Medicine and Health Sciences Commons^™

Shorter Duration Of Dual Antiplatelet Therapy Following Second Generation Drug Eluting Stent Placement, Alexandra Coy, Caitlyn M. Murtha

Physician Assistant Capstones, 2020-current

Heart disease is the leading cause of death in both men and women in The United States. Because advanced heart disease is often treated with percutaneous coronary intervention (PCI) for stent implantation, many patients will be put on dual antiplatelet therapy to prevent adverse effects such as stent thrombosis or restenosis. The purpose of this literature review is to determine if the development of second-generation drug eluting stents allows for a shorter, 6-month, duration of dual antiplatelet therapy (DAPT) versus the currently recommended 12 months. The articles discussed in this review were obtained on PubMed and narrowed using search terms …

Reducing Adverse Event With Single And Double Bundle Acl Reconstruction Techniques, Alicia Hudalla, Caroline Casey

Physician Assistant Capstones, 2020-current

Objective: Assess whether athletes or individuals who live an active lifestyle or occupation between the ages of 18-40, who have had an ACL reconstruction done by either single bundle or double bundle repair to compare whether or not double-bundle ACL reconstructive surgery reduce rates of adverse events (re-tear rates, graft failure and laxity) post ACL reconstruction as compared to single-bundle ACL reconstruction. Design: Systemic literature review. Methods: Searches were done in PubMed, utilizing the terms “single bundle vs. double bundle ACL reconstruction.” The following limits and terms were used wrong ligament discussed, systematic reviews or review, not enough participants, 10+ …

Utility Of Bariatric Surgery In The Remission Of Type 2 Diabetes Mellitus, Christine Ercoline, Alyssa Bower, Corinne Singh

Physician Assistant Capstones, 2020-current

Objective: Assess whether bariatric surgery is more effective than lifestyle modification and medication in the long-term reduction of hemoglobin A1c (HbA1c) and fasting plasma glucose among obese adults with type 2 diabetes mellitus. Design: Systematic literature review. Methods: A PubMed search was performed utilizing the terms bariatric surgery, type 2 diabetes and remission. In PubMed the following limits and terms were used: published in the last 10 years, humans, full text, clinical trial, randomized control trial, and English. Results: An analysis of three randomized control trials (RCTs) supports bariatric surgery as a modality to induce the remission of type 2 …

Investigating The Effectiveness Of Prehospital Recognition And Administration Of Intravenous Antibiotics In Septic Patients, Laura Keane, Ian Peterson

Physician Assistant Capstones, 2020-current

Objective: To compare the 30-day mortality rate of suspected sepsis patients who received prehospital (Emergency Medical Services- EMS) antibiotic administration in an ambulance as compared to antibiotic administration in the hospital. Design: Systematic literature review. Methods: Research was conducted in PubMed and Google Scholar with the search terms: sepsis, antibiotics, prehospital, EMS, ambulance. The 3 articles selected were chosen after removing articles not from a randomized control trial, no antibiotic administration, and not a free article. Results: From our meta-analysis of the three studies, we concluded that providing antibiotics before arriving at the hospital for patients with suspected septic infections. …

Use Of Cardiomems Hf Sensor In Management Of Nyha Class Iii Heart Failure, Trevor Andrunik, Anne Eady

Physician Assistant Capstones, 2020-current

Objective: Assess the ability of continuous pulmonary artery pressure monitoring via implantable CardioMEMs HF device to reduce hospitalization in New York Heart Association (NYHA) Class III heart failure patients over the age of 18. Design: Systematic literature review. Methods: Searches were conducted via PubMed and ClinicalTrials.gov using the single search term “CardioMEMs.” Inclusion criteria narrowed results to studies performed in the last 10 years, randomized control trials, cohort studies, and utilizing heart failure related hospitalization as the primary endpoint. Results: The current data unanimously asserts that the CardioMEMs HF device is effective at reducing heart failure related hospitalizations, with secondary …

Use Of Long-Acting Injectable Cabotegravir And Rilpivirine In Hiv Maintenance Therapy, Andrea K. Ferrero, Nabil Naim

Physician Assistant Capstones, 2020-current

To determine if long-acting injectables cabotegravir and rilpivirine are non-inferior to oral antiretroviral therapy at maintaining viral load suppression below 50 copies per milliliter of serum. Design: Systematic literature review. Methods: A search was done in PubMed using the terms “HIV + cabotegravir” or “HIV + cabotegravir, rilpivirine drug combination.” Limitations included non-randomized control trials, comparison of injectable regimens directly or injectables to placebo, studies that evaluate compliance or side effects only, and studies with small sample sizes. Results: Meta-analysis revealed that continued use of injectables was sufficient in maintaining viral suppression at 93.6%, 92.5%, and 94% in each of …

Is A Lumbar Puncture Necessary? Identifying The Need For A Lp With A Negative Ct Scan When Diagnosing A Non-Traumatic Subarachnoid Hemorrhage, Carlee Raymond, Erin S. Lang

Physician Assistant Capstones, 2020-current

Objective: To assess the current standard for the detection of non-traumatic subarachnoid hemorrhage (SAH), and evaluate the need for a lumbar puncture with a negative head CT. Is a negative head CT thorough enough to definitively rule out a SAH?

Design: Systematic literature review

Methods: Our research began on the PubMed database using the search terms Subarachnoid Hemorrhage and Lumbar Puncture. We filtered our data with filters including; data in the last ten years, primary research, and full text articles.

Results: Retrospective studies include; Bianchi et al. (2021), Chee et al. (2020) and Tulla et al.(2018). All three studies showed …

Prophylactic Intravenous Prehydration With Sodium Bicarbonate Or Sodium Chloride In The Prevention Of Contrast Induced Acute Kidney Injury, Briana Lockett, Caroline Dong

Physician Assistant Capstones, 2020-current

Introduction: Iodinated contrast media is a crucial component in the diagnostic work up of many life-threatening illnesses. However, it has been reported to cause acute kidney injury after administration, especially in patients with pre-existing renal disease. Several prophylactic treatments have been studied in hopes of minimizing these adverse events. The current standard of care in this patient population is prophylactic intravenous volume administration with either sodium chloride or sodium bicarbonate. Objective: The goal of this literature review is to determine if prophylactic intravenous volume administration with either saline or sodium bicarbonate prior to contrast administration decreases the incidence of contrast …

Effect Of Mesenchymal Stem Cells On Osteoarthritis Of The Knee, Brendan Avery, Jessica Gray

Physician Assistant Capstones, 2020-current

Osteoarthritis of the knee is one the most common sources of chronic pain due to altered joint function.¹ Current treatment modalities offer short term relief of symptoms but lack long term aid and regenerative properties.¹ Mesenchymal stem cells (MSC) offer regenerative and anti-inflammatory properties and can be collected from umbilical cord blood, adipose tissue, or bone marrow.⁴ The three studies included were all randomized controlled trials within the past 10 years that each utilized more than 30 participants who had a diagnosis of osteoarthritis and a mean age above 50 years old. MSCs were compared to corticosteroid …

Injuries In Manual And Mechanical Cpr, Macon Spruill, Malik Bangura

Physician Assistant Capstones, 2020-current

Objective: To compare the rate of injuries during cardiopulmonary resuscitation (CPR) using manual versus mechanical chest compressions with the Lund University Cardiopulmonary Assist System (LUCAS™).

Design: Systematic literature review

Methods: We investigated the use of 2 different CPR methods, manual and mechanical, in order to determine if one was more likely to cause injury in individuals during a cardiac arrest. PubMed searches were conducted using the terms “cardiopulmonary resuscitation,” “adverse effect,” “classification,” “method,” “mortality,” “statistical and numerical data,” “trends,” “complication,” “epidemiology,” and “etiology.” Studies were excluded if they took place before the year 2000, included individuals under 18 …

Effects Of Subthalamic Deep Brain Stimulation On Treating Motor Symptoms In Early Parkinson's Disease, Emily Reale, Gina Legaluppi

Physician Assistant Capstones, 2020-current

Objective: Assess the efficacy of subthalamic nucleus deep brain stimulation (STN DBS) versus solely optimal pharmacological use in early Parkinson's Disease to improve motor dysfunction. Design: Systematic Literature Review. Methods: Searches were completed on PubMed utilizing the MeSH terms: “subthalamic, deep brain stimulation, and early parkinson.” Using PubMed the following limits and terms were used: published in the last 10 years, randomized controlled trial, English, human, and removing duplicates. A total of three studies resulted after the search. Results: All three studies showed statistically significant results in reduction in disease progressive motor symptoms. Additionally, at the end of each study …

Breakthroughs In Hormonal Male Contraception, Alexander Patton, Seth Vann

Physician Assistant Capstones, 2020-current

Objective: Assess the efficacy of a nestorone plus testosterone gel at suppressing progestin levels and spermatogenesis.

Design: Systematic literature review.

Methods: Searches were done in PubMed and Dartmouth library using the terms nestorone, randomized control trial, human, and male. Limits used while searching included published in the last 10 years, randomized control trials, and English.

Results: Using the search criteria the following three studies were found that met the inclusion/exclusion criteria of this study: Ilani et al, Zitzmann et al, and Anawalt et al. All three studies were found on PubMed and reference the Ilani et al study.

Conclusion: Nestorone …

The Effect Of Platelet Rich Plasma On The Treatment Of Androgenetic Alopecia Compared To Placebo, Mackenzie D. Comstock, Hannah E. Stephenson

Physician Assistant Capstones, 2020-current

Objective: To assess the efficacy of plasma rich proteins (PRP) compared to placebo in the treatment of androgenetic alopecia (AGA).

Design: Systematic literature review

Methods: Searches were done in PubMed utilizing the terms PRP, plasma rich protein, autologous activated PRP, autologous activated plasma rich protein, androgenetic alopecia, placebo, hair count, hair density, hair follicles, hair loss, therapeutic effect, growth factors, dermatology, and regenerative medicine. Articles were excluded if they were published before 2013, involved animal studies, compared minoxidil only in their research, included only female participants, non-English articles, studies with no quantifiable data, review research articles, and injections besides the …

Ketamine As A Treatment Modality For Treatment-Resistant Depression, Tracy Wulff, Shen Cao

Physician Assistant Capstones, 2020-current

Many recent studies have demonstrated the ability of ketamine, an NMDA receptor antagonist, to produce antidepressant effects that may be effective in helping reduce treatment-resistant major depression. In particular, three double-blinded randomized control trials have been conducted to assess the viability and effectiveness of this medication for treatment. This systematic literature review will analyze these studies and determine if the overall research indicates that ketamine is useful in improving depression as measured by the Montgomery–Asberg Depression Rating Scale (MADRS)¹.

Objective: Assess the effectiveness of IV Ketamine in reducing treatment-resistant major depressive disorder as measured by the Montgomery–Asberg …

Watchman Compared To Warfarin In Reducing Risk Of Stroke In Patients With Non-Valvular Atrial Fibrillation, Peyton Parrish, Matt Isherwood

Physician Assistant Capstones, 2020-current

Objective: To determine if the WATCHMAN device is as efficacious as warfarin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) using a systematic review. Methods: Pubmed and Google Scholar databases were used to evaluate clinical trials using the search terms atrial fibrillation, watchman, warfarin, and stroke prevention. Results: Three studies met inclusion criteria, with 2 being randomized control trials (RCT), and 1 being a prospective cohort study. Reddy et al found that after 3.8 years of follow-up, patients with percutaneous closure of Left atrial appendage (LAA) met criteria for both non-inferiority and superiority, compared with warfarin for preventing …

Evaluation Of Hyperhomocysteinemia In The Progression Of Parkinson's Disease, Marisa A. Ducach, Pritpal S. Saggu

Physician Assistant Capstones, 2020-current

Abstract:

Objective:To assess the prevalence of hyperhomocysteinemia in Parkinson’s Disease (PD) and if this elevated serum level can be used as a predictive biomarker in risk assessment for the progression of cognitive decline in PD.

Design:Systematic Literature Review

Methods:A literature search was conducted through Google Scholar and Pubmed using phrases such as, “Parkinson's Disease”, and “homocysteine”, “Parkinson’s progression. Three articles, measuring serum homocysteine levels and cognitive functioning in PD patients, were selected, analyzed, and compared to assess for a relationship between homocysteine levels and cognitive decline in PD.

Results: Elevated homocysteine levels are associated with worse cognitive …

Induction Of Hypothermia In Patients With Traumatic Brain Injury, Frank Hadden, Courtney Lennix

Physician Assistant Capstones, 2020-current

Common Abbreviations:

TBI = Traumatic Brain Injury

Glasgow Outcome Scale = GOS

Glasgow Outcome Scale Extended = GOSE

Objective: To determine whether hypothermia induction improves long-term morbidity and mortality in patients with severe traumatic brain injury

Methods: A search was conducted using PubMed database and the search terms “induced hypothermia” and “traumatic brain injury”. Studies were excluded if the publication dates were over 10 years old, children were the population being studied, and the researchers were looking at other independent variables.

Results: The results from all three randomized control trials showed that the induction of hypothermia did not show effectiveness …

Transcatheter Vs. Surgical Aortic Valve Replacement In Patients At Intermediate Surgical Risk, Nichole M. Bonzano, David M. Milligram

Physician Assistant Capstones, 2020-current

Abstract

• Objective: To compare the safety and efficacy of transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis at intermediate surgical risk.
• Design: Systematic literature review.
• Methods Literature searches were done in PubMed and Scopus search engines using key terms: TAVR, trans-catheter aortic valve replacement, SAVR, surgical aortic valve replacement, severe aortic stenosis, and intermediate risk. Filters included primary research only. Inclusion criteria were articles which studied an intermediate risk patient population (STS-PROM 3-15%), primary research, and compared outcomes of TAVR and SAVR in patients with severe aortic stenosis requiring replacement. …

Mindfulness Based Stress Interventions In Physician Assistant Programs, Lucas Vance

Physician Assistant Capstones, 2020-current

Mindfulness based interventions (MBI) have been used successfully in a variety of venues from the treatment of chronic pain to reducing stress in the workplace. The benefits of MBI programs that have been studied range from self-reported anxiety, depression, and empathy levels to levels of cortisol¹ to amygdala changes seen on magnetic resonance imaging.² MBI programs have been studied in pre-medical, medical, and graduate schools, as well as, nursing programs, and generalized healthcare cohorts.

Deep Brain Stimulation Of The Subcallosal Cingulate Gyrus In The Treatment Of Treatment Resistant Depression, Megan Caravas, Melanie Sov

Physician Assistant Capstones, 2020-current

Objective: a systematic review to determine the efficacy of deep brain stimulation (DBS) targeting the subcallosal cingulate gyrus (SCG) for the treatment of treatment resistant depression (TRD). Methods: PubMed database was utilized in a search for clinical randomized control trials that were completed after the year 2000, using the terms deep brain stimulation, treatment resistant depression, and subcallosal cingulate gyrus. Results: Three clinical trials were chosen based on specific inclusion criteria as noted in the PRISMA flow chart (Chart 1). The results of the three articles showed various discrepancies. Two of the three studies demonstrated some statistical significance in reduction …