Medicine and Health Sciences Commons^™

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 …

Benefits Of Hpv Vaccination In Adolescent Males, Budd Theriot

Physician Assistant Scholarly Project Posters

HPV is the most common sexually transmitted infection in the United States, affecting approximately 75-80% of young adults at some point in their lives, and it is also known to be directly related to several forms of cancer including cervical, vaginal, penile, anal, oral, and oropharyngeal cancer. Vaccination against several high-risk strains of HPV first became available in the U.S. in June of 2006 and has been proven to be effective in creating antibodies against several strains of high-risk HPV, potentially decreasing and preventing more than 30,000 new cases of HPV related cancers each year. Despite this fact, HPV vaccination …

Obesity: Modern Medicine Vs. Lifestyle, Jenny Christianson

Physician Assistant Scholarly Project Posters

• Obesity is a rising epidemic, and is one of the most common, costly and preventable health problems the world is experiencing today (Center for Disease Control and Prevention, [CDC], 2017).

• From this, it is important to establish an effective treatment plan that can be implemented across the nation for maximum patient benefit.

• Lifestyle changes such as diet and exercise are important to any health care plan and are equally necessary to reduce health risks. However, in certain patients, lifestyle changes are not enough due to the maladaptive biologic process in their brain. Thus, additional treatment options need …

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 …

Pharmacotherapy For Impulsivity-Hyperactivity Behaviors In Autism Spectrum Disorder, Jenna Katnis

Physician Assistant Scholarly Project Posters

Hyperactivity is a shared behavior with ASD and Attention Deficit Hyperactivity Disorder (ADHD). Medications such as Methylphenidate (MPH) and α 2-a adrenergic receptor agonists are used to modify hyperactivity behavior in ADHD and thus have been used as management in ASD. A review of literature was done to evaluate the use of medications typically used for ADHD in the use of ASD. The databases searched included PubMED, PsycINFO, Cochrane, and Clinical Key. After reviewing the literature, it was found that both MPH and 2-a adrenergic receptor agonist have a potential role in pharmacotherapy for ASD. MPH may be slightly more …

Examination Of Venous Thromboembolism Prophylaxis In Patients Undergoing Total Knee Arthroplasty, William Kucera

Physician Assistant Scholarly Project Posters

Elective total knee arthroplasty (TKA) is the most frequently performed inpatient surgical procedure in the United States (Kurtz, Ong, Lau, Mowat, & Halpern 2007). Complications of this procedure include deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE). Various pharmacological agents exist for VTE prophylaxis. Warfarin and low-molecular-weight heparin (LMWH) were commonly used for VTE prophylaxis in the past, but with the emergence of novel anticoagulants including factor Xa inhibitors and direct thrombin inhibitors (DTIs), warfarin is used far less frequently. Aspirin is also approved for VTE prophylaxis. The purpose of this study was …

Treatment Of Undifferentiated Connective Tissue Disease By Primary Care Providers Using Csdmards, Leslie A. Anderson

Physician Assistant Scholarly Project Posters

•Undifferentiated connective tissue disease (UCTD) is an autoimmune disease that presents similarly to other rheumatic conditions but fails to meet laboratory requirements which indicate a specific disease such as rheumatoid arthritis, systemic lupus erythematous, Sjogren's or scleroderma.

•UCTD presentation can include arthralgias, myalgias, fatigue, fever, Raynaud’s phenomenon and sicca like symptoms with a positive antinuclear antibody (ANA) test.

•Patients with UCTD symptoms are normally referred to rheumatology but a shortage exists leaving primary care providers to treat UCTD patients.

•Using disease modifying antirheumatic drugs (DMARDs) such as hydroxychloroquine is an option but it is not commonly prescribed by PCPs.

•The …

Efficacy In Screening Patients For Lynch Syndrome, Adria Ridl

Physician Assistant Scholarly Project Posters

Lynch syndrome is an autosomal dominant syndrome caused by an inherited germline mutation of the MMR proteins. A mutation of any of the MMR proteins, MLH1, MSH2, MSH6, PMS2 and EPCAM increases the risk of developing cancer, specifically colorectal and endometrial cancer. Approximately 3% of colorectal cancers are associated with Lynch Syndrome (LS). Early identification of a patient’s hereditary cancer risk offers the best outcome. To aid clinicians in the identification of a carrier of LS clinical guidelines and risk prediction models are used. In this analysis the Amsterdam II criteria and Revised Bethesda guidelines are compared to the more …

Nrf2 Pathway And The Reduction Of Oxidative Stress, Stephanie Jacobs Uselman

Physician Assistant Scholarly Project Posters

Oxidative stress has been linked to cellular damage initiating disease processes such as cardiovascular disease, diabetes, and cancer. The Nuclear factor erythroid-derived 2(Nrf2) pathway (Figure 1) aids in age-related cellular decline. The purpose of this study was to define the relationship between Protandim, its activation of the Nrf2 pathway, and decline in oxidative stress and cellular damage. The literature review included journal articles obtained from PubMed, Google scholar, and Cochrane review within the past 5-10 years, and contained both animal and human studies. The methods used in the animal studies included ANOVA, the standardized t-test, and the Neuman-Keuls post-test. P<0.05 was considered statistically significant. The human study included healthy participants, both male and female, age 29-78 with or without a specific medical diagnosis. Statistical analysis was based on the standardized t-test with a value of p<0.05 considered statistically significant. Liu et al. (2009) conducted a study investigating Protandim’s ability to suppress cancer tumor formation. Tumor incidence declined by 33% and multiplicity of skin tumors by 57% with p = 0.003. Superoxide dismutase increased 35%, catalase 58%, and manganese superoxide dismutase 21%. In 2013, Reuland et al. conducted a study to determine if Protandim could activate the Nrf2 pathway and induce antioxidant enzymes, thereby protecting cardiomyocytes from apoptosis. Results indicated that treated cardiomyocytes showed increased levels of Nrf2 nuclear accumulation, activation of endogenous antioxidant enzymes, and protection against cell targeted oxidative stress (p<0.05). Quereshi et al. (2010) completed a study to delineate if Protandim decreased oxidative stress through the Nrf2 pathway. After six months of supplementation, TBARS decreased by 48% (p=.006), and plasma osteopontin decreased by 57% (p=.018). In 2005, Nelson et al. conducted a study to determine if Protandim decreased cellular damage. After 30 days of supplementation, TBARS declined by 40% (p =0.0001), at 120 days, TBARS declined by 40-54% (p =0.002), and superoxide dismutase and catalase increased by 30% and 54% respectively. The results from studies indicate that Protandim’s activation of the Nrf2 pathway increased endogenous antioxidant availability, resulting in decreased oxidative stress and age related cellular damage.

Genetic Factors Related To The Incidence Of Type Ii Diabetes In Adults, Andrew Bader

Physician Assistant Scholarly Project Posters

As the seventh leading cause of death in the United States, diabetes affects 29.1 million people. In May, 2015 the U.S. CDC reported, the estimated total financial burden for diabetes in the United States at greater than $245 billion ($69 billion attributed to disability, lost days at work and premature death). The purpose of this study was to investigate genetic variances in parallel with type II diabetes. Through a five year prior search of Cochrane, Medline and Pubmed this review of the literature examined studies regarding type II diabetes related genetic variances specific to non-ethnic and ethnic populations of otherwise …

Pcsk9 Inhibitors: A Review Of The Efficacy, Safety And Current Literature Recommendations, Lacey L. Jandrin

Physician Assistant Scholarly Project Posters

Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality in developed counties. It is estimated that 60 million Americans have LDL-C levels > 160 mg/dl. Only about 1/3 of these patients meet treated LDL cholesterol goals of < 70 mg/dl indicating a need for greater control. High dose statins have been the mainstay in treatment of dyslipidemia, however, up to 20% of patients are statin intolerant indicating a need for secondary treatment strategies. This lead to the development of monoclonal antibodies to proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. PCSK9 inhibitors result in decreased destruction of the low-density lipoprotein receptor (LDL-R) which leads to an increase in the transport of LDL-C to its destruction effectively reducing LDL-C levels in the blood. The purpose of this study is to analyze the literature available on the efficacy and safety of new PCSK9 inhibitors. The results of this literature review indicated that PCSK9 inhibitors effectively lowered LDL-C by an average of approximately 50%. The evidence reviewed by this analysis indicate that 70% of patients treated with PCSK9 inhibitors met LDL-C goals. The findings also indicate that the side effects associated with this new class of medications are comparable to current side effects seen with traditional cholesterol lowering agents. The largest side effect seen in up to 10% of patients were injection site reactions and did not require discontinuation of the medication. The results of this analysis indicate that PCSK9 inhibitors may be of benefit in patients who are statin intolerant, do not meet LDL-C goals on traditional statin therapy or have familial hypercholesterolemia. Education in use of injectables, cost and insurance coverage and dosing schedule are likely to be areas of continued research and may affect use of this new class of cholesterol lowering agents.

Does Pharmacogenetics Play A Role In The Treatment Of Type Ii Diabetes Mellitus?, Lucas N. Vanemelen

Physician Assistant Scholarly Project Posters

• Type 2 diabetes mellitus (T2DM) is a disease commonly presented in the family practice setting. Current therapies include one or multiple medications. Until recently, providers have used algorithms and medical expertise to control T2DM.

• Pharmacogenomics is a branch of pharmacology dealing with genetic variation on a medication response in an individual patient to discover medication compatibility, efficacy or toxicity.

• Analysis of genetic factors are still being discovered; however, this growing field may change the way medications are being prescribed for diabetes. This analysis investigated if pharmacogenetics is a useful tool for prescribing diabetic medications to T2DM patients. …

Increased Incidence Of Asthma After Previous Infantile Rsv Bronchiolitis Infection, Ellen Adelia Doebler

Physician Assistant Scholarly Project Posters

• Respiratory Syncytial Virus (RSV) is a very common infection in children less than two years of age.

• Asthma is a common respiratory disease in childhood, which may cause frequent hospitalizations.

• The purpose of this study is to determine if infants previously diagnosed with RSV bronchiolitis have an increased incidence of asthma diagnosis compared to infants not diagnosed with RSV.

• The literature review examines correlation studies of both disease processes and explores incidence of asthma in patients previously diagnosed with Respiratory Syncytial Virus bronchiolitis.

• Individuals previously diagnosed with Respiratory Syncytial Virus bronchiolitis have a higher risk …

Palivizumab Administration Decreases Recurrent Wheeze, Shelly Daniels

Physician Assistant Scholarly Project Posters

Children who have been infected with Respiratory Syncytial Virus have a higher incidence of wheeze-associated clinic visits and hospitalizations compared to children without previous RSV exposure. The purpose of this study is to determine if palivizumab, an immunoglobulin injection used to prevent RSV infections, can decrease the incidence of recurrent wheezing in children. The review of literature will follow male and female children from infancy to age 13 who were treated with palivizumab and compare these children to patients with similar demographics that were not treated with palivizumab to determine if there is any difference in incidence of wheezing. The …