Medical Specialties Commons^™

Is Cannabis Effective In Reducing Muscle Spasticity And Body Pain Amongst Patients With Multiple Sclerosis?, William E. Johnson

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not cannabis is effective in reducing muscle spasticity and body pain amongst patients with Multiple Sclerosis (MS).

STUDY DESIGN: A systematic review of three peer-reviewed studies published between the years of 2003 and 2012.

DATA SOURCES: Three randomized control trials (RCTs) evaluating if cannabis can reduce muscle spasticity and body pain for patients diagnosed with Multiple Sclerosis. All three sources were selected from PubMed and examined for outcomes that were patient oriented.

OUTCOMES MEASURED: The two primary outcomes measured include: muscle spasticity measured by the Ashworth scale, …

Is Intranasal Oxytocin An Effective Treatment For Reducing Disruptive Behavior In Individuals With Prader-Willi Syndrome?, Anna C. Maraia

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not intranasal oxytocin is an effective treatment for reducing disruptive behavior in individuals with Prader-Willi Syndrome.

STUDY DESIGN: This is a systematic review of two randomized controlled crossover trials and one randomized controlled pilot study, all of which were double-blind and placebo-controlled. All articles were peer-reviewed, written in English and published between 2011 and 2016.

DATA SOURCES: The three articles used in this systematic review were found in PubMed based on their relevance to the objective of the study, the inclusion of patient-oriented problems and published within …

Does The Ligasure Vessel Sealing System Provide Benefit In Mortality In Regards To Hepatic Resections?, Samantha M. Kleiber

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not using the LigaSure device provides any benefit in morality in patients undergoing hepatic resection surgery.

STUDY DESIGN: Review of three English language randomized control trials published in 2007, 2009 and 2012.

DATA SOURCES: Data sources obtained for this review primary studies published in peerreviewed journals, found using PubMed.

OUTCOMES MEASURED: Patient mortality, defined as death within 30 days of the surgical procedure.

RESULTS: The study done by Doklestic and et al had 3 patient mortalities occur. The deaths occurred on post op days three, four and …

Does Adalimumab Improve Symptoms In Patients With Moderate To Severe Hidradenitis Suppurativa?, Eric A. Eck

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Does Adalimumab improve symptoms in patients with moderate to severe Hidradenitis Suppurativa?”

STUDY DESIGN: A systematic review of three peer-reviewed articles published between 2011 and 2016 which present patient oriented evidence.

DATA SOURCES: Review incorporated analysis of two randomized controlled trials (RCTs) and one open label prospective trial. Studies were selected based upon the relevance to the clinical question, does adalimumab usage improve symptoms in individuals with moderate to severe hidradenitis suppurativa.

OUTCOMES MEASURED: The outcomes measured focused on patient reported reduction in hidradenitis suppurativa symptoms. …

Does Light Therapy Improve The Quality Of Life For People With Acne?, Montana W. Banks

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Does light therapy improve the quality of life for people with acne?”

STUDY DESIGN: A systematic review of three peer-reviewed primary studies published between the years of 2016 and 2018. All articles were published in the English language and in peer-reviewed journals.

DATA SOURCES: One pilot study, one multicenter, randomized, split-face control study and one single-blind, randomized, split-face study evaluating if light therapy can improve the quality of life (QOL) of people with acne. Sources were selected from PubMed and Cochrane based off of the relevance …

Optimization Of Primary Cilia Detection In Musculoskeletal Tissue, Ragen Engel

Williams Honors College, Honors Research Projects

The objective of this research project was to optimize a laboratory technique for visualizing primary cilia in musculoskeletal tissue of young swine, specifically the growth plate of long bones. This was accomplished through varying fixation procedures, antigen retrieval methods, antibody concentrations, and incubation times. By varying these parameters, a reproducible procedure was developed to examine the primary cilia in multiple tissues including ligament, fascia, and growth plate. This experiment introduced variances in fixation methods, with methanol or formalin. Paraffin and frozen embedding techniques were also varied for comparison with regards to cilia visualization. Results from the acetylated alpha tubulin (aTUB) …

Strategies To Enhance The Anti-Leukemic Activity Of Venetoclax (Abt-199) In Aml Through Targeting Of Mcl-1, Daniel Luedtke

Wayne State University Dissertations

Acute Myeloid Leukemia (AML) is a frustratingly difficult to treat disease (67% 5 year survival for children and 24% for adults). The standard of care, similar to outcomes, has seen few improvements over the last several decades. The Bcl-2 family, which controls cell survival and apoptosis, is dysregulated in AML. Bcl-2, which is overexpressed in AML and associated with chemoresistance, is a promising therapeutic target. The now FDA approved venetoclax (ABT-199) is a BH3 mimetic that is able to bind to anti-apoptotic Bcl-2 and prevent it from sequestering pro-apoptotic Bim. While overall response rates are promising, our lab and others …

Sprouty4 Is A Negative Regulator Of Erk/Mapk Signaling In Breast Cancer And Plays A Role In The Transition From In Situ To Invasive Disease, Ethan Brock

Wayne State University Dissertations

Breast ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive ductal carcinoma (IDC). It is still unclear which DCIS will become invasive and which will remain indolent. Previous data by our group found that Sprouty4 transcript was differentially expressed between three DCIS cell lines and a non-transformed breast epithelial cell line. Sprouty proteins are important regulators of ERK/MAPK signaling, and have been studied in various cancers. We hypothesized that Sprouty4 is an endogenous inhibitor of ERK/MAPK signaling and that its loss/reduced expression is a mechanism by which DCIS lesions progress toward IDC, including triple-negative disease. Using immunohistochemistry we …

Understanding The Utilization Of Community-Based Services In Late Old Age: A Participatory Approach For Connecting Through The Communication Ecology, Carrie Leach

Wayne State University Dissertations

As the pool of eligible recipients continues to grow, understanding service system utilization and barriers can help ensure very old adults can access support from their communities when needed. Mounting research demonstrates that investment in community-based services to ensure seniors remain independent translates to saved government dollars. As a contributing researcher of a multi-year county-wide older adult needs assessment in Monroe County, Michigan, data collected from 1,870 people revealed a communication disjuncture between seniors and service providers. In response, officials convened a post assessment working group that focused on communication and outreach. Along with members of the Community Advisory Group …

Investigation Of The Role For Methyl-Cpg Binding Protein 2 Variant Mbd2_V2 In Cancer Stem Cells And Obesity-Associated Cancers, Emily A. Teslow

Wayne State University Dissertations

Obesity is a risk factor for both TNBC and PCa, and pro-inflammatory features associated with obesity, including upregulated production of ROS, promote CSCs. Previously published work from the Bollig-Fischer laboratory established that TNBC CSCs could be inhibited by neutralizing ROS in culture with H2O2 targeted antioxidants. In this report, antioxidant treatment resulted in the downregulation of mRNA splicing variant MBD2_v2. MBD2_v2 was highly expressed in CSCs versus bulk TNBC cells and supported self-renewal in vitro. As obesity is coupled with increased ROS, we hypothesized that obesity could drive CSCs via MBD2_v2 expression. The work presented in this thesis addressed this …

Novel Insights Into The Use Of Ercc1 As A Biomarker For Response To Platinum-Based Chemotherapy In Lung Cancer, Joshua Ryan Heyza

Wayne State University Dissertations

ERCC1/XPF is a DNA endonuclease with variable expression in primary tumor specimens, and has been investigated as a predictive biomarker for efficacy of platinum-based chemotherapy in non-small cell lung cancers where up to 30-60% of tumors harbor low to undetectable ERCC1 expression. The failure of an international, randomized Phase III clinical trial utilizing ERCC1 expression to predict response to platinum-based chemotherapy suggests additional mechanisms underlying the basic biology of ERCC1 in the response to platinum-DNA damage remain unknown. In this work, we aimed to characterize a panel of ERCC1 knockout cell lines generated via CRISPR-Cas9 where we identified a synthetic …

Comparing Screening And Treatment Of Bacterial Vaginosis And Pregnancy Outcomes, Stephanie Severson

Physician Assistant Scholarly Project Papers

Despite evidence that bacterial vaginosis can lead to poor perinatal outcomes the consensus remains against a screening and treatment protocol for all pregnant women. Due to variability in a multitude of factors, a generalized recommendation is difficult to make. There are inconsistencies among stage of gestation that screening took place and treatment selection. The multiple variables in demographics also make providing best practice recommendations difficult. Lack of recommendations are largely due to harm of treatment in those who were misdiagnosed. The development of polymerase chain reaction (PCR) has the capability to reduce misdiagnosis. Newer studies have shown benefit of early …

Treatment Options For Post Treatment Lyme Disease Syndrome, Barbara Bowman

Physician Assistant Scholarly Project Posters

With the high incidence of Lyme disease in the endemic areas of North America, it is important to appropriately diagnosis and treat this condition to prevent post treatment Lyme disease syndrome (PTLDS). Background information regarding Lyme disease is given. The purpose of this research is to discuss the treatment options available for those patients that fit the case definition of PTLDS. A literature review was conducted using several different electronic databases finding peer reviewed research articles pertaining to the treatment options available for PTLDS. Extended antibiotic use is shown to be not beneficial in most cases. Alternative treatment options listed …

Expedited Partner Therapy For Gonorrheal And Chlamydial Infections, Nicholas Coburn-Pierce

Physician Assistant Scholarly Project Posters

Sexually transmitted infections (STI) such as Neisseria Gonorrhoeae and Chlamydia Trachomatis pose a challenge to the healthcare system worldwide. Treating sexual partners is as crucial to controlling the spread of these infections as treating index patients. However, because of problems associated with stigma, reaching affected populations, and ensuring follow-up, unique solutions are require to ensure partners receive treatment. One solution is Expedited Partner Therapy (EPT). EPT refers to treating patients, and providing necessary medication for both patient and partner. Current recommendations are for oral doses one gram of azithromycin and 400 milligrams of cefixime. This literature review looked at thirteen …

Early Aggressive Insulin Therapy In Type 2 Diabetes, Bryan Johnson

Physician Assistant Scholarly Project Posters

Metformin has been proven beneficial for the first-line treatment of type 2 diabetic mellitus (T2DM) due to its efficacy and low adverse effect profile. Current US guidelines do not address the use of early intensive insulin use in T2DM. Treatment plans are slowly adjusted over the months until the A1C goal is met. Insulin is initiated several years after the time of T2DM diagnosis and utilized as second-line therapy. Dual therapy of insulin and metformin have shown regression of T2DM in certain patient populations. However, the linear relationship between diabetes and cardiovascular disease does not show greater improvement with dual …

The Effects Of Resveratrol On Dbc1 & Cadherin Expression In Prostate Cancer, Micah Bower-Kaiser

PCOM Biomedical Studies Student Scholarship

Prostate cancer (PCa) is an incredibly common disease in the United States, with approximately 170,000 new diagnoses and 30,000 deaths occurring on an annual basis. The current mainstay of treatment for PCa is known as androgen deprivation therapy (ADT), which has proven to be an effective short-term option in earlier stages of the disease. Unfortunately, longer periods of ADT risk accelerating progression of the cancer to the point where 25% of all treated patients relapse to an incurable, metastatic, and highly lethal form known as castration-resistant prostate cancer (CRPC). In approximately 60% of CRPC cases, a splice variant of androgen …

Platelets To The Rescue? A Literature Review Of The Safety And Efficacy Of Platelet-Rich Plasma For Symptomatic Osteoarthritis Of The Knee, Timothy Simonich

Physician Assistant Scholarly Project Posters

Osteoarthritis of the knee is one of the most common joint disorders in the United States with rising prevalence due to obesity and an aging population. Regarding non-surgical approaches to management, there has been growing interest in the use of intra-articular injections with Platelet Rich Plasma (PRP).

Delaying Diabetes In The Native American Population, Seth Tramm

Physician Assistant Scholarly Project Posters

Diabetes is a debilitating disease process caused by the body’s inability to control blood glucose levels. With over 30 million diabetics in the United States and another 85 million prediabetics, the effects of this disease are wide-spread and far-reaching. Native American/Alaska Native populations have a nearly two-fold increase in prevalence of diabetes when compared to non-native populations. Risk factors for diabetes in all populations include modifiable risks such as obesity, diet, and physical inactivity as well as non-modifiable factors such as age, family history, and ethnicity. Studies have shown that early identification of symptoms, coupled with proper and intentional treatment …

Benefits Of 3d Breast Tomosynthesis Combined With 2d Digital Mammography In Screening Women For Breast Cancer, Danielle M. Swanson

Physician Assistant Scholarly Project Posters

• Breast cancer screening imaging options have progressed greatly over • the years in sensitivity, specificity, and image quality. According to DynaMed Plus, in 2012 there were 522,000 deaths by breast cancer and 1,677,000 total cases of breast cancer documented (Dynamed, 2018). For years, traditional screening for breast cancer involved 2D digital mammography which obtains two views of each breast. With advances in technology, the use of 3D breast tomosynthesis has become an advantageous addition to routine breast cancer screening protocols at many health care facilities.

• My literature review of articles was found in PubMed, DynaMed Plus, Cochrane Library, …

Digital Monitoring Technologies Could Enhance Tuberculosis Medication Adherence In Uganda: Mixed Methods Study, Angella Musiimenta, Wilson Tumuhimbise, Aaron T. Mugaba, Conrad Muzoora, Mari Armstrong-Hough, David Bangsberg, J. Lucian Davis, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Effective administration of tuberculosis therapy remains challenging. The recommended strategy of direct observed therapy is challenging and its implementation has been limited in many settings. Digital adherence technologies could be promising patient-centered strategies for monitoring adherence. However, few quality studies have assessed patients’ experiences with these technologies. Objective: To explore TB patients’ perceptions of a digital adherence intervention composed of a digital adherence monitor and SMS texts. Methods: We purposively sampled TB patients who owned phones, had been taking TB medication for at least a month, and were receiving their treatment from Mbarara Regional Referral Hospital. We interviewed 35 …

Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson

Williams Honors College, Honors Research Projects

Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …

The Effects Of Sports Specialization And Injury Rates In Collegiate Athletes, Brianne Heydinger

Williams Honors College, Honors Research Projects

BACKGROUND: Sport specialization has been thought to cause burnout, overuse injuries, and isolation within a pediatric population. PURPOSE: The purpose of this study was to examine the effects of sports specialization in collegiate athletes. METHODS: Twenty fourth-year athletes at The University of Akron (age 22.1 ±.72 yrs.) chose to participate in the study. Athletes were provided with a survey regarding high school sport participation, and informed consent was obtained to access their collegiate medical records. NExTT© database was used to collect data on the number of injuries each participant sustained while in collegiate athletics. The number of sports played in …

Quickcough: An Instrumentational Proximal Airway Clearance Technique (Act) For Select Patients With Neuromuscular Disease (Nmd), Sean X. Sullivan, Russell K. Catania, Madison K. Plaster, Sydney E. Kandray, Mariah Costa

Williams Honors College, Honors Research Projects

Patients with neuromuscular disease (NMD) requiring tracheostomy and mechanical ventilation secondary to respiratory failure encounter increased difficulty in removing pulmonary secretions from the airways. To combat issues associated with current treatment modalities for insufficient cough efficacy (cost, poor mobility, discomfort, lack of evidence), we have developed an instrumentational proximal airway clearance technique (ACT) which augments a manual proximal ACT developed by a client with NMD. QuickCough is a 3D-printed PLA attachment to the tracheostomy apparatus which has demonstrated its ability to facilitate pressure changes necessary to increase patient’s peak cough flow (PCF) by providing a stronger exsufflation for the patient. …

Development And Exploration Of A Z-Shaped Foot And Ankle Internal Fixation Plate, Rhaz Shaghaghi Paul, Ian Hames, Sean Rich

Williams Honors College, Honors Research Projects

This paper will detail the design process of developing a Z-shaped foot and ankle internal fixation plating system. Group 6: Plates for the Sole was made up of 5 team members, who worked together to accommodate their client’s request to complete a biomechanical analysis of a Z-Plate design and a construct a prototype. The Z-Plate’s purpose is to provide podiatrists with a new solution that can fit nicely on the small, irregular bones of the foot, while also remaining strong enough to withstand the forces and torques of the foot.

Regulating Medicolegal Death Investigations, Antoinette Vicks

Walden Dissertations and Doctoral Studies

Medicolegal death investigators (MDIs) are a crucial part of the death investigation process but the profession remains unregulated and lacks a required accreditation or licensing process that many other professions use. Research shows the current medicolegal death investigations system, though a crucial government function, has existing deficits in its functionality that affect service delivery. The current study was based on an educational theory and utilized open ended survey questions. Data from 16 investigators was collected through surveys where relevant information was asked in the context of their situation and questions were specific to the phenomenon being studied. The data was …

Socio-Anthropological Methods To Study The Feasibility And Acceptability Of The Minimally Invasive Autopsy From The Perspective Of Local Communities: Lessons Learnt From A Large Multi-Centre Study, Maria Maixenchs, Rui Anselmo, Guillermo Martínez Pérez, Kelvin Oruko, Selidji Todagbe Agnandji, Pamela Catherine Angoissa Minsoko, Kounandji Diarra, Mahamane Djiteye, Zulfiqar Ahmed Bhutta, Shujaat Zaidi

Department of Paediatrics and Child Health

The minimally invasive autopsy (MIA), an innovative approach for obtaining post-mortem samples of key organs, is increasingly being recognized as a robust methodology for cause of death (CoD) investigation, albeit so far limited to pilot studies and research projects. A better understanding of the real causes of death in middle- and low-income countries, where underlying causes of death are seldom determined, would allow improved health planning, more targeted prioritization of available resources and the implementation of coherent public health policies. This paper discusses lessons learnt from the implementation of a Feasibility and Acceptability (F&A) study evaluating the MIA approach in …

Assessing Nutritional Status Of Critically Ill Patients Using Serum Prealbumin Levels, Khushbakht Arbab, Hafsa Majid, Lena Jafri, Aysha Habib, Ahmed Raheem, Bushra Jamil, Bushra Akram, Madiha Hashmi

Department of Pathology and Laboratory Medicine

Background: Malnutrition in hospitalized patients, contributes to poor outcomes. Biomarker serum prealbumin, can prevent the complications by commencement of nutritional support to improve clinical outcomes. This study was designed to assess the association between low serum prealbumin level (<18 mg/dl), with length of stay and all cause intensive care unit mortality.
Methods: This cross-sectional study was conducted from July 2016 to July 2017 at Aga Khan University Hospital Karachi Pakistan. All consecutive patients, aged between 18 to 70 years, admitted in medical or surgical intensive care unit were included. Demographic, clinical history and blood samples for analysing serum prealbumin were obtained on first day of admission. Patients were categorized into two groups …

Blended Learning Mediated Fostering Of Students’ Engagement In An Undergraduate Medical Education Module, Lena Jafri, Hafsa Majid, Salman Siddiqi, Najmul Islam, Faraz Khurshid

Department of Pathology and Laboratory Medicine

Introduction: The study investigated students’ perception of introducing blended learning strategies to engage and motivate them towards lecture halls and Problem Based Learning (PBL) sessions for improving the quality of the overall students’ learning experience.
Methods: A prospective study was conducted at the Aga Khan University Medical College involving a total of one hundred four (104) year II medical students for the Endocrine and Reproduction module in the academic year 2018. This module ran for six weeks. Modifications in teaching methods were made for this module introduced after approval from Endocrine & Reproduction module, year II and curriculum committees. Written …

Common Alternative Diagnoses Among A Pediatric Hospital-Based Cohort Evaluated For Tuberculosis In Karachi, Pakistan: The Need For Facilitated Referral In Tuberculosis Clinics, Sadia Shakoor, Fatima Mir, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: Children evaluated for tuberculosis (TB) are often diagnosed with miscellaneous conditions that mimic TB. Knowledge of differentials informs policy on service provision through liaison with referral centers offering definitive diagnosis and treatment for common alternative disorders.
Methods: We reviewed medical records of children who were offered diagnostic testing for TB (culture or Xpert MTB/RIF) at a tertiary care hospital in Karachi, Pakistan to identify common alternative diagnoses among children who are evaluated for TB.
Results: From January 2014 to December 2015, of 126 culture or Xpert MTB/RIF negative children presenting with chronic symptoms, 31 were diagnosed and treated for …

Randomized Trial Of Polychromatic Blue-Enriched Light For Circadian Phase Shifting, Melatonin Suppression, And Alerting Responses., J. P. Hanifin, S. W. Lockley, K. Cecil, K. West, M. Jablonski, B. Warfield, M. James, M. Ayers, B. Byrne, E. Gerner, C. Pineda, M. Rollag, G. C. Brainard

Department of Neurology Faculty Papers

Wavelength comparisons have indicated that circadian phase-shifting and enhancement of subjective and EEG-correlates of alertness have a higher sensitivity to short wavelength visible light. The aim of the current study was to test whether polychromatic light enriched in the blue portion of the spectrum (17,000 K) has increased efficacy for melatonin suppression, circadian phase-shifting, and alertness as compared to an equal photon density exposure to a standard white polychromatic light (4000 K). Twenty healthy participants were studied in a time-free environment for 7 days. The protocol included two baseline days followed by a 26-h constant routine (CR1) to assess initial …