Medicine and Health Sciences Commons^™

The Role Of Primary Care Providers In Maintaining Weight Loss By Preventing Behavioral Relapse, Hayden R. Blanchard

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Supporting patients in optimizing health by treating obesity remains a relevant goal for primary care providers. While weight loss is frequently achieved with behavioral modification, maintaining weight loss by avoiding behavioral relapse is much more difficult. Patient may lose weight by reducing overall energy intake, incorporating intensive behavior change programs, utilizing pharmacotherapy as needed and, in certain cases, undergoing bariatric surgery. With a focus on behavior change and maintenance, primary care providers can support patients by planning more frequent follow up appointments, at least every one to three months. In these visits, PCPs can: focus on reenforcing lifestyle change principles …

Basic Principles Of Chronic Wound Care Management, Mahi-Ruhi Ladhani Jain

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This CME article aims to address the basics of chronic wound management, especially related to chronic venous insufficiency, peripheral arterial disease, and diabetes. Many providers do not know how to treat or manage chronic wounds and may use outdated methods to treat the wounds. There are many wound care supplies and resources available for providers when it comes to wound care management. However, the information is spread out across different resources. This article aims to create a resource that allows one to have a basic understanding of wounds and the different ways to manage them. In the article, I will …

Introducing Comprehensive Sexuality Education And Hiv Prevention And Treatment Methods Through Pop-Up Clinics To Secondary School Girls In Kwazulu-Natal, South Africa, Eliza I. Tobin, Joaquin Carlos Pinga, Caitlyn Stanya

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Human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system leading to people living with HIV (PLHIV) immunodeficient and more susceptible to other infections or diseases (UNAIDS, 2023b). This can lead to acquired immunodeficiency syndrome (AIDS) within 8-10 years of infection (UNAIDS, 2023b). HIV does not always present symptoms, making it hard for people to identify their HIV status without proper screening. The lack of awareness around a person’s status has led HIV to spread worldwide. In addition to the worldwide spread of HIV, there is no cure for the disease, however, antiretroviral therapy (ART) is mainly used …

Reducing The Prevalence Of Overweight And Obesity In Children Ages 10-13 In Charleston, West Virginia Through A School-Based Nutrition Education And Physical Activity Program, Isabella Tullio, Emma Heffley, Natalie Scardino

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Childhood overweight and obesity, the excessive or abnormal accumulation of fat causing a health risk, is primarily caused by lifestyle issues including inadequate physical activity and too many calories from food and drinks (WHO, 2020; Mayo Clinic, n,d). Key determinants of health for childhood obesity include physical environment, socioeconomic status or occupation, education level, and school environments. Children with parents who have low socioeconomic status, live in a food desert, (a neighborhood with limited access to fresh fruits, vegetables, and whole grains), or a food swamp, (a neighborhood with a saturation of fast-food outlets, convenience stores, and corner stores), or …

One In Every Twenty-Six, Rey'na Riggans

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There is a disorder that is rather common within the world and yet is not well known. It is a something that affects one in every twenty-six individuals. It is called epilepsy. Epilepsy is a neurological disorder in which a person to experience bursts of random electrical activity within their brains, these bursts being called "seizures." This article discusses this disorder and goes into detail about the forms of it, procedures that are done to try and help those living with epilepsy, and artwork that is inspired by this disorder.

High Energy Blue Light Induces Oxidative Stress And Retinal Cell Apoptosis, Jessica Malinsky

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Blue light (BL) is a high energy, short wavelength spanning 400 to 500 nm. Found in technological and environmental forms, BL has been shown to induce photochemical damage of the retina by reactive oxygen species (ROS) production. Excess ROS leads to oxidative stress, which disrupts retinal mitochondrial structure and function. As mitochondria amply occupy photoreceptors, they also contribute to oxidative stress due to their selectively significant absorption of BL at 400 to 500 nm. ROS generation that induces oxidative stress subsequently promotes retinal mitochondrial apoptosis. BL filtering and preventative mechanisms have been suggested to improve or repair BL-induced retinal damage, …

Cme: Vitamins, Antidepressants, And The Placebo Effect - How To Help Your Patients, Nicko Inocencio

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Depression affects roughly 280 million people globally. The disease puts patients at increased risk for stroke, cardiovascular disease, hypertension, and diabetes. The psychosocial causes of depression are well-known, but the biochemical causes are multifactorial. Theories range from homocysteine excess, calcium modulation at the neuron, inflammation, cortisol elevation, and disruption of the HPA axis. At the center, however, is serotonin, norepinephrine, and dopamine. Pharmacologic treatment directly aims at modulation of serotonin, norepinephrine, and dopamine. First-line treatment is a combination of SSRIs/SNRIs with cognitive behavioral therapy. If patients do not see improvement with the above therapy other agents such as bupropion, mirtazapine, …

Vitamin D Enhanced Vitamin D Receptor (Vdr) Inhibition Of Nlrp3 Inflammasome Activation Can Attenuate The Development Of Autoimmune Thyroiditis, Alexzon Mandac

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Autoimmune Thyroiditis (AIT) is a prevalent autoimmune disease affecting approximately 2% of the population. Characterized by the gradual loss of thyroid function through an autoimmune attack on the thyroid gland, the disease manifests symptoms that negatively affect one’s quality of life. The mechanisms behind the disease’s pathophysiology are not fully understood; however, researchers are examining the involvement of the NLRP3 inflammasome in the disease. This thesis will address the question of whether Vitamin D can act as an inhibitor of the NLRP3 inflammasome and attenuate the progression of AIT in mouse model. Current investigations explore the effects of NLRP3 inhibition …

Managing Neonatal Pain: A Guideline For Non-Neonatal Providers, Kelly Stanton

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Neonatal pain, especially in settings outside of the NICU or newborn nursery, is often under-recognized or even unnoticed altogether. Many providers and parents do not know how to recognize when a neonate is in pain and many do not know how to minimize or alleviate this pain effectively. Even when providers know how to assess pain in neonates, they typically assess for acute pain in the presence of chronic pain, or vice-versa. Untreated pain in neonates harms brain development and can lead to behavior defects later in life for these babies. Due to these outcomes, the recognition and effective treatment …

The Positive Effects Of Medical Cannabinoids On The Dysregulated Endocannabinoid System In Autism Spectrum Disorder Patients, Caroline J. Reichelderfer

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Autism Spectrum Disorder (ASD) is a developmental disability. The symptoms include a lack of social skills, a need for repetitive patterns of life, difficulty in communication, speaking deficits and numerous other symptoms. While the specific cause is unknown, there is much research being done on mechanisms including dysregulations of the immune system, endocannabinoid system, and overall brain (Nez Govorova 2021, Pol 2021). The Endocannabinoid system is a recently discovered branch of the nervous system composed of endocannabinoids which are produced naturally in the body; lipid-based neurotransmitters that bind to cannabinoid receptors (CBRs) and cannabinoid receptor proteins that are expressed throughout …

How And Why Do Race And Gender Affect Adhd Diagnosis Levels?, Caitlin N. Bennett

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Attention-deficit hyperactivity disorder (ADHD) is a disorder of the brain that impairs one’s daily functioning and focus. Previous research has shown that two groups are disproportionately under-diagnosed: females and Black people. It is important to understand why these groups, and possibly others, are under-diagnosed as those without a diagnosis do not get the treatment that they need. Literature reveals that differences in symptom presentation (inattentive vs. hyperactive), biases in symptom reports, barriers to accessing mental healthcare, and negative stigmas about, and within, certain groups lead to the under-diagnosis of females and Black people. In conclusion the diagnostic criteria of ADHD …

Inpatient Management Of An Intravenous Drug User With Tetanus, Nina Paris

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Tetanus is rare in the United States now due to the tetanus vaccine but there is still the potential too see patients with tetanus. IV drug users, neonates, and geriatric populations are at an increased risk of developing tetanus. Tetanus is caused by Clostridium tetani, a spore forming and exotoxin releasing anaerobic bacteria. The symptoms of tetanus are caused by the exotoxin tetanospasmin which inhibits the release of inhibitory neurotransmitters, leading to sustained neuronal stimulation. The classic symptoms of tetanus are lockjaw (trismus), neck stiffness, back arching, and fever. Patients can be febrile, tachycardic, tachypneic, and hypertensive on exam. …

Increasing Inpatient Volume And Efficiency Through Decreasing Readmission Rates At Fox Chase Cancer Center, Courtney Pokallus, Islande Victorin

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This paper outlines the semester long strategic plan created by Islande Victorin and Courtney Pokallus for Fox Chase Cancer Center. This strategic plan includes a background of the organization, SWOT analysis on the organization, identification of potential problems and a gap analysis, a strategic summary, and all outlines and plans for the strategic plan.

Recolonization Of Microbiomes’ Influence On Autism Spectrum Disorder, Hattie Cole

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In recent years, there has been an increase in the number of studies conducted on the complications of gastrointestinal (GI) comorbidities associated with autism spectrum disorder (ASD) in children. Some of these GI issues include irritable bowel syndrome (IBS), diarrhea and constipation. The causes of these disorders are poorly understood. The dominant gut phyla are Firmicutes and Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria and Verrucomicrobia. Research conducted on children with ASD compared with typical developing (TD) children showed higher ratios of Firmicutes/Bacteroidetes in the ASD group. Biflobacterium, Actinobacteria phyla, has been shown to be a good intestinal bacterium that may help with …

The Safety Of Covid-19 Vaccines In Pregnancy, Lauren Zacharias

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SARS-CoV-2 has caused over 800,000 deaths in the United States since it was first detected here in 2020. Despite there being 3 available COVID-19 vaccines in the US, and recommendations by the CDC and countless other public health agencies that any potential risks are outweighed by the benefit of the vaccines, only 31% of pregnant women in the US are vaccinated against COVID-19 due to unfounded claims by an anti-vaccination movement that COVID mRNA vaccines cause infertility. This presentation explores where these claims originated, why they are untrue, the risks of COVID-19 infections in pregnancy, and the potential benefits of …

In Patients With Hepatocellular Carcinoma (Hcc) (P), Is Bevacizumab With Atezolizumab (I) More Effective Than Sorafenib (C) In Long-Term Clinical Prognosis (O)?, Joon Lee

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Hepatocellular carcinoma (HCC) is the third leading cause of cancer death globally. China contributes to half of the global incidence of liver cancer, with about 70-85% being HCC. Definitive treatment for this condition would be surgical resection with liver transplant but for obvious reasons, the majority of affected patients are unable to meet the necessary criteria. Sorafenib is a form of chemotherapy that has been the mainstay treatment of HCC since its approval in 2007. More recently, the combination of Bevacizumab and Atezolizumab has shown greater efficacy in the treatment of unresectable HCC. Additionally, this new combination therapy shows favorable …

A Clinical Review Of Persistent Pulmonary Hypertension In The Newborn, Kaela Mahoney

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Persistent pulmonary hypertension in the newborn (PPHN) is an illness of the circulatory and respiratory systems which affects approximately 0.002% of newborns but carries a significant morbidity and mortality burden. Diagnostic measures are focused on determining etiology whereas treatment measures are intended to improve pulmonary function. It is crucial for neonatal providers to be aware of patients at risk for developing PPHN and be prepared to initiate treatment early. This presentation reviews pathophysiology, etiology, risk factors, diagnosis, and treatment of PPHN.

Management Of Adult Growth Hormone Deficiency Related To Hypopituitarism, Kellie Jamin

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The treatment of growth hormone deficiency (GHD) is well-established in childhood but less understood in adults, given the more complex role that growth hormone (GH) assumes in this population. Decreased functionality of the pituitary gland, otherwise known as hypopituitarism, can present with an isolated GHD in adulthood, which may result from a number of factors including neoplasm, ischemia, infection, traumatic injury, or systemic disease. Adult GHD may be definitively diagnosed with a stimulation test, the insulin tolerance test (ITT) being the study of choice. With a positive ITT, the disorder can be treated with growth hormone replacement therapy (GHRT), which …

The Effectiveness Of Probiotics In Adults With Depressive Symptoms, Brianna Rees

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Introduction: Depression affects over 21 million adults in the United States and continues to rise, affecting more people due to the recent pandemic. Because the prevalence of this debilitating mental health disease is increasing, it is even more crucial to find additional therapeutic treatments to alleviate depressive symptoms in adults whose depression is not controlled on current anti-depressant medication or therapy. Depression has been shown to be linked to the gut-brain axis, meaning gut health is connected to our mental health. Therefore, probiotics may be effective in altering the gut microbiome, and ultimately affecting cognitive patterns in the brain.

Methods: …

Queer Patients: An Underserved And At Risk Population, Joshua Schmidt

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Queer patients in America have faced a history of discrimination as both a community and as individuals. As such, this marginalization acts as a barrier to resources, including healthcare. Clinicians must be aware of said barrier and actively work towards dismantling it within their interactions with queer patients. This article makes a case for increasing sexual health conversations in order to assess queer patients and encourage a stronger patient-provider relationship for a community that is reluctant to seek medical attention, and also more likely to participate in higher risk behaviors.

Implementation Of Mental And Substance Misuse Screenings Into Routine Prep Therapy Encounters, Kieran Talkiewicz

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It has been well documented over the years that lesbian, gay, bisexual, transgender, queer/ questioning (LGBTQ+) populations are disproportionately affected by a higher burden of mental health illnesses, alcohol abuse, and illicit substance abuse when compared to heterosexual populations. This article will recommend utilizing routine Pre-Exposure Prophylaxis (PrEP) therapy encounters, a common point of contact for primary care for sexual minority populations, to perform screening for mental health and substance use. Due to men who have sex with men (MSM) being the highest utilizing population of this therapy, and disproportionately burdened by psychiatric and substance use disorders, this article will …

Complex Regional Pain Syndrome: Not A Catch-All, Amanda Shulski

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Complex Regional Pain Syndrome (CRPS) is prolonged and disproportionate neuropathic pain and inflammation which presents after surgery, fracture, or trauma to a limb. This phenomenon has been recognized in the literature since the civil war but the pathophysiology has only become clear over the last 20 years. There are no diagnostic tests for CRPS and it is a relatively rare condition with only about 20 cases in 100,000 people per year. CRPS is then under-recognized by some providers but over-diagnosed by others. Occasionally, providers use CRPS as a catch-all for unexplained pain rather than a recognized condition with specific diagnostic …

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

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Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

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Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

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Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

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Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Bodily Autonomy And Anti-Vaccine Discourse During The Covid-19 Pandemic, Haley Sherman

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This paper explores the relationship between anti-vaccine discourse and ideas about bodily autonomy. I analyze the cyclical nature of vaccine hesitancy and show that it can lead to misinformation and harmful narratives. This paper uses theories of bodily autonomy that identify a concept called moral obligation. This concept, as explored by Alberto Giubilini, is a utilitarian approach in which citizens have a responsibility to their governments to get vaccinated so that, in turn, their governments can fulfill their obligation of protecting other individuals’ health (Giubilini 2020, 54). A discourse analysis of four key players in the anti-vax movement shows that …

The Outcomes Of Cemented Versus Cementless Total Knee Arthroplasty In Modern Day Patients With Osteoarthritis, Jordan Powelson

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Osteoarthritis (OA), the degeneration of cartilage and bone, is the most progressive musculoskeletal disease and a leading cause of disability in the United States, affecting over 27 million adults. Although conservative treatments for knee OA are available, total knee arthroplasty (TKA) is the only definitive treatment for end-stage knee OA. For the past several decades, the use of bone cement has been the gold standard for total knee arthroplasty, but the cementless TKA is being revisited as an option as the age of patients seeking TKA decreases and the average BMI increases. This review analyzes and compares the outcomes of …

A Case Of Protein Losing Enteropathy After Fontan Operation, Gina Kim

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Protein Losing Enteropathy (PLE) is a condition in which an excessive amount of proteins are lost through the gastrointestinal tract leading to hypoproteinemia and manifesting as edema, ascites, and diarrhea. While in most cases PLE is a treatable disorder with good outcomes, the morbidity and mortality of the disorder is significantly elevated in patients with a history of Fontan surgery–an operation used to palliate patients born with a single ventricle by rerouting venous blood return directly to pulmonary circulation. After failure of first-line therapeutics of diuretics and steroids, this case study explores the successful treatment of a 5-year-old patient with …

Vaccine Hesitancy Among Healthcare Workers In The Covid-19 Era, Gabriella Checchi

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Vaccination against harmful, deadly pathogens have been an essential tool in the scientific world and have shaped our community as we know it today. They have allowed us to live in a society where members of the community are protected from certain severe disease and can help to decrease the death toll of these diseases. Vaccines have allowed us to eradicate smallpox, a disease that ravaged the world and killed over 300 million people. They have been a one of the most useful advances in medical science so far. And yet today, as SARS-CoV-2 continues to spread rampantly throughout the …