Medicine and Health Sciences Commons^™

Obesity: Modern Medicine Vs. Lifestyle, Jenny Christianson

Physician Assistant Scholarly Project Papers

Obesity is a rising epidemic, and is one of the most common, costly and preventable health problems the world is experiencing today (Center for Disease Control and Prevention, [CDC], 2017). From this, it is important to establish an effective treatment plan that can be implemented across the nation for maximum patient benefit. Lifestyle changes such as diet and exercise are important to any health care plan and are equally necessary to reduce health risks. However, in certain patients, lifestyle changes are not enough due to the maladaptive biologic process in their brain. From this, additional treatment options need to be …

Comparing Prevalence Of Medication-Related Osteonecrosis Of The Jaw (Mronj) Due To Denosumab And Bisphosphonates As A Side Effect Of Osteoporosis Treatment, Kendra Apland

Physician Assistant Scholarly Project Papers

As the baby boomer generation continues to age, the diagnosis of osteoporosis and its side effects will continue to increase. Denosumab and bisphosphonates (BPs) are some of the most common medication classes used to treat osteopenia and osteoporosis, but it is believed that both medications have the possible side effect of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this paper is to uncover if MRONJ is a side effect of osteoporosis treatment and which medication carries the highest incidence rate. Through a review of several electronic databases and several peer reviewed research articles, a wide range of reported …

Letrozole Vs. Clomiphene Citrate For Infertility In Polycystic Ovarian Syndrome, Kailey Potratz

Physician Assistant Scholarly Project Papers

Polycystic Ovarian Syndrome (PCOS) is the leading cause of anovulatory infertility and the most common endocrinopathy in women of reproductive age (Rosenfield & Ehrmann, 2016). It has been recognized that women with PCOS often struggle with infertility and require medication to stimulate ovulation to become pregnant. Currently, the first-line treatment for infertility associated with PCOS is clomiphene citrate, which was introduced in the 1960s (Morad & Farag, 2015). However, it has been proposed that an aromatase inhibitor, specifically letrozole, should become the first-line treatment for these patients due to a decreased adverse effect profile, a lower incidence of simultaneous multiple …

The Efficacy And Safety Of Statins In The Primary Prevention Of Cardiovascular Disease, Kayla M. Ashton

Physician Assistant Scholarly Project Papers

Atherosclerotic plaques can form in the blood vessels from particles of cholesterol. These plaques are a major cause of cardiovascular disease and have the ability to result in fatal cardiovascular events. In researching this topic, PubMed, the Cochrane Library, DynaMed, and ClinicalKey were all utilized in finding articles published from 2002 to 2018. There are several organizations with conflicting guidelines recommending the use of statin medications in the primary prevention of cardiovascular disease. The research evaluated discovers data is inconclusive on the benefit of statin medications in this primary prevention as well as the safety of long-term statin use. Some …

Screening Techniques For Alzheimer’S Disease, Christina Nicole Brooks

Physician Assistant Scholarly Project Papers

Alzheimer’s disease is a neurodegenerative disease that affects more than 55 million Americans. By the year 2050, experts project this disease will have increased three fold. Many screening techniques have been investigated to detect this disease early and begin treatment to slow its progression. The purpose of this study was to explore which medical modalities are the most effective for screening of Alzheimer’s disease. This literature review includes three databases, including PubMed, CINHAL, and Cochrane Database of Systematic Reviews. Topics that were researched include: cognitive screening tests, neuroimaging, laboratory diagnostic testing, DNA, and combined studies. Research was conducted from October …

Superior Capsular Reconstruction In The Active Population With A Massive Irreparable Rotator Cuff Tear, Hernandez Emmanuel

Physician Assistant Scholarly Project Papers

The prevalence of rotator cuff tears is a leading cause of upper extremity functional disability and affects people across the lifespan. The primary age groups that are diagnosed include young adults as well as the elderly population. Early diagnosis and identification of rotator cuff injuries are paramount for the appropriate treatment to be facilitated. Approximately one-fifth of rotator cuff tears (RCT) are diagnosed as “massive” and prove to be difficult for orthopedic surgeons to repair. If the massive RCT is also diagnosed as “irreparable”, surgical intervention is technically difficult and is a challenging procedure. Historically, treatment options have been limited …

Examination Of Venous Thromboembolism Prophylaxis In Patients Undergoing Total Knee Arthroplasty, William Kucera

Physician Assistant Scholarly Project Papers

Elective total knee arthroplasty (TKA) is the most frequently performed inpatient surgical procedure in the United States (Kurtz, Ong, Lau, Mowat, & Halpern 2007). Complications of this procedure include deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE). Various pharmacological agents exist for VTE prophylaxis. Warfarin and low-molecular-weight heparin (LMWH) were commonly used for VTE prophylaxis in the past, but with the emergence of novel anticoagulants including factor Xa inhibitors and direct thrombin inhibitors (DTIs), warfarin is used far less frequently. Aspirin is also approved for VTE prophylaxis. The purpose of this study was …

Associations Among Acne Vulgaris And Western Diet, Kate Meredith Suda

Physician Assistant Scholarly Project Papers

Acne vulgaris is one of the most common dermatologic conditions, especially among the adolescent population. The pathogenesis of acne is largely multifactorial, with heredity and hormones strongly contributing to one’s risk of developing the chronic inflammatory skin condition; it is related to excess sebum production by sebaceous glands, inflammation within comedones, and hyperproliferation of Propionibacterium acnes. High prevalence rates of acne in the adolescent population cannot be attributed to heredity alone, but by the influence of Western diet that overstimulates a key conductor of metabolism, the growth factor-sensitive kinase known as mTORC1. Many investigations show associations between acne and Western …

New Ways Of Predicting Efficacy Of Antidepressants, Kayla Ternes

Physician Assistant Scholarly Project Papers

Major depressive disorder (MDD) is a neuropsychiatric condition that is becoming increasingly prevalent in our country. According to Cai, Huang, and Hao (2015), MDD is “common and devastating” (p. 61) and has a very complex pathophysiology. Until recently, a definitive etiology had not been found, however, new evidence has suggested that Brain-derived neurotrophic factor (BDNF) and cognitive-emotional biomarkers may be a key into the mechanism of this disorder.

My literature review of articles found in PubMed, CINAHL, Cochrane Library, and PsychINFO within the last ten years focused on the hypotheses of the pathophysiology of MDD, cognitive-emotional biomarkers, and BDNF. The …

Exercise In The Treatment Of Major Depressive Disorder, Larissa Ann Haug

Physician Assistant Scholarly Project Papers

Objective

The purpose of this research and systematic literature review is to determine how exercise can be incorporated into the treatment of major depressive disorder (MDD) and its efficacy.

Methods

In this review, four databases were searched including SportDiscus, Pubmed, Cochrane Database of Systematic Reviews, and PsycInfo from October 1 to January 5, 2018. A variety of key terms were used when searching. Works chosen for review were published after the year 2000, were peer reviewed, and included randomized control trials (RCTs), pilot studies, systematic reviews, and meta-analyses. Sources that were excluded included those published prior to the year 2000, …

The Impact Of Circadian Misalignment On Cardiometabolic Health, Cynthia Marie Mills

Physician Assistant Scholarly Project Papers

The circadian system is important in all living organisms because it generates a 24-hour rhythm for physiological and behavioral processes enabling anticipation and adaptation to daily changes in the environment. The prevalence of cardiometabolic diseases, which are linked to lifestyle choices, has been rising at an alarming rate. Modernization and globalization are two of many factors to blame for lifestyle changes resulting in circadian disruption. The purpose of this literature review is to explore circadian misalignment with regards to its mechanism and impact on cardiometabolic health and to determine possible interventional measures. The primary focus is on lifestyle change, particularly …

Integrative Medicine In Primary Care, Ashley M. Bjornerud

Physician Assistant Scholarly Project Papers

Integrative medicine (IM) is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health (Rakel, 2017). Commonly, integrative medicine is associated with complementary and alternative medicine therapies (CAM). These are two separate entities. CAM is one of the modalities used in integrative medicine.

The review of the literature on IM analyzed studies in primary care settings in all parts of the world. Definitions of IM and CAM are evaluated. Defining what IM is and how to incorporate this approach in …

Treatment Of Undifferentiated Connective Tissue Disease With Csdmard’S Through Primary Care Providers In The Absence Of Intervention Via Rheumatology, Leslie Ann Anderson

Physician Assistant Scholarly Project Papers

Undifferentiated connective tissue disease (UCTD) was first defined by Leroy over 30 years ago. UCTD is described as an autoimmune disease which presents similarly to other rheumatic diseases but fails to meet laboratory requirements which indicate a specific disease such as rheumatoid arthritis, systemic lupus erythematous, Sjogren's or scleroderma. Common signs and symptoms manifested by patients with UCTD include arthralgias, myalgias, fatigue, fever, Raynaud’s phenomenon and sicca like symptoms in addition to having a positive antinuclear antibody (ANA) test. Often patients with these symptoms are referred to rheumatology. Unfortunately, there is a shortage of rheumatology providers across the nation. Although …

A Bridge Too Far? Risks And Benefits Of Perioperative Bridging Therapy, Jordan Buchholz

Physician Assistant Scholarly Project Papers

The long-term use of oral anticoagulants is common among certain high-risk patient populations for the prevention of thromboembolic events such as stroke, pulmonary embolism (PE), and other systemic events. According to Garwood et al. (2017) it is estimated that 15-20% of chronically anticoagulated patients will undergo a surgery or procedure that will require anticoagulation interruption annually. During this interruption period, “bridging” anticoagulant therapy is often utilized with unfractionated heparin or low-molecular weight heparin to ensure adequate anticoagulation is achieved (Ayoub et al., 2016). However, there has been an ongoing debate whether or not the benefits of perioperative anticoagulant bridging therapy …

Glycemic Control And Type 1 Diabetes Mellitus: Current Standard Treatment Vs. Closed-Loop Insulin Pumps, Kelsey Daley

Physician Assistant Scholarly Project Papers

As of 2015, 9.4% of the US population had a diagnosis of Diabetes Mellitus (DM). Although most of the data sets studied encompass type 1 (T1) and type 2 (T2) DM data in all ages of patients, the focus of this project will be primarily on T1DM patients. A thorough review of the current literature reveals that there are effective methods currently available for the management of T1DM patients. These methods include: closed-loop insulin pumps that integrate a continuous glucose monitor (CGM) and insulin pump into one effective system that calculates the needed insulin doses through complicated algorithms, CGM with …

Limb Salvage For Diabetic Patients With Peripheral Arterial Disease, Jamie Jesse Johnson

Physician Assistant Scholarly Project Papers

Diabetes is rapidly increasing throughout the United States. According to the Center for Disease Control (CDC) (2017), the total number of patients diagnosed with diabetes is 23.1 million, patients with undiagnosed diabetes are 7.2 million, for a combined total number of patients with diabetes exceeding 30.2 million and growing.

According to the CDC (2016), approximately 8.5 million people in the United States have peripheral artery disease (PAD), which includes 12-20% of individuals who are older than age 60. According to a study performed by Swaminathan et al. (2014), 186,000 patients underwent lower extremity amputation (LEA). Data also shows that patients …

Systemic Therapy Versus Catheter Directed Techniques For The Treatment Of Acute Massive Pulmonary Embolism, Lawrence Duane Lee

Physician Assistant Scholarly Project Papers

Acute massive pulmonary embolism is characterized by obstruction of the pulmonary arterial tree that exceeds 50% of the cross-sectional area causing acute and severe cardiopulmonary failure from right ventricular overload. Systemic thrombolytic therapy is recommended as standard, first-line treatment in patients with massive pulmonary embolism unless contraindicated and catheter directed therapies, including low dose thrombolytic administration directly into thrombus and mechanical thrombectomy can be adjunctive or used as an alternative to systemic treatments. This literature review researched articles looking both systemic thrombolysis and endovascular techniques for the treatment of acute massive pulmonary embolism with an emphasis on long term clinical …

The Efficacy And Safety Of Creatine Supplementation In The General Population, Cody Baxter

Physician Assistant Scholarly Project Papers

The purpose of this study was to determine whether supplementation with creatine monohydrate is efficacious beyond the realm of its most popular use, which is in athletics. This study investigated the safety of creatine supplementation in the general population. References were collected through a review of PubMed and Scopus databases. Initial keywords searched were creatine supplementation and creatine safety. Where possible, trials with human subjects were utilized. Studies focused on creatine’s effects in athletes or weightlifting parameters were eliminated. Topics were further narrowed down by conditions with the most amount of research and medical concerns recognized as common to primary …

Childhood Trauma: An Analysis Of Associated Co-Morbidities And Various Psychotherapies, Brittney L. Benson

Physician Assistant Scholarly Project Papers

American and European studies suggest that anywhere from 14 to 67% of children have experienced at least one traumatic event throughout their life. Furthermore, about 13.4% of them go on to develop post-traumatic stress disorder (PTSD) or symptoms (Diehle, J., Opmeer, B.C., Boer, F., Mannarino, A.P., & Lindauer, R.J., 2015). One study suggests that as many as 63.9% of adults suffer from ACEs (Adverse Childhood Experiences) (CDC, 2016). The 4th Edition of the Diagnostic and Statistical Manual (DSM-IV) states that PTSD is the most common Axis I disorder in children that are victims of abuse with statistics ranging from 20% …

Exercise Therapy For Chronic Low Back Pain, Jeanmarie Dahl

Physician Assistant Scholarly Project Papers

Chronic low back pain (CLBP) is currently ranked as the 13th most frequent diagnosis in family practice (DynaMed Plus, 2017). Unfortunately, the severe nature of this pain leads providers to prescribe opiates for these patients. Opiates are effective for short term pain management but they have a significant side effect profile. Other forms of management for CLBP need to be identified and utilized. The purpose of this study was to determine the role exercise therapy plays in the treatment and management of patients with chronic low back pain.

A literature review was conducted in order to find high quality systematic …

The Neuroprotective Effects Of Targeted Temperature Management On Post-Cardiac Arrest Patients, Timothy Hovde

Physician Assistant Scholarly Project Papers

Novel methods of ensuring survival following cardiac arrest and resuscitation are of supreme importance to the medical community. Targeted temperature management (TTM) has become increasingly utilized pre-hospital, in emergency departments, and within intensive care units to increase the likelihood of survival to hospital discharge. TTM has further been used to attempt to improve neurological functioning. The efficacy and mechanism behind TTM remains poorly understood. In several patient populations it also remains unproven. The purpose of this study is to assess the physiological mechanism, survival, neurological recovery and methodology of TTM use and implementation.

Literature review was utilized to assess the …

Pre-Participation Physical Examination: Are Current Cardiovascular Recommendations Enough?, Steven Jacob Pietrusza

Physician Assistant Scholarly Project Papers

Inclusion of screening electrocardiograms (EKGs) during pre-participation physical examination has been a topic of debate for some time. There is unquestioned usefulness in the ability of a well-trained health care provider in using EKG to identify cardiac abnormalities. Further, there have been several contemporary EKG criteria published that increase specificity and sensitivity of detection of disease. However, these criteria do not account for athletes less than 14 years of age, and that demographic represents a large portion of patients seeking pre-participation screenings in the United States. The lack of research into pediatric cardiac remodeling secondary to activity, coupled with the …

The Effectiveness Of Oral Non-Steroidal Anti-Inflammatories Versus Steroid Injections In Patients With Shoulder Pain, Darren Scott Pledger

Physician Assistant Scholarly Project Papers

Shoulder pain is the third most common musculoskeletal complaint in primary care. Therefore, it is important that we have quality evidenced based treatments to guide clinicians in treating shoulder pain. I examined in this review whether corticosteroid injection into the glenohumeral joint or oral NSAIDs was more effective in reducing shoulder pain as well as the side effects associated with each treatment modality. Search methods included the PubMed and Cochrane databases. Only studies comparing corticosteroid injection and oral NSAIDs were included and not each treatment individually. In conclusion, corticosteroid injections into the glenohumeral joint accelerate pain relief but have equal …

Cannabinoid Therapy In Chronic Pain Management, Breanna Joy Privratsky,

Physician Assistant Scholarly Project Papers

In 1996, the state of California was the first in the union to allow for the use of medical marijuana. Since then, 28 more states have enacted similar laws (National Conference of State Legislatures, [NCSL], 2017). With the ever-growing opiate problem that has now been classified as an epidemic by the Centers for Disease Control and Prevention, medical marijuana could be a viable alternative to this problem. As of 2014, the CDC reported opioid deaths were up 369%, which is more than 91 deaths per day from overdose (Centers for Disease Control, [CDC], 2017). The purpose of this study is …

Comparing The Effectiveness Of A Low Carbohydrate Diet And Metformin On Glycosylated Hemoglobin Reduction In Type Two Diabetes Mellitus, Ashley Schultz

Physician Assistant Scholarly Project Papers

In this study, a low carbohydrate diet and metformin pharmacotherapy were compared to determine their effect on HbA1c in the type two diabetic patient. Several high quality studies were examined along with each treatment's effect on mainly HbA1c, but also other parameters such as body weight, cholesterol, and fasting and post prandial blood glucose levels. The study showed that both the low carbohydrate diet and metformin pharmacotherapy were effective at lowering HbA1c in the type two diabetic patient. The low carbohydrate diet showed a 0.2% increase in HbA1c all the way to a 2.2% decrease in baseline HbA1c in the …

Treating Peri And Postnatal Depression And Anxiety, Emily M. Stevenson

Physician Assistant Scholarly Project Papers

While diagnoses of depression and anxiety are not uncommon for women during pregnancy and after delivery, one of the greatest challenges in the plan of treatment is to ensure that the offspring are kept safe while the psychological well-being of the mother is appropriately cared for. The objective of this literature review is to evaluate the commonly prescribed treatment methods for prenatal and postnatal depression, focusing on the efficacy of antidepressant medications and nonpharmacologic treatments while evaluating the effects these medications have on the fetus/breastfeeding infant. The method of research included 15 studies completed within the past ten years on …

Antibiotic Therapy In Preventing Exacerbations Of Severe Chronic Obstructive Pulmonary Disease, Jamie Trautner

Physician Assistant Scholarly Project Papers

Chronic obstructive pulmonary disease (COPD) is a progressive disease that has no cure but is treatable. The treatment goal is to have adequate symptom control, decreased exacerbations, prevent hospitalizations and maintain an independent quality of life. The above are attainable by lifestyle changes and pharmacotherapy. The review of literature is to determine if the benefits of long-term antimicrobial therapy outweigh the risks in the treatment of severe COPD. The search included PubMed, Cochrane and Clinical Key databases. Keywords searched include: chronic obstructive pulmonary disease, antibiotics, macrolides, antibacterial, azithromycin, bronchodilators, standard therapy, COPD exacerbations, adverse effects, and long-term. The gold standard …

Decreased Mortality Of Pulmonary Arterial Hypertension In Duchenne Muscular Dystrophy And Down Syndrome, Mitchell Volin

Physician Assistant Scholarly Project Papers

The genetic cause of significant disorders like Down syndrome (DS) and Duchenne muscular dystrophy (DMD) is well documented. Pulmonary arterial hypertension (PAH), a co-morbid condition, is tied to mortality among these groups. If undetected or untreated, in DS, this condition can lead to complications with coronary and lung disease later in life. If undetected or untreated in DMD it can hasten the inevitable prognosis of the disease. Individuals with the ability to communicate their symptoms and actively participate in treatment are at an advantage with subsequent benefit. DS and DMD significantly decrease physical ability and communication capacity.

Genetic research has …

Allergen Specific Immunotherapy And The Effect On Allergy Induced Asthma, Cord Tanner Landrum

Physician Assistant Scholarly Project Papers

Allergies are a major public health problem affecting over 300 million people worldwide (Asamoah et. al). An allergic response can occur when a harmless substance, such as tree pollen, is inhaled into the body and mistakenly identified as a harmful substance. Antibodies then bind to the allergen causing a release of chemicals that leads to symptoms such as nasal congestion, runny nose, itchy eyes or skin reactions. For some people, this reaction can also affect the lungs and airways leading to asthma symptoms.

This review analyzes articles from PubMed, Cochran, Clinical Key and references found from UpToDate articles to assess …