Medical Specialties Commons^™

Basic Principles Of Chronic Wound Care Management, Mahi-Ruhi Ladhani Jain

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This CME article aims to address the basics of chronic wound management, especially related to chronic venous insufficiency, peripheral arterial disease, and diabetes. Many providers do not know how to treat or manage chronic wounds and may use outdated methods to treat the wounds. There are many wound care supplies and resources available for providers when it comes to wound care management. However, the information is spread out across different resources. This article aims to create a resource that allows one to have a basic understanding of wounds and the different ways to manage them. In the article, I will …

Evaluating Causes Of Sinus Tachycardia In The Pediatrics Population And Managing In A Primary Care Setting, Guillemette Calderwood

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This article’s goal is to fill a gap in research that compares causes of tachycardia in children by appropriately addressing epidemiology, what is physiologically happening with tachycardia, symptoms that may be associated with it, as well as a differential diagnosis. This review specifically discusses positional orthostatic tachycardia syndrome, anxiety, hyperthyroidism, as well as infection. This is important and needed in order to help providers in diagnosing the cause for this common arrhythmia.

Impact Of Sleep Deprivation On Stress And Performance In Students: Best Interventions, Brianna Crowley

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Sleep is an essential part of physical and mental well-being, yet, many individuals underestimate its importance.^1,2,4 Sleep deprivation can lead to a variety of detriments including memory loss, disorganized thinking, and mood changes.^3,6,7 Because of this, academic performance can be directly impaired as well, which further perpetuates a vicious cycle of sleep deprivation and increasing stress.⁸ Interventions to help improve sleep include adequate sleep hygiene, appropriate physical exercise, lifestyle changes, practicing mindfulness, and using pharmaceutical aids. Providers must continue to address this common issue among patients as it truly impacts various aspects of life and follow good …

Early Onset Colorectal Cancer: Research, Trends & Challenges, Sarah E. Smith

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Early onset colorectal cancer (EOCRC) incidence and mortality are rising in a global trend, contrasting with improvements seen in late-onset colorectal cancer (LOCRC). EOCRC appears to differ in presentation, histology, and pathology from LOCRC painting concerns of a more aggressive tumor profile. With incidence steadily climbing, there is still lacking awareness and guidance on screening for EOCRC. This article aims to provide background on EOCRC including epidemiology, risk factors, and traits, as well as to explore methods for adjusting provider screening criteria to combat this concerning trend.

Herniated Nucleus Pulposus Radiculopathy In Athletes, Elizabeth G. Massel

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Herniated nucleus pulposus (HNP), commonly referred to as intervertebral disc (IVD) herniation, is the second most common cause of neck and back pain, and most common cause of radiculopathy. The purpose of this CME article is to provide guidance on the medical management and secondary prevention of HNP in athletic populations, and highlight the pathophysiological process of mechanical overload putting athletes at a proportionately higher risk of the disease. It will address the unique pathophysiology of overuse-related HNP, as opposed to underuse, with the mechanical overload on vertebral discs associated with many sports. It will also review, with more emphasis …

Diagnosis And Management Of Cyclic Vomiting Syndrome, Sara Read

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Cyclic vomiting syndrome (CVS) is a chronic and debilitating condition that can be encountered in a multitude of clinical settings. It is classified as a functional gastrointestinal disorder and is often misdiagnosed. Proper identification and management of this condition are crucial to patient care and quality of life. This article reviews the hypothesized etiologies, clinical presentation, and diagnosis of CVS as well as recommendations for management in a variety of settings. As an understudied and underdiagnosed condition, it is important that clinicians have a basic understanding of this disorder.

Management Of Opioid Use Disorder In Primary Care, Carolyn Jeffries

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The prevalence of opioid use disorder (OUD) in the United States, and worldwide, has drastically increased in the span of 2-3 years. OUD is considered chronic condition and as such requires routine care over a lifetime. This makes OUD patients excellent candidates to be managed by primary care providers (PCPs). This article discusses the various barriers to treatment of OUD in a primary care setting as well methods and models that aim to mitigate these barriers. We will also review how to take a detailed assessment of an OUD patient, mainstays of medication assisted treatment (MAT), and management of side …

Choosing The Route Of Delivery: A Discussion Of Vaginal And Cesarean Births, Camille Green

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The percentage of cesarean deliveries in the United States has increased to a rate of 32.1%, double what the World Health Organization recommends as an ideal rate for maternal and fetal benefits. The majority of cesarean sections are performed on women who have never had the procedure before and this increases the risk for subsequent cesarean deliveries. Half of the indications for primary cesarean delivery were found to be non-reassuring fetal heart tracings and arrest of labor, both of which are subject to obstetric provider judgment and comfort level. Among these there is also an increasing incidence of elective primary …

Increasing Inpatient Volume And Efficiency Through Decreasing Readmission Rates At Fox Chase Cancer Center, Courtney Pokallus, Islande Victorin

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This paper outlines the semester long strategic plan created by Islande Victorin and Courtney Pokallus for Fox Chase Cancer Center. This strategic plan includes a background of the organization, SWOT analysis on the organization, identification of potential problems and a gap analysis, a strategic summary, and all outlines and plans for the strategic plan.

Exploring Factors Contributing To Compassion Fatigue In Emergency Departments And Possible Interventions, Neggin Assadi

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The ED is a fast paced, busy, and unpredictable environment. Increased exposures to death, suffering, and trauma can make the ED a stressful environment and makes providers more susceptible to a phenomenon called compassion fatigue (CF), a diminished ability to feel compassion towards those they are tasked to care for. Three main contributors to CF in the ED are a poor workplace environment, workplace aggression/violence, and traumatic events. Exploring what contributes to these stressors and proposing ways to reduce them can help ED providers combat CF.

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 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.

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 …

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 …

Initial Antihyperglycemic Options For Populations With Type 2 Diabetes Who Cannot Take Metformin, Rena Ogino

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Type 2 diabetes is a common disease in the United States that can result in life-threatening cardiac, vascular, and/or renal complications. The treatment of type 2 diabetes includes but is not limited to exercise, diet, multi-disciplinary approaches, and pharmaceuticals. Metformin is the first line pharmaceutical for newly diagnosed type 2 diabetes, however patients may be unable to tolerate metformin. With more than seven different antihyperglycemic drug classes and over twenty antihyperglycemic drugs, clinicians may have difficulty choosing the best agent for patients when metformin is not tolerated. This article compares common anti-hyperglycemic pharmaceutical agents and their drug classes, focusing on …

The Effectiveness Of Probiotics In Adults With Depressive Symptoms, Brianna Rees

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Introduction: Depression affects over 21 million adults in the United States and continues to rise, affecting more people due to the recent pandemic. Because the prevalence of this debilitating mental health disease is increasing, it is even more crucial to find additional therapeutic treatments to alleviate depressive symptoms in adults whose depression is not controlled on current anti-depressant medication or therapy. Depression has been shown to be linked to the gut-brain axis, meaning gut health is connected to our mental health. Therefore, probiotics may be effective in altering the gut microbiome, and ultimately affecting cognitive patterns in the brain.

Methods: …

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

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Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Treatment Of Hypothyroidism: Desiccated Thyroid Extract, Aimee Fong

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The treatment of hypothyroidism with Levothyroxine (T4) has been well studied and FDA approved. However, many patients continue to have signs and symptoms of hypothyroidism while on Levothyroxine treatment despite reaching appropriate thyroid levels. An additional thyroid treatment known as desiccated thyroid extract (DTE) is made from dried pig thyroid glands and is advertised as a “natural” alternative to Levothyroxine. Despite lack of FDA approval and studies surrounding DTE, clinicians have prescribed DTE to patients, many of whom reported relief of their symptoms. The following poster highlights the approach to the treatment of hypothyroidism with Levothyroxine and DTE and outlines …

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 …

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

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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 …

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 …

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 …

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.

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 …

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 …

In Patients With Hepatocellular Carcinoma (Hcc) (P), Is Bevacizumab With Atezolizumab (I) More Effective Than Sorafenib (C) In Long-Term Clinical Prognosis (O)?, Joon Lee

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Hepatocellular carcinoma (HCC) is the third leading cause of cancer death globally. China contributes to half of the global incidence of liver cancer, with about 70-85% being HCC. Definitive treatment for this condition would be surgical resection with liver transplant but for obvious reasons, the majority of affected patients are unable to meet the necessary criteria. Sorafenib is a form of chemotherapy that has been the mainstay treatment of HCC since its approval in 2007. More recently, the combination of Bevacizumab and Atezolizumab has shown greater efficacy in the treatment of unresectable HCC. Additionally, this new combination therapy shows favorable …

The Diverse Neurological Manifestations Of The Sars-Cov-2 Pandemic, Asmeda Spalding

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SARS-CoV-2 remains an international public health concern and can be encountered in all aspects of healthcare. Although most neurological manifestations are benign, clinicians must be aware and able to recognize more serious conditions that require urgent referral and intervention. Patients at risk for severe cases should be given extra attention given their propensity for neurological and clinical deterioration. This article highlights the most common and urgent neurological symptoms and diagnoses of the COVID-19 pandemic as well as clinical pearls for their identification.

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

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Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …