Medicine and Health Sciences Commons^™

40-Day Fit, A Journey For Heroes, Michael B. O'Neill

Doctor of Leadership

This project is a collective portfolio of discovery and development that explores the intersection of societal health and the vitality of the church, recognizing a state of decline in both areas. This critical, yet often overlooked issue, is the foundation of this research-driven initiative. It is a practical process of diagnosis and treatment of a problem or an opportunity, in context, leading to application. The portfolio project represents a journey of discovery and reframing, where research methods, strategic objectives, and project milestones guide the identification of needs, problems, and opportunities. These elements serve as the driving forces behind crafting solutions …

Heparin Induced Thrombocytopenia (Hit), Tanya Yatskiv

Doctor of Medical Science (DMSc)

Introduction:

Heparin was first discovered in 1915 and is still widely used to this day.1 In 1958 however, it was noted that a small percentage of recipients of heparin develop antibodies to the drug which cause a mild to moderate thrombocytopenia and can progress the patient into a severe prothrombotic state.2 The prothrombotic state can be detrimental due to venous and arterial thromboembolisms that lead to life and limb-threatening manifestations. The mechanism of the thrombocytopenia and immune reaction was not identified until 1973.2 The adverse drug effect is induced by platelet-activating antibodies against platelet factor 4 (PF4) and heparin.3 These …

Meta-Analysis Of The Rate Of Unplanned Pregnancies In Rural Areas Of The United States And The Use Of Technology-Based Sexual Education Programs, Hannah Audiss

Doctor of Medical Science (DMSc)

Objective

To discuss rural-urban disparities of adolescent unplanned pregnancies and sexual education availability. The potential of virtual sexual education programs are discussed by examining two studies that have used technology-based interventions to assess variables related to pregnancy prevention.

Data Sources

A review was conducted by gathering randomized controlled trials and systematic reviews utilizing databases such as ScienceDirect, PubMed and Wiley Online Library. Research articles included in this paper were from 1995 to present day and are inclusive of all races.

Study Eligibility Criteria

Studies were included if the interventions worked with young adolescents ages 13-24 year old, utilized technology-based interventions …

The Association Between Prenatal Acetaminophen Use And Adhd Development In Childhood, Jocelyne Blanco

Doctor of Medical Science (DMSc)

Background: The purpose of this article is to produce a review of the literature on a recently growing topic of interest. We believe the widespread use of acetaminophen in pregnancy makes the rising concern for acetaminophen use in pregnancy and the development of childhood attention deficit hyperactivity disorder (ADHD) a national public health matter. The mechanism of action of acetaminophen, the pathophysiology of drug transfer through the placental barrier, and the most up-to-date research studies were analyzed with the goal of bringing clarity and promoting healthy pregnancies for all.

Methods: PubMed, PLOS One, and Google Scholar served as the cornerstone …

Thoughtful Integration Of Active Learning Teaching Strategies Into Physician Assistant Education, Daniel Berger

Doctor of Medical Science (DMSc)

Introduction:

The future of healthcare relies upon how we train student clinicians. It is integral to continually reevaluate our methodologies of teaching and work to better approach the challenging task of educating competent and compassionate physician assistants in a short two-to-three-year window. While the traditional modality of teaching has been primarily lecture-based, there has been a growing movement to incorporate active learning into medical education. This learner-driven model puts students in the driver’s seat and allows for greater amounts of self-directed learning prior to class followed by the reinforcement of concepts during class time. Though lecture-based teaching could be the …

The Role Of Self-Sampling For Hpv In The Primary Prevention Of Cervical Cancer, Divya Patel

Doctor of Medical Science (DMSc)

Introduction:

Cervical cancer is a striking women's health problem worldwide. It is the fourth most common cancer in women and the seventh most common cancer worldwide1. There were roughly 604,000 new cases of cervical cancer and 342,000 deaths in 20202. Most of these cases occur in developing countries due to ineffective screening initiatives2. Screening essentially allows pre-cancerous lesions to be identified at stages where they can easily be treated; screening methods include cytology and HPV testing (Human Papillomavirus)1. HPV has over 100 strains and is one of the most common risk factors for cervical cancer. HPV testing is more sensitive …

Lipoprotein(A): Review Of Existing Guidelines And Application For Practicing Clinicians, Daniella Manarang

Doctor of Medical Science (DMSc)

Purpose A growing amount of research has constituted lipoprotein(a) as an independent risk factor for cardiovascular disease. The main objective of this review is to summarize the current guidelines for testing and managing Lp(a) and provide guidance to clinicians on how to practically utilize Lp(a) with what is known today. Methods: EBSCO, PubMed, and Ovid were searched for this review. Search terms included lipoprotein(a), clinical practice, guidelines, screening, and cardiovascular disease. Sources within ten years were obtained to cover recent material. Results: The current literature on the association between Lp(a) and CVD outcomes and up-to-date guidelines on testing and management …

Early Management Of Nutritional Deficiencies To Reduce Musculoskeletal Disabilities Of Pediatric Populations In Africa, Kristin Freitas

Doctor of Medical Science (DMSc)

An estimated 1.3 billion individuals live with disabilities across the world, however many of these impairments are developed throughout childhood and could be prevented or treated with prompt and early intervention. In Africa, nutritional deficiencies are a common reason for disability in pediatric populations, often due to a limited supply of resources and diets high in grains and beans. This results in the development of genu varum and valgum deformities, which are most commonly caused by rickets attributed to calcium deficiencies in these areas. The children often go untreated, evidently causing musculoskeletal disabilities and further complications of osteomalacia or fractures …

The Role Of Niacinamide In Skin Cancer Risk Reduction, Britny Ruilova Tellez

Doctor of Medical Science (DMSc)

The contents of this article are the author’s original unpublished findings.

Background: Each year, approximately 6 million Americans are treated for skin cancer, resulting in a total annual medical expense of $8.9 billion 1. The two most common types of skin cancer are basal cell carcinoma (BCC) followed by squamous cell carcinoma (SCC)2. The metastatic potential of these cancers is minimal; however, their treatment may involve severe scarring and disfigurement2. In contrast, melanoma is an aggressive skin malignancy that grows rapidly and can metastasize in a quick manner2. Risk factors of these skin cancers include UV exposure, fair skin complexions, …

Sodium-Glucose Cotransporter 2 Inhibitor (Sglt2-I) In The Prevention Of Diabetic Kidney Disease Progression, And Its Role As An Antihypertensive Agent In The African American Population, Aran Michael G. Manalang

Doctor of Medical Science (DMSc)

Introduction:

Needs Assessment:

Originally used as antidiabetic medications, later clinical trial data showed beneficial effects in reducing the onset and progression of renal complications in people with and without diabetes. 13 Randomized clinical trials and ‘real world’ observational studies involving mostly type 2 diabetes patients showed that SGLT2-i can slow the decline in glomerular filtration rate (GFR), and reduce the onset of microalbuminuria and slow or even reverse the progression of proteinuria.13 Additionally, with diabetes being one of the many chronic conditions still primarily managed by primary care providers (PCP), it falls upon these professionals to have the knowledge and …

Review Of The Literature: Analysis Of The Effectiveness Of Mobile Integrated Health - Community Paramedicine Programs In Reducing Pre-Hospital Ems Calls And Transportations, Annika N. Schultz

Doctor of Medical Science (DMSc)

Pre-hospital Emergency Medical Service (EMS) systems, including fire departments and ambulance transport services, are increasingly overburdened with high call volumes and unnecessary utilization of services leading to provider burnout, depletion of resources and rising healthcare costs. Many local EMS systems have recognized a need for a more sustainable solution to help reduce the number of unnecessary 9-1-1 calls and transportation to the Emergency Department (ED). Local agencies are beginning to expand the role and scope of practice for paramedics through programs referred to as Mobile Integrated Health – Community Paramedicine (MIH-CP). This new branch of medicine aims to provide patient-centered …

The Role Of Pharmacogenetics On Breast Cancer Treatment Efficacy And Toxicity, Noor Alani

Doctor of Medical Science (DMSc)

Purpose: This research article aims to shed light on the pivotal role of pharmacogenetics in breast cancer treatment by examining genetic variations that influence the efficacy and toxicity of commonly used drugs. Furthermore, this study highlights the significance of personalized treatment approaches in optimizing patient outcomes.

Method: A comprehensive literature search was conducted using databases such as PubMed. Search terms included "pharmacogenetics," "breast cancer treatment," "genetic markers," and "adverse effects." This review critically analyzes relevant studies that focus on the impact of genetic variations on the response to drugs used in breast cancer treatment.

Results: The review …

Emerging Evidence For Diagnosis And Treatment Of Wake Up Stroke Patients, Asa Di Carlo

Doctor of Medical Science (DMSc)

Strokes are the leading cause of permanent disability and the second leading singular cause of death in more developed countries.3 Over 13 million individuals worldwide suffer strokes annually, 1 with the vast majority of these being from an ischemic event. Out of these, 20-25% actually occur in individuals who wake up with stroke symptoms, which historically has been considered outside of the time window for treatment.2,3 Previous guidelines indicate that in patients with acute ischemic strokes IV thrombolytic therapy should be administered within 4.5 hours for symptom onset, and is not recommended in patients with an unknown time of symptom …

Discussion Of The Risks And Benefits Of Intensive Blood Pressure Control In The Elderly, Kennedy Emerson

Doctor of Medical Science (DMSc)

PURPOSE:

The primary purpose of this paper is to review the current available evidence on benefits and risks of intensive blood pressure control (< 120 mmHg systolic) in the greater than 75-year-old population. The secondary purpose will focus on discussion of general recommendations for blood pressure treatment in non-diabetics in this population.

METHOD:

A PubMed and NEJM literature search was directed towards search terms: hypertension, intensive, standard, older, and elderly, as well as search terms surrounding risk: adverse event, fall, fracture, syncope, AKI, and mortality. Fourteen articles are used for the basis of this paper, six of which are large scale RCTs.

RESULTS:

Though there has been a general lack of consensus on appropriate hypertensive management in the elderly, data has increasingly shown that lower blood pressure goals …

Impacts Of Stigma On Female Service Members, Alisha Weatherly-Kershaw

Doctor of Psychology (PsyD)

There are a variety of factors that prevent people from seeking mental health treatment. The stigma associated with mental health disorders or seeking treatment is a primary deterrent. This stigma is particularly impactful within the armed forces when they are assessed for fitness for duty. Because most research examines stigma’s impact on male military members, this study aims to identify the type of stigma that creates the most significant barrier to female service members seeking mental health treatment. Results indicate that stigmatizing perceptions of service members significantly impact female service members holding negative views towards seeking treatment.

Transgenerational Wellness: Trauma Informed Christian Spiritual Formation, Winford Amos

Doctor of Ministry

Certain mindsets, processes, and practices produce health inequities and disparities including poor spiritual health. Young adults between the ages of eighteen and twenty-five years old are experiencing challenges with mental health and substance use resulting in a high rate of suicides and overdose related deaths. Many are experiencing co-occurring substance use and mental health challenges and have a history of trauma. There are limited options available for integrated treatment. Accessibility to services is very difficult due to limited providers and limited resources at this age. Church attendance has decreased significantly for young adults which limits the capacity of the church …

Aspirin In The Primary Prevention Of Cardiovascular Disease, Briana Stephanie Murar

Doctor of Medical Science (DMSc)

For decades, people have prophylactically used aspirin (ASA), or acetylsalicylic acid, to mitigate their risk for cardiovascular disease (CVD). The role of ASA as a means of secondary prevention for CVD is well established, however there are conflicting schools of thought as to whether or not it should be used as primary prophylaxis. While this indication has been studied for more than 30-years, questions remain pertaining to the risk of bleeding that is associated with ASA usage, which ranges from mild epistaxis to life threatening hemorrhage.1 Lifestyle and behavioral factors play a large role in a person’s CVD risk, however …

Special Topics In Neuroendocrinology Allopregnanolone: Pathophysiology, Effects On Mood, Emerging Treatments, Sarah Jane Lance

Doctor of Medical Science (DMSc)

KEY POINTS

● Allopregnanolone is a neurosteroid and metabolite of progesterone that has been shown to play a role in mood regulation.

● Low levels and rapid declines in this neurosteroid are associated with mood disorders such as those within the menstrual cycle, postpartum depression, chronic stress, anxiety, post-traumatic stress disorder, and major depression. Studies have also linked it to moodrelated aspects of addiction.

● Medications that increase allopregnanolone, such as serotonin reuptake inhibitors and Brexanolone, are correlated with improved symptoms. These medications represent established and newly developed drugs that increase its level and are currently used for treatments of …

Fertility Considerations In Prescribing Hormonal Contraceptives In Individuals With Polycystic Ovary Syndrome, Andrea M. Reichle

Doctor of Medical Science (DMSc)

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder and the most common cause of infertility among females of reproductive age.1 While the name “polycystic ovary syndrome” implies people diagnosed with PCOS have numerous cysts on their ovaries, this is not always the case. Clinicians currently use the Rotterdam criteria to diagnose PCOS.2 These criteria include: irregular periods/anovulatory cycles, clinical or biochemical signs of androgen excess (acne, hirsutism, androgenic alopecia, etc.), and numerous ovarian cysts seen on imaging.2 A diagnosis of PCOS can be made when at least two of three criteria are met.2 As this has become a …

Regional Anesthesia Techniques For Total Knee Arthroplasty: Reducing Post-Operative Complications And Improving Rehabilitation And Recovery, Miguel Castaneda

Doctor of Medical Science (DMSc)

Purpose

Total knee arthroplasty (TKA) is one of the most commonly performed procedures in the developed world, with several hundred thousand performed yearly in the United States alone.1 Majority of the patients will experience severe post-operation pain following TKA, limiting early mobilization and slowing the rehabilitation process. 2 Femoral nerve blocks (FNB) are often used for TKA analgesia, but cause a decrease in quadricep strength, increasing the risk of postoperative falls as well as limiting early post-operative mobilization.2 Other nerve blocks, such as femoral triangle block and adductor canal block are thought to preserve quadricep strength aiding in quicker recovery …

Evaluating The Effects Of Cannabis Use On Fertility And Artificial Reproductive Technology, Iridiana Hermenegildo

Doctor of Medical Science (DMSc)

Background: Cannabis is widely used among males and females of reproductive age. A growing body of research suggests the endocannabinoid system is negatively impacted by the use of cannabis affecting many factors required for fertility. Objective: This article aims to evaluate existing literature on trends seen in patients undergoing artificial reproductive therapy (ART) and the effects cannabis has on fertility outcomes, including conception. Methods: This is a systematic review searching PubMed, MEDLINE, and Academic Search Premier databases through August 2022 using keywords derived from three defined concepts. Articles were then evaluated for relevance and included if meeting criteria. Results: …

Evaluating The Role Of The Mediterranean Diet In The Progression Of Heart Failure, Valerie C. Miller

Doctor of Medical Science (DMSc)

INTRODUCTION

The prevalence of heart failure (HF) in the United States has been increasing for years. Many individuals, especially our older population, are ending up hospitalized, causing financial burden and worsened quality of life for our patients. HF is one of the leading causes of hospitalization and death in older adults in the United States.¹ Nearly one million patients are hospitalized due to HF every year and of those, many will be readmitted within a month of discharge.⁵ The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and Heart Failure Society of America (HFSA) guidelines define HF as “a complex …

A Comparison Of Therapeutic Regimens In The Treatment Of Hypothyroidism, Christina M. Cranley

Doctor of Medical Science (DMSc)

Hypothyroidism is a chronic medical condition that results in the inadequate production of thyroid hormones. Thyroid hormones are essential for the metabolism of almost every organ in the body. The prominent symptoms of hypothyroidism include lack of energy, weight gain, constipation, and intolerance to cold temperatures. Medical therapies aim to replenish thyroid hormones enough to meet the body's metabolic demands. Unfortunately, many individuals experience persistent symptoms despite stable thyroid hormone levels. Current treatment options for hypothyroidism include Levothyroxine, Liothyronine, and Desiccated Thyroid Extract (DTE). Levothyroxine contains synthetic T4 and is the current gold-standard medical therapy in hypothyroid patients. Liothyronine, synthetic …

The Walking Well: Effects Of Hypothalamic Amenorrhea On Athletic Performance, Annalise H. Lau

Doctor of Medical Science (DMSc)

Hormonal balance and normal menstrual cycles are key factors in athletic performance. Unfortunately, female athletes themselves are often under the impression that a lighter weight will improve their performance. Even many healthcare providers do not emphasize or are unaware of the health consequences of prolonged irregular menstruation. The main purpose of this article is to review the health consequences hypothalamic amenorrhea has on female athletes and to provide education for healthcare providers regarding the importance of recovery. A literature search was conducted utilizing PubMed, Scopus, PLOS One and EBSCO. The following keywords were input into the search bar: hypothalamic amenorrhea, …

The Impact Of Adverse Childhood Experiences On Type 2 Diabetes Mellitus And The Role Of Early Intervention, Alexus S. Yang

Doctor of Medical Science (DMSc)

ABSTRACT

Purpose: The purpose of this article is to provide an understanding of negative health effects of adverse childhood experiences (ACEs) on Type II Diabetes Mellitus and the role of primary healthcare providers in decreasing morbidity and mortality through screening and intervention. Method: A literature search was conducted through PubMed, EBSCO, ProQuest Education and PLOS ONE using keywords such as: adverse childhood experiences (ACEs), type 2 diabetes mellitus, primary care intervention. The most relevant articles were selected with additional selectivity based on the publication year as the basis for this piece.

Results: Currently, minimal information exists on the …

Ketamine Use For Prehospital Status Seizures That Are Refractory To Benzodiazepines, Kyle B. Safko

Doctor of Medical Science (DMSc)

In North America, epilepsy affects between 16 and 51 people 100,000, with the most affected being those with lower socioeconomic status¹. Most ambulance services carry benzodiazepines, but what happens if administration of these drugs do not terminate seizure activity? The American Epilepsy Society concluded that 50% of patients do not respond to benzodiazepines if they have been stable and compliant on typical antiepileptic drugs and they experience a seizure⁷. A literature review was done looking at alternative treatment options for status seizures, specifically ketamine administration. Multiple case reviews, literature reviews and retrospective studies demonstrate the effectiveness …

Considerations Of Pocus Vs Manual Pulse Check In Predicting Rosc For Patients Presenting In Pea, Steven M. Shockley

Doctor of Medical Science (DMSc)

Background: Point of care ultrasound (PoCUS) has enabled providers to draw a contrast between true PEA (Pulseless Electrical Activity) and pseudo-PEA. The incorporation of PoCUS pulse checks in PEA and pseudo-PEA has been shown to more accurately predict Return of Spontaneous Circulation (ROSC) when compared to standard manual pulse checks. However, concerns have been raised in recent observational studies regarding increased duration of PoCUS pulse checks compared to manual pulse checks leading to suboptimal CPR and subsequent deterioration of ACLS protocol integrity. Objective: This clinical review aims to examine the utility and practical implementation of PoCUS versus manual pulse …

Utilizing Vitamin D Supplementation In Heart Failure, Rachel Alexanian

Doctor of Medical Science (DMSc)

Background: The purpose of this article is to procure a literature review on a relatively new area of research, ultimately aimed at improving the lives of those with heart failure. This article sheds light on the benefits of vitamin D supplementation, and it contributes significantly to the conversation regarding mitigating the complications of heart failure. Herein we aim to offer insight into whether vitamin D supplementation is beneficial for a patient with heart failure.

Method: PubMed, MeSH, and PLOS One literature searches were conducted with the following search terms: heart failure, hospitalization, vitamin D, quality of life, and …

Diet Recommendations For Patients With Irritable Bowel Syndrome, Tia M. Kinilau

Doctor of Medical Science (DMSc)

Introduction

Irritable bowel syndrome (IBS) is a very common chronic functional gastrointestinal (GI) disease that is characterized by abdominal pain in association with defecation and change in bowel habits.1 The condition has a multifactorial and incompletely understood pathophysiology, including altered brain-gut interactions, microbiome changes, differed GI motility, psychological factors, and food hypersensitivity.2 With the heterogenicity of the disorder, there is no standardized treatment for IBS, leading its therapy to rely on symptomatic treatments.2 The influence of dietary triggers on the generation of IBS symptoms is well-known and includes different mechanisms including immune activation, mast cell inflammation, and luminal distention.2 Studies …

Determinants Of State Average Life Expectancy, Alex Grimes, Spencer Sprague, Cole Thomas

Student Scholarship - College of Business

In this paper, our dependent variable is average life expectancy by state in the United States. The purpose is to determine which factors have an impact on average life expectancy, as well as the magnitude of these impacts. While other studies have been conducted on life expectancy, our focus is different in a subtle but important way. Rather than centering on individual life expectancy, studying factors like “activity” or “genetics,” we focus on the broader population in a state and which factors affect life expectancy on a macro-scale. There is little known about this topic that isn’t in direct reference …