Medicine and Health Sciences Commons^™

Implementation Of Mental And Substance Misuse Screenings Into Routine Prep Therapy Encounters, Kieran Talkiewicz

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It has been well documented over the years that lesbian, gay, bisexual, transgender, queer/ questioning (LGBTQ+) populations are disproportionately affected by a higher burden of mental health illnesses, alcohol abuse, and illicit substance abuse when compared to heterosexual populations. This article will recommend utilizing routine Pre-Exposure Prophylaxis (PrEP) therapy encounters, a common point of contact for primary care for sexual minority populations, to perform screening for mental health and substance use. Due to men who have sex with men (MSM) being the highest utilizing population of this therapy, and disproportionately burdened by psychiatric and substance use disorders, this article will …

Vulvodynia: Making The Diagnosis And Improving Treatment Outcomes, Sophia Campbell

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Vulvodynia is an underdiagnosed condition that affects about 25% of women1. Patients report frustration and a lack of knowledge in the medical community regarding their symptoms of vulvar pain. Painful penetration makes performing an internal pelvic exam difficult, and patients may avoid annual gynecological appointments due to fear. It is imperative for providers to understand and implement the correct approach for accurate diagnosis. Once the diagnosis of vulvodynia has been identified, the multimodal treatment plan should be implemented to include pharmacological therapy, referral to physical therapy, and psychotherapy. With continued research and the use of evidence-based practice, the gap in …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

Capstone Showcase

Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …

The Safety Of Covid-19 Vaccines In Pregnancy, Lauren Zacharias

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SARS-CoV-2 has caused over 800,000 deaths in the United States since it was first detected here in 2020. Despite there being 3 available COVID-19 vaccines in the US, and recommendations by the CDC and countless other public health agencies that any potential risks are outweighed by the benefit of the vaccines, only 31% of pregnant women in the US are vaccinated against COVID-19 due to unfounded claims by an anti-vaccination movement that COVID mRNA vaccines cause infertility. This presentation explores where these claims originated, why they are untrue, the risks of COVID-19 infections in pregnancy, and the potential benefits of …

Conditions That Mimic Attention Deficit Hyperactivity Disorder In A Pediatric Population: A Diagnostic Guide For Primary Care Providers, Elena Schatell

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This article outlines common neurobiological, developmental, psychological, and other medical diagnoses and conditions that symptomatically mimic attention deficit hyperactivity disorder (ADHD) in the pediatric population. Many of these disorders are comorbid with ADHD, but they may also be misdiagnosed as ADHD. Due to the similarity in presentation, these conditions must be included when formulating a differential diagnosis. Accurately diagnosing a child with ADHD requires a thorough evaluation and work up to rule out diagnoses on the differential.

Understanding One Dietary Supplement For Pcos, Eva Schofield

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Poly Cystic Ovarian Syndrome (PCOS) is the most common condition in women of reproductive age, yet nearly 70% of individuals with PCOS remain undiagnosed. For many women who do receive a diagnosis, it takes experiencing symptoms for two years or longer and receiving care from an average of 3 different providers before a diagnosis can be established. In an environment where prevalence is high, diagnosis rate is low and delayed, and dissatisfaction is prevalent regarding the health care women receive, many patients may turn to self-diagnosis and online resources to find their own therapeutic options. This CME article aims to …

The Dogma Of Tissue Ischemia With Local Anesthetic And Epinephrine Use, Laura Morrissey

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Epinephrine is often combined with Lidocaine for local anesthetic use as it improves the duration and quality of Lidocaine and promotes wound hemostasis.^1-2 Despite these benefits, epinephrine has been historically contraindicated from being injected into fingers, toes, ears and the nose due to concern over the vasoconstrictive properties of epinephrine leading to ischemia in these end-arteriole areas.^3-7 However, there is very little documented evidence of this happening with epinephrine use.^5-13 An exhaustive review done by Denkler in 2001 reviewed 21 cases between 1889-2001 that involve epinephrine local injection prior to digit ischemia. However, none of these cases …

Case Report: Fournier's Gangrene, Abigail Groos

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•Fournier’s gangrene is a rare manifestation of the already sparse skin infection known as necrotizing fasciitis, specifically of the scrotal and perineal region. This case illustrates a patient in the emergency department with a severe necrotizing skin infection who quickly progressed to sepsis and multiorgan damage. It is important to understand the common presentation, complications, and ideal management of patients with necrotizing fasciitis.

Safety, Efficacy, And Reversibility Of Novel Male Contraceptives For Improved Pregnancy Prevention, Danielle Anton

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Unintended pregnancy is a global issue that can result from contraceptive failure or from a lack of contraceptive use. A literature search was conducted to explore novel methods of male contraceptives being developed for improved pregnancy prevention. Seven articles were selected, reporting on either oral contraceptive pills, transdermal gel, injectable hormonal, or bilateral intravas deferens polymer injection. The most common adverse events reported across all studies include changes in libido, mood, weight gain, acne, and headache. After reaching hormone and sperm concentration levels sufficient for pregnancy prevention, authors reported complete reversibility of contraceptive effects. Four studies described changes in various …

Continuing Medical Education On Immunothombosis In Sepsis, Vivienne Van Nguyen

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In the past decades, the incidence of sepsis complicated by immunothrombosis has increased in critically ill patients, especially those with sepsis and septic shock. Despite intensive surveillance and prevention of the underlying causes, these disease syndromes are frequently fatal. The increased incidence of immunothrombosis in sepsis has been accompanied by many critical issues and concerns regarding current diagnostic and treatment protocols. This paper offers a concise critical assessment of the current state of knowledge about sepsis and immunothrombosis among clinicians in the ICU as well as problem concerning the recognition of sepsis and immunothrombosis and their management.

Does Administration Of Probiotics To Women Aiming To Get Pregnant Reduce The Risk Of Pregnancy Complications?, Olivia Kreider

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This paper aims to assess the role of the vaginal and uterine microbiota in pregnancy complications, specifically miscarriages. With 1% of women experiencing recurrent miscarriages, the need to further research risk factors for miscarriages is evident. The findings of this research revealed there may be a place for probiotics in the prevention of pregnancy complications. Studies have shown that there is an impact of various bacteria within the uterine and vaginal microbiota on conceiving and maintaining healthy, full-term pregnancies. Considering these findings, it is recommended that healthcare providers consider recommending probiotic supplements to anyone aiming to conceive, especially those who …

Case Of Acute Onset Cerebral Ischemia Involving The Subcortical Region: Corona Radiata, Devin Nichols

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Corona radiata cerebral infarcts have the capability of leaving detrimental residual deficits if not recognized and treated promptly. This article describes the presentation and management of a 43-year-old woman who was transferred from a local community hospital to a larger institution’s emergency department. Initially presenting with nausea, vomiting, and dysarthria and examined global left sided extremity weakness and dysarthria, leading to a confirmed diagnosis via magnetic resonance imaging (MRI) of a corona radiata infarction.

Altitude Illness, Kali Hepner

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With an increasing number of individuals traveling to high altitudes, it is important to address the risk these individuals face of developing altitude related illnesses. An example of high altitude related illness might be the elevation transition of travelers flying into Denver, Colorado (1,673 m) with the intention to then drive up to Rocky Mountain National Park’s Alpine Visitor Center (3,595 m) in the same day. This poses increased risk of unacclimatized visitors experiencing altitude illness in remote areas of the national park. This poster summarizes the diagnosis, prevention, and treatment of altitude illnesses so that clinicians and travelers may …

Recolonization Of Microbiomes’ Influence On Autism Spectrum Disorder, Hattie Cole

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In recent years, there has been an increase in the number of studies conducted on the complications of gastrointestinal (GI) comorbidities associated with autism spectrum disorder (ASD) in children. Some of these GI issues include irritable bowel syndrome (IBS), diarrhea and constipation. The causes of these disorders are poorly understood. The dominant gut phyla are Firmicutes and Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria and Verrucomicrobia. Research conducted on children with ASD compared with typical developing (TD) children showed higher ratios of Firmicutes/Bacteroidetes in the ASD group. Biflobacterium, Actinobacteria phyla, has been shown to be a good intestinal bacterium that may help with …

Bodily Autonomy And Anti-Vaccine Discourse During The Covid-19 Pandemic, Haley Sherman

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This paper explores the relationship between anti-vaccine discourse and ideas about bodily autonomy. I analyze the cyclical nature of vaccine hesitancy and show that it can lead to misinformation and harmful narratives. This paper uses theories of bodily autonomy that identify a concept called moral obligation. This concept, as explored by Alberto Giubilini, is a utilitarian approach in which citizens have a responsibility to their governments to get vaccinated so that, in turn, their governments can fulfill their obligation of protecting other individuals’ health (Giubilini 2020, 54). A discourse analysis of four key players in the anti-vax movement shows that …

The Outcomes Of Cemented Versus Cementless Total Knee Arthroplasty In Modern Day Patients With Osteoarthritis, Jordan Powelson

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Osteoarthritis (OA), the degeneration of cartilage and bone, is the most progressive musculoskeletal disease and a leading cause of disability in the United States, affecting over 27 million adults. Although conservative treatments for knee OA are available, total knee arthroplasty (TKA) is the only definitive treatment for end-stage knee OA. For the past several decades, the use of bone cement has been the gold standard for total knee arthroplasty, but the cementless TKA is being revisited as an option as the age of patients seeking TKA decreases and the average BMI increases. This review analyzes and compares the outcomes of …

A Case Of Protein Losing Enteropathy After Fontan Operation, Gina Kim

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Protein Losing Enteropathy (PLE) is a condition in which an excessive amount of proteins are lost through the gastrointestinal tract leading to hypoproteinemia and manifesting as edema, ascites, and diarrhea. While in most cases PLE is a treatable disorder with good outcomes, the morbidity and mortality of the disorder is significantly elevated in patients with a history of Fontan surgery–an operation used to palliate patients born with a single ventricle by rerouting venous blood return directly to pulmonary circulation. After failure of first-line therapeutics of diuretics and steroids, this case study explores the successful treatment of a 5-year-old patient with …

A Clinical Review Of Persistent Pulmonary Hypertension In The Newborn, Kaela Mahoney

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Persistent pulmonary hypertension in the newborn (PPHN) is an illness of the circulatory and respiratory systems which affects approximately 0.002% of newborns but carries a significant morbidity and mortality burden. Diagnostic measures are focused on determining etiology whereas treatment measures are intended to improve pulmonary function. It is crucial for neonatal providers to be aware of patients at risk for developing PPHN and be prepared to initiate treatment early. This presentation reviews pathophysiology, etiology, risk factors, diagnosis, and treatment of PPHN.

Management Of Adult Growth Hormone Deficiency Related To Hypopituitarism, Kellie Jamin

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The treatment of growth hormone deficiency (GHD) is well-established in childhood but less understood in adults, given the more complex role that growth hormone (GH) assumes in this population. Decreased functionality of the pituitary gland, otherwise known as hypopituitarism, can present with an isolated GHD in adulthood, which may result from a number of factors including neoplasm, ischemia, infection, traumatic injury, or systemic disease. Adult GHD may be definitively diagnosed with a stimulation test, the insulin tolerance test (ITT) being the study of choice. With a positive ITT, the disorder can be treated with growth hormone replacement therapy (GHRT), which …

Diagnostic Imaging Read By Ai-Assisted Technology Within The Emergency Department, Joshua Leland

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Introduction: The emergency department (ED) has had an appreciable increase in volume over the past two decades with more individuals utilizing the ED now than a decade ago which has placed a strain on healthcare resources. Specifically adding to the rising costs in healthcare are diagnostics including chest x-rays. To combat this, institutions across the nation are developing deep-learning and artificial intelligence (AI) programs to assist in reading these diagnostics. Therefore, this systematic review analyzes the use of AI programs by clinicians in the ED to read diagnostic imaging compared to those who do not use these algorithms.

Methods: This …

How Religion & Acceptance Affect Attachment: The Impact Of Familial Factors On Lgb Youth, Emily Stine

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Growing up a member of the lesbian, gay, and bisexual (LGB) community comes with its own distinct struggles. Whether it be attempting to integrate an LGB sexual identity with a religious identity, or coming out to friends and family members, there are multiple opportunities for an LGB individual to experience rejection. This rejection, or fear of potential rejection, can detrimentally impact someone’s mental health. As LGB identities are becoming more accepted overall, LGB youth tend to come out earlier. As a result, the coming out experience often coincides with a particularly turbulent time in their social and emotional development. One …

The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor

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Natural brain processes make all individuals susceptible to unconscious bias; however, stressful, fearful, or anger-evoking situations as well as the negative influence of media and social surroundings increase the risk of holding obstructive bias, and there is a greater risk of being negatively impacted by this phenomenon when belonging to a minority population (Rose & Flores, 2020). As a result, high rates of infant mortality (10.2 deaths per 1,000 live births for the Non-Hispanic Black population compared to 4.1 in the White population) and cardiovascular related diseases (190.0 cases per 1,000 in the Non-Hispanic Black population compared to 161.3 in …

Detecting Multiple Myeloma In The Primary Care Setting, Anna Schweidler

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Multiple myeloma (MM) is a hematological malignancy arising from differentiated B-lymphocyte white blood cells called plasma cells. Hematological malignancies are the fourth most diagnosed cancers, composing approximately 9% of all cancer diagnoses. Specifically, multiple myeloma attributes to approximately 2% of cancer diagnoses in the United States². MM incidence has increased significantly over the past years, increasing 40% in the United States and 126% globally from 1990-2016 ². Affecting 7.0 out of every 100,000 people², multiple myeloma is considered a rare form of blood cancer. Many strides have been made in the treatment of multiple myeloma …

The Clinician’S Approach To Primary Dysmenorrhea: Nutrient And Supplement Modifications, Rachel Albert

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As evidence-based practice on health topics and standards continually evolves, it remains the responsibility of the clinicians to seek out data and newly discovered information that may pertain to patient populations. A longstanding issue that clinicians must address is the approach to primary dysmenorrhea. Currently it is estimated that 50% to 90% of the female population in the reproductive age group experiences this condition, making it the most prevalent health related problem among women of these ages. While this number represents a wide range of the population, many women still accept the symptoms of dysmenorrhea as commonplace and therefore do …

Comparison Of Psychotherapy To Mdma-Assisted Psychotherapy In The Treatment Of Patients With Ptsd, Julia Hasircoglu

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Post traumatic stress disorder (PTSD) is a devastating disease that has high morbidity and mortality. Despite therapy, almost half of patients with PTSD will have chronic and devastating symptoms. The novel agent methylenedioxymethamphetamine (MDMA) has shown promise in phase 3 clinical trials; and, investigation into other therapies is warranted given our current treatment resistance. The objective of the research is to compare the use of MDMA assisted psychotherapy to psychotherapy alone.

Cme: Ischemic Stroke Recognition And Management, Mae Missana

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Stroke is defined as a sudden onset of neurologic deficit caused by interrupted blood flow. Stroke is divided into two subtypes: ischemic and hemorrhagic. Roughly 87% of all strokes are ischemic with infarcts caused by obstruction to carotid artery circulation or vertebrobasilar artery circulation. Symptoms of ischemic and hemorrhagic stroke are similar on physical exam;therefore use of imaging is essential to determine treatment pathway. Asstroke is one of the leading causes of death in the United States, it is important to recognize the signs and symptoms, employ the necessary tools to evaluate and identity stroke, and deliver timely treatment to …

The Use Of Buprenorphine In The Treatment Of Opioid Use Disorder (Oud), Kevin Dise

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Per the CDC, there were 91,799 drug overdose deaths, of which 75% of these deaths involved an opioid in 2020. Furthermore, the rate of overdose deaths involving synthetic opioids (excluding methadone) increased 56% from 2019 to 2020. Synthetic opioids like fentanyl and its derivatives are easily producible, very inexpensive, and have extremely high potency. To effectively reduce use of illicit opioids, the underlying addiction disorder must be recognized first to adequately treat the disease. Treatment for opioid addiction is critical due to the high risk of mortality and significant disruption to daily functioning. Medication-assisted treatment couples medication use with counseling/therapy, …

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

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Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

Antibiotics May Be Unnecessary In The Treatment Of Acute Uncomplicated Diverticulitis, Madison Gump

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Acute diverticulitis is one of the most common gastrointestinal diseases worldwide and is increasing in prevalence. Symptoms include abdominal pain, fever, changes in bowel habits, nausea, and vomiting. Traditionally, this disease has been treated with antibiotics, but new research has emerged that has provided evidence that it may be safe to treat acute uncomplicated cases without antibiotics. This represents an area of medicine where it may be possible to reduce the use of unnecessary antibiotics and, therefore, contribution to bacterial antibiotic resistance. The current research studies do have some limitations and future studies with larger, more diverse patient populations and …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

Capstone Showcase

Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …