Medicine and Health Sciences Commons^™

Is More Always Better? Efficacy Of Hctz, Low Versus High Dose Therapy In Dual Combination Treatment For Hypertension, Amanda Amy Diep

Physician Assistant Capstones

Currently, 1 in 5 U.S. adults are not aware that they have HTN; thus, a minimum of 20% of patients have BPs that are not at goal.7 With such a large number of patients untreated and uncontrolled, efforts have been made to improve patient attainment of these BP goals. Single-pill fixed-dose combination drugs were made available for this purpose. This option reduces medical costs for patients, increases medication compliance, and provides greater therapeutic results. Looking at trends for fixed-dose combination antihypertensive therapy, a commonly used formulation is a thiazide diuretic combined with an ARB.

Per the European Society of Hypertension-European …

The Effects Of Bariatric Surgery On Obese Patients With Type 2 Diabetes, Nwanneka Dike

Physician Assistant Capstones

Bariatric surgery including Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric band may play a role in glycemic control by improving insulin secretion and sensitivity, specifically through improvement in the main incretin hormones known as glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP). These surgical interventions have been shown to provide effective long-term treatment for patients by providing durable weight loss, improving obesity-related comorbidities and fostering better health outcomes.

Achieving glycosylated hemoglobin levels below 7% can be very challenging in obese diabetic patients. Therefore, the effect of bariatric surgery compared to standard medical therapy alone in attaining this goal and …

The Screening And Management Of Comorbid Depression In Type 1 Diabetes For Improved Compliance, Rebecca N. Evans

Physician Assistant Capstones

Advanced practice and primary care providers are increasingly managing the ever-growing population of patients with diabetes—with a 2016 American Academy of Family Physicians (AAFP) study from the Medical Expenditures Panel Survey (MEPS) finding that a full 48 percent of medical encounters for the subset of patients with diabetes but no other chronic health conditions were in fact managed by general clinicians.1 Patients with diabetes face chronic, severe sequelae of their disease, often suffering comorbid conditions as well, including mental health diagnoses. Physician assistants (PAs) are likely to face increased diabetic patient caseloads—frequently including patients with unmet mental healthcare needs, and …

Does Living In A Rural Vs An Urban Environment During Childhood Increase The Risk Of Developing Or Exacerbating Asthma?, Lyndsay Garner

Physician Assistant Capstones

Medical literature that explored the relationship between asthma and differing environments was reviewed. The majority of the studies available involved case-control, cross-sectional studies and systematic reviews. Evidence revolving around this topic is contradictory, including the effects of rural and urban environment on asthma as well as the effects of air pollution on asthma exacerbations, was inconclusive.

Combined Oral Contraception And Ovarian Cancer Risk Prediction, Tara Grayson

Physician Assistant Capstones

This paper specifically examines whether women ages 25-50 who have taken oral contraceptives for at least 5 years are at a reduced risk for developing ovarian cancer over their lifetime compared to women ages 25-50 who have never used oral contraceptives. The answer to this question is particularly important in clinical practice in order to implement risk prediction and preventative counseling strategies, particularly for women with BRCA mutations, a strong family history of ovarian cancer, or personal history of breast cancer.

Pre-Exposure Prophylaxis As A Prevention Strategy For Hiv Seroconversion In The Men Who Have Sex With Men Population With Comparison Of Its Effectiveness In Other At-Risk Groups, Jack W. Jones Iii

Physician Assistant Capstones

Since the beginning of the United States AIDS epidemic in the early 1980s, the medical community has overcome significant challenges in the diagnosis and treatment of Human Immunodeficiency Virus (HIV) infections. Many advancements in suppressing HIV viral loads and maintaining healthy immune system function in HIV positive patients have been achieved with antiretroviral therapy (ART). Moreover, these drugs have been shown to be effective for preventing HIV infections. Once-daily Truvada (emtricitabine/tenofovir disoproxil fumarate) has been approved by the FDA for this purpose. The availability of this preventive therapy, commonly known as preexposure prophylaxis (PrEP), necessitates educating at-risk patient populations about …

The Effects Of Hyperbaric Oxygen Therapy On Chronic Diabetic Ulcer Healing, Breann Kinsey

Physician Assistant Capstones

Current wound management for chronic diabetic ulcers is unreliable and frequently fails. Due to this unsatisfactory outcome, many diabetic patients are at risk for further complications such as amputations or death. Hyperbaric oxygen therapy (HBOT) has the potential to promote chronic diabetic ulcer healing as an adjunct treatment tool by reducing tissue hypoxia and ischemia. The purpose of this medical literature review is to examine the effect of HBOT, compared to standard wound care alone, on chronic diabetic lower extremity ulcer healing. Unfortunately, limitations of existing medical evidence hinder the use of HBOT as a conventional treatment modality for non-healing …

Efficacy Of Placebo Analgesia Treatment In The Management Of Chronic Non-Cancer Pain Compared To Opioids A Review, Robert Hill

Physician Assistant Capstones

Little is known regarding how the use of placebo analgesia compares to opioids affect long-term treatment efficacy in patients with chronic non-cancer pain over the first two years of treatment. To best answer this question, one must understand the transition from acute to chronic pain along nociceptive signaling pathways. This literature review aims to describe the major nociceptive signaling pathways involved in opioid and placebo analgesia and to discuss how placebo treatment affects chronic pain undergoing central sensitization. It will also review the current understanding of placebo effect and discuss the effects of dose-extending placebo use of opioid tolerance.

Gastric Bypass Surgery As An Alternative Treatment To Pharmacologic Therapy For Lowering Hba1c In Obese Type 2 Diabetic Patients, Pooja Kachhia

Physician Assistant Capstones

Focusing on therapy, many options are available for treating T2DM; however, of the numerous treatment choices, determining the most effective disease control is paramount. T2DM therapeutic measures includes lifestyle modifications, such as eating healthfully, exercising regularly, and losing excess weight. In addition, medicines are also prescribed to lower blood sugar to help prevent and delay complications. While the use of prescription medications to treat T2DM is a widely accepted and effective intervention, recent studies have shown that Roux-en-Y gastric bypass procedure can be an alternate and potentially more effective treatment. Although it is primarily used for bariatric therapy, Roux-en-Y gastric …

A Literature Review Of Type 2 Diabetes Mellitus & The Prevalence Of New Onset Atrial Fibrillation, John B. Mills Jr.

Physician Assistant Capstones

Atrial fibrillation (AF) is one of the most commonly diagnosed cardiac arrhythmias; however, details regarding the risk factors of AF are not necessarily well identified.1,2 This literature review will investigate the likelihood of a direct correlation between pre-existing type 2 diabetes mellitus (T2DM) and new-onset AF. Highlighting a definitive association between AF and T2DM has been a perplexing pursuit in research studies of epidemiology.2 The literature review will examine multiple studies and investigate the extent and significance to which T2DM and AF are related. The specific goal will be to assess whether T2DM patients over the age of 55, with …

Moderate To Severe Crohn's Disease: Are We Treating Successfully?, Valarie M. Kane

Physician Assistant Capstones

There are many medications indicated for the treatment of CD. Selection should aim to balance side-effects and long-term complications. The initial choice in medication treatment should also incorporate the individual profile of the patient as well making more potent medications available to higher risk patients instead of the standard stepwise approach.6 While the immunosuppressive medications azathioprine, 6-mercaptopurine and methotrexate are corticosteroid-sparing, they are not highly effective at mucosal healing or disease prevention. Because of this factor, immunosuppressive medications were not directly compared in this review.

Long-Term Outcomes Of Single Vs. Multiple Courses Of Antenatal Corticosteroids In Mothers At Risk For Preterm Delivery, Ellen K. Lee

Physician Assistant Capstones

Although it is well-known that the administration of antenatal corticosteroids to mothers at risk of preterm birth improves outcomes in premature infants, premature births and associated morbidity and mortality are still prevalent. Typical mortality associated with premature births account for approximately one-third of all infant deaths in the United States. Infants born before 25 weeks gestation have the highest mortality rate, and if they survive, are at the greatest risk for severe morbidity, which translate into higher risk of hospital readmission and significant medical costs. Premature neonates are at a higher risk for acute complications, including necrotizing enterocolitis, growth difficulties, …

Can Measuring Levels Of Serum Adhesion Proteins Replace The Ankle Brachial Index In The Fight Against Peripheral Artery Disease?, Mark K. Massey

Physician Assistant Capstones

If you knew that you were going to have one of both of your legs amputated due to a preventable medical condition in the future, then any sane person would want to find a way of preventing such a disabling and life changing event. Currently peripheral artery disease (PAD) is a growing threat to health in modern times, which can lead to the situation mentioned above. Due to diet and lifestyle risk factors, PAD incidence has increased as the world has become more developed.1 Mankind is unlikely to stop its march onward towards ever more developed states of living, which …

Nonpharmacologic Treatment Of Generalized Anxiety Disorder: Put Your Mind To It, Roseanna M. Pauli

Physician Assistant Capstones

Since GAD is usually a life-long disorder, selecting a therapy that is both effective and safe is essential. The relative safety of nonpharmacologic therapies compared to drug therapy, coupled with the preference to avoid medications, are factors favoring nonpharmacologic means for control of GAD. Whether one form of nonpharmacologic therapy is superior in efficacy to another, specifically whether CBT is better in adult patients, is worth examining. In addition, because this disorder is chronic, the durability of therapeutic actions is important, for which reason evidence confirming symptom control for at least one year’s duration is preferable.

The Use Of Probiotics In Diverticular Disease, Amanda M. Neri

Physician Assistant Capstones

Probiotics are becoming an important source of preventative treatment, due to their possible mechanism of action in modulating the immune system in the gut. Probiotics are also cost effective and have easy accessibility, which can play a role in treatment for gut related diseases. One disease that affects many people in society is diverticular disease, which has been shown to have inflamed and altered gut microbiota. Not only does this disease reduce the quality of life for patients, but also has an increased mortality rate.1 This increase in mortality is mainly due to complications of the disease process.1Obesity has also …

Health Coaching In Low Income, Underserved Patients With Diabetes Mellitus Type 2, Liane Tongol

Physician Assistant Capstones

Implementation of health care coaching into a treatment plan for T2DM low income/underserved patients may address barriers to managing their overall care (i.e. sociocultural factors, financial inaccessibility). Health care coaches are individuals who are involved in the chronic disease management of a patient that function as a source of support and to keep patients accountable for their decisions in overall management of their chronic disease. They play a vital role in empowering patients to take control of their health through education by establishing goals and helping patients navigate their current lifestyle in order to reach these goals.

Comparing The Effects Of High-Intensity Interval Training Versus Moderate Intensity Continuous Training On Vo2max/Peak, Blood Pressure, And Weight Loss In Patients With Cardiovascular Disease Or Risk Factors, Kirsten Shimizu

Physician Assistant Capstones

With increasing numbers of persons affected by CVD, it is important to examine innovative forms of exercise to find regimens that may fit individual lifestyles. A common barrier for adults meeting the minimum-recommended level of physical activity is lack of time.10 Decreasing the time required for effective exercise would surmount this barrier. Current guidelines suggest that 1 minute of vigorous activity equates to 2 minutes of moderate intensity activity. Thus, HIIT may provide a novel way to incorporate vigorous exercise for people who are limited on time or those not fit enough to perform continuous high-intensity exercise.11 Current research comparing …

How Does Angiotensin Ii Receptor Blocker (Arb) Therapy Compare To Angiotensin Converting Enzyme (Ace) Inhibitor Therapy In Prevention Of Long-Term Complications In Idiopathic Hypertension?, Makenzie Saxe

Physician Assistant Capstones

Medical evidence to date confirms that ACE inhibitors and ARBs provide equivalent blood pressure control. However, for prevention of specific outcomes, the data show stronger support for ACE inhibitors than ARBs, and vice-versa. Nonetheless, there is no clear answer as to whether one of these drugs has overall superiority for prevention of long-term complications of hypertension.

Can Preseason Performance Tests Discriminate Injury Risk In Female Collegiate Volleyball Players, Justine Benner, Heidi Cooke, Colby Critchfield, Samantha Dunn, Sarah Eddy, Linda Froemming

Student-Faculty Research - College of Physical Therapy

Purpose: Prior research has demonstrated a 4-fold greater risk of a non-contact time-loss lower quadrant injury in collegiate female VB players (3). The purpose of this study was to validate effectiveness of functional performance tests to discriminate injury risk in female collegiate volleyball players.

A Thematic Analysis Of Adults’ Reflection On Childhood Experiences Being Parented By An Adult With Mental Health Issues, Jennifer Luja, Meg O'Malley

Thinking Matters Symposium Archive

Children are impacted by their relationships with caregivers. The objective of this research was to develop awareness of the impact on children being cared for by caregivers with mental health issues by examining the experiences of individuals who had a caregiver with severe and persistent mental health issues during childhood. Researchers also gained insight on how social workers can be more supportive to children in these circumstances. The researchers conducted interviews with five participants, the recordings of which were then transcribed and coded to identify themes. Prevalent themes include critiques of available services, resiliency and challenges of family members as …

Accuracy Of Self-Collected Vaginal Swabs In The Diagnosis Of Bacterial Vaginosis, Vaginal Candidiasis, And Trichomoniasis, Anna Chase

Thinking Matters Symposium Archive

Vaginitis is the most common gynecological problem seen in primary care. It is estimated to account for 10 million primary care visits each year. The most common causes of vaginitis - responsible for up to 90% of cases - are bacterial vaginosis (BV), vaginal candidiasis (“yeast infections”), and trichomoniasis. The purpose of this evidence-based project was to evaluate whether self-collected vaginal swabs are as accurate as those collected by a provider during a speculum exam in the diagnosis of BV, yeast infections, and trichomoniasis.

In order to appropriately diagnose and treat vaginitis, samples from a vaginal swab are often required. …

Measuring Birth Trauma Rates In Maine Using Public Data, Mike Lapika

Thinking Matters Symposium Archive

An increasing number of states are creating databases that collect and organize health insurance claims from public and private health care payers. Since December 2016, at least 18 states have these “all-payer claims databases” (APCDs), including Maine. APCDs are intended to inform cost containment and quality improvement by increasing transparency and informing consumer choice. For this project, we assessed how Maine’s APCD data might be used to produce standardized quality measures across facilities in the state. Specifically, we tested a birth outcome quality measure developed by the Agency for Healthcare Research and Quality (AHRQ), Birth Trauma – Injury to Neonate …

Evidence And Interventions For Children With Handwriting Deficits, Josephine Hatch

Thinking Matters Symposium Archive

The purpose of this project was to determine effective interventions shown to increase fine motor skills in children who experience handwriting deficits related to ADD/ADHD or other attention deficits. The project was prepared for a pediatric outpatient OT at Hasbro Children’s Hospital. The information was found via the USM databases through specific search terms and parameters.
This work is significant because many OTs and teachers are working with children who have deficits in handwriting and fine motor abilities. There needs to be additional research conducted specifically with children who have ADD/ADHD and exhibit fine motor and handwriting deficits.
The research …

Male Determining Gene Nix May Bring An End To Transmission Of Diseases Through Mosquitoes, Mohammed Mahdi

Thinking Matters Symposium Archive

Female mosquitoes take blood from humans to gain protein needed to produce eggs, and in the process they can transmit viruses, such as Zika, Dengue, and chikungunya, or parasites, such as malaria. Male mosquitoes do not transmit diseases. This literature review will examine what is known about how sex is determined in mosquitoes and how this can be used to manipulate the females that spread diseases to humans. Using CRISPR Cas9, the lab of Zhijian Tu removed the Nix gene from mosquito embryos; all of these were feminized. Ectopic overexpression of Nix gene product in mosquito embryos caused even genetically …

Shelby Powell's Portfolio, Shelby Powell

Honors College Portfolios

The field of pediatric nursing is one that has captured my heart since I was 16. When I thought about what I wanted to be when I grew up, the only aspiration in my clearly uncertain plan was that I wanted to work with children. Soon after, I came to see the huge gratification that being a peds nurse could bring me. Through the work I have completed in my honors independent study, I have had the opportunity to focus on and learn more about this exceptional and rewarding field.

I began with comprising an educational blog focused on the …

Antibiotic As First Line Treatment For Uncomplicated Appendicitis, Loretta Winn

Physician Assistant Capstones

If antibiotic therapy were to be accepted in the US there are several likely benefits. The most obvious benefit would include a lower healthcare cost burden. The cost of surgical intervention compared to medical management is higher, and this cost places a higher financial burden on the patient and their family. Medical management would provide a safe and effective alternative for those who are at high risk for anesthesia complications or for those who are pregnant. There are also many rural facilities that may benefit if the area is not equipped with tools for surgery. It could provide a comparable …

Insight - April 2019, Dugoni School Of Dentistry

Insight

Whether you are involved in clinical research, biomedical research, the scholarship of teaching and learning, improvement of the health care system, or professional partnerships that advance the field, we aim to spotlight the work of people at the Dugoni School.

Santa Clara Magazine, Volume 60 Number 2, Spring 2019 [Print Issue V. 60:1], Santa Clara University

Santa Clara Magazine

28 - TECHNOLOGY, WONDER & US We’re at the epicenter of the biggest ecosystem of information exchange in history. How do we ensure tech fosters human flourishing? By Dorian Llywelyn, S.J. Illustrations by Derek Brahney.

36 - QUERY RESULTS What questions should we be asking about ethics and AI? Here are six. By Irina Raicu J.D. ’09. Illustrations by Paul Blow.

40 - A CURIOUS CASE If you want to innovate for the world, you need the room to do it. Sanjiv Das and a tale of machine learning, mortgages, and mistaken identity. By Deborah Lohse. Illustrations by Ellen Weinstein. …

Identifying Potential Predictors Of Health Literacy And Steps Taken To Pursue Kidney Transplant Among African-Americans On Dialysis, Stacy Skelton

Dissertations

The dissertation attempts to address the disparity seen in all transplant centers today, the low number of African-American end-stage renal disease(ESRD) patients pursing kidney transplant as renal replacement therapy. Currently, there are two renal replacement options, dialysis or a kidney transplant. Research has shown that kidney transplant provides the best health care outcomes in terms of quality of life and decrease mortality. While African-Americans carry the burden of the disease by being four times more likely to have ESRD they only represent 1/3 of the kidney transplants done in the United States. There have been three attempts to increase access …

Haitian American Women With Type 2 Diabetes Mellitus: An Integrative Review, Balkys L. Bivins, Indra R. Hershorin, Lonar Anthony Umadhay

Faculty Articles

Diabetes is escalating at staggering levels in the United States and worldwide. This paper will present a review of relevant literature that supports the need for research in Haitian American women, a particularly vulnerable group, with type 2 diabetes mellitus. It will also unveil the cultural factors that pose challenges to the treatment and management of this condition.