Digital Commons Network^™

Just-In-Time Decision Making: Preliminary Findings Of A Goals Of Care Rapid Response Team, Donna S Zhukovsky, Yvonne Heung, Parema Enriquez, Nelda Itzep, Zhanni Lu, Nico Nortje, Penny Stanton, Angelique Wong, Eduardo Bruera

Faculty, Staff and Student Publications

CONTEXT: The COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOC RRT) to optimize resource utilization balanced with goal-concordant patient care.

OBJECTIVES: Primary study objective was to evaluate feasibility of the GOC RRT by describing the frequency of consultations that occurred from those requested. Secondary objectives included adherence to consultation processes in terms of core team member participation and preliminary efficacy in limiting care escalation.

METHODS: We conducted a retrospective chart review of patients referred to GOC RRT (3/23/2020-9/30/2020). Analysis was descriptive. Categorical variables were …

Sars-Cov-2 Restructures Host Chromatin Architecture, Ruoyu Wang, Joo-Hyung Lee, Jieun Kim, Feng Xiong, Lana Al Hasani, Yuqiang Shi, Erin N Simpson, Xiaoyu Zhu, Yi-Ting Chen, Pooja Shivshankar, Joanna Krakowiak, Yanyu Wang, David M Gilbert, Xiaoyi Yuan, Holger K Eltzschig, Wenbo Li

Faculty, Staff and Student Publications

Some viruses restructure host chromatin, influencing gene expression, with implications for disease outcome. Whether this occurs for SARS-CoV-2, the virus causing COVID-19, is largely unknown. Here we characterized the 3D genome and epigenome of human cells after SARS-CoV-2 infection, finding widespread host chromatin restructuring that features widespread compartment A weakening, A-B mixing, reduced intra-TAD contacts and decreased H3K27ac euchromatin modification levels. Such changes were not found following common-cold-virus HCoV-OC43 infection. Intriguingly, the cohesin complex was notably depleted from intra-TAD regions, indicating that SARS-CoV-2 disrupts cohesin loop extrusion. These altered 3D genome/epigenome structures correlated with transcriptional suppression of interferon response genes …

Lipid Nanoparticle-Mediated Mrna Delivery In Lung Fibrosis, Matteo Massaro, Suhong Wu, Gherardo Baudo, Haoran Liu, Scott Collum, Hyunho Lee, Cinzia Stigliano, Victor Segura-Ibarra, Harry Karmouty-Quintana, Elvin Blanco

Faculty, Staff and Student Publications

mRNA delivery enables the specific synthesis of proteins with therapeutic potential, representing a powerful strategy in diseases lacking efficacious pharmacotherapies. Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by excessive extracellular matrix (ECM) deposition and subsequent alveolar remodeling. Alveolar epithelial type 2 cells (AEC2) and fibroblasts represent important targets in IPF given their role in initiating and driving aberrant wound healing responses that lead to excessive ECM deposition. Our objective was to examine a lipid nanoparticle (LNP)-based mRNA construct as a viable strategy to target alveolar epithelial cells and fibroblasts in IPF. mRNA-containing LNPs measuring ∼34 nm had …

Pembrolizumab And Cabozantinib In Recurrent Metastatic Head And Neck Squamous Cell Carcinoma: A Phase 2 Trial, Nabil F Saba, Conor E Steuer, Asari Ekpenyong, Ashley Mccook-Veal, Kelly Magliocca, Mihir Patel, Nicole C Schmitt, William Stokes, James E Bates, Soumon Rudra, Jill Remick, Mark Mcdonald, Marin Abousaud, Aik Choon Tan, Muhammad Zaki Hidayatullah Fadlullah, Ritu Chaudhary, Jameel Muzaffar, Kedar Kirtane, Yuan Liu, Georgia Z Chen, Dong M Shin, Yong Teng, Christine H Chung

Faculty, Staff and Student Publications

Anti-programmed cell death protein 1 (PD-1) therapy is a standard of care in recurrent metastatic head and neck squamous cell carcinoma (RMHNSCC). Vascular endothelial growth factor inhibitors, including tyrosine kinase inhibitors, have immunomodulatory properties and have offered promising results when combined with anti-PD-1 agents. We conducted a phase 2, multicenter, single-arm trial of pembrolizumab and cabozantinib in patients with RMHNSCC who had Response Evaluation Criteria in Solid Tumors v.1.1 measurable disease and no contraindications to either agent. We assessed the primary end points of tolerability and overall response rate to the combination with secondary end points of progression-free survival and …

Giant Cell Arteritis In An Elderly Female With Pulmonary Tuberculosis, Ashwin Parchani, Ashish Baweja, Harnoor Singh, Yatharth Malik, Vinod Gupta, Minakshi Dhar, Monika Pathania

Faculty, Staff and Student Publications

Giant cell arteritis (GCA) is a type of systemic vasculitis that primarily affects people over the age of 50 and affects the medium to large arteries. GCA's clinical manifestations can be varied and non-specific, similar to those observed in atherosclerosis. Here, the authors present a case of an elderly woman with pulmonary tuberculosis with GCA masquerading as atherosclerosis.

The Circadian E3 Ligase Fbxl21 Regulates Myoblast Differentiation And Sarcomere Architecture Via Myoz1 Ubiquitination And Nfat Signaling, Bo Hu, Jian-Xing Ma, Adam S Duerfeldt

Faculty, Staff and Student Publications

Diabetic retinopathy and age-related macular degeneration are common retinal diseases with shared pathophysiology, including oxidative stress-induced inflammation. Cellular mechanisms responsible for converting oxidative stress into retinal damage are ill-defined but have begun to clarify. One common outcome of retinal oxidative stress is mitochondrial damage and subsequent release of mitochondrial DNA into the cytosol. This leads to activation of the cGAS-STING pathway, resulting in interferon release and disease-amplifying inflammation. This review summarizes the evolving link between aberrant cGAS-STING signaling and inflammation in common retinal diseases and provides prospective for targeting this system in diabetic retinopathy and age-related macular degeneration. Further defining …

Deep Learning-Enabled Fully Automated Pipeline System For Segmentation And Classification Of Single-Mass Breast Lesions Using Contrast-Enhanced Mammography: A Prospective, Multicentre Study, Tiantian Zheng, Fan Lin, Xianglin Li, Tongpeng Chu, Jing Gao, Shijie Zhang, Ziyin Li, Yajia Gu, Simin Wang, Feng Zhao, Heng Ma, Haizhu Xie, Cong Xu, Haicheng Zhang, Ning Mao

Faculty, Staff and Student Publications

Background

Breast cancer is the leading cause of cancer-related deaths in women. However, accurate diagnosis of breast cancer using medical images heavily relies on the experience of radiologists. This study aimed to develop an artificial intelligence model that diagnosed single-mass breast lesions on contrast-enhanced mammography (CEM) for assisting the diagnostic workflow.

Methods

A total of 1912 women with single-mass breast lesions on CEM images before biopsy or surgery were included from June 2017 to October 2022 at three centres in China. Samples were divided into training and validation sets, internal testing set, pooled external testing set, and prospective testing set. …

Weight Loss For Bariatric Patients: Arterial Embolization Versus Gastric Bypass, Morgan Bernhardt

Physician Assistant Scholarly Project Papers

The primary aim of this systematic literature review is to determine the safety and efficacy of left gastric artery embolization (LGAE) in comparison to Roux-en-Y gastric bypass (RYGB) for bariatric patients. A total of four prospective studies focusing on left gastric artery embolization were selected and reviewed. A total of five studies were selected that discussed Roux-en-Y gastric bypass. All studies used have a publication date of 10 years or less. The research shows evidence that RYGB, an invasive surgical operation, has been proven to result in long-term efficacy of weight loss but can be associated with a higher risk …

Manual Vs. Mechanical Chest Compressions In Adult Cardiac Arrest, Brittany Ann Almquist

Physician Assistant Scholarly Project Papers

The purpose of this literature review is to compare the use of manual versus mechanical chest compressions during cardiopulmonary resuscitation (CPR) in the treatment of adult cardiac arrest patients. A literature review was performed using the databases CINAHL, Embase, and PubMed. Studies chosen were peer reviewed randomized controlled trials, respective reviews, a cross-over controlled trial, and an experimental trial. Only articles from the last seven years were included in this review. After exclusion criteria were applied, ten articles were relevant and utilized. Four themes were identified in the literature review specific to studies of cardiac arrest with utilization of CPR …

A Comparison Of Pharmacotherapy Versus Complementary Medicine In The Treatment Of Migraines, Samantha Braaten

Physician Assistant Scholarly Project Papers

Migraine headache is a common, universal neurological disorder that can be complicated to treat. Despite the wide availability of treatments used as prophylactic agents against migraines, outcomes have been inconsistent, and a number of patients do not respond to prophylactic medications. Therefore, it is important to investigate new non-pharmacological modalities accompanied with less adverse effects and maximal efficacy. To determine if complementary medicine modalities such as acupuncture, botulinum toxin-A, or cognitive behavioral therapy can be as effective as traditional pharmacotherapy for the treatment of migraines, a literature review was completed using meta-analyses and clinical trial reviews. Despite the fact there …

Liraglutide Versus Semaglutide: Long Term Weight Loss Management In Obese Individuals, Mckenzie Burke

Physician Assistant Scholarly Project Papers

Obesity has been a source of complications affecting multiple aspects from a physiological and psychological standpoint which has been steadily growing. There are a multitude of weight loss programs and medications with the idea of sustaining consistent weight loss to include use of the pharmaceuticals discussed within this review. The purpose of this literature review is to compare the efficacy and safety with use of liraglutide versus semaglutide (GLP-1 receptor agonists) in respect to long term weight loss management while in conjunction to lifestyle modifications within the obese population. Thorough research has been done with the aid of health science …

Alternative Treatment Modalities For Plantar Fasciitis, Chelsey Clark

Physician Assistant Scholarly Project Papers

Plantar Fasciitis is a common and frequent condition in adult patients. The purpose of this literature review is to determine whether evidence exists for alternative treatments in the regimen of plantar fasciitis that has not been resolved with the standard treatment. The review was done using Pubmed, CINAHL and SportDiscus. Research was included on the following alternative treatments of PF: corticosteroid injections, extracorporeal shockwave, dry needling, Platelet-Rich Plasma (PRP), Autologous Blood Injection (ABI), cupping, custom insoles, and ultrasound therapy. A total of 12 research articles were included in this review. The alternative treatments considered within this literature review had some …

Efficacy Of Transcutaneous Electrical Nerve Stimulation Vs. Calcitonin Gene Related Peptides In The Application Of Migraine Prophylaxis, Matthew Davis

Physician Assistant Scholarly Project Papers

Worldwide migraines affect millions of people everyday causing significant impact on patient’s lives. Oftentimes, these patients have failed several first-line therapies for migraine prophylaxis causing pharmaceutical companies to develop newer therapies. The purpose of this systematic literature review is to evaluate the effectiveness and tolerability of transcutaneous electrical nerve stimulator (TENS) devices versus calcitonin gene related peptide (CGRP) antagonists in the application of migraine prophylaxis. PubMed and ClinicalKey were searched with key terms, 17 sources were selected that were published after 2016. Sources included meta-analysis, literature review, and randomized control trials. The data showed that TENS devices as well as …

Evaluating And Comparing The Safety And Efficacy Of Rimegepant Versus Lasmiditan In Aborting Acute Migraine Headaches In The Adult Migraineur, Anthony Douthit

Physician Assistant Scholarly Project Papers

Migraine headaches are one of the most common causes of primary headaches. Worldwide, migraines are one of the leading causes of disability and while the mechanism of migraines are not entirely understood, they result in significant disability for those who experience them. Dihydroergotamine was introduced for migraine treatment in the 1920s and in the 1990s triptans were introduced and have been the mainstay of acute migraine treatment since their introduction. In recent years, there have been several developments in the acute treatment and prophylaxis of migraine headaches. Some of the more widely studied and recently developed interventions include calcitonin gene …

A Comparison Of Common Treatment Modalities For Veterans Diagnosed With Post-Traumatic Stress Disorder Versus Low-Dose Ketamine Therapy, Kristopher Flynt

Physician Assistant Scholarly Project Papers

The purpose of this research and systematic literature review is to compare the drug ketamine’s efficacy at treating post-traumatic stress disorder for veterans and active-duty military compared to approved Food and Drug Administration (FDA) options and combination medication/psychotherapy. In this review, three databases were searched including Pubmed, ClinicalKey, and PsycInfo from October 3 to January 9, 2023. Additionally, the Veterans Affairs (VA)/Department of Defense (DOD) Clinical Practice Guidelines was utilized. A variety of key and mesh terms were utilized when database searching. Chosen works for review included randomized control trials, systematic reviews, meta-analysis, and retro-perspective studies. Sources that were excluded …

Associations Between Screen Use And Depression In The Youth Population, David Franta

Physician Assistant Scholarly Project Papers

The association between depression in the youth population and screen use has remained largely unclear. Depression is a common finding in children and adolescents, and as mobile phones, computers, and television are becoming more readily available to young populations, evaluation of the relationship between the two could likely be very important. Unfortunately, little concrete evidence has been established regarding the direct effects of screen time and the presence or development of depression. A literature review comprised of both cross-sectional and longitudinal studies was performed to evaluate the current literature regarding screen use and depression in the youth population, including differences …

Home-Based Cardiac Rehab Vs. Center-Based Cardiac Rehab In Rural Areas, Timothy Fresonke

Physician Assistant Scholarly Project Papers

Cardiac rehabilitation in rural areas can present unique challenges. The main challenge is the locations patients must travel to receive such care. Some patients are expected to travel more then an hour away, on multiple occasions during the week, to undergo therapy. This can be an issue for many patients and something that has been studied and is starting to be addressed in various countries. A literature review was done to see if there was a safe and effective alternative to the traditional center-based cardiac rehabilitation. The electronic search databases PubMed, Embase and CINAHL Complete were utilized to search for …

Food Intolerance In Patients With Depression, Victoria Gingrey

Physician Assistant Scholarly Project Papers

Depression is a multifactorial condition affecting people worldwide. Medication is commonly prescribed for the treatment of depression, but some patients have difficulty finding a medication that is both effective and tolerable while others prefer to avoid medications all together. It has been suggested that dietary modification may reduce the depressive symptoms. As lifestyle changes may be difficult to maintain long term, determining specific foods to avoid for individual patients may improve adherence. A meta-analysis of 10 articles was performed. Articles were found using the electronic search databases PubMed and PsychInfo. Serology differences were appreciated between patients with depression and healthy …

Cognitive Behavior Therapy Versus Internet Cognitive Behavior Therapy In Adults With Anxiety Or Depression, Heather Greenwood

Physician Assistant Scholarly Project Papers

According to the American Psychiatric Association, the prevalence of anxiety and depression in adults in their lifetime are nearly 30% and 16.6% respectively. The combination of pharmacotherapy and psychotherapy interventions (including talk therapy or cognitive behavior therapy (CBT)) are considered best practice, but in recent years there has been an increase in the popularity of applications and web-based services categorized as “internet cognitive behavior therapy”, or ICBT. The question proposed is, are these services as good for patient outcomes as traditional in-person CBT? A literature review was performed using electronic medical database PubMed with key word searches for cognitive behavior …

Proning Versus Respiratory Pharmacotherapeutics In Hospitalized Covid-19 Patients, Sasha Marie Hopfauf

Physician Assistant Scholarly Project Papers

The purpose of this research and literature review is to compare the use of prone positioning and respiratory pharmacotherapeutics within hospitalized COVID-19 patients and the outcomes associated with each. A literature review was performed using the databases PubMed, Clinical Key, DynaMed, and CINAHL. A variety of key terms were used when searching. Studies chosen were retrospective reviews, a cross sectional study, an interventional study, and a pilot study. Articles within the last three years were utilized after exclusion criteria was applied. A total of thirteen articles were included within this project. The research shows that pulmonary vasodilators such as inhaled …

Gabapentin As An Effective Treatment Option For Alcohol Use Disorder, Monica Hurst

Physician Assistant Scholarly Project Papers

The purpose of this literature review is to determine whether gabapentin is an effective treatment option for alcohol use disorder (AUD). Utilizing data sourced primarily from published clinical trials, gabapentin’s effect on heavy drinking, abstinence, withdrawal symptoms and alcohol cravings will be explored. This review will also compare gabapentin’s efficacy against currently approved AUD treatment options, along with what dosages are most efficacious while contributing the fewest adverse effects. The data presented in this literature review undeniably demonstrates a positive effect of gabapentin on alcohol use disorder; Specifically, the data shows that gabapentin at multiple dosages helps to decrease heavy …

A Comparison Of Anti-Calcitonin Gene-Related Peptide Monoclonal Antibodies And Standard Migraine Prophylaxis In Those With Episodic Migraines, Alexie Harms

Physician Assistant Scholarly Project Papers

The purpose of this research study is to determine if anti-calcitonin gene related peptide monoclonal antibodies (CGRP mAbs) more effective and tolerable in reducing the number of migraine days in comparison to conventional migraine prophylactic use of Propranolol, Amitriptyline, and Topiramate. Migraines are debilitating and a frequent reason for primary care visits interfering with an individual’s work, school, and daily life. Standard of care treatment options for migraine prophylaxis are drugs initially developed for other diseases and can lead to unnecessary and unwanted side effects decreasing treatment adherence in the prevention of migraines. In this literature review, electronic search databases …

Active Toxoplasmosis Infection: Efficacy And Safety Of Treatment Options, Daniele Krouse

Physician Assistant Scholarly Project Papers

This literature review intends to investigate the safety and efficacy of two different drug treatment regimens, pyrimethamine versus trimethoprim-sulfamethoxazole, for active toxoplasmosis infections. Affecting nearly 11% of the United States population and up to 80% of the populations of tropical countries, Toxoplasmosis infection is the second leading cause of death from food borne illness. Current classic management of active infection with pyrimethamine is correlated with numerous undesirable side effects, high cost and need for complex use of adjunctive medications. It is necessary to identify alternative treatment options with fewer side effects, less complex regimens, lower cost, and easier access for …

Fertility Treatment In Pcos: Metformin Vs. Inositol, Kaylina Kelley

Physician Assistant Scholarly Project Papers

The most common endocrine disorder affecting women is polycystic ovary syndrome (PCOS) (Pourghasem, 2019). Metformin is commonly used to decrease insulin resistance and increase fertility in these women. However, it is known to cause many side effects, which are mostly gastrointestinal related. Myoinositol is a B-vitamin that is thought to also decrease insulin resistance and increase fertility with few side effects. The purpose of this literature review is to determine whether myoinositol is a comparable substitute for metformin in patients with PCOS suffering with infertility. This was done by evaluating pregnancy rates, insulin resistance, and side effects of metformin and …

Pregnancy Planning: Hormonal Contraception Versus Natural Family Planning, Melanie Loehrer

Physician Assistant Scholarly Project Papers

Statement of the problem: Natural family planning methods provide women with an opportunity to use natural methods to plan pregnancy. This is done through daily monitoring of symptoms and biomarker fluctuation in accordance with hormonal changes throughout the menstrual cycle to identify the fertile window. Through the identification of the fertile window and ovulation, one can determine appropriate days for sexual intercourse. This format allows participants to develop a greater understanding and in-depth knowledge of reproductive health to avoid or achieve pregnancy. The use of natural family planning has greatly increased over the last two decades, growing the demand for …

Long-Term Control Of Type Ii Diabetes Mellitus And Weight Through Roux-En-Y Gastric Bypass Surgery Versus Weight Loss Medication, Alexandra Laber

Physician Assistant Scholarly Project Papers

Type II diabetes mellitus (T2DM) affects hundreds of millions of individuals in the United States and is only becoming more common. The disease can damage organs all throughout the body and even lead to death. The goal of treatment is to lower blood glucose, but since T2DM tends to be associated with obesity, another common goal in treatment is weight loss. However, this is difficult for many people to achieve, and intense medical treatment is sometimes needed. Since T2DM is a lifelong disease, interventions must be considered in the long term. The purpose of this project is to compare long-term …

Platelet-Rich Plasma Vs Corticosteroid: Osteoarthritis Symptoms, Joshua Zetocha

Physician Assistant Scholarly Project Papers

Osteoarthritis (OA) is a disease that hundreds of millions of people suffer from across the world (Palazzo et al., 2016). Currently, corticosteroid intra-articular injections are frequently administered to help with pain and inflammation related to OA (Pereira et al, 2015). A relatively new treatment option is Platelet-Rich Plasma (PRP) intra-articular injections. PRP injections use the patient’s own plasma, injected into the affected joint space, to reduce inflammation and potentially improve both pain and functionality. This literature review will investigate whether the newer PRP injections relieve pain and improve functionality of OA patients better than corticosteroid injections. The literature review was …

Effectiveness Of Knee Joint Injury Treatments In The Prevention Of Post-Traumatic Osteoarthritis, Jenna Zaeske

Physician Assistant Scholarly Project Papers

The purpose of this research and systematic literature review is to determine the effectiveness of rest, physical therapy, and/or surgical intervention following either anterior cruciate ligament (ACL) or meniscus injuries in short- and long- term osteoarthritis outcomes. The short- and longterm outcomes were evaluated to compare the prevalence and progression of osteoarthritis after joint injury. In this literature review, the electronic database PubMed was used to find relevant research. Many keywords were used when searching for articles. Sources included for review had research on ACL or meniscus injuries specifically. Other knee injuries, non-knee injuries and non-human subjects were excluded. Articles …

Aspirin Vs. Pravastatin For Prevention Of Preterm Delivery In Patients At Risk For Pre-Eclampsia, Mary Weisberg

Physician Assistant Scholarly Project Papers

This literature review is an examination of the use of low-dose aspirin therapy versus the use of pravastatin therapy to prevent preterm delivery in women at risk of developing preeclampsia. Preeclampsia is defined as new onset hypertension after 20 weeks of gestation with evidence of maternal organ or uteroplacental dysfunction or proteinuria. Preeclampsia is a serious condition that affects pregnant women and their growing fetuses which may lead to maternal or fetal demise. The Prevention of preeclampsia with the use of low-dose aspirin in the first 12-16 weeks is currently the mainstay of treatment for women with moderate to severe …

Perimenopausal Depression Screening And Treatment Efficacy Between Antidepressants And/Or Hormone Replacement Therapy, Mandy Stenehjem

Physician Assistant Scholarly Project Papers

During the menopause transition (MT), also known as perimenopause, women are at a significantly increased risk of depression. Although the pathophysiology is not fully understood, it is likely to be complex and multifactorial. Data evaluating the involvement of HPA axis dysregulation and correlating female reproductive hormone fluctuations, specifically estradiol, are factors that may contribute to this incidence. Currently antidepressants are the treatment for depression but with biological changes occurring during perimenopause, hormone replacement therapy alone or in combination may have comparable antidepressant effects. The combination of menopause symptoms, depressive symptoms, and psychosocial challenges, make recognition and treatment depend on many …