Medicine and Health Sciences Commons^™

Aspirin Use Following Preeclampsia To Prevent Future Adverse Cardiovascular Outcomes, Kristi Bohlig

Physician Assistant Scholarly Project Posters

• Introduction: Preeclampsia during pregnancy warrants therapy with low dose aspirin. The purpose of this review is to investigate if these women are at increased future risk for cardiovascular morbidity and mortality, and if aspirin therapy prevents future cardiovascular events.

• Research Questions: Do women who had preeclampsia during pregnancy have increased future cardiovascular morbidity and mortality? • Does continued aspirin use in postpartum women, who had preeclampsia during pregnancy; decrease future cardiovascular morbidity and mortality?

• Research Methods: Literature review was conducted utilizing CINAHL, Dynamed plus and PubMed databases.

• Discussion: Many studies have found that preeclampsia does increase …

Comparison Of Rivaroxaban And Warfarin In The Prevention Of Recurrent Venous Thromboembolism, Philip J. Heiden

Physician Assistant Scholarly Project Posters

The purpose of this systematic literature review is to determine the efficacy and safety of rivaroxaban (Xarelto) compared to warfarin (Coumadin), for the long term prophylaxis of recurrent venous thromboembolism (VTE). Rivaroxaban was chosen as the primary representative of factor Xa inhibitors because of its simplistic once a day dosing regimen. The PubMed database was extensively searched, using a variety of key terms, from September 10 to November 30, 2018. Works chosen include propensity-matched cohorts, retrospective studies, systematic reviews, and meta-analyses. All of which were published within the last 10 years; sources dated prior to 10 years were excluded. Studies …

Early Aggressive Insulin Therapy In Type 2 Diabetes, Bryan Johnson

Physician Assistant Scholarly Project Posters

Metformin has been proven beneficial for the first-line treatment of type 2 diabetic mellitus (T2DM) due to its efficacy and low adverse effect profile. Current US guidelines do not address the use of early intensive insulin use in T2DM. Treatment plans are slowly adjusted over the months until the A1C goal is met. Insulin is initiated several years after the time of T2DM diagnosis and utilized as second-line therapy. Dual therapy of insulin and metformin have shown regression of T2DM in certain patient populations. However, the linear relationship between diabetes and cardiovascular disease does not show greater improvement with dual …

Benefits Of 3d Breast Tomosynthesis Combined With 2d Digital Mammography In Screening Women For Breast Cancer, Danielle M. Swanson

Physician Assistant Scholarly Project Posters

• Breast cancer screening imaging options have progressed greatly over • the years in sensitivity, specificity, and image quality. According to DynaMed Plus, in 2012 there were 522,000 deaths by breast cancer and 1,677,000 total cases of breast cancer documented (Dynamed, 2018). For years, traditional screening for breast cancer involved 2D digital mammography which obtains two views of each breast. With advances in technology, the use of 3D breast tomosynthesis has become an advantageous addition to routine breast cancer screening protocols at many health care facilities.

• My literature review of articles was found in PubMed, DynaMed Plus, Cochrane Library, …

Comparison Of Pharmacologic Treatments For Postmenopausal Osteoporosis, Kaitlyn Wirtz

Physician Assistant Scholarly Project Posters

• The prevalence of osteoporosis in the United States in adults > 50 years of age is “more than 10 million people overall and 33 million have low bone mineral density (BMD) at the hip” (DynaMed Plus, 2018).

• To combat postmenopausal osteoporosis, two treatment options include bisphosphonates and the anti-receptor activator of nuclear factor kappa β ligand (RANKL) agent (denosumab).

• The purpose of this scholarly project is to determine if there is a statistical significance regarding safety, efficacy, and preference between bisphosphonates and denosumab.

• Three databases were searched: PubMed, CINAHL, and Cochrane Database of Systematic Reviews. Topics researched …

Intermittent Fasting In Weight Management, Alyse Engen

Physician Assistant Scholarly Project Posters

Obesity is associated with a variety of medical conditions that adversely affect metabolic and cardiovascular health. In order for health care providers to adequately educate and promote weight management, they need to be aware of the various dietary regimens and the efficacy and adverse effects associated with each. This literature review assesses the efficacy, metabolic benefits, and cardiovascular benefits of both intermittent energy restriction and continuous energy restriction from ten articles found on various databases within the past five years. The findings indicate that although not proven superior or inferior, intermittent energy restriction provides statistically similar results to continuous energy …

Comparing Screening And Treatment Of Bacterial Vaginosis And Pregnancy Outcomes, Stephanie Severson

Physician Assistant Scholarly Project Posters

• Evidence shows that bacterial vaginosis (BV) can lead to poor perinatal outcomes.

• The goal of this project is to answer the question of which pregnant patients should be screened for BV and does identification and treatment of BV during pregnancy improve perinatal outcomes.

• Due to variability in a multitude of factors, a generalized recommendation is difficult to make. Lack of recommendations are largely due to harm of treatment in those who were misdiagnosed.

• The development of polymerase chain reaction (PCR) has the capability to reduce misdiagnosis.

• Newer studies have shown benefit of early screening and …

Embolus Prevention: Anticoagulant Therapy In Comparison To Watchman's Procedure In Patients With Atrial Fibrillation, Erik Fladmo

Physician Assistant Scholarly Project Posters

• Atrial fibrillation or A-fib is a common cardiac disease that occurs as individuals get older.

• A risk factor of atrial fibrillation is blood clot formation and dislodgement or ‘embolus’ in the left atrium.

• Current treatment methods to prevent clot formation include anticoagulants, as well as a left atrial appendage closure device, The Watchman’s device is the only FDA approved left atrial appendage closure device.

• Study results confirm the rising efficacy and cost effectiveness of Watchman’s device versus long term anticoagulant therapy as well as their adverse effects regarding placement and post procedure; however further randomized control …

Is A Varicocelectomy Beneficial In The Era Of Assisted Reproductive Technologies, Chukwuka Oscar Nnoli

Physician Assistant Scholarly Project Posters

Clinical varicoceles are the most frequent physical finding associated with infertile men and impaired semen parameters. There is evidence that suggests varicocele repair improves semen parameter and increases the chances of natural pregnancy. Today, varicocele repair is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in Vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). In this literature review, data examining whether varicocelectomy before ART leads to improved pregnancy outcomes is reviewed. Current data suggest that there is a significant clinical benefit when correcting a varicocele in oligospermic men before IVF/ICSI. Similarly, men with non-obstructive azoospermia also …

Platelets To The Rescue? A Literature Review Of The Safety And Efficacy Of Platelet-Rich Plasma For Symptomatic Osteoarthritis Of The Knee, Timothy Simonich

Physician Assistant Scholarly Project Posters

Osteoarthritis of the knee is one of the most common joint disorders in the United States with rising prevalence due to obesity and an aging population. Regarding non-surgical approaches to management, there has been growing interest in the use of intra-articular injections with Platelet Rich Plasma (PRP).

Glucagon-Like Peptide-1s Compared To Sulfonylureas In The Treatment Of Adults Diagnosed With Type Ii Diabetes Mellitus In Primary Care, Tracy Kirchner

Physician Assistant Scholarly Project Posters

Type II diabetes mellitus (T2DM) is a prevalent disease in our country. Bullard et al. (2018) report approximately 21 million adults have T2DM in the United States. “The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity” (Yang et al., 2018). Treatment of T2DM is individualized to each patient based on their co-morbidities, fiscal responsibility, and route of administration options. Sulfonylureas and Glucagon-like Peptide-1s (GLP-1) are two classes of antidiabetic drugs that are available for use as second line treatment options after metformin. This review …

Comparing Rates Of Macrosomia And Neonatal Hypoglycemia Of Differing Treatment Modalities Of Gestational Diabetes Mellitus, Ashleigh Milbrath

Physician Assistant Scholarly Project Posters

Gestational diabetes mellitus (GDM) is a known potential complication that can occur during pregnancy. Unmanaged GDM can result in maternal hyperglycemia, which can cause increased neonatal complications, two of which are macrosomia and neonatal hypoglycemia. To prevent maternal hyperglycemia, treatment of GDM typically begins with dietary changes, home glucose monitoring, increased exercise patterns and other lifestyle modifications. However, if maternal hyperglycemia persists after two weeks of maternal lifestyle modifications, there are not current best practice guidelines established for the treatment of GDM. Historically, subcutaneous multiple daily dosed insulin (MDI) has been the gold standard for treatment after lifestyle modification. However, …

Delaying Diabetes In The Native American Population, Seth Tramm

Physician Assistant Scholarly Project Posters

Diabetes is a debilitating disease process caused by the body’s inability to control blood glucose levels. With over 30 million diabetics in the United States and another 85 million prediabetics, the effects of this disease are wide-spread and far-reaching. Native American/Alaska Native populations have a nearly two-fold increase in prevalence of diabetes when compared to non-native populations. Risk factors for diabetes in all populations include modifiable risks such as obesity, diet, and physical inactivity as well as non-modifiable factors such as age, family history, and ethnicity. Studies have shown that early identification of symptoms, coupled with proper and intentional treatment …

Letrozole Vs. Clomiphene Citrate For Infertility In Polycystic Ovarian Syndrome, Kailey Potratz

Physician Assistant Scholarly Project Posters

Purpose

To determine if letrozole is an equal or better alternative to clomiphene citrate for infertility treatment in PCOS patients.

Literature Review

Letrozole was found to have higher ovulation rates, fewer twin pregnancies/more single births, higher pregnancy rates, and higher live birth rates compared to clomiphene citrate. There were conflicting results for endometrial thickness and single follicle stimulation. Neither letrozole or clomiphene citrate was superior to the other for ovarian hyperstimulation syndrome. There were no significant differences between letrozole and clomiphene citrate regarding congenital abnormalities and miscarriage rates. The results regarding ectopic pregnancies were comparable between both groups.

Conclusion

The …

Limb Salvage For Diabetic Patients With Peripheral Arterial Disease, Jamie Jesse Johnson

Physician Assistant Scholarly Project Posters

•According to the Center for Disease Control (CDC) (2017), the total number of patients diagnosed with diabetes is exceeding 30.2 million and rapidly increasing.

•According to the CDC (2016), approximately 8.5 million people in the United States have peripheral artery disease (PAD), which includes 12-20% of individuals who are older than age 60.

•According to a study performed by Swaminathan et al. (2014), 186,000 patients underwent lower extremity amputation (LEA). Data also shows that patients undergoing LEA have a mortality rate of 20% noted within one year, and a 40% to 50% mortality rate indicated within 18 months.

•The review …

Systemic Therapy Versus Catheter Directed Techniques For The Treatment Of Acute Massive Pulmonary Embolism, Lawrence Duane Lee

Physician Assistant Scholarly Project Posters

•Acute massive pulmonary embolism is characterized by obstruction of the pulmonary arterial tree that exceeds 50% of the cross-sectional area causing acute and severe cardiopulmonary failure from right ventricular overload.

•Systemic thrombolytic therapy is recommended as standard, first-line treatment in patients with massive pulmonary embolism unless contraindicated and catheter directed therapies, including low dose thrombolytic administration directly into thrombus and mechanical thrombectomy can be adjunctive or used as an alternative to systemic treatments.

•This literature review researched articles looking at both systemic thrombolysis and endovascular techniques for the treatment of acute massive pulmonary embolism with an emphasis on long term …

The Impact Of Circadian Misalignment On Cardiometabolic Health, Cynthia Marie Mills

Physician Assistant Scholarly Project Posters

The circadian system is important in all living organisms because it generates a 24-hour rhythm for physiological and behavioral processes enabling anticipation and adaptation to daily changes in the environment. The prevalence of cardiometabolic diseases, which are linked to lifestyle choices, has been rising at an alarming rate. Modernization and globalization are two of many factors to blame for lifestyle changes resulting in circadian disruption. The purpose of this literature review is to explore circadian misalignment with regards to its mechanism and impact on cardiometabolic health and to determine possible interventional measures. The primary focus is on lifestyle change, particularly …

The Efficacy And Safety Of Statins In The Primary Prevention Of Cardiovascular Disease, Kayla M. Ashton

Physician Assistant Scholarly Project Posters

Atherosclerotic plaques can form in the blood vessels from particles of cholesterol. These plaques are a major cause of cardiovascular disease and have the ability to result in fatal cardiovascular events. In researching this topic, PubMed, the Cochrane Library, DynaMed, and ClinicalKey were all utilized in finding articles published from 2002 to 2018. There are several organizations with conflicting guidelines recommending the use of statin medications in the primary prevention of cardiovascular disease. The research evaluated discovers data is inconclusive on the benefit of statin medications in this primary prevention as well as the safety of long-term statin use. Some …

Associations Among Acne Vulgaris And Western Diet, Kate Meredith Suda

Physician Assistant Scholarly Project Posters

Acne vulgaris is one of the most common dermatologic conditions, especially among the adolescent population.

The pathogenesis of acne is largely multifactorial, with heredity and hormones strongly contributing to one’s risk of developing the chronic inflammatory skin condition.

High prevalence rates of acne in the adolescent population cannot be attributed to heredity alone, but by the influence of Western diet (WD) that overstimulates insulin-like growth factors (IGFs).

The purpose of this scholarly project is to determine if there is an association between the presence of acne vulgaris and the consumption of WD, and if a physiological link between the high …

Screening Techniques For Alzheimer's Disease, Christina Nicole Brooks

Physician Assistant Scholarly Project Posters

Alzheimer’s disease is a neurodegenerative disease that affects more than 55 million Americans. By the year 2050, experts project this disease will have increased three fold. Many screening techniques have been investigated to detect this disease early and begin treatment to slow its progression. The purpose of this study was to explore which medical modalities are the most effective for screening of Alzheimer’s disease. This literature review includes three databases, including PubMed, CINHAL, and Cochrane Database of Systematic Reviews. Topics that were researched include: cognitive screening tests, neuroimaging, laboratory diagnostic testing, DNA, and combined studies. Research was conducted from October …

Pre-Participation Physical Exams: Are We Doing Enough?, Steven Jacob Pietrusza

Physician Assistant Scholarly Project Posters

•Inclusion of screening electrocardiograms (EKGs) during pre-participation physical examination has been a topic of debate for some time. There is unquestioned usefulness in the ability of a well-trained health care provider in using EKG to identify cardiac abnormalities.

•Further, there have been several contemporary EKG criteria published that increase specificity and sensitivity of detection of disease. However, these criteria do not account for athletes less than 14 years of age, and that demographic represents a large portion of patients seeking pre-participation screenings in the United States.

•The lack of research into pediatric cardiac remodeling secondary to activity, coupled with the …

Comparing Prevalence Of Medication-Related Osteonecrosis Of The Jaw (Mronj) Due To Denosumab And Bisphosphonates As A Side Effect Of Osteoporosis Treatment, Kendra Apland

Physician Assistant Scholarly Project Posters

As the baby boomer generation continues to age, the diagnosis of osteoporosis and its side effects will continue to increase. Denosumab and bisphosphonates (BPs) are some of the most common medication classes used to treat osteopenia and osteoporosis, but it is believed that both medications have the possible side effect of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this paper is to uncover if MRONJ is a side effect of osteoporosis treatment and which medication carries the highest incidence rate. Through a review of several electronic databases and several peer reviewed research articles, a wide range of reported …

Treatment Options For Hidradenitis Suppurativa: Efficacy, Risks, Benefits, Katherine A. Hennager

Physician Assistant Scholarly Project Posters

Hidradenitis suppurativa is a chronic, recurrent follicular occlusion disease with painful, sometimes debilitating, cutaneous draining lesions and subcutaneous abscesses (DynaMed Plus, 2016). Hidradenitis suppurativa is understood to be a multifactorial disease that is hard to treat in some patients, especially those with a severe form of the disease. For this project, the efficacy of adalimumab for hidradenitis suppurativa was assessed and whether it is more beneficial than traditional treatments used. Adalimumab is a TNF-alpha inhibitor which belongs to the biologic DMARDs drug class. Kimball et al. (2012) found that at week 16 of their trial 3.9% of the placebo patients, …

The Neuroprotective Effects Of Targeted Temperature Management On Post-Cardiac Arrest Patients, Timothy Hovde

Physician Assistant Scholarly Project Posters

Novel methods of ensuring survival following cardiac arrest and resuscitation are of supreme importance to the medical community. Targeted temperature management (TTM) has become increasingly utilized pre-hospital, in emergency departments, and within intensive care units to increase the likelihood of survival to hospital discharge. TTM has further been used to attempt to improve neurological functioning. The efficacy and mechanism behind TTM remains poorly understood. In several patient populations it also remains unproven. The purpose of this study is to assess the physiological mechanism, survival, neurological recovery and methodology of TTM use and implementation.

Literature review was utilized to assess the …

Comparing The Effectiveness Of A Low Carbohydrate Diet And Metformin On Glycosylated Hemoglobin Reduction In Type Two Diabetes Mellitus, Ashley Schultz

Physician Assistant Scholarly Project Posters

In this study, a low carbohydrate diet and metformin pharmacotherapy were compared to determine their effect on HbA1c in the type two diabetic patient. Several high quality studies were examined along with each treatment's effect on mainly HbA1c, but also other parameters such as body weight, cholesterol, and fasting and post prandial blood glucose levels. The study showed that both the low carbohydrate diet and metformin pharmacotherapy were effective at lowering HbA1c in the type two diabetic patient. The low carbohydrate diet showed a 0.2% increase in HbA1c all the way to a 2.2% decrease in baseline HbA1c in the …

The Effect Of Statins In Primary Prevention On All-Cause Mortality, Brian Adams

Physician Assistant Scholarly Project Posters

During routine yearly physicals, primary care providers often evaluate serum laboratory lipid levels. Many of these patients have no past medical history of cardiovascular events related to atherosclerotic disease. Some patients do not have secondary risk factors, such as diabetes mellitus or smoking history.

Previous cardiovascular events provide stronger indications for the use of HMG-CoA reductase inhibitors (statins). In the absence of these, the provider may turn to current guidelines, in this case the 2013 the American College of Cardiology and the American Heart Association published the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular …

Analysis Of Metabolic Syndrome As A Modifiable Risk Factor For Prostate Cancer, Michael Butler

Physician Assistant Scholarly Project Posters

• Prostate cancer and metabolic syndrome are both prevalent among men in developed countries with peak incidence after age 50.

• Prostate cancer has no known modifiable risk factors.

• Most risk factors for metabolic syndrome are modifiable.

• If metabolic syndrome is identified as contributing to the risk of prostate cancer it would give an element of self determination to men at risk for prostate cancer.

• Past studies provide conflicting results in the correlation between these two conditions.

• A literature review was performed to evaluate consistencies in current literature.

• Metabolic syndrome or its components do not …

Prophylactic Use Of Metformin To Decrease The Incidence Of Breast Cancer In High Risk, Predisposed Women, Aly Dahl

Physician Assistant Scholarly Project Posters

• Breast cancer is one of the most common types of cancer in American women and is the second leading cause of mortality.

• In 2015, 234,190 new diagnoses were made and 40,730 deaths from breast cancer.

• Along with a thorough history from the patient, there are also several risk assessment models that should be utilized, such as the common Gail-2 model.

• Any women with a significant family history should also be educated on genetic counseling and/or testing to detect a BRCA1 or 2 mutation.

• Numerous individuals who are positive for this gene elect to undergo prophylactic …

Brugada Syndrome; Preventive Screening Measures To Decrease Associated Cardiac Deaths, Matthew Ryba

Physician Assistant Scholarly Project Posters

• Brugada syndrome is a sodium channel deficiency in the myocardium that can cause arrhythmias and sudden cardiac death. The myocardium deficient sodium channels can be inherited or affected by environment factors such as fever or medications.

• Screening for this syndrome can be challenging because many times the first symptom of Brugada syndrome is cardiac arrest. Though incidents of sudden cardiac deaths are low, sudden cardiac death can impact families and communities.

• In Italy, screening ECG’s is claimed to have reduced sudden cardiac events by 85% (Maron, 2014). Preventing sudden cardiac death in these patients through sensible, reasonable …

Alpha-1 Deficiency: Better Detection May Improve Outcomes For Copd Patients, Angela Schuster

Physician Assistant Scholarly Project Posters

Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that results in debilitating illnesses like: emphysema, COPD, liver disease, and panniculitis. AATD is highly under-diagnosed based on epidemiologic and population studies that suggest that fewer than 10% of the 60,000-100,000 individuals in the U.S. suspected to have severely deficient alleles have been identified ( Rahaghi et al., 2012). This study examines strategies aimed at improving detection of AATD. The findings indicate that utilizing flags to alert providers of the need for AATD testing initiated by RTs or automated within EMR systems are effective strategies for increasing testing rates and potentially improving …