Physician Assistant Scholarly Project Posters

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  Comparing the Long Term Use of H2 Antagonists (H2RAs) and Proton Pump Inhibitors (PPIs) and the Incidence of Colitis

  Reiner Kremer

  • Commonly used medications for GERD may affect the colonic mucosa

  • H2 antagonists (H2RAs) ranitidine, cimetidine famotidine reduce acid secretion by 60 to 70%.

  • Proton pump inhibitors (PPIs) omeprazole, pantoprazole, lansoprazole, esomeprazole and rabeprazole reduce acid secretion by inhibiting the H+ (proton) secreting pump, reducing hydrochloric acid by 80 to 95%.

  • Diarrhea is one of the most commonly reported adverse events.

  • H2RAs and PPIs have the physiological and functional potential to interfere with gastrointestinal physiology by altering intestinal pH.

  • Microcytic colitis causing chronic diarrhea and colonic inflammation is a significant complication risk after the > 4-8 week use of H2RAs and PPIs.

  • The overall incidence of microcytic colitis has increased in both Europe and North America concurrent to the use of PPIs and H2RAs.

  • Drugs associated with microscopic colitis are the H2 antagonist ranitidine (Zantac) and proton pump inhibitors lansoprazole (Prevacid), omeprazole (Prilosec) and esomeprazole (Nexium).

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  Hypertonic Saline Therapy in Cystic Fibrosis

  Idil Mohamed

  Cystic fibrosis is an autosomal recessive genetic disorder that severely affects the lungs as well as other organs in the body. The pathophysiology of cystic fibrosis lung disease involves the production of thick and sticky mucus that accumulates leading to obstruction and inflammation of the airways. This disease is characterized by abnormal transport of sodium and chloride across an epithelium by defective genes, resulting in thick mucus secretions.

  Nebulized hypertonic saline (3% NaCl) improves mucociliary clearance through rehydration of the airway surface liquid of the lungs. The purpose of this study is to evaluate the effects of nebulized hypertonic saline in improving lung function and decreasing exacerbation rates in older children (10-18 years of age) and adults with stable cystic fibrosis compared to normal saline (0.9%).

  The review of literature will focus on comparing the use of nebulized hypertonic saline in enhancing mucociliary clearance in CF patients compared to other methods. The expected outcome is that nebulized hypertonic saline treatment will improve lung function and decrease exacerbation of CF in these groups.

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  Effectiveness of Treatments for Low Back Pain

  Angela K. Salveson

  Low back pain with or without radiculopathy symptoms is increasingly becoming a common complaint for patients. The purpose of this study is to evaluate the most effective treatment for patients experiencing low back pain with or without radiculopathy symptoms with the goal of pain reduction/elimination and positive long term results. The review of literature explores studies that discuss treatment options of surgical intervention or conventional treatment such as physical therapy. This information supplies health care providers with the tools to educate patients on treatment options and possible outcomes in hopes to offer the best treatment for the individual. Results show that patients can have pain reduction or relief and return to normal activity level in a shorter time frame with treatment of conventional methods versus surgical interventions. The findings indicate treatment alternatives that may not have been considered as beneficial before. In addition, the findings may provide guidance to when a patient should be referred to a surgeon for treatment versus starting with physical therapy or other non-surgical treatment options. This information should help health care providers reduce a patient’s low back pain and improve their quality of life.

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  Comparing Fecal Microbiota Transplant (FMT) to Vancomycin: in Treatment of Recurrent Clostridium difficile Infections (CDI)

  Christopher Seil

  • Clostridium difficile infection (CDI) is the main cause of antibiotic-associated pseudomembranous colitis.

  • CDI has tripled over the last ten years due to the increased use of broad spectrum antibiotics. CDI has become increasingly difficult to manage with traditional therapies such as metronidazole and vancomycin due to mutations in the pathogen, resulting in resistant organisms.

  • The purpose of this review was to determine if fecal microbiota transplantation (FMT) is more effective in treating and curing CDIs than traditional vancomycin therapy.

  • The hypothesis was that FMT will have better treatment outcomes than traditional vancomycin therapy.

  • The findings indicated that FMT is a more cost effective, safer, and overall better treatment option for CDI than traditional therapies such as vancomycin.

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  Lyme Disease Outcomes with Immediate, Short Duration Antibiotic Use Versus Delayed, Longer Duration Use

  Lori A. Steinley

  Lyme disease is the fastest growing vector-borne disease in the United States, according to the Infectious Disease Society of America (IDSA). The guidelines for diagnosis provided by the IDSA include evidence of erythema migrans rash with validation of a positive two-tier serology testing. With no established treatment standards, decreased sensitivity of testing and inconsistency of observing the rash, practitioners following the guidelines may delay treatment of antibiotics. This delay could cause progression of severity of symptoms.

  The purpose of this study is to compare implementation and duration time of antibiotics and establish the treatment protocol for best clinical outcomes for Lyme disease. Diagnosis will be based on practitioner’s clinical judgment with or without positive serology testing and erythema rash. Review of literature will define late, chronic and recurrent Lyme disease, describe recurrent treatment of Lyme disease, compare and contrast present protocols with different duration and types of antibiotics, and examine markers and subjective reports as evidence of improvement. Guidelines and recommendations will be provided from Lyme disease experts.

  Significant results found that early implemented, shorter duration antibiotic use provided the greatest clinical improvement long term.

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  Acute Myocardial Infarction: Are we overlooking NSTEMI?

  Kevin D. Swenson

  • Acute myocardial infarction (AMI) is one of the leading causes of death in the United States.

  • The purpose of this study was to examine methods of clinical differentiation between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) and then to compare the various treatment methods and subsequent outcomes in STEMI versus NSTEMI.

  • A compilation of systematic reviews, medical journals, practice guidelines, medical texts and meta-analyses were researched for the purpose of this study.

  • NSTEMI patients are older, have more comorbidities and present with more atypical symptoms than STEMI patients.

  • NSTEMI patients are treated less aggressively than STEMI patients both in-hospital and after discharge.

  • Based on current practices, NSTEMI mortality and major adverse cardiac events (MACE) rates are higher than in STEMI patients.

  • Recent coronary angiography (CAG) outcome comparisons generally show similar mortality and hazard ratios and suggest better revascularization in NSTEMI than in STEMI.

  • Early invasive treatment in NSTEMI has shown more positive results than late invasive treatment and is most effective in intermediate- to high-risk patients.