Medicine and Health Sciences Commons^™

The Effects Of Prophylactic Probiotic Use On Reducing Group B Streptococcus Colonization In Pregnant People, Effie Karriker, Melissa Tomback

Nursing Student Course Papers

Group B Streptococcus (GBS) is a gram-positive coccus that normally colonizes the digestive and genital tract (Puopolo & Madoff, 2023). Worldwide, approximately 18% of pregnant people[1] carry GBS, and in the United States of America (USA), approximately 25% of pregnant people are GBS positive (Center for Disease Control and Prevention, 2022). GBS can be passed onto an infant during birth when it travels through the vaginal canal, a process called vertical transmission. Unfortunately, for newborns who have an immature immune system, GBS can result in early onset GBS disease requiring a lengthy stay in the NICU or even death. …

Effects Of Digestion, Cell Culture Media, And Mucous On The Physical Properties, Cellular Effects, And Translocation Of Polystyrene And Polymethacrylate Nanoparticles, Zainab Jabor, Steev Sutton

Pharmacy Student Publications

The discovery of plastic and metal nanoparticles in organisms, foods, and beverages has generated numerous studies on the effects of these particles on the barrier cells and their subsequent absorption into the body. Following ingestion, nanoparticles travel down the gastrointestinal tract (GIT), and their physicochemical characteristics change in response to the change in proteins and pH during their digestion. We measured the translocation of digested nanoparticles across a co-culture monolayer of Caco-2 and various combinations (1:9, 5:5, and 9:1) of HT29-MTX-E12. The in vitro model of the intestine was used to determine the translocation of digested 20 nm polymethacrylate (PMA) …

Playing Well With Others: Evaluating An Intervention To Prepare Students For Interprofessional Collaborative Learning, Kelli S. Fox

Social Work Faculty Publications

National trends in health care delivery focus on quality team-based care, patient safety, reducing costs and improving practitioner satisfaction (Interprofessional Education Collaborative, 2016). Health profession students, including social workers, are expected to be workforce ready for a complex interprofessional work environment. Educators are charged with developing effective ways to teach collaborative team skills as part of the curriculum (Rubin et al., 2018; Thistlethwaite et al., 2014). Educators across health professions recognize the importance of providing opportunities to immerse students in experiential, person-centered interprofessional teamwork to adequately prepare them for the workforce. (Cohen Konrad et al., 2017; Mokler, 2020). Planned interprofessional …

Plethysmography Variation Index (Pvi) Utility In Guiding Goal-Directed Fluid Therapy During Major Abdominal Surgery, Ricky Malo

Nurse Anesthesia Student Capstones

When considering intra-operative MAP maintenance, preload is a significant driving factor of stroke volume and therefore cardiac output. In major abdominal surgeries, large fluid shifts are common and accurate fluid resuscitation is extremely important to maintain hemodynamic stability and promote optimal patient outcomes. Invasive methods of measuring fluid status range from esophageal doppler derived flow time (FTc) and arterial line-derived metrics such as stroke volume variation (SVV) and pulse pressure variation (PPV). However, invasive means are not always warranted for every surgical procedure or patient and there is a higher potential risk for complication. Plethysmography Variation Index (PVI) has been …

Neurotoxic Effects Of General Anesthesia On The Developing Brain And The Use Of Spinal Anesthesia As An Alternative Approach For The Neonate And Infant Undergoing Genitourinary Surgery, Makaela E. Delucca

Nurse Anesthesia Student Capstones

Spinal anesthesia (SA) in the child under two years old is an excellent option when undergoing short genitourinary procedures. The use of SA in this patient population can avoid the potential deleterious neurocognitive effects on the developing brain that general anesthesia (GA) poses. A comprehensive literature review was conducted via retrospective case study, case control study, integrated review, and prospective study. The objective of this literature review is to examine the potential long-term neurotoxic effects of GA in the infant, as well as the benefits of SA. GA in the younger population has been shown to produce lower gray matter …

The Effects Of Mindfulness On Stress Reduction And Academic Performance In Students Studying Health Sciences, Julia Montalto

Nurse Anesthesia Student Capstones

Students studying health sciences are often consumed by rigorous curricula and demanding clinical schedules. The extensive concentration and commitment required of these students can be exhausting. This can lead to stress, poor academic performance, substance use and a decreased quality of life (Fauzi et al., 2021, Flowers & Bernard, 2020, Gao et al., 2022, & Melaku et al., 2015). Recent trends in academia have led to an integration of mindfulness-based stress reduction (MBSR) programs into the curriculum of graduate and undergraduate schools. Studies have shown that a consistent practice of some form of mindfulness is associated with a decrease in …

Perioperative Pain Management In Morbidly Obese Patients Undergoing Bariatric Surgery, Jean-Louis Luther

Nurse Anesthesia Student Capstones

Patients with morbid obesity are a growing patient population. These patients present a unique set of challenges in healthcare management. These unique challenges have been a long-standing concern to anesthesia providers in appropriately managing postoperative pain with opioids. Multimodal analgesia strategies have been adopted by many providers to minimize opioid-related side effects that are highly desirable in bariatric surgical procedures. The literature reviewed for this manuscript highlights the challenges this population presents to anesthesia providers, as well as conclusively supports alternative approaches utilizing multimodal pain management.

Impact Of Intrathecal Morphine On Patient Outcomes In Major Abdominal Surgery, Tori E. Howe

Nurse Anesthesia Student Capstones

Colorectal enhanced recovery after surgery (ERAS) guidelines for patients undergoing major abdominal surgeries have started to include intrathecal morphine (ITM) as part of the protocol to improve patient outcomes. There is interest amongst other abdominal surgical disciplines in expanding the use of ITM. When used as a single bolus, ITM has shown to have an intravenous (IV) opioid sparing effect postoperatively, as well as improved pain scores for up to 24 hours (Koning et al., 2020). However, ITM coincides with unique considerations and side effects. There is a dose-dependent concern of ITM causing respiratory depression postoperatively that necessitates additional monitoring …

Ketorolac: To Bleed Or Not To Bleed? That Is The Question, Elisabeth E. Stewart

Nurse Anesthesia Student Capstones

Ketorolac is a readily available, inexpensive, moderate to severe pain management adjunct. As opioids lost favor, ketorolac gained popularity, as an opioid-sparing alternative (Corsini et al., 2021). Anecdotally, surgeons have been resistant to intra-operative intravenous ketorolac due to perceived bleeding risks. As such, this review seeks to evaluate the literature to determine whether ketorolac administration is associated with clinically significant bleeding in adult breast surgery patients. The results demonstrated conflicting evidence for ketorolac use. No literature has established a causal relationship between ketorolac and clinically significant bleeding. Future research avenues include geriatric, pediatric, labor and delivery, dosing, and randomized control …

Perioperative Methadone Use And Postoperative Pain Control In Adult Patients Undergoing Elective Spinal Fusion Surgery, Amelia Haney

Nurse Anesthesia Student Capstones

Patients undergoing elective spinal fusion surgeries often experience moderate to severe postoperative pain (Murphy et al., 2017). The use of perioperative methadone has been suggested as an effective adjunct for patients to reduce postoperative pain, decrease opioid use, and improve patient satisfaction (Murphy et al., 2017). Traditional opioid management of orthopedic spine surgeries include intermittent injections or patient-controlled analgesia devices. These approaches may cause fluctuating levels of opioids or require patient education and cooperation to be effective (Murphy & Szokol, 2019). Methadone has a much longer elimination half-life when compared to other opioids, and therefore may provide patients with a …

Benefits Of Ketamine Versus Propofol In Acute Traumatic Brain Injuries With Elevated Intracranial Pressure, Marissa Diloreto

Nurse Anesthesia Student Capstones

Ketamine is a widely used medication that can be administered for the delivery of anesthesia as well as analgesia while supporting hemodynamics. A commonly taught concept based on early research is that ketamine should not be administered to those with acute brain injuries. Early research had stated that ketamine can cause a dangerous increase in intracranial pressure (ICP) and thus a decrease in cerebral perfusion and oxygenation in those with traumatic brain injuries (TBI) (Takeshita et al., 1972). More recent research has shown that ketamine may be efficacious for patients with TBIs and can decrease ICP (Dengler et al., 2022). …

The Role Of Intraoperative Esmolol Vs Ketamine In Laparoscopic Cholecystectomy, Rebekah Bitar

Nurse Anesthesia Student Capstones

As the understanding of opioid dependence mechanisms and origins in the adult population continues to evolve in the United States, so does the pursuit of alternative avenues for analgesia. Many opioid substance-use disorder patients can trace the origins of their dependence to routine prescription and administration of opioids during surgical procedures (Bohringer et al., 2020). One such procedure where opioids are frequently utilized for intraoperative and postoperative analgesia is laparoscopic cholecystectomy. Incidence of gall bladder disease is closely related to obesity (Hines & Marschall, 2018). Gallstone disease continues to be a common and costly health problem affecting 10 to 20% …

The Effectiveness Of The Six Minute Walk Test For Tracking Progress In Patients With Post-Covid Condition: A Case Report, Jason Angellano, Alexander M. Ferreira, Colleen Mcgonagle, Yurong Ren, Michael Tran

Case Report Papers

Background and Purpose Post-COVID Condition (PCC) is defined as the presence of symptoms related to SARS-CoV-2 four weeks past the initial infection. The SARS-CoV-2 virus impacts many organs and body systems. The six-minute walk test (6MWT) is a standardized measure of cardiovascular endurance commonly used in physical therapy practice. Use of the 6MWT has been studied in specific patient populations (e.g., geriatrics, Parkinson’s disease, stroke, and chronic obstructive pulmonary disorder). The purpose of this case report is to discuss the utility of the 6MWT as a measure of walking capacity in individuals with PCC.

Case Description The patient was a …

Effects Of Intravenous Lidocaine Infusions On Postoperative Opioid Consumption In Adults Undergoing Laparoscopic Abdominal Surgery, Kayla Richardson

Nurse Anesthesia Student Capstones

Lidocaine is a local anesthetic that is often administered to surgical patients undergoing anesthesia. While it was originally utilized as an intravenous antiarrhythmic or for local infiltration, it is now frequently used for the proven opioid-sparing and anti-inflammatory effects during surgeries (Beaussier et al., 2018). A common complaint of postoperative patients is pain, and the administration of intravenous lidocaine can potentially decrease patients' perception of pain after surgical procedures (Lee & Schraag, 2022).

Opioids are commonly administered to patients to help control their pain immediately after surgical procedures. Though opioids are the typically chosen treatment for acute surgical pain, they …

The Utility Of Thromboelastography In Acute Perioperative Trauma Resuscitation Of The Adult Coagulopathic Patient, Alexandra Sofia Keokosky

Nurse Anesthesia Student Capstones

One quarter of all patients admitted to level I trauma centers receive transfused blood, and approximately 25% of trauma transfusion recipients are diagnosed with coagulopathies during the resuscitation process (Hess et al., 2008; Kutcher & Cohen, 2021; Maegele et al., 2007). Such pathologies have been associated with negative clinical outcomes such as increased transfusion requirements, organ failure, sepsis, and death. (Barash et al., 2013; Cole et al., 2019; Hess et al., 2008; Sayce et al., 2020). Current laboratory standards of care to diagnose coagulopathies such as prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) are …

Recurrence And Metastasis Of Breast Cancer After Volatile Inhalation Agents For Primary Cancer Resection, Elise Amico

Nurse Anesthesia Student Capstones

Surgical resection of a breast tumor is frequently a treatment option for cancer, and in some cases can be curative (Hurtado et al., 2021). Multiple factors increase the risk of metastasis or recurrence including the neuroendocrine stress response to surgery and manipulation of the tumor itself (Kim, 2018). Additional factors include depression of cell-mediated immunity including sympathetic nervous system (SNS) stimulation, hypothalamic-pituitary-adrenal (HPA) axis stimulation, and pain (Hurtado et al., 2021). Research suggests that anesthetic selection, particularly total intravenous anesthesia versus volatile inhalation anesthesia (IA), has an impact on cancer recurrence and metastasis in breast cancer patients, however it remains …

Effectiveness Of Ondansetron Prior To Spinal Anesthesia In Obese Parturients Undergoing Caesarean Delivery, Peter O. Lind

Nurse Anesthesia Student Capstones

Spinal anesthesia is the preferred route of anesthesia for parturients undergoing casesarean section (Hawkins et al., 2011). Parturients with obesity undergo caesarean delivery and have higher rates of initial intrathecal failure comparatively to non-obese (Hood, et al, 2015). Obesity is on the rise leading to a reconsideration as to the dosing of spinal anesthetic type (Dennis, 2017). Historically, the utilization of ondansetron, as a selective 5-HT3 antagonist, has been utilized prior to spinal administration to prevent the sympathectomy that can occur (Sahoo et al., 2012). This has decreased the utilization of vasopressors which can be detrimental to the fetus during …

Use Of Micro-Ct To Examine Effects Of Heat On Coronal Obturation, Ivy Shen, Joan Daniel, Kali Vo, Chul Ahn, Carolyn Primus, Takashi Komabayashi

Dental Medicine Faculty Publications

Purpose: The aim of this study was to categorize the effects of heat on coronal obturation with gutta-percha and sealer using X-ray micro-computed tomography (micro-CT).
Methods: Ten single-rooted, extracted human teeth were shaped using ProTaper NEXT files to size X5 (#50/Taper 6%) with 2.5% NaOCl irrigation. A single ProTaper NEXT X5 gutta-percha point was then inserted with epoxy resin (AH Plus) or tricalcium silicate (EndoSequence BC) sealer (n = 5/group), and cut at the cemento-enamel junction. The teeth were scanned using micro-CT (SkyScan1272) to obtain 11 sagittal 2-D images. Three calibrated raters categorized the coronal 0.5 mm of the …

Airway Management And The Hypoglossal Nerve Stimulator For Obstructive Sleep Apnea Patients, Chandler Barnes

Nurse Anesthesia Student Capstones

The pathophysiology of obstructive sleep apnea (OSA) relates to anatomical and non-anatomical factors. Anatomical considerations correlate to narrowing of the pharynx. When present, non-anatomical factors can intensify the severity of OSA and ease of collapsibility of upper airway tissue. The negative consequences of untreated OSA are well-defined and many treatment options are available. The novel hypoglossal nerve stimulator makes for a viable treatment option in patients who do not tolerate more traditional therapy, such as continuous positive airway pressure (CPAP), and meets eligibility requirements of device implantation as outlined by the Food and Drug Administration (FDA). The Inspire® Hypoglossal Nerve …

The Effects Of Propofol Versus Sevoflurane In Surgical Lung Cancer Patients, Jordan Kelley

Nurse Anesthesia Student Capstones

Non-small cell lung cancer (NSCLC) is the most prevalent type of lung cancer. Lung cancer leads all cancer death rates worldwide. Surgical treatment for NSCLC warrants a role for the anesthetist to influence recurrence-free survival, overall survivability, and overall mortality. Literature suggests propofol and sevoflurane are linked to immunosuppressive characteristics by decreasing immunity via different mechanisms. Propofol has known anti-inflammatory effects, but studies reveal sevoflurane has similar capabilities. Sevoflurane may attenuate the metastatic potential of lung cancer by stopping platelet activation, but sevoflurane may also enhance other pathways of metastasis. Similarly, propofol has anti-metastatic abilities, hindering angiogenesis by downregulating necessary …

Comparing Intravenous And Inhalation Anesthetics For Intraoperative Anesthesia In Adult Patients With An Acute Traumatic Brain Injury, Natasha K. Moody

Nurse Anesthesia Student Capstones

As research and science has progressed to further analyze the effects of anesthetics on cerebral physiology, the margin of safety for each anesthetic is reassessed to enhance patient outcomes and recovery. The purpose of this review is to strategically examine and provide updated information on the impact of specific anesthetics administered during the intraoperative period as it applies to patients with acute traumatic brain injury (TBI). In efforts to preserve the cerebral physiology of the patient, current research has identified benefits of administering intravenous over inhalation anesthetics to reduce secondary injuries that have been linked to chronic TBI, morbidity, and …

The Impact Of Dexmedetomidine Use In Patients Over The Age Of 60 Undergoing General Anesthesia On Postoperative Delirium Incidence, Elaina Branco

Nurse Anesthesia Student Capstones

Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are of concern in the elderly population undergoing an anesthetic due to increased mortality and decreased quality of life that can ensue. Sui et al. (2021) reported a 15-50% incidence of POD in elderly surgical patients. Dexmedetomidine is a highly selective, alpha-2 agonist with sedative, analgesic, and anxiolytic properties that mimics a sleep-like state and causes bradycardia and hypotension but not respiratory depression. Dexmedetomidine has neuroprotective properties, including anti-apoptosis and anti-inflammation (Wu et al., 2019). A current review of the literature revealed that dexmedetomidine use can decrease POD incidence in the aged …

The Effect Of Clonidine On Hyperbaric Bupivacaine And Opioid In Cesarean Section Women Under Spinal Anesthesia, Novisi Abba

Nurse Anesthesia Student Capstones

Pain is undoubtedly one of the most undesirable outcomes associated with cesarean section in parturients. The most effective post-cesarean section pain relief option should prioritize maternal, fetal, and neonatal safety, with minimal to no medication transfer to the fetus and neonate. In obstetric anesthesia, neuraxial approaches, with the inclusion of adjuncts like clonidine for pain management may provide some additional benefits. Consequently, obstetric anesthesia practitioners have increasingly used intrathecal clonidine to alleviate post-cesarean section pain. This manuscript examines whether intrathecal clonidine, when combined with hyperbaric bupivacaine and/or opioids (fentanyl and/or preservative-free morphine), has a sustained analgesic effect in parturients following …

Do The Benefits Of Sugammadex Outweigh Its Higher Cost Compared To Neostigmine?, Ashley Mcdonald

Nurse Anesthesia Student Capstones

Neuromuscular blocking agents (NMBAs) are frequently utilized in anesthetic practice to relax the vocal cords in preparation for endotracheal intubation and to facilitate optimal operating conditions for various surgical procedures. Residual muscle paralysis in the postoperative period is a serious consequence of NMBAs that can lead to severe consequences including airway obstruction, hypoxia, reintubation, aspiration, and pneumonia. Neuromuscular blockade (NMB) is overcome either by spontaneous recovery or, in most cases, with the use of a reversal agent. Two of the most common reversal agents are neostigmine, a cholinesterase inhibitor, and sugammadex, a modified gamma-cyclodextrin. Of the two medications, sugammadex is …

Coronal And Apical Leakage Among Five Endodontic Sealers, Kali Vo, Joan Daniel, Chul Anh, Carolyn Primus, Takashi Komabayashi

Dental Medicine Faculty Publications

Purpose: The aim of this study was to use dye penetration to measure apical and coronal leakage simultaneously in single-canal teeth that had been treated endodontically using a single-cone obturation technique.

Methods: One hundred single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size-X5 (50/.06), then randomly assigned to five sealer groups for single-cone gutta-percha obturation. The teeth were soaked in 0.6% rhodamine B at 37°C for seven days, then the roots were ground mesiodistally and the maximum apical and coronal dye penetration was measured. Differences in leakage among the sealer groups were examined using …

Effects Of Heat On Seven Endodontic Sealers, Daniel Chavarria-Bolanos, Takashi Komabayashi, Ivy Shen, Jose Vega-Baudrit, Maria G. Gandolfi, Carlo Prati, Mauricio Montero-Aguilar

Dental Medicine Faculty Publications

Purpose: To examine the microscopic surface features, chemical composition, and thermodynamic profile of seven endodontic sealers (AH Plus, Adseal, MTA-Fillapex, RoekoSeal, GuttaFlow 2, GuttaFlow BioSeal, and EndoRez) exposed to high-temperature changes using an endodontic obturation device.

Methods: The thermal properties were examined using scanning calorimetry (DSC) and thermogravimetric analysis (TGA). Then, six disc-shaped specimens of each sealer were prepared and divided into two groups – a room temperature group and a heat exposure group – for analysis of surface and chemical changes using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS).

Results: DSC analysis showed that AH Plus had …

Efficacy Of Dexmedetomidine As An Opioid Sparing Adjunct To Regional Anesthesia For Shoulder Surgery, Matthew Austin

Nurse Anesthesia Student Capstones

Regional anesthetics are often the preferred route for patients who are having orthopedic shoulder procedures (Rai & Bhutia, 2017). Traditionally, plain local anesthetics, like bupivacaine or ropivacaine, are used as the local anesthetic of choice because of their fast onset and relatively predictable duration of action. However, several different additives have been trialed to prolong the duration or improve the density of regional blocks. When looking at additives to regional anesthetic techniques, side effects and duration of the block can be unpredictable and unpleasant. For example, additives like fentanyl, morphine, and dexamethasone have been trialed in regional techniques and have …

The Rehabilitation Of A 75-Year-Old Male Presenting With A Right Hip Flexor Strain Concomitant With Numerous Psychosocial Factors: A Case Report, Jillian Battista, Megan Chapski, Suma Varanasi, Jillian Witwicki

Case Report Papers

Background: Musculoskeletal disorders, often well understood, are a leading cause of disability worldwide. Concomitant psychosocial factors add a layer of complexity to the treatment of musculoskeletal disorders. The purpose of this case report is to highlight the potential impact psychological factors have in the rehabilitation of musculoskeletal disorders, specifically the rehabilitation of a right hip flexor strain.
Case Description: The patient was a 75-year-old male referred to outpatient physical therapy for the assessment of a right hip flexor strain, presenting with psychosocial factors including anxiety and kinesiophobia. Procedural interventions included patient education, neuromuscular re-education, therapeutic exercise, and manual therapy, but …

Utilizing An Evidence-Based Practice Framework In Non-Operative Acl Rehabilitation - A Case Report, Eric Norman, Michael Madore, Kathryn Magee, Tyler Calimer, Parker Nally

Case Report Papers

Study Design: Case Report. Background: The patient was a 51-year-old female who tore her left anterior cruciate ligament (ACL) playing pickleball and opted for non-operative treatment. The clinicians involved treated the patient using the three pillars of practice: relevant scientific evidence, clinician experience, and patient perspective.
Treatment: The patient’s treatment consisted of therapeutic exercises, neuromuscular re-education, soft tissue massage, and motivational interviewing. Therapeutic exercises were designed to strengthen the muscles surrounding her hip and knee. Neuromuscular re-education helped to improve the patient’s knee stability and balance, while soft tissue massage was used to decrease swelling. Motivational interviewing helped her better …

Effectiveness Of A Multidisciplinary Chronic Pain Management Program In A Local Pain Center, Charlotte L. Barker, Danielle A. Sultan, Woon Yuen Koh, Stephen Z. Hull, Ling Cao

Osteopathic Medicine Student Publications

Objectives: There has been increased recognition of multidisciplinary approach for managing chronic pain. There is a high incidence of co-morbid depression and anxiety as well as functional disability impacting activities of daily living with chronic pain diagnoses. In the current study, we assessed the effectiveness of an affordable Living Life Well Pain Rehabilitation Program (LLWPRP), developed in a local outpatient chronic pain clinic. Methods: Retrospective data analysis using data collected from May 2012 - May 2015 with total of 86 patients was performed. The LLWPRP is a 12-week program with biweekly meetings. It involves a combination of education about pain, …