Therapeutics Commons^™

Empagliflozin In The Treatment Of Type 2 Diabetes: Evidence To Date, Jay H. Shubrook, Babak Baradar Bokaie, Sarah E. Adkins

Faculty Publications & Research of the TUC College of Osteopathic Medicine

In the last decade, researchers have gained a greater understanding of the pathophysiologic mechanisms of type 2 diabetes as a chronic and progressive disease. One of the more recent treatment targets is the kidney. The kidneys become maladaptive in diabetes by increasing the reabsorption of glucose above the normal physiologic renal threshold. This discovery has led to the development of the sodium/glucose cotransporter 2 inhibitors (SGLT2). These agents readjust the renal threshold for glucose reabsorption to a lower level and decrease glucose reabsorption, while increasing urinary glucose when the glucose is above the renal threshold and subsequently lowering plasma glucose. …

Off-Label Use Of Transmucosal Ketamine As A Rapidacting Antidepressant: A Retrospective Chart Review, Linda Nguyen, Patrick J. Marshalek, Cory B. Weaver, Kathy J. Cramer, Scott E. Pollard, Rae Reiko Matsumoto

Faculty Publications & Research of the TUC College of Pharmacy

Objective: This study evaluated the effectiveness and safety of subanesthetic doses of ketamine using an off-label, transmucosal administration route in patients with treatment-resistant depression.

Methods: A retrospective chart review was conducted to identify patients who met the inclusion criteria for treatment-resistant major depressive disorder. Seventeen such patients who received subanesthetic doses of ketamine were included. Patient demographics, efficacy (drug refill, clinician notes), side effects, and concurrent medications were assessed.

Results: Benefit from low-dose transmucosal ketamine was noted in 76% of subjects (average age 48 years, 88% female), with a dose duration lasting 7–14 days. No notable side …

Is Proton Beam Therapy More Effective Than Intensity-Modulated Radiotherapy In Prostate Cancer Treatment?, Daniel Zelefsky

The Science Journal of the Lander College of Arts and Sciences

Prostate cancer is the most common form of cancer found in American males. Breaking technological advances in prostate cancer treatment continue to develop to help fight this disease, one such is proton beam therapy. Proton beam therapy is theorized to spare even more healthy tissue than photon radiotherapy because it delivers a majority of its radiation during the Bragg peak. Since this technology is substantially costlier than any other form of radiation therapy, physicians are assessing its effectiveness and determining if it is worth the cost. Currently, there is no significant difference seen in patient quality of life between recipients …

Oncology Section Edge Task Force On Breast Cancer Outcomes: A Systematic Review Of Outcome Measures For Functional Mobility, Mary Insana Fisher, Jeannette Lee, Claire Davies, Hannah Geyer, Genevieve Colon, Lucinda Pfalzer

Physical Therapy Faculty Publications

Background: Breast cancer treatments in women with breast cancer often result in physical impairments that lead to activity limitations and participation restrictions. These limitations and restrictions manifest in impaired functional mobility skills that may impact survivorship. Thus, evaluation of functional mobility is an important part of survivorship care.

Purpose: To identify functional mobility outcome measures that possess strong psychometric properties and are clinically useful for examination of women treated for breast cancer.

Methods: Multiple electronic databases were searched for articles published after 1995. Studies were included if they reported psychometric properties, used clinically feasible methods, were performed on adults, and …

The Effects Of Home-Based Pilates In Healthy College-Age Females, Betsy Donahoe-Fillmore, Mary Insana Fisher, C. Jayne Brahler

Physical Therapy Faculty Publications

Objectives: To quantify and determine the effects of Pilates on core endurance, hamstring flexibility, balance, body composition/mass and perceived stress level in healthy college age females.

Study Design: Randomized controlled trial design.

Background: Emerging research on the Pilates technique is inconclusive regarding benefits to core endurance, flexibility, balance, body mass, and perceived stress.

Methods and Measures: Female college students (n=57; 18-35 years old) were randomly assigned to a Pilates group, who exercised at home with a DVD, or a control group who did not engage in Pilates practice. Core endurance, hamstring flexibility, balance, body composition and stress measurements were taken …

Effect Of Tai Chi Exercise Combined With Mental Imagery Theory In Improving Balance In A Diabetic And Elderly Population, Abdulrahman Alsubiheen, Jerrold S. Petrofsky, Noha S. Daher, Everett Lohman, Edward Balbas

College of Health & Human Services (TUN) Publications and Research

BACKGROUND: One of the effects of diabetes mellitus (DM), peripheral neuropathy, affects the sensation in the feet and can increase the chance of falling. The purpose of the study was to investigate the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on improving balance in people with diabetes and an age matched control group.
MATERIAL AND METHODS: Seventeen healthy subjects and 12 diabetic sedentary subjects ranging from 40–80 years of age were recruited. All subjects in both groups attended a Yang style of TC class using MI strategies, 2 sessions a week …

Treating Acute Migraines: Triptans Vs. Antiemetics, Samuel Reisman

The Science Journal of the Lander College of Arts and Sciences

Influential American medical organizations and publications have published guidelines for the treatment of acute migraine headaches that omit antiemetics, usually suggesting triptans as the first line of treatment. A review of the few comparative studies directly contrasting clinical outcomes of triptans and antiemetics in the treatment of acute migraines suggest that both treatment options are relatively equal in efficaciousness. The added burden of triptan usage, including an added risk of adverse effects and a high cost per dose, would seem to warrant an antiemetic-first approach to migraine treatment, as recommended by several international health communities. Possible reasons for the prominent …

Transposon Based Gene Therapy As A Treatment For Cancer, Jacob Stauber

The Science Journal of the Lander College of Arts and Sciences

Gene therapy is the use of genes to treat or prevent diseases. Diseases such as cancer, which are difficult to treat using conventional methods, can be treated using gene therapy. The transport of the therapeutic transgene can be accomplished using viral or non-viral methods. However, widespread use of viral vectors is limited due to its high cost of manufacture and safety concern. Non-viral vectors are limited in their effectiveness. The use of transposons such as the Sleeping Beauty transposon system can effectively deliver the transgene with less concern than viral vectors. This review discusses the various vectors and treatment strategies …

Is The Neuraminidase Inhibitor Tamiflu Effective In The Treatment Of Influenza?, Eliyakim Hershkop

The Science Journal of the Lander College of Arts and Sciences

Influenza is a disease that has caused the deaths of tens of millions people in the last century alone. The influenza neuraminidase protein is essential in the mechanism infection. It enables the virus to leave the infected cell and proliferate. Antiviral neuraminidase inhibitor drugs can be used for treatment. The drug Tamiflu is the standard of care for both treatment and prophylaxis of influenza. The Cochrane reports of 2009 and 2014 conclude that evidence is lacking to support this. Numerous bodies disagree. Cochrane also question the accuracy and credibility of many studies and agencies in support of Tamiflu. This paper …

Biological Therapy In The Treatment Of Ulcerative Colitis, Tzipora Glanzman

The Science Journal of the Lander College of Arts and Sciences

Ulcerative colitis (UC), a subdivision of inflammatory bowel disease, is a chronic disease of the large intestines. Ulcerative colitis is normally a lifelong chronic illness with times of intense flairs and remission. During a flare, the lining of the colon becomes inflamed, and develops small ulcers causing patients to experience rectal bleeding, vomiting, anemia and diarrhea. The treatment options available to treat colitis are very small, causing many patients to need a total colectomy with in the first five years of their diagnosis. However, recent advancement in bio-technology has led to the development of a large array of new therapeutic …

Insomnia And Exacerbation Of Anxiety Associated With High-Epa Fish Oil Supplements After Successful Treatment Of Depression, Lauren B. Blanchard, Gordon C. Mccarter

Faculty Publications & Research of the TUC College of Pharmacy

A 54-year-old male consulted his general practitioner for increasing general anxiety and mild panic attacks despite effective treatment for recurrent major depressive disorder, which included a fish oil supplement enriched in eicosapentaenoic acid (EPA). The patient would awaken suddenly at night with shortness of breath and overwhelming worry. During the daytime, he felt a general, nonspecific anxiety and frequently experienced sympathetic activation upon confronting routine challenges. He also experienced dyspnea-induced feelings of panic. He reported that he stopped taking the fish oil supplements after several more months of symptoms, and his anxiety and insomnia then largely disappeared. Several weeks later, …

The Effect Of Music Therapy Interaction On Child And Parental Preoperative Anxiety In Parents Of Children Undergoing Day Surgery, Christopher R. Millett

Theses and Dissertations--Music

Young children who experience high levels preoperative anxiety often exhibit distress behaviors, experience more surgical complications, and are at a higher risk for developing a variety of negative postoperative consequences. A significant factor in pediatric preoperative anxiety is the level of anxiety present in their caregivers. Music therapy interventions addressing a variety of procedural outcomes have been met with success. The purpose of this study was to investigate the comparative effectiveness of two music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers.

A total of 40 pediatric patient and caregiver dyads were included in …

Is Yoga Effective In Reducing Fibromyalgia-­Related Symptoms In Women With Fibromyalgia?, Molly R. Beckmann

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not yoga is effective in reducing fibromyalgia-related symptoms in women with fibromyalgia.

Study Design: Review of two published double blind, randomized controlled trials published in 2010 and one before-after study published in 2012 were used for this review and selected based on their relevance to the clinical question

Data Source: Studies were found using PubMed, AMED, and CINAHL Plus.

Outcomes Measured: All three studies measured improvement of fibromyalgia symptoms based on a variety of well-validated measures, most notably the Fibromyalgia Impact Questionnaire, the Quality of Life Profile …

Is Pilates-Based Exercise Effective In Improving Balance In Healthy Adults Over The Age Of 18?, Abby Ott

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not Pilates-based exercise is effective in improving balance in healthy adults over the age of 18.

Study Design: Review of three English language randomized controlled trials (RCTs) published in 2006, 2009 and 2012.

Data Sources: Three non-blind randomized controlled trials published in peer reviewed journals found via PubMed.

Outcome(s) Measured: Efficacy was measured with the experimental group participating in a predetermined number of Pilates classes and the control group refraining from any exercise or continuing their pre-study, non-Pilates exercise routines. Change in balance was measured using a …

Does Balneotherapy Effectively Reduce Non-Specific Chronic Low Back Pain In Adults?, Jenna Srebnik

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not balneotherapy effectively reduces non-specific chronic low back pain in adults.

STUDY DESIGN: Review of three single blind, follow up randomized controlled trials (RCT), published in 2012 and 2005.

DATA SOURCES: Three peer reviewed RCTs were found using PubMed and all compared balneotherapy against various control groups.

OUTCOMES MEASURED: Low back pain of patients was assessed using dose of analgesic consumed, visual analog pain scale (VAS) and Oswestry Low Back Pain Disability Questionnaire (OSWDQ). The tools used to assess significance of outcomes measured were Pvalues, change in …

Does Neuromuscular Electrical Stimulation As An Adjunct To Traditional Physical Therapy Improve Post-Operative Mobility After Total Knee Arthroplasty In Comparison To Traditional Pt Alone In Patients 50-85 Years Old?, Kelsey L. Welsh

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective Evidence Based Medicine (EBM) review is to determine whether or not neuromuscular electrical stimulation (NMES) as an adjunct to traditional physical therapy (PT) improves post-operative mobility including walking and stairclimbing ability following total knee arthroplasty (TKA) in comparison to traditional PT alone in patients 50-85 years old.

STUDY DESIGN: Review of three English language primary studies published after 1999.

DATA SOURCES: Three randomized controlled trials comparing traditional PT with PT and adjuvant NMES following TKA in patients 50-85 years old found using PubMed and EBSCOhost Web.

OUTCOMES MEASURED: Clinical outcome was measured in each …

Dysregulation Of Micrornas In Blood As Biomarkers For Diagnosing Prostate Cancer, Rhonda W. Daniel

Theses and Dissertations

Prostate cancer is the most common noncutaneous cancer among men, yet current diagnostic methods are insufficient and more reliable diagnostic markers need to be developed. The answer that can bridge this gap and enable more efficient diagnoses may lie in microRNAs. These small, single stranded RNA molecules impact protein expression at the translational level and regulate important cellular pathways. Dysregulation of these small RNA molecules can have tumorigenic effects on cells and lead to many types of cancers.

Currently the Prostate-Stimulating Antigen (PSA) is used as a diagnostic marker for prostate cancer. However, many factors can elevate PSA levels such …

Femtosecond Laser Beam Propagation Through Corneal Tissue: Evaluation Of Therapeutic Laser-Stimulated Second And Third-Harmonic Generation, William R. Calhoun Iii

Theses and Dissertations

One of the most recent advancements in laser technology is the development of ultrashort pulsed femtosecond lasers (FSLs). FSLs are improving many fields due to their unique extreme precision, low energy and ablation characteristics. In the area of laser medicine, ophthalmic surgeries have seen very promising developments. Some of the most commonly performed surgical operations in the world, including laser-assisted in-situ keratomileusis (LASIK), lens replacement (cataract surgery), and keratoplasty (cornea transplant), now employ FSLs for their unique abilities that lead to improved clinical outcome and patient satisfaction.

The application of FSLs in medical therapeutics is a recent development, and although …

Drug Interactions With Glutaredoxin Orthologues, Kahlilah R. Napper, Thomas C. Leeper, Ram Khattri, Daniel Morris, Caroline Davis

Williams Honors College, Honors Research Projects

Glutaredoxin, an enzymatic protein, is an important component of cell viability and function. It catalyzes reactions involved in DNA synthesis and innate immunity [1,4]. Glutaredoxin is also essential in antibiotic resistance in pathogenic bacterial species. Pseudomonas aeruginosa in particular is responsible for infecting the lung tissue of its human hosts, resulting in the development of pneumonia and cystic fibrosis [3]. Because glutaredoxin is pertinent in cell proliferation of eukaryotic and bacterial cells alike, medicinal fragments that take advantage of the subtle differences in protein structure of the orthologous proteins can be synthesized and enhanced to bind bacterial glutaredoxins, without inhibiting …

The Effect Of Statin Therapy On Heart Failure Events: A Collaborative Meta-Analysis Of Unpublished Data From Major Randomized Trials, David Preiss, Ross T. Campbell, Heather M. Murray, Ian Ford, Chris J. Packard, Naveed Sattar, Michael B. Clearfield

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Aims: The effect of statins on risk of heart failure (HF) hospitalization and HF death remains uncertain. We aimed to establish whether statins reduce major HF events.

Methods and results: We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled endpoint statin trials from 1994 to 2014. Collaborating trialists provided unpublished data from adverse event reports. We included primary- and secondary-prevention statin trials with >1000 participants followed for >1 year. Outcomes consisted of first non-fatal HF hospitalization, HF death and a composite of first non-fatal HF hospitalization or HF death. HF events occurring(MI) were excluded. …

Program Active Ii: Design And Methods For A Multi-Center Community-Based Depression Treatment For Rural And Urban Adults With Type 2 Diabetes, Mary De Groot, Jay H. Shubrook, Frank Schwartz, W. Guyton Hornsby Jr., Yegan Pillay, Chandan Saha

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Objective: Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to …

What To Do After Basal Insulin: 3 Tx Strategies For Type 2 Diabetes, Lubaina Presswala, Jay H. Shubrook

Faculty Publications & Research of the TUC College of Osteopathic Medicine

While many family physicians have become comfortable with using once-daily basal insulin such as glargine or detemir, what to do after basal insulin is much more complex. This review builds upon an earlier article in this journal, “Insulin for type 2 diabetes: How and when to get started,” by explaining 3 strategies to consider when basal insulin alone isn't enough.

Cancer Survivorship Care: An Emphasis On Rehabilitation Needs In Maine, Cassandra Dawley, Charles Dowd, Irina Fedulow, Miranda Carlson, Lisa Gerhardt, Erin Pike, Kaitlin Powers, Nicole Christine, Angela Serrani

Disease Prevention and Health Promotion Resources

Presentation proposing that standardized rehabilitation and wellness services be incorporated into cancer treatment as well as into a personalized plan of care to be carried out after cancer treatment ends. Proposal is based on research regarding evidence of causation concerning impairments developed as a result of a cancer diagnosis and cancer treatment, evidence regarding rehabilitation and physical activity as an effective intervention in the prevention and treatment of impairments from cancer diagnosis and cancer treatment, and the underlying behavioral change theory for incorporation of a Cancer Survivorship Rehabilitation Algorithm which includes the use of rehabilitation and wellness services in the …

Current Therapeutic Research Is Now Indexed On Pubmed., John N Van Den Anker, Karel Allegaert, Walter K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

No abstract provided.

Development Of A Thin-Film Porous-Microelectrode Array (P-Mea) For Electrical Stimulation Of Engineered Cardiac Tissue., Hiren Vrajlal Trada 1977-

Electronic Theses and Dissertations

Electrical stimulation has been increasingly used by research groups to enhance and increase maturation of cells in an engineered cardiac tissue (ECT). Current methods are based on using off-the-shelf wires or electrodes to deliver a stimulus voltage to the in-vitro tissue in culture medium. A major issue with this approach is the generation of byproducts in the medium due to the voltage levels required, which are typically in the range of 5V-10V. No solution currently exists that can accomplish electrical stimulation of cells in an ECT at a low voltage level. Therefore, in this study a novel, porous, thinfilm, microelectrode …

Effects Of Yoga On Arm Volume Among Women With Breast Cancer Related Lymphedema: A Pilot Study, Mary Insana Fisher, Betsy Donahoe-Fillmore, Laura Leach, Colleen O'Malley, Cheryl Paeplow, Tess Prescott, Harold L. Merriman

Physical Therapy Faculty Publications

Lymphedema affects 3–58% of survivors of breast cancer and can result in upper extremity impairments. Exercise can be beneficial in managing lymphedema. Yoga practice has been minimally studied for its effects on breast cancer related lymphedema (BCRL). The purpose of this study was to determine the effect of yoga on arm volume, quality of life (QOL), self-reported arm function, and hand grip strength in women with BCRL. Six women with BCRL participated in modified Hatha yoga 3×/week for 8 weeks. Compression sleeves were worn during yoga sessions. Arm volume, QOL, self-reported arm function, and hand grip strength were measured at …

Cancer Survivorship Care: An Emphasis On Rehabilitation Needs In Maine, Miranda Carlson, Nicole Christine, Charles Dowd, Cassandra Dawley, Irina Fedulow, Lisa Gerhardt, Erin Pike, Kaitlin Powers, Angela Serrani

Disease Prevention and Health Promotion Papers

The first section of this report addresses the evidence of causation concerning impairments developed as a result of a cancer diagnosis and cancer treatment. The second section investigates the evidence regarding rehabilitation and physical activity as an effective intervention in the prevention and treatment of impairments from cancer diagnosis and cancer treatment. The third section discusses the underlying behavioral change theory for incorporation of our Cancer Survivorship Rehabilitation Algorithm (Appendix 1), which details our proposed use of rehabilitation and wellness services in the continuum of cancer care and includes an outline for a survivorship care plan. This section also discusses …

Normative Scores For The Nih Toolbox Dynamic Visual Acuity Test From 3 To 85 Years, Carol Li, Jennifer L. Beaumont, Rose Marie Rine, Jerry Slotkin, Michael C. Schubert

Physical Therapy Faculty Research

As part of the National Institutes of HealthToolbox initiative, a computerized test of dynamic visual acuity (cDVA) was developed and validated as an easy-to-administer, cost- and timeefficient test of vestibular and visual function. To establish normative reference values, 3,992 individuals, aged 3–85 years, without vestibular pathology underwent cDVA testing at multiple clinical research testing facilities across the United States. Test scores were stratified by sociodemographic characteristics. cDVA was worse in males (p <0.001) and those subjects 50 years or older, while there was no difference in dynamic visual acuity across age groups binned from 3 to 49 years. Furthermore, we used these normative cDVA data as a criterion reference to compare both the long (validated) and short versions of the test. Both versions can distinguish between those with and without vestibular pathology (p D0.0002 long; p D0.0025 short). The intraclass correlation coefficient between longand short-cDVA tests was 0.86.

Effects Of Pde4 Pathway Inhibition In Rat Experimental Stroke, Fan Yang, Rachita K. Sumbria, Dong Xue, Chuanhui Yu, Dan He, Shuo Liu, Annlia Paganini-Hill, Mark J. Fisher

Pharmacy Faculty Articles and Research

PURPOSE: The first genomewide association study indicated that variations in the phosphodiesterase 4D (PDE4D) gene confer risk for ischemic stroke. However, inconsistencies among the studies designed to replicate the findings indicated the need for further investigation to elucidate the role of the PDE4 pathway in stroke pathogenesis. Hence, we studied the effect of global inhibition of the PDE4 pathway in two rat experimental stroke models, using the PDE4 inhibitor rolipram. Further, the specific role of the PDE4D isoform in ischemic stroke pathogenesis was studied using PDE4D knockout rats in experimental stroke. METHODS: Rats were subjected to either the …

The Kras/Mapk Pathway And Ligand Independent Activation Of Erα: Implications For The Treatment Of Endometrial Cancer, Kari Ring

Dissertations and Theses (Open Access)

Hormonal therapy remains a first line option for the treatment of recurrent endometrial cancer (EC), however, many tumors demonstrate de novo or acquired resistance. Member kinases of the PI3K/AKT and Ras/MAPK pathways activate estrogen receptor α (ERα) independent of estrogen, however, few studies have evaluated the role of the Ras/MAPK pathway in predicting response to hormonal therapy in EC. The aims of this project were to evaluate the role of ligand independent activation of ERα in EC and to explore therapeutic implications for the treatment of recurrent EC.

A xenograft model for recurrent EC was used to evaluate the effect …