Physician Assistant Scholarly Project Posters

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  A Review of Barrett's Esophagus

  Suzanne M. Zayan

  Barrett’s Esophagus is a premalignant condition that predisposes patients to the development of esophageal adenocarcinoma.

  •Esophageal adenocarcinoma dramatically rising over several decades; survival rates of less than 17% in a five year period.

  •Management and treatment continues to evolve: use of radio-frequency ablation effective to treat low grade dysplasia

  •Studies of risk factors and treatment options explored:

  Efficacy and durability of endoscopic radiofrequency ablation for treatment of low grade dysplasia as option for metaplasia eradication

  –Gastrointestinal pathologist expert reviews ensure identification of dysplasia prior to treatment
  –Appropriate endoscopic surveillance intervals
  –Gastroenterology guidelines for screening and surveillance for long term management
  –Lifelong endoscopic surveillance individualized to monitor for recurrence of metaplasia
  

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  Insulin Patch Pumps in Type 2 Diabetes

  Cristin Altendorf

  • DM is a leading cause of death in Americans

  • A HbA1c above 6.5% is diagnostic for DM because it is at this level the patient is at risk for retinopathy and other microvascular disease

  • The purpose of this study is to determine alternative methods of maintaining tighter control on HbA1c to lessen the effects of type II diabetes.

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  Oral Immunotherapy in IgE-Mediated Cow’s Milk Protein Allergy

  Jody Bauer

  Cow’s milk allergy prevalence in children has been increasing significantly over the last several decades. The diagnosis of a cow’s milk allergy (CMA) can occur through several methods such as signs and symptoms, double blind oral food challenge, skin prick testing, IgE and IgG4 serum levels. Currently, there are no treatments beyond strict allergen avoidance. The patient’s quality of life is impacted with the fear of inadvertent exposure resulting in allergic reactions that may be life threatening. Recent studies have explored desensitization to CM using oral immunotherapy (OIT), subcutaneous immunotherapy, and sublingual immunotherapy (SLIT). Research has found that desensitization will decrease the risk of allergic response to accidental exposures with the hope of lifelong tolerance to CM. The findings indicate means of successful desensitization, lifelong tolerance through maintenance regimens, and methods of increasing safety during desensitization.

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  Use of Donepezil in Alzheimer's Disease: Suggested Practice Guidelines

  Tamara Berg

  Alzheimer’s disease (AD) is the cause of 60-80% of dementia (2014 Alzheimer’s disease, 2014). AD is estimated to affect over 5 million people over age 65 in the US (2014 Alzheimer’s disease, 2014). With the onset of baby boomers reaching the age of 65 and increased longevity it is estimated that 16 million persons will have Alzheimer’s by 2050. Eighty two percent of persons with AD are over age 85. In 2014 AD is the 6th leading cause of death and the highest cost disease in the US. (2014 Alzheimer’s disease, 2014)

  The predicted increase in prevalence and incidence of Alzheimer’s disease and longevity of the disease represents an increased disease burden on families and society and a need for effective management over many years. The purpose of this study will be to determine the effect of donepezil, a cholinesterase inhibitor, at various stages of the disease compared to placebo and to determine the best clinical practice guidelines.

  The earlier the onset of donepezil therapy, the more significant effect is seen on preserving cognitive function and delayed nursing home placement. Persons at all stages (mild to very severe retain the ability to respond to donepezil. At end stage disease, it may be efficacious to discontinue donepezil.

  These findings indicate that health care providers need to improve the screening and early initiation of donepezil in the management of Alzheimer’s disease as well as monitoring benefits and harm at later stages of the disease.

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  Alpha Lipoic Acid: A Potential Therapeutic Option for Painful Peripheral Neuropathies

  Jessica Curcio

  • Peripheral neuropathy (PN) is a major public health concern.

  • There are many etiologies for PN including injury, infection, toxicity, genetics, metabolic disease and nutritional deficiencies.

  • Alpha lipoic acid (ALA), also known as thioctic acid, is a potent antioxidant and cofactor in many cellular metabolic processes.

  • Oxidative damage plays a significant role in the pathogenesis of both diabetic peripheral neuropathy (DPN) and chemotherapy induced peripheral neuropathy (CIPN).

  • Because of the antioxidant capability ALA has been studied for its potential benefit in preventing and treating PN

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  Migraine Prophylaxis with Petasites Hybridus

  Lena DeLuca

  • Petasites hybridus (butterbur) as an effective prophylaxis for migraine disorders. • Computerized literature searches were carried out in DynaMed, COCHRANE, EBSCO, CINAHL and MEDLINE.

  • The examination of literature will comprise of trials that evaluate Petasites hybridus extract Petadolex® in various dosages and placebo.

  • Petasites hybridus extract Petadolex® demonstrates a decreased frequency of migraine attacks and a greater improvement (>50%) after 3-4 month than placebo.

  • Further studies are indicated to investigate extract recommendation for dosing and duration of treatment in pediatric population.

  • Additional studies are required to confirm effectiveness and safety in long-time use before treatment with Petasites hybridus extract can be suggested as an alternative option for the prophylaxis of migraine.

  • Trials reviewed for this paper suggests that the patented Petasites hybridus extract Petadolex® is a safe and excellently tolerated treatment for migraine prevention.

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  Hypoglossal Nerve Stimulation Therapy in Obstructive Sleep Apnea

  Taylor Fontaine

  • Obstructive sleep apnea (OSA) is a disorder that results in loud snoring, gasping respirations, and excessive daytime sleepiness.

  • OSA also has the potential to progress to other significant diseases such as hypertension, diabetes mellitus, stroke, and pulmonary hypertension.

  • Continuous positive airway pressure (CPAP) has been the first line treatment for OSA since the early 1980’s. Unfortunately, despite the ability of CPAP to significantly improve symptoms of OSA, a large amount of patients struggle to comply with this treatment.

  • A new alternative treatment for OSA is hypoglossal nerve stimulation therapy (HGNS), resulting in an increase in muscle tone to the oropharynx, keeping the airway patent during inspiration.

  • This review of the literature will examine the efficacy and compliance rates of CPAP, as well as the safety and efficacy of HGNS.

  • Research found that there is in fact a need for an alternative therapy for OSA due to high CPAP noncompliance rates.

  • The findings also indicate that despite favorable outcomes in clinical trials, more research is needed to determine the prolonged safety and efficacy of HGNS surgery.

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  PFAPA: A Periodic Febrile Syndrome Afflicting Children

  Jessica Lahti

  • Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA).

  • Auto-inflammatory disorder occurring in affected children every 3-8 weeks.

  • Onset around age 2; lasting into second decade of life.

  • A current pathophysiologic theory is PFAPA is a disorder of the innate immune system involving interleukins, chemoattractants, and cytokines that stimulating the inflammatory response causing symptoms associated with PFAPA.

  • Early diagnosis of PFAPA may help prevent the unnecessary use of antibiotics.

  • Biomarker CD64, galectin-3 and the MPV may be useful in the diagnosis of PFAPA along with other laboratory values during the febrile attack period of PFAPA.

  • Traditional and current treatment of PFAPA is single dose of corticosteroids at onset of symptoms.

  • Treatment with tonsillectomy was found to have an 80% cure rate.

  • No statistical difference between corticosteroid and tonsillectomy treatments.

  • Treatment of PFAPA with antibiotics was found ineffective.

  • Treatment of PFAPA with vitamin D, was found by one study to have promising results.

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  Carotid Endarterectomy versus Carotid Stenting in the Treatment of Carotid Artery Stenosis

  Parker B. Martin

  • Carotid artery stenosis secondary to atherosclerotic plaque is a leading cause of CVA in the United States

  • Stenosis of the common carotid artery greater than 70% typically needs intervention

  • The purpose of this study is to determine which procedure will have the best long term outcomes and prevent re-stenosis of the carotid artery.

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  Treatment of Resistant Depression

  Brittany Michels

  • Depression is a common and debilitating disease complicated by comorbidities, medication side effects, limited alternative treatment options, and poor patient adherence.

  • Currently, clinical practice guidelines are available outlining the indications and treatment options for depression.

  • Discussion will involve pathophysiology of the disease process and possible treatments, such as pharmacotherapy, cognitive behavioral therapy and somatic therapy, including electroconvulsive therapy (ECT).

  • ECT is widely accepted as an effective treatment for severe refractory depression, but has a negative social stigma despite its effectiveness.

  • This paper has shown ECT remains the most effective treatment of severe refractory depression in adult patients, despite the negative reputation it holds.

  • Repetitive Transcranial Magnetic Stimulation (rTMS) will be also be discussed as a possible alternative to established methods of treatment.

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  Adolescent Idiopathic Scoliosis: Comparing and Contrasting Operative Versus Non-Operative Treatment Abstract

  Ethan Morris

  • Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. It affects 2-4 percent of adolescents aged 10-16 years. Although most adolescents diagnosed with scoliosis will not develop clinical symptoms, ten percent will progress and require medical intervention due to the potential for rib deformity and respiratory compromise as well as significant emotional distress due to aesthetic changes in appearance. Primary care providers should be prepared to evaluate and recommend treatment when idiopathic scoliosis is discovered or addressed by the patient. Three major factors that determine whether scoliosis will progress are patient gender, magnitude of curve on presentation, and patient’s growth potential. Treatment options include non-operative, such as observation, exercises, bracing, and electrical stimulation, as well as operative interventions including spinal fusion using a variety of rod implants. The review of literature explores studies that compare the non-operative and operative treatment options for AIS. It was found that non-operative therapy can be used as a comparable and preferable option to surgery for many AIS patients. The findings indicate that the AIS patient outcomes as well as criteria of each treatment option is determined by many factors, including; patient’s age, gender, maturity of the bone, presence of secondary complications, location and severity of the curve, psychological implications of a deformity, and the patient’s willingness to participate in treatment.

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  Acupuncture: A Comparison Study of Sham Acupuncture, Traditional Chinese Acupuncture and Current Practice Guidelines for the Treatment of Chronic Musculoskeletal Pain in Adults

  Kayla Olson

  • Chronic pain is one of the most difficult conditions to treat.

  ---Close monitoring of controlled medications

  ---Unnecessary, expensive surgeries

  • Alternatives to medication is increasingly necessary.

  • Integrative medicine incorporates traditional western medicine with unconventional therapies, such as acupuncture.

  ---Evaluate the treatments’ efficacy for chronic neck and back pain by evaluating meta-analysis studies and randomized controlled trials.

  • Physiology is a large component of understanding how and if the acupuncture works.

  ---Non-invasive functional magnetic resonance imaging

  ---Neurotransmitters and their response to acupuncture

  • Acupuncture therapy for improvement of chronic musculoskeletal pain

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  Adverse Cardiovascular Function Secondary to Inappropriate Exogenous Androgenic Anabolic Steroid Usage in Young Adult Males

  Nicholle Rothengass

  • In today’s society body image and athletic performance are emphasized and influenced by peers’ perception. The inappropriate use of AAS in young males has steadily increased over the past few decades. The purpose of this study is to determine the long-term effects AAS have upon the cardiovascular system. The review of literature will explore studies that identify long-term abuse of injected AAS, which are used by adult male athletes’ ages 18-40 compared to those equivalent male athletes who have never used any form of drugs or steroids and their effects on the cardiovascular system. The researcher plans to analyze the data of these studies to better determine how to diagnosis, detect and educate those patients who are susceptible to injury due to AAS usage. The research findings indicated that there is a direct correlation between AAS and young athletic males. Several research studies found a direct correlation between the usage of exogenous steroids and severe cardiovascular effects within the same age group of athletes. The data indicated that providers need to be aware of the increase in AAS users among the younger generation. With a strong emphasize on an athletic males ability to perform one sport to the highest level along with displaying an ideal body image that society demands has been found to have an increase in AAS abuse among this population. The identification and education of patients at risk for or who are abusing AAS is crucial to prevent irreversible cardiovascular events and/or dysfunctions from occurring secondary to abuse.

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  Implementing Animal Therapy into Current Medicinal Practices

  Jenna Schiefelbein

  • The purpose of this study was to explore an unconventional intervention of medicine; specifically the integration of animals into current healthcare practices.

  • The review of literature evaluated the implementation of animal therapy in medicine, both in the past and present.

  • It was demonstrated that incorporating animal-assistance therapy into modern day medicine had a positive correlation with overall patient health, pain control, and disposition.

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  Do Mouth Guards Prevent Concussions in Contact Sports?

  Lindsey Siemens

  • Concussion is one of the leading cause of traumatic brain injury in 13-22 year olds

  • The purpose of this study is to determine whether or not mouth guards provide protection from sports-related concussions in 13-22 year old athletes participating in contact sports

  • Which type of mouth guard is the most effective in preventing or reducing the severity of these injuries?

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  Pre-hospital Tranexamic Acid Use for Trauma

  Troy Thompson

  • Nearly 40% of deaths after trauma can be attributed to blood loss. It is well known that early surgical interventions, combined with other treatment modalities found in the hospital setting, lead to the decreased morbidity and mortality of trauma patients. However, in an outpatient setting, treatments for hemorrhage control are extremely limited.

  • The purpose of this literature review was to explore tranexamic acid (TXA) use as an option for hemorrhage control and to determine its effect on morbidity and mortality in both prehospital and outpatient settings. TXA is an FDA approved antifibrinolytic that has proven efficacy for hemorrhage control during many types of surgery and for conditions such as heavy menstrual bleeding. TXA acts on the normal processes of the body’s clotting cascade and promotes clotting, while preventing clot breakdown.

  • Data supporting the use of TXA in settings outside of the hospital has previously been limited. This literature review explored recently conducted studies that demonstrate the effects on morbidity and mortality of patients treated with TXA in setting outside of a hospital.

  • Evidence from information gathered further promoted the use of TXA in settings such as, EMS, battlefield medicine, and rural health care facilities in certain types of trauma. TXA administration reduced the morbidity and number of deaths from blood loss in the aforementioned settings.

  • The findings advocate for the addition of TXA into trauma protocols shows it will lead to a decrease in the number of deaths due to blood loss in trauma.

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  Effects of Saw Palmetto on Lower Urinary Tract Symptoms From Benign Prostatic Hyperplasia

  Michael Trimble

  • Benign prostatic hypertrophy (BPH) is common in older males and can cause lower urinary tract symptoms (LUTS).

  • Saw Palmetto, an herbal supplement, is normally implemented as an alternative medication to treat lower urinary tract symptoms associated with BPH.

  • The review of literature evaluated studies comparing the effects and outcomes of Saw Palmetto versus commonly prescribed medications such as antiadrenergic agents.

  • There are conflicting studies indicating Saw Palmetto’s efficacy on lower urinary tract symptoms and reduction of BPH.

  • Saw Palmetto has no side effects, and is available at a low cost when compared to prescribed medications for BPH.

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  Does Pharmacogenetics Play a Role in the Treatment of Type II Diabetes Mellitus?

  Lucas N. VanEmelen

  • Type 2 diabetes mellitus (T2DM) is a disease commonly presented in the family practice setting. Current therapies include one or multiple medications. Until recently, providers have used algorithms and medical expertise to control T2DM.

  • Pharmacogenomics is a branch of pharmacology dealing with genetic variation on a medication response in an individual patient to discover medication compatibility, efficacy or toxicity.

  • Analysis of genetic factors are still being discovered; however, this growing field may change the way medications are being prescribed for diabetes. This analysis investigated if pharmacogenetics is a useful tool for prescribing diabetic medications to T2DM patients. It was found that health care providers will be able to maximize therapy to those currently taking diabetic medication.

  • The goal would be to personalize the treatment of T2DM by ensuring compatibility of the medication being prescribed. Although many genes have been implicated in the response to diabetic medications, the findings indicate that health care providers can improve the quality of care of patients taking diabetic medications by choosing the correct diabetic medication for the individual patient.

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  Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection Antibiotic Prophylaxis Treatment Compared With Alternative Treatment Options

  Heather Watkins

  • Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infection, known as PANDAS, is a clinical diagnosis made after a child develops Obsessive Compulsive Disorder and/or ticks after a Streptococcal Pharyngitis. Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infection is diagnosed in children 3 years of age until 14 years of age. The purpose of this study is to determine if antibiotics versus selective serotonin reuptake inhibitor with cognitive behavior therapy versus prophylaxis with antibiotics should be used in the treatment of children who develops PANDAS. The review of literature will explore studies that compare current treatment options with new research and alternate treatment options. The researcher plans to analyze the data of these studies to better enhance treatment options for children diagnosed with PANDAS. The lack of knowledge and understanding of the diagnosis will allow providers to get a better understanding of the diagnosis and the best possible treatment. It’s anticipated that the best treatment for children diagnosed with PANDAS is antibiotic treatment for positive rapid strep test or positive Antistreptolysin O titers. The findings may indicate that health care providers need more education on PANDAS and treatment. Pediatricians along with mid-level providers should evaluate and diagnose any children with a positive ASO titer who has developed OCD with PANDAS. These children should be re-evaluated within four weeks to assess response to treatment.

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  The Efficacy of Electrocardiograms as a Screening Tool to Detect Cardiac Abnormalities in Young Athletes

  Cody William

  • Sudden cardiac death (SCD) among athletes can be attributed to increased cardiovascular demands associated with vigorous exercise.

  • The majority of athletes who experience sudden cardiac death are asymptomatic.

  • Pre-participation history and physicals, (H&P) help to identify underlying cardiovascular disorders with the potential to increase the risk of SCD in an athlete.

  • The efficacy of pre-participation H&Ps to identify underlying cardiac etiology has been debated.

  • The purpose of this research is to:

  ---Determine incidence and cause of SCD among athletes (Table 1).

  ---Determine the efficacy and evidenced-based criteria for the interpretation of ECGs in athletes.

  ---Evaluate cost-effectiveness of screening with ECG.

  • The findings indicate:

  ---Incidence of SCD is 1-3/100,000 athletes.

  ---The addition of ECG to the H&P improves sensitivity to 70% and specificity to 94.1% resulting in early detection of cardiac abnormalities and decreases the incidence of SCD.

  ---The refined criteria significantly reduces false-positive rates for ECG interpretation (p<0.0001).

  ---The ECG saves an additional 2.1 life years/1000 athletes screened at a cost of $88.

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  Proven Family-Based Interventions in the Treatment of Pediatric Obesity

  Sarah Winter

  • Childhood obesity continues to be ever expanding.

  • This is leading to increasing health care needs and costs.

  • Despite numerous interventions, the rates continue to climb.

  • The purpose of this study is to identify family-based childhood obesity interventions that are proven to decrease the rates of childhood obesity.

  • A literature review explores multiple different family-based childhood obesity interventions.

  • The effective interventions are examined closely to discover commonalities between the interventions.

  • Family-based interventions that decrease childhood obesity share similar attributes.

  • The proven interventions may indicate the need to focus coordination of care with the patients and their families.

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  The da Vinci Robotic Surgical Systems In Atrial Septal Defect Repair, Coronary Artery Bypass Graft and Mitral Valve Repair

  Randy Yergenson

  Historically, these cardiac interventions have been performed using partial or complete open sternotomy.
  1. Coronary artery bypass grafting (CABG)
  2. Atrial septal defect (ASD) repair,
  3. Mitral valve repair and/or replacement

  In 2000, the Federal Food and Drug Administration approved the use of the da Vinci Robotic Surgical System. Less invasive surgical option.

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  Weighing the Risks and Benefits of Radiation Exposure and Diagnostic X-Rays in Children

  Leah Costello

  The number of X-rays, specifically CT scans, performed on patients in the United States is increasing exponentially every year. Children are at most risk for long term damage from this increase in radiation exposure. This study explores how much risk children are being exposed to and how we can, as practitioners, make informed decisions about when or when not to order CT scans. The purpose of this paper is to provide practitioners the information needed to help patients decide if the long-term risks of cancer from medical radiation outweigh the potential benefit of diagnostic or therapeutic radiation. The review of literature looked at both sides of this question. Some researchers claim that the risk of radiation has been overblown and exploited by a news-hungry press. However, all the researchers report that there are real concerns about radiation dose and dose adjustments for pediatric patients. It was found that by reviewing the studies that have been performed, clinicians can reach a middle ground in which no unnecessary radiation exposure is allowed, but the use of extremely helpful diagnostic tools, like CT scan, are employed to diagnose and treat conditions as early in the disease process as possible.

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  Palivizumab Administration Decreases Recurrent Wheeze

  Shelly Daniels

  Children who have been infected with Respiratory Syncytial Virus have a higher incidence of wheeze-associated clinic visits and hospitalizations compared to children without previous RSV exposure. The purpose of this study is to determine if palivizumab, an immunoglobulin injection used to prevent RSV infections, can decrease the incidence of recurrent wheezing in children. The review of literature will follow male and female children from infancy to age 13 who were treated with palivizumab and compare these children to patients with similar demographics that were not treated with palivizumab to determine if there is any difference in incidence of wheezing. The anticipated results are that patients treated with palivizumab will have a decreased incidence of recurrent wheeze. The findings may indicate that prevention of RSV with palivizumab will improve long-term health in children.

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  Continuous Subglottic Suctioning of Intubated Patients in the ICU

  Dan Deutsch

  Ventilator associated pneumonia (VAP) is a common complication in mechanically ventilated patients. It causes substantial morbidity and mortality, as well as substantial cost to the patients and healthcare systems. One of the major risk factors identified for risk of VAP is the aspiration of secretions from the oropharynx. One intervention aimed at decreasing the incidence of secretion aspiration is an endotracheal tube (ETT) that can be hooked up to suction, providing continuous subglottic suctioning. The purpose of this paper was to explore the use of continuous subglottic suctioning and its effects on the incidence of ventilator-associated pneumonia. Review of literature explored studies including randomized control trials and metaanalyses that measured the effects of continuous subglottic suction on the incidence of VAP as well as length of time on ventilator. This information was utilized to determine if there is a statistically significant difference in the rates of VAP with continuous subglottic suction as compared to traditional oral care measures. The review demonstrated that there was a statistically significant decrease in the rates of VAP in ventilated patients that receive continuous subglottic suctioning.