Physician Assistant Scholarly Project Posters

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  Examination of Venous Thromboembolism Prophylaxis in Patients Undergoing Total Knee Arthroplasty

  William Kucera

  Elective total knee arthroplasty (TKA) is the most frequently performed inpatient surgical procedure in the United States (Kurtz, Ong, Lau, Mowat, & Halpern 2007). Complications of this procedure include deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE). Various pharmacological agents exist for VTE prophylaxis. Warfarin and low-molecular-weight heparin (LMWH) were commonly used for VTE prophylaxis in the past, but with the emergence of novel anticoagulants including factor Xa inhibitors and direct thrombin inhibitors (DTIs), warfarin is used far less frequently. Aspirin is also approved for VTE prophylaxis. The purpose of this study was to determine if a superior drug or combination of drugs exist for VTE prophylaxis based on patient outcomes, cost effectiveness, and risk profile. This review of literature analyzed studies from the past 10 years that compared aspirin, warfarin, Lovenox, and the novel anticoagulants for VTE prophylaxis in post-operative TKAs. Study outcomes included VTE prevention, bleeding risk, and cost. Reversal agents were also examined. Findings of this author’s literature review demonstrated that currently, no one superior medication exists for prophylaxis of VTE events in patients undergoing TKA (Cafri et al., 2017). However, current research indicates that both factor Xa inhibitors and aspirin have emerged as the medications of choice. Of the two, aspirin is commonly favored as it does not require laboratory monitoring, it is cost effective, and it is available over the counter. It also has less risk of major bleeding compared to factor Xa inhibitors.

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  Systemic Therapy versus Catheter Directed Techniques for the Treatment of Acute Massive Pulmonary Embolism

  Lawrence Duane Lee

  •Acute massive pulmonary embolism is characterized by obstruction of the pulmonary arterial tree that exceeds 50% of the cross-sectional area causing acute and severe cardiopulmonary failure from right ventricular overload.

  •Systemic thrombolytic therapy is recommended as standard, first-line treatment in patients with massive pulmonary embolism unless contraindicated and catheter directed therapies, including low dose thrombolytic administration directly into thrombus and mechanical thrombectomy can be adjunctive or used as an alternative to systemic treatments.

  •This literature review researched articles looking at both systemic thrombolysis and endovascular techniques for the treatment of acute massive pulmonary embolism with an emphasis on long term clinical outcomes.

  •Study results demonstrated the efficacy and safety of systemic thrombolysis and catheter directed therapies as well as adverse effects; however, further randomized trials are needed, as acknowledged by many of the authors included in this paper, comparing both treatment options for hemodynamically unstable patients with emphasis on long term sequalae.

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  The Impact of Circadian Misalignment on Cardiometabolic Health

  Cynthia Marie Mills

  The circadian system is important in all living organisms because it generates a 24-hour rhythm for physiological and behavioral processes enabling anticipation and adaptation to daily changes in the environment. The prevalence of cardiometabolic diseases, which are linked to lifestyle choices, has been rising at an alarming rate. Modernization and globalization are two of many factors to blame for lifestyle changes resulting in circadian disruption. The purpose of this literature review is to explore circadian misalignment with regards to its mechanism and impact on cardiometabolic health and to determine possible interventional measures. The primary focus is on lifestyle change, particularly sleep, as an interventional measure for circadian misalignment. Studies were included if they included a cardiometabolic disease risk factor studied in the context of circadian alignment/misalignment or sleep duration/architecture. The data indicates that circadian misalignment and sleep deprivation impede cardiovascular function and cause a decrease in glucose tolerance and insulin sensitivity; however, restoring circadian rhythmicity and correcting for sleep deprivation improves several health indices including glucose tolerance, insulin sensitivity, blood pressure, and cardiac remodeling.

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  Pre-Participation Physical Exams: Are We Doing Enough?

  Steven Jacob Pietrusza

  •Inclusion of screening electrocardiograms (EKGs) during pre-participation physical examination has been a topic of debate for some time. There is unquestioned usefulness in the ability of a well-trained health care provider in using EKG to identify cardiac abnormalities.

  •Further, there have been several contemporary EKG criteria published that increase specificity and sensitivity of detection of disease. However, these criteria do not account for athletes less than 14 years of age, and that demographic represents a large portion of patients seeking pre-participation screenings in the United States.

  •The lack of research into pediatric cardiac remodeling secondary to activity, coupled with the significant overlap in normal pediatric EKG findings with adult pathological EKG findings create a difficult position for any health care provider.

  •A literature review was performed to determine if screening EKGs are effective both medically and economically in athletes less than 14 years of age.

  •Based on the review, the limitations of contemporary EKG criteria, the inability to prove cost effectiveness in the US healthcare model, and the lack of research into activity modulated pediatric cardiac remodeling should reinforce that the ACC/AHA checklist is an appropriate foundation for conducting pre-participation physical examination.

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  The Effectiveness of Oral Non-Steroidal Anti-Inflammatories versus Steroid Injections in Patients with Shoulder Pain

  Darren Scott Pledger

  - The fact that shoulder pain is the most common musculoskeletal complaint in primary care shows that clinicians must have an arsenal of quality interventions to treat this problem.

  - The need for quality research and evidenced based guidelines are necessary to educate clinicians on their treatment options, the efficacy of those treatments, and their safety profiles.

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  Letrozole vs. Clomiphene Citrate for Infertility in Polycystic Ovarian Syndrome

  Kailey Potratz

  Purpose

  To determine if letrozole is an equal or better alternative to clomiphene citrate for infertility treatment in PCOS patients.

  Literature Review

  Letrozole was found to have higher ovulation rates, fewer twin pregnancies/more single births, higher pregnancy rates, and higher live birth rates compared to clomiphene citrate. There were conflicting results for endometrial thickness and single follicle stimulation. Neither letrozole or clomiphene citrate was superior to the other for ovarian hyperstimulation syndrome. There were no significant differences between letrozole and clomiphene citrate regarding congenital abnormalities and miscarriage rates. The results regarding ectopic pregnancies were comparable between both groups.

  Conclusion

  The results provide information supporting letrozole as an adequate first-line alternative to clomiphene citrate for infertility in patients with PCOS.

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  Cannabinoid Therapy in Chronic Pain Management

  Breanna Joy Privratsky

  In 1996, the state of California was the first in the union to allow for the use of medical marijuana. Since then, 28 more states have enacted similar laws (National Conference of State Legislatures, [NCSL], 2017). With the ever-growing opiate problem that has now been classified as an epidemic by the Centers for Disease Control and Prevention, medical marijuana could be a viable alternative to this problem.

  As of 2014, the CDC reported opioid deaths were up 369%, which is more than 91 deaths per day from overdose (Centers for Disease Control, [CDC], 2017). The purpose of this study is to compare medical marijuana to opiates in safety and addiction; in addition, the efficacy of using cannabis as an alternative for individuals who deal with chronic pain will be investigated.

  A literature review was conducted to find systematic reviews, meta-analyses and randomized controlled trials (RCTs) that evaluated medical marijuana and opiates for the treatment of chronic pain.

  Four databases were surveyed with multiple sources found in CINAHL, Cochrane Database, PubMed and PsycINFO.

  Current literature shows that cannabinoids may provide potential benefit with short-term use, but not without possible adverse effects. With the current lack of research on long-term treatment of chronic pain with cannabinoids, additional research needs to be conducted to further understand the potential adverse effects associated with cannabinoid use.

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  Comparing the Effectiveness of a Low Carbohydrate Diet and Metformin on Glycosylated Hemoglobin Reduction in Type Two Diabetes Mellitus

  Ashley Schultz

  In this study, a low carbohydrate diet and metformin pharmacotherapy were compared to determine their effect on HbA1c in the type two diabetic patient. Several high quality studies were examined along with each treatment's effect on mainly HbA1c, but also other parameters such as body weight, cholesterol, and fasting and post prandial blood glucose levels. The study showed that both the low carbohydrate diet and metformin pharmacotherapy were effective at lowering HbA1c in the type two diabetic patient. The low carbohydrate diet showed a 0.2% increase in HbA1c all the way to a 2.2% decrease in baseline HbA1c in the studies that were examined. The metformin pharmacotherapy showed between a 0.45% decrease up to a greater than 1% decrease from baseline HbA1c in the studies examined within this project. After looking at the other parameters that were affected by each treatment, it was concluded that choosing treatment between the two options studied will be highly dependent on each individual patient and their readiness and willingness to implement lifestyle changes. Both methods of treatment are equally as effective and can be beneficial to different patients.

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  Treating Peri and Postnatal Depression & Anxiety

  Emily M. Stevenson

  - The objective of this research is to evaluate the commonly prescribed treatment methods for prenatal and postnatal depression, focusing on the efficacy of antidepressant medications and nonpharmacologic treatments while evaluating the effects these medications have on the fetus/breastfeeding infant.

  - The method of research included 15 studies completed within the past ten years on women who were pregnant or who had delivered a baby within the past 12 months. One study did evaluate long-term effects on offspring, which included a participant number of 3,342 children who were exposed to antidepressants during pregnancy. The total number of participants in the studies were 8,069 women.

  - Limitations within the data are due to small sample sizes in several of the studies and few available studies that directly evaluate this population of women and children.

  - Data results suggest that while cognitive group therapy does provide depression symptom improvement in prenatal and postnatal depression and anxiety, antidepressant medications tend to have a positive effect earlier in treatment. Unfortunately, many of these antidepressant medications have also been proven to have both short and long tern effects on the offspring exposed to pharmacologic treatment.

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  Associations Among Acne Vulgaris and Western Diet

  Kate Meredith Suda

  Acne vulgaris is one of the most common dermatologic conditions, especially among the adolescent population.

  The pathogenesis of acne is largely multifactorial, with heredity and hormones strongly contributing to one’s risk of developing the chronic inflammatory skin condition.

  High prevalence rates of acne in the adolescent population cannot be attributed to heredity alone, but by the influence of Western diet (WD) that overstimulates insulin-like growth factors (IGFs).

  The purpose of this scholarly project is to determine if there is an association between the presence of acne vulgaris and the consumption of WD, and if a physiological link between the high glycemic food and dairy products that compose the typical WD exists.

  Includes current research that focuses on the pathophysiology of acne vulgaris, the breakdown of high glycemic foods and dairy products and their propensity to cause inflammatory acne,as well as hyperinsulinism.

  Anticipated to be found that consuming a WD increases IGFs leading to hyperinsulinemia, and furthermore, acne presentation by increased sebum production.

  More research is needed before universal associations can be established.

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  New Ways of Predicting Efficacy of Antidepressants

  Kayla Ternes

  Major depressive disorder (MDD) is a neuropsychiatric condition that is becoming increasingly prevalent in our country. According to Cai, Huang, and Hao (2015), MDD is “common and devastating” (p. 61) and has a very complex pathophysiology. Until recently, a definitive etiology had not been found, however, new evidence has suggested that Brain-derived neurotrophic factor (BDNF) and cognitive-emotional biomarkers may be a key into the mechanism of this disorder.

  A literature review of articles found in PubMed, CINAHL, Cochrane Library, and PsychINFO within the last ten years focused on the hypotheses of the pathophysiology of MDD, cognitive-emotional biomarkers, and BDNF. The review found that MDD has a multitude of interconnecting systems that highlight its mechanism, and this is why it is so difficult to find a treatment option that works. However, cognitive-emotional biomarkers were able to predict the efficacy of certain antidepressants in the treatment of MDD. BDNF was also found to be decreased in patients with MDD and increased after treatment with certain medications. These systems may help predict better treatment response and an overall improvement of the burden of this disease.

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  Antibiotic Therapy in Preventing Exacerbations of Severe Chronic Obstructive Pulmonary Disease

  Jamie Trautner

  • Chronic obstructive pulmonary disease (COPD) is a progressive disease that has no cure but is treatable. The treatment goal is to have adequate symptom control, decreased exacerbations, prevent hospitalizations and maintain an independent quality of life.

  • The review of literature is to determine if the benefits of long-term antimicrobial therapy outweigh the risks in the treatment of severe COPD.

  • The gold standard for pharmacotherapy consists of inhaled corticosteroids and bronchodilators (long-acting beta2agonist (LABA).

  • Adding azithromycin to standard therapy for patients with frequent exacerbations showed a 27% reduction in exacerbation frequency.

  • With prolonged use of antimicrobials there is an increased risk of bacterial resistance. However, in doing this research, it was found that bacterial resistance was not noticed between azithromycin (52%) versus placebo (57%), p = 0.64.

  • Although long-term antimicrobial therapy is becoming a hot topic, it is imperative that we continue to study the detrimental development of bacterial resistance.

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  Decreased Mortality of Pulmonary Arterial Hypertension in Duchenne Muscular Dystrophy and Down Syndrome

  Mitchell Volin

  The genetic cause of significant disorders like Down syndrome (DS) and Duchenne muscular dystrophy (DMD) is well documented. Pulmonary arterial hypertension (PAH), a co-morbid condition, is tied to mortality among these groups. Individuals with the ability to communicate their symptoms and actively participate in treatment are at an advantage with subsequent benefit. DS and DMD significantly decrease physical ability and communication capacity. Genetic research has allowed for earlier identification of, or predisposition for, the development of PAH. Work has also progressed toward manipulation at the genetic level to decrease the severity and even eradicate the cardiopulmonary disorder. This information is beginning to be applied in treatment for individuals with PAH. A literature review was conducted to identify the research, prediction methods and treatment of PAH in individuals with Duchenne muscular dystrophy (DMD) and Down syndrome (DS) as it relates to decreased mortality or increased life expectancy among those groups. The results showed significant gains in the understanding of PAH, DS and DMD individually. There was little evidence of research focusing on PAH as it pertains particularly to DS or DMD.

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  The Effect of Statins in Primary Prevention on All-Cause Mortality

  Brian Adams

  During routine yearly physicals, primary care providers often evaluate serum laboratory lipid levels. Many of these patients have no past medical history of cardiovascular events related to atherosclerotic disease. Some patients do not have secondary risk factors, such as diabetes mellitus or smoking history.

  Previous cardiovascular events provide stronger indications for the use of HMG-CoA reductase inhibitors (statins). In the absence of these, the provider may turn to current guidelines, in this case the 2013 the American College of Cardiology and the American Heart Association published the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.

  There is however, controversy, even within the evidence to this guideline, about the effect of statins in primary prevention with respect to the reduction that they have on all-cause mortality. There are many factors that could influence the use of statin therapy for primary prevention. These could include non-fatal myocardial infarction, non-fatal cerebral vascular accident, among others. One of the biggest factors is all-cause mortality.

  A review of the evidence cited for these guidelines demonstrates that the majority of the clinical trials did not show a reduction in all-cause mortality, in primary prevention. It is important to understand that this evidence comes directly from the same evidence that the ACC/AHA used to create the primary prevention guidelines.

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  Fructose and its Contribution to Cardiovascular Disease and Metabolic Syndrome

  Jessica Anderson

  The incidence of obesity, cardiovascular disease, and combination of symptoms classified as “metabolic syndrome” that eventually leads to type 2 diabetes have risen dramatically over the past few decades. The current dietary guidelines that advised patients to avoid dietary fats were originally developed in the 1960’s. This led the way for food manufacturers to remove fats in processed foods and replace them with sugars, particularly fructose. At the time there was no clinical trial data that definitively supported these guidelines.

  The increased use of fructose as a food additive has dramatically increased the per-capita consumption of this sugar. More recent research has found that the unique structural and metabolic differences of fructose as compared to glucose lead to specific pathophysiologic changes in the body that promote obesity, hypertension, atherosclerosis, dyslipidemia and glucose intolerance. Other studies have also found that consumption of certain fats may be beneficial and protective, actually preventing some of the previously mentioned conditions.

  It is evident that fructose consumption, as compared to glucose or fat consumption, leads to a higher incidence of cardiovascular disease and metabolic syndrome in the population. New dietary guidelines, strategies, and changes to food production are necessary to combat this problem, however the reversal of rules that have been in place for decades will be difficult and take many years. Therefore, to have the most impact, patient education needs to start at the primary care level.

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  Curcumin and Fish Oil: Potential Alternative or Adjunctive Treatments to NSAIDs and Immune Modulating Medications for the Treatment of Chronic Inflammation

  Vicki Andvik

  The aim of the present review is to evaluate the efficacy and safety of curcumin and fish oil as alternative or adjuvant treatments to NSAIDs and immune modulating medications for the treatment of chronic inflammation.

  An online search of CINAHL, PubMed, Cochrane and Alt Healthwatchdatabases was conducted. It was limited to peer-reviewed articles and clinical trials in academic journals within the last ten years.

  Current research suggests that curcumin may be efficacious in the treatment of chronic inflammation. It is generally regarded as safe up to 12 gm/day with mild gastrointestinal effects but poor bioavailability has limited its clinical application.

  Current research provides evidence that fish oil is efficacious for the treatment of chronic inflammation in a variety of chronic diseases. It is generally regarded as safe at doses of 3 gm/day with mild gastrointestinal effects and no increased risk of bleeding.

  In vitro studies have demonstrated a synergistic anti-inflammatory effect when curcumin and fish oil are used concomitantly.

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  Proton Pump Inhibitors (PPIs): A Review of the Efficacy, Usage, and Current Literature Recommendations

  Travis M. Booke

  • As Klepser, Collier, and Cochran (2013) noted, PPIs are a class of agents that reduce acid secretion by parietal cells in the stomach by irreversibly blocking H+/K+ adenosine triphosphate. They are commonly prescribed for many gastrointestinal (GI) conditions including gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, and Helicobacter pylori infections. They are frequently utilized in the primary care setting. The purpose of this study was to examine the efficacy, usage, and current literature on PPIs.

  • There were several complications noted with PPI usage. Gomm et al. (2016) found that that use of PPI is associated with an increased risk of dementia and that avoiding PPIs may contribute to the prevention of dementia. Klepser et al. (2013) concluded that PPIs were associated with renal disease after controlling for confounding conditions. They noted patients who had renal disease were twice as likely to have used PPIs in the past. In yet another study, Lazarus et al. (2016) concluded that PPI use is an independent risk factor for CKD and AKI, while H2 antagonist use is not. Shih et al. (2014) concluded PPI use was associated with an increased risk of myocardial infarction for both a 7- and 14- day window period. Finally, van der Hoorn et al. (2015) also determined that PPI use was associated with a substantially increased risk of requiring osteoporosis medication and fractures.

  • Histamine-2-receptor antagonists (H2RAs) are often prescribed in place of PPIs. Sigterman et al. (2013) concluded that were superior to H2RAs in treating heartburn in patients both treated empirically and in patents with endoscopy-negative reflux disease (ENRD). PPIs were also noted to be more effective in patients requiring long-term treatment. H2RAs, however, were found to be superior to PPIs in speed of relief of symptoms and may be a better option for patients with only occasional symptoms.

  • Rickenbacher et al. (2014) studied medical vs. surgical management of GERD. Their data showed a statistically significant pooled effect estimate in favor of fundoplication over medical management of GERD, although several patients complained of dysphagia after surgery. Nissen fundoplication has long been the surgical intervention of choice for GERD treatment. It has some drawbacks in that many patients complain of dysphagia and bloating post-surgery. Lal et al. (2017) compared laparoscopic Nissen fundoplication (LNF) to laparoscopic anterior partial fundoplication (LAPF) and found it to be just as effective as LNF for GERD treatment with less dysphagia.

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  Analysis of Metabolic Syndrome as a Modifiable Risk Factor for Prostate Cancer

  Michael Butler

  • Prostate cancer and metabolic syndrome are both prevalent among men in developed countries with peak incidence after age 50.

  • Prostate cancer has no known modifiable risk factors.

  • Most risk factors for metabolic syndrome are modifiable.

  • If metabolic syndrome is identified as contributing to the risk of prostate cancer it would give an element of self determination to men at risk for prostate cancer.

  • Past studies provide conflicting results in the correlation between these two conditions.

  • A literature review was performed to evaluate consistencies in current literature.

  • Metabolic syndrome or its components do not increase the risk of developing overall prostate cancer.

  • Metabolic syndrome does increase mortality from prostate cancer.

  • Men with metabolic syndrome are found to have higher grades of disease upon diagnosis of prostate cancer

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  Evaluating Internet Based Cognitive Behavioral Therapy in Adults with Depression

  Togan Cottrell

  • Depression is one of the most prevalent and costly mental health issues worldwide.

  • Cognitive Behavioral Therapy (CBT) has been a long-standing treatment for patients with depression. CBT has been proven to reduce or eliminate depression symptoms while increasing quality of life.

  • Due to lack of access to care and a deficiency of mental health providers throughout the United States, the frequent and lengthy visits that are required for traditional CBT may not be an option.

  • The use of internet based CBT has been studied as an alternative to traditional therapy and may serve to fill a gap in current care.

  • This review of literature examined the use of internet based forms of CBT in patients ages 18 and older.

  • Internet based forms reviewed included videoconferencing, computer based therapy and smartphone applications.

  • Current research was examined to determine the safety of internet based CBT and compare the cost and outcomes to in- person therapy.

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  Prophylactic Use of Metformin to Decrease the Incidence of Breast Cancer in High Risk, Predisposed Women

  Aly Dahl

  • Breast cancer is one of the most common types of cancer in American women and is the second leading cause of mortality.

  • In 2015, 234,190 new diagnoses were made and 40,730 deaths from breast cancer.

  • Along with a thorough history from the patient, there are also several risk assessment models that should be utilized, such as the common Gail-2 model.

  • Any women with a significant family history should also be educated on genetic counseling and/or testing to detect a BRCA1 or 2 mutation.

  • Numerous individuals who are positive for this gene elect to undergo prophylactic treatment, such as an oophorectomy, mastectomy or the use of Tamoxifen, or an aromatase inhibitor, also called selective estrogen receptor modulators or SERMS.

  • These medications reduce the amount of estrogen in the body, have been shown to reduce cases of breast cancer, but also come with side effects, such as an increased risk of endometrial cancer, cataracts or venous thrombolytic events.

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  Prolotherapy: Applications, Mechanism of Action, Controversy and Evidence

  Boris M. Davydov

  Merriam-Webster defines prolotherapy (PROLO) as “an alternative therapy for treating musculoskeletal pain that involves injection of irritant substance (as dextrose) into a ligament or tendon to promote the growth of new tissue”. Experimental research and multiple clinical trials have generated evidence suggesting that PROLO is effective at treating a variety of musculoskeletal conditions, including tendinopathies, joint instability and ligament laxity. PROLO may also hold a potential to delay or avoid joint replacement and rotator cuff surgeries. Further research is needed to demonstrate the therapeutic effect of PROLO unequivocally.

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  Metformin and Vitamin B12 Deficiency: Consequences and Patient Monitoring

  Kathryn Dietz

  • The incidence of type 2 diabetes has been increasing at a rapid rate in the United States.

  • Metformin is recommended as the first line treatment to be started at the time of diagnosis in all patients without contraindications and has been associated with vitamin B12 deficiency.

  • There are currently no clinical guidelines for the routine monitoring of B12 levels in this population.

  • The purpose of this scholarly project is to determine if there are consequences of this deficiency and to make recommendations for screening patients.

  • It includes current research that focuses on the pathophysiology of a B12 deficiency, the prevalence and consequences of such a deficiency, and practices in monitoring patients for it.

  • While many type 2 diabetics treated with metformin will develop a vitamin B12 deficiency, there may not be any consequences of this deficiency.

  • More research is needed before universal guidelines can be established. At this point in time, monitoring B12 levels should be a decision based on individual patient’s risk factors and symptoms.

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  Prescription Opioids: A Band-Aid for Chronic Low Back Pain

  Rebekah Dunn

  Pain is one of the most common reasons patients seek medical care in the outpatient clinic and emergency department setting.

   • In the last decade, per the Centers for Disease Control (CDC), prescription drug abuse and overdose, specifically opioids, has become the leading cause of injury and deaths in the United States.

  • “Opioids—primarily prescription pain relievers and heroin—are the main driver of overdose deaths and were involved in 28,647 deaths in 2014…opioid overdoses have quadrupled (an increase of 200%) since 2000” (Rudd et al. 2016).

  • In 2016 the CDC established guidelines of clinical practice regarding management of chronic low back pain (CLBP).

  • Clinical evidence shows treatments such as physical therapy, chiropractic care and cognitive behavioral therapy provide positive outcomes.

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  Language Concordance: Overcoming Language Barriers

  Pamela Flavin-Lee

  • Language discordance is a growing problem facing health care today. Communication barriers can be cultural or language based and are commonly cited as a major contributor to poor patient compliance and health outcomes.

  • This research project seeks to identify promising developments aimed at overcoming language discordance through analysis of different translation implementation methods and correlating these with health outcomes.

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  Introduction of Peanuts to the Pediatric Patient

  Leslee Graff

  Peanut allergies have been diagnosed exponentially over the last ten-years and are more severe now than ever before. (DuToit et al. 2106) Some of the latest statistics are citing more than double the amount of peanut allergies diagnosed in the last few years. Guidelines set forth in 2010, by the American Academy of Allergy, Asthma, and Immunology stated that peanut, milk, soy, wheat, egg, and other tree nuts were to be avoided until three years of age, unless these patients have other chronic illnesses such as asthma or other atopic conditions. If so, the patient is to abstain from these items until the age of five years. Once the patient reaches this stage of life, foods are to be introduced slowly, in small quantities, one food at a time. (American Academy of Allergy, Asthma & Immunology, 2010) The guidelines have changed in the last two-years after a study known as Learning Early About Peanut Study, LEAP, became published in 2015. It was previously advised to withhold peanut-laden foods until at least three years of age. Recent guidelines suggest children who are exposed to these food sources can allow for desensitization from these allergens at an early age, before their immune systems are completely competent, minimizing potential anaphylactic reactions. (Learning Early About Peanut Study, 2011) The results of this project aim to justify the newest guidelines and research and show that introduction to the peanut protein at age four to six months, allows for immune competency in the pediatric body and quite possibly in-utero. The pathophysiology of the immune response is exponentially different as the body continues to be introduced to cross-reactive allergens as you age.