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  The Role of the Gut Microbiome in Autoimmune Disorders

  Sierra Baxter

  According to the National Institute of Health (NIH), it is estimated that over 24 million Americans are diagnosed with autoimmune disorders, and the cases are increasing (2005). A significant risk factor that has been linked to the formation of these diseases is the gut microbiome. The gut microbiome of the adult plays a vital role in the efficacy of the immune system. The purpose of this research and systematic literature review is to determine how the gut microbiome can influence autoimmune disorders. In this review, five databases were searched including PubMed, DynaMed, Cochrane Library, Embase, and Clinical Key. A variety of keywords and mesh terms were implemented with searching. The search time frame was limited to the previous fifteen years. Inclusion criteria included peer-reviewed journals, meta-analysis, systematic reviews, randomized controlled trials, and case studies. Exclusion criteria originally included animal studies, pediatric, or geriatric focused research. Much of the research presented shows correlations between gut dysbiosis and autoimmune disorders. Although most research does show trending data, no single definitive conclusion has been made regarding the influence of the gut microbiome and its influence on autoimmune diseases. More research still needs to be completed to possibly use gut dysbiosis as a biomarker or possible treatment tool to prevent autoimmune disorders.

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  A Comparison of SGLT2 Inhibitors to Current Guideline Directed Medical Therapy for the Treatment of Heart Failure in Non-diabetic Patients

  Rebecca R. Beyer

  Heart failure remains a complex disease that affects an increasing number of patients annually. For heart failure, most of the research has focused on the hemodynamic changes of the heart chambers and the medications that slow the disease progression. Recent studies have investigated treatment options that may disrupt the neuro-hormonal and pathophysiologic cell changes that lead to further progression of heart failure. Although the mechanisms by which the sodium-glucose cotransporter 2 (SGLT2) inhibitors are not entirely understood, they are believed to directly affect the cardiac electrolyte imbalances that trigger the cellular changes which contribute to the altered contractility, adrenergic receptor changes, and resulting hemodynamic changes seen with heart failure. To evaluate SGLT2 inhibitors in the treatment of heart failure in diabetic and non-diabetic patients, placebo studies for SGLT2 inhibitors and current guideline-directed therapies including betablockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor agonists, and angiotensin receptor-neprilysin inhibitors were compared for each class of medications using the hazard ratios and confidences intervals of the all-cause mortality rates. The results showed that treatment with SGLT2 inhibitors in patients with heart failure with reduced ejection fraction (HFrEF) may be comparable to other guideline-directed therapies. Because of the lack of data specific to patients with heart failure with preserved ejection fraction (HFpEF), further research is needed to assess these medications’ efficacy in this population. When assessing the available pooled data for HFrEF and HFpEF patients, SGLT2 inhibitors appear to be a promising area of research compared to the HFpEF recommended therapies.

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  Buprenorphine Versus Methadone for Opioid Use Disorder

  Ben DeVries

  The purpose of this literature review is to analyze the use of Buprenorphine and Methadone for the treatment of opioid use disorder. Comparison of overall safety, efficacy, morbidity and mortality between the two treatment options is accomplished throughout this article. The literature review was performed using databases: PubMed, Clinical Key, Cochane and Uptodate. Results were limited to studies completed within the past 7 years. Methadone has been the treatment mainstay of opioid use disorder for decades. Buprenorphine has increased in popularity and prevalence for treatment of opioid use disorder, especially after receiving FDA approval for such use in 2002. Several benefits of Buprenorphine therapy were discovered including a significant reduction in overdose fatalities, more convenient dosing options and easier access to prescribing locations. Retention rates of those receiving Buprenorphine was found to be lower, sometimes quite significantly, than those who received Methadone therapy. A review of the literature showed that those receiving Methadone for the treatment of opioid use disorder have a higher likelihood of hospitalization or fatal overdose during the initiation of therapy. A significantly higher retention rate was shown in those receiving Methadone, in comparison to Buprenorphine. However, Methadone use was found to have an association with occurrences of neonatal abstinence syndrome in those taking the medication during pregnancy. A common negative theme throughout the literature review was the lack of a control population when comparing Buprenorphine and Methadone. Conclusively, neither Methadone nor Buprenorphine were found superior when used for treatment of opioid use disorder. Careful consideration must be given to the patient’s personal situation, drug use history and likelihood of compliance.

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  Cannabidiol: An Adjunctive Therapy to Risperidone for Autistic Children Experiencing Behavioral Outbursts

  Cherie Dowell

  The purpose of this systemic literature review was to evaluate the safety, efficacy, and tolerability of medical cannabis in the treatment of aggression, irritability, and self-injurious behaviors in autistic children that are currently receiving risperidone. For this literature review, DynaMed, Cochrane, PubMed, ClinicalKey, and CINAHL were searched using various keywords and phrases. Studies that were included in this review were published after 2005, were peer-reviewed, and included systemic reviews, journal articles, clinical trials, randomized control trials, and meta-analyses. Studies that did not directly discuss autism and behavioral issues; autism treatment with risperidone, medical cannabis, or cannabidiol; that did not specifically address the pediatric or adolescent population; or that did not directly discuss human subjects were excluded. Ten resources were selected for this review. Risperidone treatment effectively decreases symptoms of aggression, irritability, and self-injurious behaviors, by half, in autistic children. However, with long-term use weight gain, extrapyramidal symptoms, and hypersomnia are common. Rare cases of metabolic syndrome have occurred. Research regarding cannabidiol treatment in autism is limited. Recent studies show a lessening of aggression and self-injurious behaviors when treated with cannabidiol; however, decreased appetite, somnolence, and restlessness are common. One case of psychosis has occurred. Current research regarding cannabidiol use in treating behavioral outbursts in autistic children shows promise; however, more large-scale, double-blind studies should be performed before treatment with cannabidiol can be considered a safe and effective adjunctive therapy to risperidone treatment

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  The Effects of Initiating Metformin, to Prevent or Delay Type II Diabetes, in Patients with Prediabetes

  Kelsey K. Abraham and Jeanie McHugo

  The purpose of this literature review is to explore metformin’s role in the treatment of patients with prediabetes within the primary care setting. The efficacy of metformin versus lifestyle modifications will be compared as well as metformin, as adjunctive therapy, to lifestyle modifications. Along with efficacy, a systematic analysis will examine the three above mentioned therapies regarding diabetes risk reduction. Lastly, this review will examine the safety and tolerability of metformin, specifically in patients with prediabetes. The data presented shows evidence that lifestyle modifications are first line treatment for prediabetes while metformin use should be reserved for those who fail lifestyle modifications or are considered to be high risk and/or patients that have shown more effective results with metformin therapy: BMI ≥ 35 kg/m 2 , patients less than 60 years old, and women who have a prior history of gestational diabetes mellitus. Decades of research show that metformin is an effective and safe treatment option for patients with prediabetes. However, the combined efficacy of lifestyle modifications and metformin use in prediabetic patients needs to be further studied to find out why additive benefits are not demonstrated.

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  The Gut-Brain Axis: Treating Depression Through Microbiome Alterations

  Alexandria Bachman-Williams

  • The purpose of this study is to explore the role of gut microbiome alterations in the treatment of anxiety and depression. • There are multiple pathological pathways that lead to the development of anxiety and depression. • Research shows a link between pathologic bacteria and low grade inflammation. This causes a disruption of neurotransmitters that are current targets of pharmacological treatment of depression and anxiety. • Transfer of “pathogenic” bacteria caused increased symptoms of anxiety and depression. • Treatment with probiotics and “protective” bacteria showed decreased BDI scores and improved symptoms. • Studies were small but show need for further research

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  The Effect of Proton Pump Inhibitors on Normal Gastrointestinal Flora Leading to Weight Change

  Emi L. Binstock

  The goal of this literature review was to determine what effects proton pump inhibitors (PPIs) have on the normal gastrointestinal (GI) flora and how that may lead to weight loss or weight gain. A literature search was performed using the database PubMed. Only articles from the last ten years (2009-2019) were included in this review. Keywords used in the search are listed below. After exclusion criteria was applied, 30 articles were relevant and used in this review. Five themes were identified in the literature review. An investigation of normal GI flora associated with weight loss and weight gain identified a common conclusion that the ratio of Firmicutes to Bacteroidetes was higher in obesity. The investigation of PPIs effects on the normal GI flora was less conclusive; however, a common finding was an increase in Streptococcaceae (phylum Firmicutes), which can commonly be found in the oral cavity. This finding suggests that oral flora may have a greater survival rate in lower parts of the GI system with treatment of PPIs due to the decreased gastric acidity. The final investigation, which looked into the association between PPI use and weight change revealed a greater likelihood that PPIs will cause weight gain with four studies supporting weight gain and two studies supporting weight loss. Alternative treatments such as H2 receptor antagonists, laparoscopic Roux-en-Y gastric bypass, probiotics, and lifestyle management were also explored. Although further research needs to be completed, it appears that PPIs are associated with an increase in Streptococcaceae of the phylum Firmicutes, which has been linked to weight gain.

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  Efficacy of Bariatric Surgery Compared to Non-Surgical Treatments for Morbid Obesity

  Erica Donovan

  The purpose of this research is to show the efficacy of Roux-en-Y gastric bypass and sleeve gastrectomy as compared to traditional diet and exercise models. Finding ways to combat morbid obesity has resulted in invasive surgical techniques because traditional diets and exercise work infrequently and often fail. Systematic reviews, metaanalysis, randomized controlled trials and retrospective studies were found using the data base of CINAHL, SportsDiscus, PsycInfo, Embase, and PubMed. All of the studies were published no later than 2014 and used human adult subjects ages 19-65. The studies reviewed show that bariatric surgery is a safe and effective obesity treatment with low risk of post-operative complications and mortality related to surgery. The reviewed studies find that patients who undergo the Roux-en-Y gastric bypass can lose 80% or more of excess weight and those who undergo sleeve gastrectomy can lose 60% or more of excess weight. The data supports that the bariatric surgeries discussed here help people maintain weight loss for up to ten years.

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  Aspirin Use Following Preeclampsia to Prevent Future Adverse Cardiovascular Outcomes

  Kristi Bohlig

  • Introduction: Preeclampsia during pregnancy warrants therapy with low dose aspirin. The purpose of this review is to investigate if these women are at increased future risk for cardiovascular morbidity and mortality, and if aspirin therapy prevents future cardiovascular events.

  • Research Questions: Do women who had preeclampsia during pregnancy have increased future cardiovascular morbidity and mortality? • Does continued aspirin use in postpartum women, who had preeclampsia during pregnancy, decrease future cardiovascular morbidity and mortality?

  • Research Methods: Literature review was conducted utilizing CINAHL, Dynamed plus and PubMed databases.

  • Discussion: Many studies have found that preeclampsia does increase risk of cardiovascular morbidity and mortality, but this difference is not statistically significant until later decades in life. There is also new evidence that the risks of bleeding from prophylactic aspirin therapy outweigh the benefit of decreasing cardiovascular and ischemic events. Based on this information, it is prudent to further research and study this group and stratify their risk as well as researching if there is a better modality upon which to provide prophylaxis with lower risk than benefit.

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  Aspirin Use Following Preeclampsia to Prevent Future Adverse Cardiovascular Outcomes

  Kristi Bohlig

  • Introduction: Preeclampsia during pregnancy warrants therapy with low dose aspirin. The purpose of this review is to investigate if these women are at increased future risk for cardiovascular morbidity and mortality, and if aspirin therapy prevents future cardiovascular events.

  • Research Questions: Do women who had preeclampsia during pregnancy have increased future cardiovascular morbidity and mortality? • Does continued aspirin use in postpartum women, who had preeclampsia during pregnancy; decrease future cardiovascular morbidity and mortality?

  • Research Methods: Literature review was conducted utilizing CINAHL, Dynamed plus and PubMed databases.

  • Discussion: Many studies have found that preeclampsia does increase risk of cardiovascular morbidity and mortality, but this difference is not statistically significant until later decades in life. There is also new evidence that the risks of bleeding from prophylactic aspirin therapy outweigh the benefit of decreasing cardiovascular and ischemic events. Based on this information, it is prudent to further research and study this group and stratify their risk as well as researching if there is a better modality upon which to provide prophylaxis with lower risk than benefit.

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  A Comparison of Pharmacologic Interventions in Pregnant Women with Opioid Use Disorder

  catherine K. Bopp

  The purpose of this research and systematic literature review is to determine which pharmacotherapeutic agent, methadone or buprenorphine, leads to better outcomes in cases of pregnant mothers with opioid use disorder (OUD).

  Outcomes considered are maternal compliance, neonatal abstinence syndrome severity, and neonatal length of hospital stay. In the review, PubMed, Clinical Key, Cochrane Database of Systematic Reviews, and DynaMed Plus were searched. Key terms searched were “methadone, buprenorphine, pregnancy”, “opioids, pregnancy”, “neonatal abstinence syndrome” and “medication assisted treatment, pregnancy”. Several studies were excluded, as their study population was not specified to have diagnosed OUD in pregnancy. The drawbacks to many of the studies is the inconsistencies in study conditions, and very small sample sizes. Much of the research presented shows evidence for the use of buprenorphine in the treatment of OUD in pregnancy. Buprenorphine seems to be a better medication assisted treatment (MAT) for the neonate in terms of reduced neonatal abstinence syndrome (NAS) and reduced length of hospital stay postpartum, while methadone still performs better for adherence for the mother. More research still needs to be done in order to demonstrate buprenorphine’s superior efficacy compared to methadone use in pregnant patients with OUD

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  A Comparison of Pharmacologic Interventions in Pregnant Women with Opioid Use Disorder

  Catherine M. Bopp

  The purpose of this research and systematic literature review is to determine which pharmacotherapeutic agent, methadone or buprenorphine, leads to better outcomes in cases of pregnant mothers with opioid use disorder (OUD). Outcomes considered are maternal compliance, neonatal abstinence syndrome severity, and neonatal length of hospital stay. In the review, PubMed, Clinical Key, Cochrane Database of Systematic Reviews, and DynaMed Plus were searched. Key terms searched were “methadone, buprenorphine, pregnancy”, “opioids, pregnancy”, “neonatal abstinence syndrome” and “medication assisted treatment, pregnancy”. Several studies were excluded, as their study population was not specified to have diagnosed OUD in pregnancy. The drawbacks to many of the studies is the inconsistencies in study conditions, and very small sample sizes. Much of the research presented shows evidence for the use of buprenorphine in the treatment of OUD in pregnancy. Buprenorphine seems to be a better medication assisted treatment (MAT) for the neonate in terms of reduced neonatal abstinence syndrome (NAS) and reduced length of hospital stay postpartum, while methadone still performs better for adherence for the mother. More research still needs to be done in order to demonstrate buprenorphine’s superior efficacy compared to methadone use in pregnant patients with OUD.

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  Treatment Options for Post Treatment Lyme Disease Syndrome

  Barbara Bowman

  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 on the internet are shown to be not evidence based. Therefore, symptomatic treatment options seem to be the best positive outcome-based option available for providers to use. These options are discussed in detail throughout this research. Though much more research is needed regarding the topic, this will give providers the information currently available that they will need to know when treating patients with PTLDS. Hopefully this will provide the patients with PTLDS the best outcome possible for improving their quality of life post Lyme disease.

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  Fertility Options for Women with Endometriosis: In Vitro Fertilization versus Surgical Excision or Ablation

  Jenny Brown

  Endometriosis negatively affects the fertility of many women of reproductive age worldwide. Some women with endometriosis are able to conceive without reproduction assistance, while others require medical intervention. In vitro fertilization and surgical management are available and widely used in the treatment of endometriosis associated infertility. In vitro fertilization has been found to be effective in women with stages I-IV endometriosis, with varying degrees of success at each stage. These varying results may be due to oocyte quality and availability as well as endometriosis location. Surgical excision and/or surgical ablation of endometriosis/endometriomas may also improve chance of successful pregnancy but has been found to decrease ovarian reserve and therefore decrease future fertility as a result of ovarian damage and decreased ovarian reserve. This project will discuss surgical treatment of endometriosis and in vitro fertilization in patients with endometriosis and the result of each on achieving and maintaining pregnancy.

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  Obesity: Modern Medicine vs. Lifestyle

  Jenny Christianson

  • Obesity is a rising epidemic, and is one of the most common, costly and preventable health problems the world is experiencing today (Center for Disease Control and Prevention, [CDC], 2017).

  • From this, it is important to establish an effective treatment plan that can be implemented across the nation for maximum patient benefit.

  • Lifestyle changes such as diet and exercise are important to any health care plan and are equally necessary to reduce health risks. However, in certain patients, lifestyle changes are not enough due to the maladaptive biologic process in their brain. Thus, additional treatment options need to be available to these patients.

  • Both medical therapies, pharmacological and surgical, were found to be beneficial in augmenting lifestyle changes in multiple studies. Therefore, it was concluded that pharmacologic and surgical therapies are valid options in resistant obesity in addition to lifestyle changes such as diet and exercise.

  • This study was a systematic literature review which evaluated studies from CINAHL, Clinical Key, Cochrane Library, and PubMed to formulate a conclusion. Research focused on two pharmacotherapy options, phentermine and orlistat, in addition to two surgical options, gastric bypass and sleeve gastrectomy, for added weight loss treatment when compared to lifestyle alone.

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  Expedited Partner Therapy For Gonorrheal and Chlamydial Infections

  Nicholas Coburn-Pierce

  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 studies, and aimed to determine whether EPT is still superior to standard partner notification at reducing further infection, and reinfection in adult Gonorrhea and Chlamydia (GC) patients in the US. Research indicates that EPT remains a viable, cost effective measure at controlling the spread of GC infections. EPT appears to be the best available option despite use of second line treatments in resistance prone infections. Additionally, there is a need for future, large scale, US based randomized controlled trials to unequivocally show the continued effectiveness of EPT.

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  Expedited Partner Therapy for Gonorrheal and Chlamydial Infections

  Nicholas Coburn-Pierce

  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 studies, and aimed to determine whether EPT is still superior to standard partner notification at reducing further infection, and reinfection in adult Gonorrhea and Chlamydia (GC) patients in the US. Research indicates that EPT remains a viable, cost- effective measure at controlling the spread of GC infections. EPT appears to be the best available option despite use of second-line treatments in resistance-prone infections. Additionally, there is a need for future, large- scale, US-based randomized controlled trials to unequivocally show the continued effectiveness of EPT.

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  Pelvic Examinations for Ovarian Cancer Screening in Asymptomatic Adult Women

  Riann Collar

  There is discrepancy amongst organizations and the medical community whether bimanual pelvic examinations should be performed in asymptomatic women for routine screening. The purpose of this literature review was to determine whether bimanual pelvic examinations are beneficial for screening for ovarian cancer in comparison to no screening. In addition, research was conducted to see if healthcare providers’ professional beliefs align with the evidence and national recommendations, to determine women’s thoughts and beliefs regarding pelvic examinations, and identify other screening methods if bimanual pelvic exams are determined to be an invalid screening tool. Throughout reviewing peer reviewed articles and high quality evidence, it was found that bimanual pelvic exams have low sensitivity for screening, which is not ideal due to false positives; however, several researchers still feel this is an important screening tool. Also, many providers still consider the pelvic exam beneficial when performed annually on asymptomatic women as part of a well woman exam and continue to perform them routinely in the office. Research also shows that the majority of women do not feel uncomfortable or pain during a pelvic exam and the majority wish to continue having them performed on a regular basis. Combinations of different screening methods such as pelvic examination with serum CA 125 annually and serum CA 125 with transvaginal ultrasound annually were found to be effective in screening for ovarian cancer in asymptomatic women.

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  Pelvic Examinations for Ovarian Cancer Screening in Asymptomatic Adult Women

  Riann Collar

  There is discrepancy amongst organizations and the medical community whether bimanual pelvic examinations should be performed in asymptomatic women for routine screening. The purpose of this literature review was to determine whether bimanual pelvic examinations are beneficial for screening for ovarian cancer in comparison to no screening. In addition, research was conducted to see if healthcare providers’ professional beliefs align with the evidence and national recommendations, to determine women’s thoughts and beliefs regarding pelvic examinations, and identify other screening methods if bimanual pelvic exams are determined to be an invalid screening tool. Throughout reviewing peer reviewed articles and high-quality evidence, it was found that bimanual pelvic exams have low sensitivity for screening, which is not ideal due to false positives; however, several researchers still feel this is an important screening tool. Also, many providers still consider the pelvic exam beneficial when performed annually on asymptomatic women as part of a well-woman exam and continue to perform them routinely in the office. Research also shows that the majority of women do not feel uncomfortable or pain during a pelvic exam and the majority wish to continue having them performed on a regular basis. Combinations of different screening methods such as pelvic examination with serum CA-125 annually and serum CA-125 with transvaginal ultrasound annually were found to be effective in screening for ovarian cancer in asymptomatic women.

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  The Impact of Medical Marijuana on the Opioid Crisis

  Carl David Eastep

  • The opioid crisis dictates the need for research into alternative treatments for acute and chronic pain.

  • Comprehensive literature review was conducted to determine if medical marijuana might play a role in the treatment of acute and chronic pain.

  • The addiction profiles of medical marijuana and prescription opiates were compared along with the adverse effects and quality of life.

  • No use for medical marijuana for the treatment of acute pain.

  • Likely some benefits from medical marijuana for chronic pain.

  • Addictive profile

  • Marijuana – marijuana withdrawal syndrome.
  • Prescription Opiates – highly addictive

  • Adverse Effects

  • Prescription Opiates > Marijuana

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  Intermittent Fasting in Weight Management

  Alyse Engen

  Obesity is associated with a variety of medical conditions that adversely affect metabolic and cardiovascular health. In order for health care providers to adequately educate and promote weight management, they need to be aware of the various dietary regimens and the efficacy and adverse effects associated with each. This literature review assesses the efficacy, metabolic benefits, and cardiovascular benefits of both intermittent energy restriction and continuous energy restriction from ten articles found on various databases within the past five years. The findings indicate that although not proven superior or inferior, intermittent energy restriction provides statistically similar results to continuous energy restriction when assessing efficacy of weight loss. There are also similar metabolic and cardiovascular benefits when comparing intermittent energy restriction and continuous energy restriction, although continuous energy restriction may have a benefit in the diabetic population due to potential adverse side effects in diabetics adhering to intermittent energy restriction. The result of this literature review allows providers to recommend an alternative weight management technique in patients who are unsuccessful or unable to adhere to a continuous energy restriction diet.

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  Embolus Prevention: Anticoagulant Therapy in Comparison to Watchman's Procedure in Patients with Atrial Fibrillation

  Erik Fladmo

  • Atrial fibrillation or A-fib is a common cardiac disease that occurs as individuals get older.

  • A risk factor of atrial fibrillation is blood clot formation and dislodgement or ‘embolus’ in the left atrium.

  • Current treatment methods to prevent clot formation include anticoagulants, as well as a left atrial appendage closure device, The Watchman’s device is the only FDA approved left atrial appendage closure device.

  • Study results confirm the rising efficacy and cost effectiveness of Watchman’s device versus long term anticoagulant therapy as well as their adverse effects regarding placement and post procedure; however further randomized control trials are needed to compare both therapies particularly novel oral anticoagulants head to head rather than through extrapolation.

  • Long term effects of Watchman’s device need to be studied.

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  Exercise Compared to SSRIs in the Treatment of Major Depressive Disorder

  Tiffany Fletschock

  Major Depressive Disorder (MDD) is a common disease seen every day by primary care providers across the United States. According to the Centers for Disease Control and Prevention (CDC, 2018), eight percent of all adults over the age of 20 suffer from depression, and a study by the American Psychological Association found depressive disorders to cost roughly $71 billion annually. Today, psychotherapy is the recommended first-line therapy for treating MDD, but pharmacotherapy is more commonly used. Alternative forms of therapy are also being researched in order to avoid the use of medication while adequately treating the symptoms of MDD. For this review, seven databases were searched including PubMed, Cochrane Database of Systematic Reviews, PsycInfo, Cinahl, DynaMed, ClinicalKey, and ScienceDirect from September 1 to November 21, 2018. Works chosen for review were published after the year 2000 and included randomized controlled trials (RCTs), systematic reviews, and meta analyses. This review found several benefits of using exercise to treat MDD while reducing risks, but exercise alone is not superior in effectiveness to psychotherapy or pharmacotherapy. Overall, exercise offers the greatest benefit in reducing MDD symptoms when used as an augmented therapy to either psychotherapy or pharmacotherapy. Limitations of this literature review include lack of studies with longevity or large sample sizes.

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  The Impact of Shift Work on Health and Wellbeing

  Stephanie M. Gagelin

  • Many of today’s industries require workers to perform shift work (typically during 1600-0700). If workers are awake during this time period, circadian misalignment occurs. This scholarly project uses research studies and meta- analyses to provide information about increased health risks associated with circadian misalignment, focusing on the categories of glucose metabolism, cardiovascular system, carcinogenesis, and mental health and acuity.

  • Shift work has been found to increase BMI and waist circumference of employees, as well as increase blood glucose levels to “prediabetic” levels in previously euglycemic individuals.

  • Shift work has been proven to increase high-sensitivity C-reactive protein (hs-CRP), an acute phase reactant that indicates inflammation and has been found to be a precursor to cardiovascular disease. Additionally, shift work has been demonstrated to increase risk for several cardiovascular diseases, including myocardial infarction and ischemic stroke.

  • Men who work shift work are at higher risk for developing prostate cancer, and women who have performed shift work for over 30 years are at increased risk for breast cancer development.

  • Working a night shift job and its associated sleep deprivation was proven to make medical interns more susceptible to developing depression, as well as more likely to make medical errors due to their sleep deprivation.

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  Reducing the Health Care Burden Caused by Undocumented Immigrants

  Juan Carlos Garcia Ramirez

  • Uncompensated health care and Emergency Department (ED) overcrowding are a national crisis in the United States, and uninsured patients are a major contributor. Undocumented Immigrants (UIs) are a large component of the uninsured patient population.

  • The purpose of this study is to evaluate for efficacy and taxpayer value two large-scale potential solutions: Federally Qualified Health Centers (FQHCs), and expanded Medicaid.

  • The method of research included a variety of key terms in electronic search databases such as CINAHL Complete, PubMed, and Google Scholar, and only articles published between 2014 and 2018 by peer- reviewed journals or gray literature (.gov) were included.

  • A Limitation of this study was the inability to conduct a single or limited number of systematic searches of related studies or articles and filter the results using a prescribed set of inclusion or exclusion criteria.

  • Data results suggest that while expanded Medicaid does reduce uncompensated health care, it has been shown to increase ED use and overcrowding, at least in the short-term. Therefore, the notion that expanded Medicaid successfully reduces ED overcrowding, was found to be false. FQHCs are a reasonable solution, but there are too few, and relatively unheard of among the target population.