Physician Assistant Scholarly Project Posters

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  Anticoagulation Therapy for the Elderly with Atrial Fibrillation

  Rebecca Hoistad

  • Atrial fibrillation increases in occurrence as we age with about 9% of patients developing it by age 90. When a patient is diagnosed with atrial fibrillation, one of the drugs that they are prescribed is an anticoagulant. The purpose of this drug is to prevent thrombus formation in addition to preventing an ischemic stroke. Today, there are many options available for anticoagulation therapy. The options include aspirin, vitamin K antagonists like warfarin, factor Xa inhibitors like rivaroxaban and apixaban, direct thrombin inhibitors like dabigatran, and antiplatelet agents such as clopidogrel.

  • A review of the literature was done of peer reviewed journal articles using the databases PubMed, Dynamed, CINAHL and Clinical Key. A total of 14 articles were used in this paper with the inclusion criteria of being published within the past five years, the patients all have atrial fibrillation, over 65 years old, and are on some form of anticoagulation therapy.

  • Previously, warfarin has been one of the few anticoagulation drugs on the market until the newer novel anticoagulants were released. Bell et al. (2016) found that warfarin is still used in 53.6% of the patients, even though the prevalence has decreased by 3.9% between the years of 2011 and 2013. (p

  • It was found that patients who were diagnosed with atrial fibrillation needed some form of anticoagulation as compared to no anticoagulation to reduce stroke. Most of the studies compared warfarin versus no anticoagulation treatment. There were not many studies that looked at the newer novel anticoagulants. It was mentioned that there has been a decrease in warfarin use since the newer novel anticoagulants have been released. There are considerations that a prescriber needs to be conscious of before prescribing a specific anticoagulant. Some of these considerations are renal function, other medication usage to avoid drug-drug interactions and age.

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  The Effectiveness, Benefits, and Challenges of FertilityAwareness-based Methods of Family Planning

  Annette M. Larson

  The aim of this scholarly project was to evaluate data regarding the efficacy, challenges, and benefits of fertility awareness-based methods (FABMs) of family planning, in order to determine whether there are methods that may be considered effective and beneficial options. After reviewing the available literature regarding current FABMs, it became evident that there are, in fact, current methods available which are viable choices. The most effective methods according to this data are the ovulation and Sympto-Thermal methods, which have actual-use efficacy ratings that, when compared to the commonly prescribed oral contraceptive pill, would recommend them for use. The FABMs, as with all user-dependent family planning options, come with their own set of challenges which affect their actual-use efficacy rates. The FABMs also tout a set of unique benefits which recommend them for use. Though the FABMs may not be the family planning option of choice for all women, the evidence compiled in this review highly recommends them for further study and application. Motivated women who desire a natural option are excellent candidates for these methods.

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  Autism: Benefits and Outcomes of Early Diagnosis and Intervention

  Mitchel Leers

  •The purpose of this review was to determine the importance of early diagnosis and intervention during infancy, leading to significant outcomes which include improvements in communication skills, receptive language and social interaction in children with ASD.

  •Nass et al.,(2016) described ASD as a “heterogeneous group of biologically based, neurodevelopmental disorders characterized by impairments in two areas: deficits in social communication and social interactions and restricted plus repetitive patterns of behavior, interests, and activities”

  •The findings showed that early diagnosis and referral to intervention makes a significant impact on children with ASD showing improvements in many areas of delay including receptive communication, adaptive behavior, social interactions, social approach, joint attention, and IQ.

  •The finding found when applying early intervention children maintained the gains in all areas with no to minimal regression loss of skills after a two year follow-up.

  •The findings indicated that most providers that incorporate screening tools into their practice are referring to early intervention centers and the children are starting intervention prior to official diagnosis.

  •The findings showed that most children are being diagnosed at appropriate ages ranging from 30-120 months.

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  Opioid Maintenance Treatment: Methadone, Buprenorphine, and Naltrexone

  Nicole Lemieux

  Opioid dependence plagues the United States with millions of people suffering from the effects. Throughout recent years, there has been a surge in research in treatment options for patients suffering from opioid dependence. Three medications have stood out: methadone, buprenorphine, and naltrexone. The purpose of this study was to investigate the three and decipher which provides the best outcomes for patients. Research was conducted by reviewing literature via PubMed, PsychInfo and Cochrane. A review of the literature found that methadone has been used the longest and has been shown to be efficacious, but can be severely limiting for patients due to lack of clinics and the need for daily dosings. As a result, buprenorphine was developed as an alternative medication with similar efficacy and retention rates to combat the daily dosages and provide a more readily available medication. Unfortunately buprenorphine also has geographical limitations. Naltrexone is the newest medication added to the mix. Orally, it has poor retention, but an extended release form has been developed that is showing promise. There are no geographical limitations associated with naltrexone and the extended release form allows for only monthly injections. Going forward with opioid treatment, medications like naltrexone and those that are more readily available will become more widely used for treatment as patient preference is pointing towards medications that are not limited by geography or frequent dosing.

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  Folate as an Adjunctive Therapy for Treatment Resistant Depression

  Katherine McFarland

  Numerous medications are available to treat depression, yet many patients do not achieve remission or recovery of their symptoms with traditional therapies alone. Folate supplementation has been shown to be beneficial in the treatment of depression when used in addition to traditional prescription therapy. A literature review was conducted to determine the effect of low folate levels on depression and if supplementation with either folic acid or L-methylfolate benefits this patient population. Key search terms including folate, folate deficiency, methylfolate, nutrition, and depression were used to perform searches of multiple databases and journals including PubMed, CINAHL, PsycInfo, and the American Journal of Psychiatry. Studies such as the one conducted by Loria-Kohen et al. (2013), demonstrated benefit in the use of folic acid supplementation in lowering depression scores. Researchers including Zajecka et al. (2016) have shown that due to its ability to cross the blood brain barrier, L-methylfolate is the better option in the treatment of depression. Medical providers must determine the best treatment plan based on an individuals personalized needs while also considering the risks, benefits, testing options, and cost of treatment.

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  Effectiveness and Safety of the Bronchial Thermoplasty Procedure

  Kathy Mohammadi

  • Asthma: a heterogeneous disease characterized by chronic airway inflammation resulting in respiratory difficulty.

  • Bronchial Thermoplasty (BT): a bronchoscopy procedure that delivers radiofrequency energy to the tissues of airway walls thus heating the tissue, causing ablation to reduce the mass of the airway smooth muscle (ASM), hence attenuating bronchoconstriction.

  • BT was designed to decrease, de-bulk or partially eliminate excess smooth muscle tissue in the distal airways, with a subsequent decrease in the number of severe asthma attacks.

  • BT is an alternative treatment for patients with severe, uncontrolled asthma in which the airway smooth muscle is eliminated using radio ablation.

  • In this project, several studies are presented to demonstrate the effectiveness and potential adverse impacts of BT.

  • Special attention to a study performed to evaluate the safety and the effectiveness of BT in 580 asthma patients across 6 nations with symptoms despite being treated with high doses of Inhaled corticosteroid (ICS) and long acting beta agonist (LABA), the current standard of care for severe asthma.

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  Treatment Options for Patients With Irritable Bowel Syndrome & Comorbid Depression

  Elizabeth Morton

  • Irritable bowel syndrome & depression are common comorbidities, however there is a wide variability regarding the appropriate treatment regimens for these patients.

  • IBS is classified as a functional bowel disease in which patients suffer from recurrent abdominal pain or discomfort associated with alterations in bowel habits.

  • While the cause of IBS is multifactorial, studies have revealed that the dysfunction of the brain-gut pathways are a culprit to disease appearance and progression, as seen in the biopsychosocial model of IBS. This model proposes that abdominal symptoms secondarily impact anxiety & depression symptoms and that psychological factors influence physiologic aspects such as motor functions, sensory threshold & stress reactivity of the gut through the vagal & sympathetic afferents.

  • Due to the complexity of the causal mechanisms that produce symptoms of IBS with depression, there is some uncertainty regarding the best treatment regimen for these patients.

  • Commonly, patients are advised to increase physical activity, reduce stress & implement dietary modifications. Pharmacotherapy may be advised for some, depending on their symptoms, & may include antidepressants, antispasmodics or laxatives.

  • There is not a standardized method of treating IBS with comorbid depression, therefore symptom management must be performed on a patient-by-patient basis.

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  Type 2 Diabetes in Native Americans: The Influence of Historical and Cultural Factors on Incidence, Prevalence, and Strategies for Patient Education, Disease Prevention, and Management

  Tim Olsen

  Type 2 diabetes (DM2) was virtually nonexistent among Native American, Alaska Native, and Canadian First Nations people prior to the 1950s. Due to historical, cultural, environmental, and psychosocial factors, Native people suffer disproportionately higher rates of DM2 than other populations. This literature review aims to examine the influence of these factors and investigate whether insight and knowledge into them, as well as culturally sensitive approaches to disease education, prevention, and self-management can be beneficial to providers working among Native communities. The results suggested that culturally sensitive approaches are indeed of value in promoting more effective care, and that lack of cultural sensitivity can present an obstacle.

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  Early Antibiotic Exposure and Childhood Obesity

  Agatha J. Ottem

  Obesity is becoming a growing concern in today’s population. Over the last thirty years, obesity rates have doubled in adults and quadrupled in adolescents. One of the more recent theories is that childhood obesity is influenced by early exposure to antibiotics. The purpose of this project is to discuss how antibiotics alter the human gut microbiota and how this affects nutrient consumption, which can lead to childhood obesity. There is a focus on the current research studies that address if, indeed, there is a link between childhood obesity and early antibiotic exposure. Through a review of several electronic databases and several peer reviewed research articles, my research has found that there is a link between early life antibiotic exposure and childhood obesity. Studies have shown that the younger the child is at the time of antibiotic exposure, the higher the risk of obesity. In addition, the more frequent the antibiotic exposure the higher the risk, and overall, males have a higher risk than females. These findings could have an impact on future clinical practice and probiotic use.

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  The Postnatal Management of Gestational Diabetes

  Savannah Prodzinski

  • Diabetes mellitus is growing substantially in our nation. Between its natural progression and effects on other body systems, this epidemic is costing us billions of dollars a year.

  • Although gestational diabetes typically resolves after pregnancy, women who have had gestational diabetes in the past have a largely increased risk for the development of diabetes mellitus in the future.

  • Several things contribute to the development of GDM and DM: decline in β-cell function, lower adiponectin levels and HgbA1C levels in the third trimester.

  • Intervening during the critical time after delivery in women with gestational diabetes, will theoretically help prevent the further progression into diabetes mellitus.

  • We can do this by directing prevention practices such as a well-balanced diet, exercise, smoking cessation and the encouragement of breastfeeding.

  • Current recommendations for the management of these women appears to be too lenient. With a more concentrated strategy by practitioners and the involvement of educators and dieticians, ideally we can ultimately lessen this costly epidemic.

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  Brugada Syndrome; Preventive Screening Measures to Decrease Associated Cardiac Deaths

  Matthew Ryba

  • Brugada syndrome is a sodium channel deficiency in the myocardium that can cause arrhythmias and sudden cardiac death. The myocardium deficient sodium channels can be inherited or affected by environment factors such as fever or medications.

  • Screening for this syndrome can be challenging because many times the first symptom of Brugada syndrome is cardiac arrest. Though incidents of sudden cardiac deaths are low, sudden cardiac death can impact families and communities.

  • In Italy, screening ECG’s is claimed to have reduced sudden cardiac events by 85% (Maron, 2014). Preventing sudden cardiac death in these patients through sensible, reasonable preventive practices such as screening electrocardiograms and patient education is the goal.

  • Performing 12 lead electrocardiograms (ECGs) in a screening nature and pairing it with medical history and physical exam can help increase discovery of Brugada syndrome and decrease associated cardiac events.

  • The American Heart Association and the American College of Cardiology currently do not recommend screening ECGs. The International Olympic Committee and the European Society of Cardiology recommend screening ECGs for athletes.

  • The search was limited to articles that were published within the last 10 years. Databases searched included Pubmed, CINAHL, and SPORTDiscus. Several articles were found to be of significance to the topic.

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  Alpha-1 Deficiency: Better Detection May Improve Outcomes for COPD Patients

  Angela Schuster

  Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that results in debilitating illnesses like: emphysema, COPD, liver disease, and panniculitis. AATD is highly under-diagnosed based on epidemiologic and population studies that suggest that fewer than 10% of the 60,000-100,000 individuals in the U.S. suspected to have severely deficient alleles have been identified ( Rahaghi et al., 2012). This study examines strategies aimed at improving detection of AATD. The findings indicate that utilizing flags to alert providers of the need for AATD testing initiated by RTs or automated within EMR systems are effective strategies for increasing testing rates and potentially improving detection of emphysema and COPD secondary to AATD therefore eliminating diagnostic delays and improving prognosis for those affected.

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  The Association Between Antipsychotic Medication and Weight Gain

  Brian Steen

  • Antipsychotic medications are utilized for patients with many mental health problems including schizophrenia, attention deficit hyperactivity disorder, autism, bipolar mania, and psychotic depression. The antipsychotic medications treat the symptoms associated with these mental health disorders.

  • Antipsychotic medications, while being efficacious to these symptoms, can have unwanted side effects, including weight gain. The purpose of this study was to determine if there is a strong relationship with antipsychotic medication use and weight gain.

  • The review of literature was conducted with an online search of Cochrane, PubMed, and PsycInfo for journal articles, research studies, and other scholarly reviews. Articles included in the search described the proposed mechanisms of how antipsychotic medications can result in weight gain.

  • The literature review indicated antipsychotics contribute to increased weight gain with second generation antipsychotic medication use resulting in more weight gain than the use of first generation antipsychotic medications.

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  Association Between Proton Pump Inhibitor Use & Dementia: A Two-Fold Approach

  Lisa Steers

  An observational study of data derived from the German Study on Aging, Cognition and Dementia indicated that proton pump inhibitor use was associated with dementia risk (Benmassaoud, McDonald, & Lee, 2016). The purpose of this study is to explore a two-fold approach between proton pump inhibitor use and dementia. This two-fold approach will first investigate the association between dementia and proton pump inhibitor use and secondly, the proposed pathophysiology behind it. This approach to proton pump inhibitor use and dementia will allow for providers to utilize the association and make decisions to avoid chronic proton pump inhibitor use in effort to reduce or prevent dementia. Research methods include reviewing peer reviewed journal that were obtained from Pubmed, ClinicalKeyand PsycINFO. Gomm et al. (2016) found that their study participants prescribed proton pump inhibitors had a significant increase in risk of dementia (HR, 1.44 [95% CI, 1.04-1.83]). Haenischet al. (2015) found that the use of proton pump inhibitor medication increased the risk of any dementia (HR 1.38, [95% CI, 1.04-1.83]) compared to no proton pump inhibitor use. Akteret al. (2015) utilized the CANTAB software which provided multiple significant findings in several different testable areas among proton pump inhibitor users. Badiolaet al. (2013) used materials and methods such as cell culture, drug treatments, analysis of amyloid-beta peptides by ELISA, mass spectrometry of amyloid-beta species, animals and treatments, brain soluble amyloid-beta extraction and western blotting to provide one-way ANOVA and t-test to report the effect of proton pump inhibitors have on amyloid-beta degeneration in mice. Jung et al. (2015) found statistical significance between chronic acid lowering agents and vitamin B12 deficiency with a hazard ratio of 1.83 [95% CI: 1.36-2.46], p-value

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  Use of Mesenchymal Stem Cells for the Treatment of Osteoarthritis

  Dennis W. Stewart

  • Healthy articular cartilage protects and provides smooth functioning of the joint. The deterioration of the articular cartilage leads to the crippling disease known as osteoarthritis (OA).

  • OA is a leading cause of disability in the United States. Although some of the current treatment modalities, along with pharmacological treatment, may offer short term improvement with pain and function, they do not offer long term relief, and are ineffective in preventing the progression of OA.

  • In advanced stages, surgery in the form of total knee arthroplasty (TKA), is sometimes needed. This is an invasive procedure and typically requires hospitalization.

  • Now, there is a safe and effective modality on the horizon. This minimally invasive treatment is the injection of mesenchymal stem cells (MSCs) directly into the affected joint.

  • These are multipotent progenitor cells that offer immunosuppressive and anti-inflammatory action, have the capacity of self-renewal, and have high plasticity. MSCs can be harvested from the patient themselves, autologous, or can be from a donor, allogeneic.

  • A review of the literature suggests treatment of moderate to severe OA of the knee with MSC injections are a viable treatment option when compared to other treatments that include a total knee replacement. MSC s are the only treatment option that have evidence of cartilage regeneration in addition to improvement of functional mobility, pain relief, and overall improvement in quality of life.

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  Pharmacogenetic Testing in the Treatment of Major Depressive Disorder

  Brianna Strube

  • Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders in the United States and is a large cause of disability. Antidepressants take weeks/months to become effective which can lead to noncompliance. Treatment has a high failure rate which increases medical costs and leads to decreased patient outcomes.

  • Pharmacogenetic testing is the practice of analyzing genetic differences to predict a patient’s response to medications to improve efficacy and decrease adverse side effects. The purpose of this study was to investigate if pharmacogenetic-guided treatment, specifically in the use of antidepressants in MDD, has resulted in improved patient outcomes. Additionally, the cost effectiveness was also analyzed.

  • The review of literature was conducted by systematically searching the online databases PubMed and PsycINFO, and explored studies that compared the current standard of care to pharmacogenetic-guided treatment in adult patients with MDD aged 18-75.

  • The results indicated improved compliance and prognosis for patients with MDD using pharmacogenetic-guided treatment versus the current standard of care. Studies also showed cost effectiveness of pharmacogenetic-guided treatment by decreasing medical costs by having fewer clinic visits, less changes in prescriptions, less sick leave taken, and decreased hospital costs.

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  Effectiveness of Different Styles of Diabetic Education on Outcomes of the Type II Diabetic Patient

  Emil Trutwin

  •The purpose of this project is to determine if there is a significant advantage to certain diabetic education strategies that yield better outcomes in regards to control of diabetes.

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  Sucrase-Isomaltase Deficiency, an Under Considered Diagnosis

  Lindsay Venn

  • Persistent gastrointestinal (GI) complaints are a common problem in patients presenting to family practice for care.

  • Irritable bowel syndrome (IBS) is a diagnosis that adult patients are labeled with when clinicians have exhausted their differential list and no other cause of their GI symptoms can be confirmed.

  • Sucrase-isomaltase deficiency (SID) has been historically shown to present early in life as a congenital disorder, but researchers are now recognizing occurrence later in life as a mild or secondary disorder.

  • The literature emphasizes the disconcerting prevalence of sucrase-isomaltasedeficiency (SID), the persistent symptoms associated with it, and the need for further research, especially in the adult population.

  • SID testing is cost effective, very reliable, and completely non-invasive.

  • It has been proven that after treatment of SID with sucrase replacement enzyme, patients were able to return to normal sucrose digestion and had resolution of their symptoms.

  • Educating practitioners about SID and providing options for diagnosis and treatment are the first steps in helping the many patients that suffer from chronic bowel problems.

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  Prenatal Screening for Aneuploidy: Should cfDNA Replace Traditional Methods?

  Rachel Watson

  In 2011, advances in research in medical genetics led to the advent of prenatal cell-free DNA (cfDNA) or also known simply as non-invasive prenatal screening or testing (NIPS). This screen consists of analyzation of placental DNA circulating in maternal blood. NIPS has had a major impact on prenatal screening for aneuploidy. Mixed opinions and data exist as to whom this test is most appropriate for. The sensitivity and specificity of this screen in detecting common fetal aneuploidies has been well documented as superior to other screens in high-risk populations, but less so in low-risk obstetric populations. This paper will compare and contrast NIPS to more traditional screening methods such as first trimester maternal serum biochemical assay of human chorionic gonadotropin (hCG) and pregnancy associated plasma protein A (PAPP-A), and second trimester markers which include hCG, unconjugated estriol, inhibin A, and maternal serum alpha-fetoprotein.

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  A Comparison of Traditional Care and Cognitive Behavioral Therapy for Treating Depression Following Open Heart Surgery

  Derryk Allen

  Depression occurs shortly after open heart surgery in many patients. When depression is identified, traditional treatment consists of antidepressant medications along with cardiac rehabilitation and follow up care but these visits may not address depression. The purpose of this study compares traditional care with cognitive behavioral therapy. Does cognitive behavioral therapy more effectively manage depression than traditional care among male and female patients that have undergone open-heart surgery and acquired depressive symptoms? An article search of the following databases was conducted: PubMed and The Cochran Library. The review of literature explored studies that compare treatment between traditional care and CBT within the past eight years in male and female patients age 18 to 80. Freedland et al. (2009) found 73% remission rates at 9 months utilizing cognitive behavioral therapy whereas traditional care resulted in 36% remission of depressive symptoms at 9 months (p=.03). Doeringet al. (2013) determined, utilizing the Beck Depression Inventory (BDI), that CBT patients experienced a 63% remission of depressive symptoms compared to traditional care patients that experienced 25% (p<.001). A meta-analysis performed by Beltman, Voshaarand Speckens (2010) evaluated CBT for depression in patients with somatic disease. Cognitive behavior therapy was found to be superior to traditional care and indicated larger effects in studies with patients diagnosed with depressive disorder [standardized mean difference (SMD) = -0.83, 95% CI -1.36 to -0.31, p< .001]. Cognitive behavioral therapy provides healthcare practitioners an effective option that will provide improved outcomes for patients with depression.

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  Coronary Artery Calcium Scoring vs. Exercise Tolerance Testing: Diagnoses and Risk Stratification of ASCVD

  Brittany Anundson

  • Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent in today’s society and contributes to high rates of mortality involved with heart disease.

  • The initial assessment of ASCVD and risk stratification concerning the development of an acute coronary event can be performed in a number of ways.

  • Current American Heart Association (AHA) guidelines recommend exercise stress testing (ETT) as the initial, noninvasive evaluation of choice.

  • However, the accuracy of this test is highly dependent on the patient’s endurance, body mass index, and artifact, making analyzation difficult.

  • Non-contrast cardiac computed tomography (CT) with coronary artery calcium (CAC) scoring has been shown to be specific and sensitive, however only recommended for further evaluation post ETT, those with insignificant stress test findings, and those unable to exercise.

  • The purpose of this study is to determine if CAC scoring is a more useful predictor of ASCVD and acute coronary events compared to exercise stress testing.

  • The review of literature compares accuracy, predictability, and cost of ETT versus CAC scoring. • The results display high sensitivity using CAC as the initial diagnostic test in patients

  determined as low to intermediate risk for an acute coronary event without significant increase in cost.

  • The findings may be used to justify current guidelines or propose alterations to certain patient populations as to which test would be more accurate and cost-effective in the risk stratification of ASCVD.

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  Genetic Factors Related to the Incidence of Type II Diabetes in Adults

  Andrew Bader

  As the seventh leading cause of death in the United States, diabetes affects 29.1 million people. In May, 2015 the U.S. CDC reported, the estimated total financial burden for diabetes in the United States at greater than $245 billion ($69 billion attributed to disability, lost days at work and premature death). The purpose of this study was to investigate genetic variances in parallel with type II diabetes. Through a five year prior search of Cochrane, Medline and Pubmed this review of the literature examined studies regarding type II diabetes related genetic variances specific to non-ethnic and ethnic populations of otherwise healthy adults aged 18-65 years old. Methods encompassed extracting DNA from nuclear pellets. Further genotyping was conducted using SNPlex or Assays on Demand. A p value of less than 0.05 was considered statistically significant. Literature reviews utilized centre-stratified analyses, combining evidence from each centre using fixed-effect meta-analyses. The authors then assessed research subjects against controls utilizing measured genotype and additive genetic models adjusted for age and gender. Significance thresholds were then adjusted where a p value of < 0.05 was considered statistically significant. Franceschini et al. (2013), Wu et al. (2014) Hanson et al. (2013), Kato (2013), Yagootak and Frayling (2013), Sun, Yu and Hu (2014) and Pal and McCarthy (2013) stated over 60 genetic loci have been identified to date in candidate gene and genome-wide association studies regarding type II diabetes. Of the genetic loci discovered, Wu et al. (2014) and Yagatook and Frayling (2013) determined variants at TCF7L2 resemble the most robust correlation with type II diabetes. Wu et al. (2014) found a 96% concordance rate among monozygotic twins with type II diabetes, as well as a 40% incidence rate of developing type II diabetes among those who have first-degree relatives with the disease. However, Kato (2013) suggests previous studies only account for 5-10% of heritability associated with type II diabetes. Sun, Yu and Hu (2014) reported the concept of pharmacogenomics (drug molecular mechanisms related to gene variants and drug efficacy) may eventually drive clinical decision making regarding type II diabetes drug selection, dose titration and adverse side effect avoidance. Based on the results of the studies in this review, accurate genetic data reveals potential to evolve clinically into a valuable instrument, thereby facilitating optimized therapeutics and deferring or suspending the onset of type II diabetes.

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  Preventing CIA in Women with Breast Cancer Improves Psychological Well-being

  Allison Barnett

  In adult women with breast cancer, alopecia that often accompanies the use of chemotherapy can be devastating when added to the emotional distress of receiving treatment. According to the Up to Date database, cryotherapy is successful at reducing or preventing alopecia during breast cancer chemotherapy treatment. In addition, several recent studies have shown that chemotherapy-induced alopecia has a negative effect on the body image and psychological well-being of women with breast cancer. The review of literature from Cochrane and PubMed database, from the last ten years, explored studies of women ages 18-80with breast cancer that evaluated the impact of chemotherapy-induced alopecia on patient’s self-confidence, body image, and well-being including anxiety and depression. Shin, Jo, Kim, Kwon, & Myung (2014) reported that scalp cooling method significantly reduced thedevelopment of CIA in comparison to other methods and reduced relative risk by one-third. (p<0.001). Choi et al., (2014) found CIA distress was negatively associated with body image, psychosocial well-being and depression among breast cancer patients. Significant differences were found between the severity of alopecia and distress (p<0.001).This study found that CIA is a distressing side-effect of breast cancer treatment and that its prevention can minimize the psychological effects it has on a patient’s well-being. Providers can improve the care of breast cancer patients that are receiving chemotherapy by offering scalp cryotherapy, as well as the information and resources necessary to reduce the psychological sequelae and improve their patients’ quality of life

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  Does the Hygiene Hypothesis Contribute to Autoimmune and Allergic Disease in Children With Focus on Type 1 Diabetes Mellitus and Asthma

  Chad Briley

  The Hygiene Hypothesis first introduced in 1989 by an epidemiologist, Dr Strachan, as he observed an increased prevalence of allergic diseases in society. Further clinical studies and research have included autoimmunity and inflammatory disease under the umbrella of the Hygiene Hypothesis. Article searches were done in the electronic medical database, Pubmed, for articles related to the Hygiene Hypothesis and autoimmunity related to Type 1 Diabetes Mellitus (T1DM) and hygiene hypothesis and childhood asthma. Articles written in the last five years were utilized for the project. The subject group is male and female children ages birth to 18 years old with subject populations throughout the world. Research has shown that the decreased burden on the immune system due to declining family sizes, improved household amenities, higher standards of personal cleanliness, vaccinations and antibiotic use have begun to alter how the immune system responds to pathogenic stimulus as well as nonpathogenic stimulus. These are factors leading to increased autoimmunity and atopy found in children of modern society. Further study is indicated for understanding about what causes some of these conditions in modern societies. This has applications towards antibiotic use, trendy hygiene practices and further understanding of the environmental causes of these and other more common conditions.

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  Chemotherapy Cancer Treatment and Cognitive Dysfunction

  Caitlyn Cameron

  The prominence of cognitive dysfunction because of cancer treatment, referred to as “chemo brain” is increasing due to the number of cancer survivors. Research on chemotherapy related cognitive dysfunction has been focused on breast cancer survivors. The purpose of this study was to establish if a connection between chemotherapy cancer treatment and cognitive dysfunction exists. This evaluation of literature explored PubMed, DynaMed, Psychiatry Online, and Cochrane which compared cognitive abilities before and after chemotherapy cancer treatment. This paper examined the research over the last 10 years, of women ages 18-70 and the connection between chemotherapy treatment and cognitive dysfunction. Jansen et al. (2011) found significant decreases in cognitive impairment after receiving chemotherapy, followed by improvements 6 months after the completion of chemotherapy in the cognitive domains of visuospatial skill (p<0.001), attention (p=0.022), delayed memory (p=0.006), and motor function (p=0.043). Results from a study by Lindner et al. (2014) indicated that cognitive impairments were found in the cross- sectional studies including immediate free recall (p=0.03), delayed memory (p=0.02), verbal memory (p<0.001), delayed recognition memory (p=0.02), selective attention (p=0.02), and attention capacity (p<0.001). This paper has shown that a positive connection between chemotherapy cancer treatment and cognitive dysfunction exists and that the degree of cognitive dysfunction is highly variable for each individual. The results indicated that chemotherapy related cognitive dysfunction should be discussed as a debilitating side effect before chemotherapy cancer treatment is initiated. Survivor support should also be increased in order to accommodate cancer survivors affected by chemotherapy related cognitive dysfunction.