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Volume 57, Number 21: January 15, 2020, University Of North Dakota

University Letter Archive

No abstract provided.

Volume 57, Number 20: January 08, 2020, University Of North Dakota

University Letter Archive

No abstract provided.

Fostering Improvement In Occupational Performance Through Environment Modification In Skilled Nursing Facilities, Grant Baker, Erin Grensteiner, Rachel Lindemann

Critically Appraised Topics

First-year occupational therapy students at the University of North Dakota School of Medicines and Health Sciences completed this CAT. The general topic assigned was the completion of activities of daily living (ADLs) and instrumental activities of daily living (IADLs) by older adults in a skilled nursing facility (SNF). Students formed a focus question, a case scenario, and then researched and presented key findings. Students then presented implications for practice in occupational therapy with the evidence of scholarly research in the areas of theory, environment, population, and interventions. The intervention that was chosen for this CAT was the Green House Project. …

The Use Of Bottom-Up, Sensory-Based Approaches For Adolescents With Complex Trauma, Dina Nickoson, Rebecca Rimel, Cassie Madsen

Critically Appraised Topics

Complex trauma is defined as the long-term effects of repeated exposure to severe traumatic events (Fraser, McKenzie & Versnel, 2019). Children who have experienced complex trauma have a decreased ability to regulate their emotions (Warner, Spinazzola, Westcott, Gunn & Hodgdon, 2014). Not being able to process and regulate one’s emotions leads to a lack of occupational participation (Fraser et al., 2019; Warner et al., 2014). These impacts can be seen in adolescents’ daily occupations such as play, education, leisure activities, and social interactions both at home and in the community (Fraser et al., 2019; Warner et al., 2014). This type …

Supporting Adults With Chronic Pain Through The Use Of A Non-Opioid Pain Management Program, Chloe Haas, Richard Seaman, Jaslyn Seeley

Critically Appraised Topics

Chronic pain is experienced by 20.4% of adults in the United States. It is one of the most common reasons that adults seek medical attention and is linked to restrictions in mobility and daily activities (Dahlhamer et al., 2016). The incidences of anxiety and depression, perceived poor health, reduced quality of life, and dependence on opioids are common with chronic pain (Dahlhamer et al., 2016). This type of pain is described as pain experienced every day for three to six months or more (Pitcher, Von Korff, Bushnell, & Porter, 2001). Chronic pain includes headaches, pain from the lower back, cancer, …

Occupation-Based Education For Fall Prevention In Community-Dwelling Older Adults: A Critically Appraised Topic Paper, Mckenzie Dye, Samantha Hudson, Therese Pettersen

Critically Appraised Topics

Community-dwelling older adults are at a higher risk of falls due to many factors; including their environment and nutritional state. Falls have been described as “unintentionally coming to rest on the ground, floor, or other lower-level” (Buchner et al., 1993 as cited in Chase, Mann, Wasek, & Arbesman, 2012, p. 284). Community-dwelling older adults have been described in this research as individuals who are 65 years or older and who live independently. A rural community, according to the United States Census Bureau (2019) “encompasses all population, housing, and territory not included within an urban area” (para. 3) …

Effectiveness Of Self-Management Programs To Reduce Occupational Deprivation In Older Adults, Sophia Schutt, Kristin Thompson

Critically Appraised Topics

Operational definition of self-care management: Self-management is recognized as an effective approach to managing chronic health conditions by “empowering patients to understand their conditions and take responsibility for their health” (National Institutes of Health, 2010, para. 4). According to the American Occupational Therapy Association (2014), self-management is about being in charge of one’s life and managing one’s condition, instead of being managed by that condition. Memory Strategy Education Group program (MSEG) is a self-care management program that utilizes working memory strategy exercises (Coe, Martin & Stapletion, 2019). This is an example of a self-care management program that has occupation-based interventions …

Assistive Technology And In-Home Use For Individuals With Tetraplegia, Benjamin Germolus, Ashleymarie Hirdler, Mckenzie Peterson

Critically Appraised Topics

Tetraplegia (otherwise known as quadriplegia) is a common impairment treated by occupational therapy. It is defined as the impairment or loss of motor and/or sensory function of upper extremities (UEs), lower extremities (LEs), and trunk as a result of damage to the cervical segments of the spinal cord (Atrice et al., 2020). Damage to the vertebrae or spinal cord can result in spinal cord injury (SCI). The National Spinal Cord Injury Statistical Center (NSCISC) (2020) indicated the prevalence of spinal cord injuries in the United States is approximately 294,000 people. Average age of injury has reportedly increased from 29 to …

The Use Of Sensory Integration To Mitigate The Traumatic Environment Of The Nicu: A Critically Appraised Topic (Cat), Heather Bowman, Audrey Soulek, Abby Werkmeister

Critically Appraised Topics

In 2018, one in 10 infants were born premature in the United States, which is classified as being born prior to 37 weeks gestation (Centers for Disease Control [CDC], 2019). This includes an average of 7,303 babies each week (March of Dimes, 2020). The final months and weeks in utero are shown to be critical to typical development (CDC, 2019). The organs associated with the sensory system begin to develop within utero around eight weeks and the development of the senses continues well into childhood and adolescence (Mayo Clinic, 2020). Hearing and vision are the last two sensory systems to …

Treatment Of Clostridioides Difficile With Fecal Microbiota Transplantation, Brenton Green

Physician Assistant Scholarly Project Posters

Research was performed to discuss the epidemiology and current guidelines of Clostridioides difficile infection (CDI), recurrent C. difficile infection (rCDI), the different modalities of fecal microbiota transplantation (FMT), the donor screening process, as well as the safety and efficacy of treatment.

• Utilizing Clinical Key, NCBI database, Dynamed Plus, Cochrane Review, and the websites for the CDC and FDA, a literature review encompassing recent research and human studies relating to CDI.

• Recent studies within five years were preferred, however since C. difficile has sparsely changed, older data was utilized with updates applied accordingly.

• Oral antibiotics are intended for …

Occupational Therapy Intervention Approaches For Successful Employment Outcomes For Individuals With An Intellectual Disability, Kaitlyne Dittberner, Heidi Janssen, Shivangi Patel

Critically Appraised Topics

“Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. Disability is thus not just a health problem. It is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives” (Boyt Schell & Gillen, 2019, pp. 1196). Disability is a natural part of the human experience, and does not inhibit an individual’s ability to successfully contribute to society. “Intellectual disability is a developmental disability that is diagnosed before the age of 18 and expected to last throughout life. It involves significant limitations in intellectual functioning …

Occupational Therapy Lymphedema Management And Its Relationship To Quality Of Life, Jessica Blackman, Marissa Dreiling, Ashley Mutziger

Critically Appraised Topics

In the United States, one in five women who survive breast cancer will develop lymphedema (DiSipio, Rye, Newman, & Hayes, 2013). Lymphedema is the chronic, progressive swelling of tissue due to inadequate lymphatic function. Over time, protein-rich fluid accumulates in the tissue, causing skin and tissue to enlarge (Maclellan & Greene, 2014). This condition often leads to impaired performance of activities of daily living (ADL) and instrumental activities of daily living (IADL) due to this abnormal swelling. Activities of daily living are defined as “activities oriented toward taking care of one’s own body” (Rogers & Holm, 1994, p. S19). Instrumental …

Effectiveness Of Complete Decongestive Therapy (Cdt) As A Lifestyle Management Intervention For Adults With Secondary Lymphedema., Hannah Curlett, Alexia Gallagher, Amy Shaver

Critically Appraised Topics

The National Cancer Institute (2019) explains that lymphedema is a condition where there is a buildup of fluid in soft tissues as a result of the lymphatic system being damaged or blocked. Lymphedema is estimated to impact 2 to 3 million people in the United States, with secondary lymphedema being the most common form (Rockson & Rivera, 2008). Prevalence rates for lymphedema are likely underestimated, as not all patients have received treatment for their condition (Rockson & Rivera, 2008). Secondary lymphedema occurs when the lymph system is damaged or blocked from cancer, infection, injury, removal of lymph nodes, radiation, or …

Evidence Of Occupation-Based Interventions For Acute Inflammatory Demyelinating Polyneuropathy Symptoms: A Critically Appraised Topic, Stacy Buschette, Jacob Kullot, Allison Mcgauvran

Critically Appraised Topics

Polyneuropathies cause damage to multiple peripheral nerves on both sides of the body, resulting in sensory loss and weakness of the extremities (Bautista & Grossman, 2014; Mayo Clinic, 2019). Guillain-Barre Syndrome (GBS) is a disorder with an unknown distinct cause that consists of a person's immune system destroying the cells within his or her peripheral nervous system occurring in stages (Mayo Clinic, 2020; Sawant & Ferzandi, 2015). Acute inflammatory demyelinating polyneuropathy (AIDP) is an auto-immune inflammatory polyneuropathy that is a variant of GBS (Alessandro et al., 2018; Bautista & Grossman, 2014; Brooks, 2014; Mayo Clinic, 2019; National Institutes of Neurological …

Occupational Therapy Interventions For People With Type 2 Diabetes In Rural Communities, Katherine Christopherson, Meghan Janssen, Nicole Merchlewicz

Critically Appraised Topics

Type 2 diabetes mellitus, commonly called type 2 diabetes, is the seventh leading cause of death in the United States (American Diabetes Association, 2020). The prevalence of diabetes is 17% higher in rural areas as compared to urban areas (“Why Diabetes is a Concern,” 2020). Hospitalizations and deaths from type 2 diabetes complications are higher in rural areas than in urban areas (Ferdinand, Akinlotan, Callaghan, Towne, & Bolin, 2018).

Intervention Strategies For Older Adults In Rural Skilled Nursing Facilities (Snf), Mackenzie Brokaw, Hallie Longtin, Sarah Schumacher

Critically Appraised Topics

Older adults in SNFs are facing occupational deprivation due to their environments restricting occupational performance. Individuals seeking residence in SNF in urban settings tend to face more issues surrounding client-centered interventions than those in rural communities. Due to the large population of occupational therapy practitioners working in this setting, there is potential to change the culture of care residents receive in SNFs. The purpose of this CAT is to determine if implementation of occupation-based interventions decrease occupational deprivation in SNFs in rural areas.

Mental Health Resources & Healthcare Professional Students, Matthew A. Knealing

Physician Assistant Scholarly Project Posters

The reasoning for this review of literature is to determine if implementing mental health resources in graduate healthcare programs decreases the rate of depression and suicidal ideations. In this review of literature, five databases were searched. They included: PubMed, PsycInfo, CINAHL Complete, Clinical Key, and the Cochrane Library from September 15 to January 3, 2020. Due to the topic being dynamic and receiving more acknowledgment in recent years, articles reviewed were restricted to the last six years within the United States. Works chosen were peer reviewed, which included meta analysis, cross sectional, systemic reviews, longitudinal and, survey method studies. Sources …

Review Of Anticoagulation Therapy In Unprovoked Pulmonary Embolism, Christopher D. Klucas

Physician Assistant Scholarly Project Posters

The purpose of this research was to identify the best course of action in response to a diagnosis of unprovoked pulmonary embolism.

•The evidence demonstrates non-inferiority status of new direct oral anticoagulants (DOAC) when indirectly compared to conventional warfarin therapy.

•Aspirin was also found effective in mitigating the risk of recurrence, but to a lesser extent than both DOAC agents and warfarin.

•DOACs are reasonable alternatives to conventional therapy. Attention to individual comorbidities may allow providers to find advantage with one therapy over another.

• The research, thus far, has not been able to identify a universally safe and an …

The Safety, Accuracy, And Cost-Effectiveness Of Confirmatory Penicillin Allergy Testing In The Outpatient Setting As A Means Of Reducing Patient Morbidity And Mortality, Mitchell Mimbach

Physician Assistant Scholarly Project Posters

The purpose of this review is to investigate the prevalence of documented penicillin (PCN) allergies in health care and any negative outcomes associated with being labeled as such. Additional topics researched included the safety and accuracy of PCN allergy testing, the cost-effectiveness of PCN allergy testing versus using non-PCN related antibiotics, and barriers to confirmatory PCN allergy testing implementation. A complete review of the aforementioned topics included meta-analysis’, systematic reviews, cohorts, clinical trials, and cross-sectional studies from the last five years. Databases utilized for this research included PubMed, Cochrane Review, Embase, Dynamed Plus, and ClinicalKey. Sources that were excluded from …

Critically Appraised Topic: Evidence For The Effectiveness Of Implementing Home Modifications To Age In Place, Feyi Adewoye, Michaela Gerving, Ashley Osbjornson

Critically Appraised Topics

Older adults are at an increased risk of falling due to several factors. This is an important topic for occupational therapy practitioners. The purpose of the CAT is to provide evidence to build occupation-based interventions such as home modifications that support the improvement of community-dwelling older adults’ quality of life through engagement in activities of daily living.

The Effect Of Proton Pump Inhibitors On Normal Gastrointestinal Flora Leading To Weight Change, Emi L. Binstock

Physician Assistant Scholarly Project Posters

The goal of this literature review was to determine what effects proton pump inhibitors (PPIs) have on the normal gastrointestinal (GI) flora and how that may lead to weight loss or weight gain. A literature search was performed using the database PubMed. Only articles from the last ten years (2009-2019) were included in this review. Keywords used in the search are listed below. After exclusion criteria was applied, 30 articles were relevant and used in this review. Five themes were identified in the literature review. An investigation of normal GI flora associated with weight loss and weight gain identified a …

Efficacy Of Bariatric Surgery Compared To Non-Surgical Treatments For Morbid Obesity, Erica Donovan

Physician Assistant Scholarly Project Posters

The purpose of this research is to show the efficacy of Roux-en-Y gastric bypass and sleeve gastrectomy as compared to traditional diet and exercise models. Finding ways to combat morbid obesity has resulted in invasive surgical techniques because traditional diets and exercise work infrequently and often fail. Systematic reviews, metaanalysis, randomized controlled trials and retrospective studies were found using the data base of CINAHL, SportsDiscus, PsycInfo, Embase, and PubMed. All of the studies were published no later than 2014 and used human adult subjects ages 19-65. The studies reviewed show that bariatric surgery is a safe and effective obesity treatment …

Comparison Of Buprenorphine-Naloxone And Buprenorphine Monotherapy In Opioid Dependent Pregnant Women, Ellie Gillund

Physician Assistant Scholarly Project Posters

•The purpose of this literature review is to compare the use of buprenorphine-naloxone combination therapy to buprenorphine monotherapy as medication assisted therapy (MAT) for opioid dependent pregnant women.

•Outcomes compared in this study include maternal and neonatal safety, neonatal abstinence syndrome, and peripartum pain management.

•This review included electronic search databases: PubMed, Clinical Key, and Cochrane Library from September 1, 2019 to March 1, 2020. The search included randomized control trials, systematic reviews, and meta-analysis. Sources excluded included those published >25 years ago, those with poor study design, and those with primary focus on methadone.

•Current research shows evidence to …

Surgical Innovations For Gerd: Comparing Outcomes Of Magnetic Sphincter Augmentation And Nissen Fundoplication, Steffani N. Johnston Mack

Physician Assistant Scholarly Project Posters

Gastroesophageal reflux disease (GERD) is a common chronic upper gastrointestinal disease with both objective and subjective components. While most cases of GERD are uncomplicated and can be managed with oral medication, refractory cases require surgical intervention. The purpose of this study is to compare the efficacy of GERD’s gold standard surgical technique, the Nissen fundoplication, with a new surgical technique, magnetic sphincter augmentation.

Antibiotic Efficacy In Lower Back Pain, Alexander M. Lee

Physician Assistant Scholarly Project Posters

Chronic lower back pain affects approximately eight percent of the American population, yet no treatment has been agreed upon universally. Studies suggest that between 20-30 percent of lower back pain cases are caused by a low-virulence bacterial infection of an intervertebral disc. • This scholarly project investigated: In patients with chronic lower back pain and Modic changes after disc herniation, what is the effect of antibiotic therapy on reducing pain symptoms compared to placebo. • The literature review used the following electronic databases: ClinicalKey, Cochrane Library, Embase, and PubMed. Keywords and mesh terms refined searches to the most recent and …

An Analysis Of The Incidence And Severity Of Drug-Drug Interactions Between Prescribed Pharmaceuticals And Cannabinoids, Jennifer Mcrae

Physician Assistant Scholarly Project Posters

Identify the incidence and severity of drug-drug interactions between commonly prescribed medications and cannabinoids • Medications that are substrates for CYP2C19, CYP2C9 and CYP1A2 are at the greatest risk of interaction with concomitant use of phytocannabinoids or synthetic cannabinoids • Caution is recommended with medications metabolized via UGT or CES1, however information is currently limited and further research is necessary • Lack of universal standards for laboratory testing of cannabinoid products call into question the legitimacy of reported results in currently reported research as the contents of many cannabinoid products are inaccurately labeled

Cyp2d6 Polymorphisms And Their Effect On Opiate Metabolism, Blair Runde

Physician Assistant Scholarly Project Posters

The purpose of this research and systematic literature review is to determine if pharmacogenetic testing for the CYP2D6 enzyme responsible for the metabolism of several opiates leads to differences in serum levels, side effects, and treatment outcomes for patients with acute or chronic pain. Much of the presented research indicates an association between CYP2D6 phenotypes and differential treatment outcomes. Poor CYP2D6 metabolizers are shown to be at increased risk of analgesic failure contrasted with ultra-rapid metabolizers demonstrating better analgesic control; however, they had a higher risk of side effects and toxicity. Conflicting data is also demonstrated as well as a …

Analysis Of Tech-Based And Telemental Health Approaches Within The Adolescent And Young Adult Populations Of Rural America, Audrey K. Smeenk

Physician Assistant Scholarly Project Posters

The incidences of depression and anxiety among adolescent and young adult populations are intensifying, and resources remain limited for the management of these diseases within rural America.

• Evaluation on different interventions was completed to assess ease of access, efficacy, and patient adherence with the hope to decrease incidence of disease and increase availability of resources to rural areas.

• Based on the current completed research, there is a predominance of evidence that has shown moderate statistical data and promising outcomes from tech-based mobile applications and telemental health. Statistical evidence supports that technological based interventions are a potential treatment option …

Hyperbaric Oxygen Therapy For The Treatment Of Traumatic Brain Injuries, Jordan A. Wiedmann

Physician Assistant Scholarly Project Posters

This research and systematic literature review evaluates the safety and efficacy of Hyperbaric oxygen therapy (HBOT) to improve treatment outcomes in traumatic brain injuries (TBIs). This review included the search of PubMed, Cochrane Review, Clinical Key, and DynaMed. The search included randomized control trials, systematic reviews, and meta-analyses published in the last 20 years.

• Several studies show evidence to support the use of HBOT in TBIs, however the majority of research suggests overall insufficient evidence on the topic. Several studies also address the concern for safety and side effects, as individuals are exposed to increased pressures for long lengths …

Early Intervention: Addressing Opioid Use Disorder With Emergency Department Initiated Buprenorphine Therapy, Dustin Voss

Physician Assistant Scholarly Project Posters

An evaluation of opioid use disorder (OUD) as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria.

• The use of buprenorphine in the process of induction, its efficacy for the management of OUD, and barriers to its initiation.

• Outcomes of the initiation of office-based buprenorphine treatment are compared to emergency departmentinitiated buprenorphine treatment for the management of OUD.

• Results revealed that buprenorphine is effective in treating OUD when appropriate induction and maintenance doses are implemented. However, there continue to be barriers in prescribing that have limited access to the medication.

• Office-based buprenorphine …