to determine if no solid food or liquids by mouth for more than or less than six hours impacts the incidence of pulmonary aspiration during procedural sedation in pediatric patients. Methods: A PubMed search was conducted utilizing the following terms: “sedation, fasting, and aspiration” and “NPO, pediatrics, and pre-procedural.” Filters included: “within five years,” “review articles,” and “English.” Articles were then screened and assessed for eligibility based on pediatric population, NPO status, procedural sedation, and risk of pulmonary aspiration. Results: Two prospective observational studies and one retrospective review were selected. Beach et al. …

The Effect Of Opioid Overdose Education And Naloxone Distribution Programs On Opioid-Related Mortality, Blake Rogers, Sharon P

Physician Assistant Capstones, 2016 to 2019

Objective: To determine the effectiveness of opioid overdose education and naloxone distribution (OEND) program implementation in reducing opioid-related overdose mortality. Methods: A PubMed search was conducted using the terms “opioid overdose prevention community naloxone,” yielding 80 records, 36 of which were screened. The remaining 44 articles were reviewed for eligibility, resulting in three articles chosen for the study. Results: An interrupted time-series analysis by Walley et al., and two retrospective cohort studies by Albert et al. and Rowe et al. were analyzed. Conclusion: Studies by Walley et al. and Albert et al. demonstrated a positive association between OEND program implementation …

Long Term Outcomes Of On-Pump Cabg Versus Off-Pump Cabg, Christopher Fetrow, Jessalyn Dickerson

Physician Assistant Capstones, 2016 to 2019

Objective: Assess the long-term outcomes including mortality, revascularization and myocardial infarction events to determine whether off-pump CABG is more effective for patients compared to on-pump CABG procedures.

Methods: Studies were found using PubMed with the search term, “on and off pump CABG” which yielded 1736 studies. After assessing for records within 5 years the search was narrowed to 370 articles and then down to 353 because some articles were not available in full-text. Our search was then divided into first looking at randomized control trials and meta-analysis availability from the 353 articles meeting our criteria. After narrowing our search for …

Long-Term Proton Pump Inhibitor Use And Effect On Risk Of Fractures, Hannah Messer, Alison K. Conforto

Physician Assistant Capstones, 2016 to 2019

Objective: To conduct an analysis of literature that examined the effects of long-term proton pump inhibitors (PPIs) in adults 50 years and older on fracture risk. Methods: A literature search of the PubMed database using the terms “long-term use of PPIs” AND “fractures” Results: All 3 studies reported a statistically significant increased risk of fracture associated with long-term use of PPIs in both men and women over 50. None of the studies showed an increased risk of fracture with short-term PPI use. Conclusions: Health care providers should be informing their patients of the potential risk associated …

Community-Acquired Pneumonia In Adults: Diagnostic Reliability Of Physical Examination Techniques And Their Teaching In Academia, Amber Tordoff, Lauren A. Williams

Physician Assistant Capstones, 2016 to 2019

Background: Chest physical examination techniques are taught in academia, but their usefulness in the evaluation and diagnosis of patients in the clinical setting is controversial. Objective: To investigate the accuracy of physical examination techniques and their reliability in diagnosing community acquired pneumonia (CAP) and suggest a modified teaching approach to be used in academia. Design: Systematic Literature Review. Methods: Database search of PubMed and Google Scholar using the search terms “prediction of pneumonia in adults” and “prediction rule for pulmonary infiltrates.” Filters were implemented to include articles that only dealt with human subjects and were full text. Articles …

Probiotics As An Adjunct Treatment To Standard Therapy In Ulcerative Colitis, Melissa Maloof, Grace Berardini

Physician Assistant Capstones, 2016 to 2019

Objective: To determine the effectiveness of probiotics in addition to traditional therapy for patients with ulcerative colitis (UC) using a systematic review. Methods: PubMed and Cochrane Library databases were queried to evaluate patient clinical trials within the past five years using the search terms probiotics and ulcerative colitis. Results: Three trials met inclusion criteria. Two of three studies found no significant improvement in their primary endpoint with probiotics. Yoshimatsu, et al. found that after one year 56.6% of the placebo group remained in remission, whereas 69.5% of the probiotic group remained in remission (p>0.05).⁹ Tursi, et …

Vitamin C In The Treatment Of Septic Shock, Alyson O. Shaughnessy, Matthew Tieszen

Physician Assistant Capstones, 2016 to 2019

Objective:To assess the efficacy of improving outcomes of septic shock treatment with the addition of Vitamin C to standard treatment compared to standard therapy alone. To assess whether or not Vitamin C has a favorable outcome in the treatment of septic shock in terms of decreasing duration of vasopressor usage, reducing duration of intensive care unit (ICU) stay, and improving mortality.

Design: Systematic literature review.

Methods: Searches were conducted in PubMed and Google Scholar using the terms ascorbic acid, sepsis, septic shock, and vasopressors. In PubMed the following filters were used: humans only, clinical trials, studies within the past …

Ethyl Chloride Spray For Injection Site Analgesia, Ryan T. Pyles, Mackenzie N. Kappe

Physician Assistant Capstones, 2016 to 2019

Objective: To determine if ethyl chloride spray provides adequate analgesia prior to injections. Design: Systematic literature review. Methods: A search was conducted in both Pubmed and Scopus using search terms ethyl chloride and injection. The Pubmed search was narrowed to include studies within a 10-year publication range. Articles were excluded based on: population age range, date of publication, and if ethyl chloride was used in conjunction with another analgesic. There were no relevant articles in the Scopus search. Results: Franko O, Stern P. demonstrated that there was no statistically significant improvement in anxiety or pain perceived with ethyl chloride treatment …

Diagnostic Effectiveness Of Lead Avr As A Stemi Equivalent, Phung Vu, Karen Hayes

Physician Assistant Capstones, 2016 to 2019

Background: Acute coronary syndrome (ACS) encompasses a collection of three acute processes related to myocardial ischemia. These include: unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of ACS. Unlike the other 11 leads, lead augmented Vector Right (aVR) has been long neglected until recent years. Recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS. This implies that the use of lead aVR can be …

Effects Of A Robotic Cat On Agitation And Quality Of Life In Individuals With Dementia In A Long-Term Care Facility, Jillian Nicole Marsilio, Samantha Virginia Mckittrick, Lisa Renee Umbell, Melissa Ann Garner, Sharon Maiewski, Jeanne Wenos

Physician Assistant Capstones, 2016 to 2019

Study Objective: The purpose of this study is to determine whether introducing a robotic companion cat into a long term care facility may improve affect and, subsequently, increase participation for residents with dementia, and to determine potential benefits for caregiver roles and relationships with individuals with dementia.

Background: The number of people with dementia is growing, and the behavioral and psychological side effects are negatively affecting the quality of life for these people as well as their caregivers. Additional research is needed to help develop and confirm the use of nonpharmacological treatment for dementia with therapeutic robots.

Study Subjects: Research …

The Mckenzie Method And Treatment Of Low Back Pain, Sylvia Meyer, David Harrison

Physician Assistant Capstones, 2016 to 2019

Objective: To compare the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) exercise program to other treatment modalities for reducing pain, disability, and improving function in patients complaining of low back pain. Design: Systematic literature review. Methods: Searches were conducted in PubMed and Google Scholar using terms “McKenzie Method”, “mechanical diagnosis and therapy”, “low back pain”, “spinal manipulation”, “physical therapy”, and “placebo”. Results: In Machado et al., a statistically significant difference was found between MDT and using a first line approach (advice, reassurance, and over the counter (OTC) analgesics) regarding pain; however, it did not meet the pre-established level of …

Comparison Of The Rowland Universal Dementia Assessment Scale And Mini-Mental State Examination For Dementia Detection, Lauren Fry, Daniel Wolfe

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the ability of the Rowland Universal Dementia Assessment Scale (RUDAS) in comparison to the Mini-Mental State Examination (MMSE) to detect signs of dementia in a diverse elderly population. Design: Systematic literature review. Methods: Searches were done in PubMed, utilizing the terms MMSE, RUDAS, and dementia. Results: Using the keywords mentioned on PubMed,two articles met the inclusion and exclusion criteria: Limpawattana et al and T. R. Nielsen et al. One other article was found by searching under the “Related Articles” section on PubMed: D. Basic et al. Conclusion: The RUDAS performs just as well as …

Cervical Cytology Versus Primary Hpv Testing As Screening Tests For Cervical Dysplasia, Erin Shea, Biniam Abraham

Physician Assistant Capstones, 2016 to 2019

Background: Cervical cancer is the fourth most common cancer among women, accounting for 10% of all female cancers and 7.5% of all cancer deaths worldwide.^1,2 Human papillomavirus (HPV) has been detected in up to 99.7% of cervical cancers, making it the primary risk factor for the development of cervical cancer.³ Current guidelines recommend a screening test which includes a combination of cervical cytology as well as HPV co-testing in women over the age of 30, with HPV testing not recommended in women younger than the age of 30.¹¹ The Food and Drug Administration has approved primary HPV …

Curcumin Supplementation For Relief Of Pain Associated With Osteoarthritis, Kelly M. Schatzlein, Keely Tietjen

Physician Assistant Capstones, 2016 to 2019

NSAID Nonsteroidal Anti-inflammatory drug

OA Osteoarthritis

WOMAC Western Ontario and McMaster Universities Osteoarthritis Index

VAS Visual analogue scale

LPFI Lequesne Pain and Function Index

KOA Knee osteoarthritis

ROS Reactive oxygen species

ADL Activity of daily living

BMI Body mass index

Objective: To determine if curcumin supplementation compared to nonsteroidal anti-inflammatory drugs (NSAIDs), placebo, and rescue medications is an effective treatment of arthritic symptoms in males and females between the ages of 50 and 80 with a diagnosis of osteoarthritis.

Design: Systematic Literature Review

Methods: Searches were done in PubMed, Google Scholar, and Scopus utilizing the terms “turmeric”, “curcumin”, “osteoarthritis”, …

The Effect Of Education On Parental Attitudes And Beliefs Towards Vaccines, Alexandra Walsh, Rachel Quinn

Physician Assistant Capstones, 2016 to 2019

Introduction: The importance, safety, and efficacy of vaccines has been questioned more than ever despite the clear and significant effectiveness of vaccines to reduce the incidence of severe illnesses.¹ Currently, the only required education before administering vaccines is the Vaccine Information Statements (VIS), which is provided by the Center for Disease Control (CDC) at each vaccination visit. These statements outline benefits and risks of vaccines but are written at an above-average reading level and do not directly address specific vaccine concerns. Many vaccine concerns can be assuaged with proactive education by providers at early well-child visits.

Objective: To determine …

Effects Of Glucosamine Versus Chondroitin Sulfate In Reducing Joint Space Narrowing In Knee Osteoarthritis, Caroline Horton, Ashani Andrews

Physician Assistant Capstones, 2016 to 2019

Objective: To determine if over the counter supplements, chondroitin sulfate and glucosamine, in combination or alone, are effective in the treatment of joint space narrowing (JSN) in knee osteoarthritis.

Design: Systematic Literature Review

Methods: Database search of PubMed and MEDLINE using the search terms “glucosamine”, “chondroitin sulfate”, “osteoarthritis”, and joint space narrowing. Filters were implemented to include articles that only dealt with human subjects, that were published in 2000 or later, and were full-text. Articles were excluded if they were cohort studies, reviews, non-English papers, or had pain as the only outcome.

Results: Sawitzke et al.primary outcomes revealed no …