Physician Assistant Scholarly Project Posters

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  Is Natural Family Planning an Effective Alternative to Hormonal Contraception

  Melanie Loehrer

  Natural family planning methods provide women with an opportunity to use natural methods to plan pregnancy. This is done through daily monitoring of symptoms and biomarker fluctuation in accordance with hormonal changes throughout the menstrual cycle to identify the fertile window. Through the identification of the fertile window and ovulation, one can determine appropriate days for sexual intercourse. This format allows participants to develop a greater understanding and in-depth knowledge of reproductive health to avoid or achieve pregnancy. The use of natural family planning has greatly increased over the last two decades, growing the demand for clinical practice in applicability and assurance of the efficacy of the methods as a reliable alternative to common clinical practices such as hormonal contraceptives.

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  The Effect of Metformin vs Lifestyle Modifications on the Prevention of Prediabetes to Type II Diabetes

  Brittany McPherson

  • Literature was performed using an electronic search database to identify literature related to preventing the conversion of prediabetes to type 2 diabetes.

  • Literature review looks at the effectiveness of metformin, diet alone, exercise alone, and a combination of diet and exercise.

  • Research shows that both metformin and lifestyle modification have been effective in reducing the progression of prediabetes to type 2 diabetes.

  • While lifestyle modifications appear to show greater benefit in the short term, their impact has shown to be less effective when studied in the long term.

  • Primary care treatment of prediabetes requires a collaborative plan between providers and patients to ensure adherence to the plan.

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  Benzimidazole Adjuvant Therapy: A Review of Efficacy and Safety in Patients with Cancer

  Jared Mouw

  • The safety and toxicity profile of benzimidazoles will be assessed within a population of patients currently diagnosed with various types of cancer to determine if this class of medications could be implemented along with current cancer treatment regimens to increase efficacy and tolerance. • Databases of CINAHL, ClinicalKey, and PubMed were searched with the keywords mentioned below. Studies include those after the year 2000, and those focusing on the use of benzimidazoles on human cancer cells and tissue, case studies, or all phases of clinical trials. Excluded were those using non-human study subjects, those before the year 2000, and those not applicable based on a population not being those with cancer resulting in 11 applicable studies available for this review. • Benzimidazole’s use in those with cancer is in its early stages of research. Many of these early-stage trials showed promise that benzimidazoles may have a place in these populations with possibly less severe side effects than conventional cancer treatments. • Additionally, safety and toxicity properties among those with cancer appeared to be similar to their use in those with helminth infections. Larger-scale clinical trials will be necessary to further understand the role benzimidazoles may have as antineoplastic agents.

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  Blood-Based Versus Stool-Based Biomarker Accuracy in Detection of Colorectal Cancer and Impact of Non-Invasive Tests on Patient Participation

  Allison Obritsch

  Colorectal cancer is a very treatable cancer when detected early, therefore patient adherence and colorectal cancer screening is key to decrease mortality. The purpose of this research and systematic literature review was to determine how the accuracy of blood-based and stool-based biomarkers compared in the detection of colorectal cancer and how noninvasive testing modalities influence patient participation in colorectal cancer screening. PubMed and Clinical Key were used as search engines. In terms of patient compliance and adherence, the studies comprehensively agree that non-invasive testing modality availability can increase patient participation in screening for colorectal cancer. While there was not significant data demonstrating the impact of participation when offering blood testing, various studies demonstrated that this modality is not well known by participants. Overall, MT-sDNA testing showed to be more accurate than SEPT9 in the detection of colorectal cancer and precancerous. Of note, SEPT9 did show similar performance to FIT, which is a current FDA approved screening recommendation, in the detection of colorectal cancer and precancerous lesions. Combination testing showed trends that when SEPT9 and FIT were used in combination, sensitivity was increased, however, this in turn decreased specificity of the testing. There were not currently studies available comparing the performance of SEPT9 and MT-sDNA performance alone versus in combination, hence, further research is needed in this area to fully optimize available modalities.

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  Corticosteroid Injection vs Therapy vs Combination for Rotator Cuff Injuries

  Rodney Guy Palmer Jr.

  Rotator cuff pathologies seen in a primary care setting ranks third for musculoskeletal complaints seen by primary care providers. Rotator cuff pathologies can cause significant dysfunction in activities of daily living (ADLs), work tasks, and daily life. Some current treatment recommendations are intra-articular steroid injections, therapy only rehabilitation, or the combination of the two. This literature review researched articles comparing the effectiveness of steroid only treatments, therapy only and the combination of the two. There was conflicting evidence regarding which treatment was the most effective. Significant side effects for steroid injections were discovered which included rotator cuff rupture. Therapy demonstrated improvements with range of motion and decreasing pain. There were studies demonstrating the positive effects of combination of the two when compared to steroid injection and therapy only groups individually. There was one study that showed no difference between all three interventions. Given this information further research is indicated before a definitive answer can be concluded on which treatment approach is superior for rotator cuff pathologies. This author recommends that if a patient is a possible surgical candidate to omit the steroid injection and attempt physical therapy with orthopedic referral. If the patient is not a possible surgical candidate, then the combination of steroid injection and physical therapy should be recommended.

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  The Effects of Food on Mood: Can symptoms associated with depression be improved by what you eat?

  Kaitlyn Prochnow

  The purpose of this research and literature review is to determine whether adherence to a Mediterranean diet or a plant-based diet has better effects on decreasing depression prevalence and/or symptom severity. A variety of keywords were used to search the online database, PubMed. Clinical trials and randomized controlled trials conducted within the last 20 years were included in the initial search. Exclusions were made if studies were not specific to Mediterranean or plant-based diets, or if they were focused on other psychiatric illnesses besides depression. For the final review, ten articles were selected. After thorough analyses and comparisons of the studies, it was concluded that adherence to a Mediterranean diet had superior benefits in both preventing depression onset and aiding in treatment of depressive symptoms. The current research regarding the effects a plant-based diet has on preventing and treating depressive symptoms is inconclusive. Some studies concluded that following a plant-based diet is beneficial in prevention and treatment of depression while others reported that the lack of animal products in a diet can actually increase risk of developing depression and/or worsen depressive symptoms. Further research must be done to clarify if a modern-day plant-based diet is beneficial or detrimental in the prevention and treatment of depression.

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  Chronic Exertional Compartment Syndrome: Surgical Treatment vs Conservative Care

  Molly Ruebke

  • Summary of Problem: Chronic exertional compartment syndrome (CECS) is a relatively rare pathology characterized by pain, tightness, and/or numbness in the affected calf upon performance of repetitive physical activity, most commonly with running or serving in the military. CECS usually has a delay in diagnosis due to low levels of awareness among clinicians and a wide range of differential diagnoses for chronic exertional leg pain. The natural course of CECS is often not self-limiting and therefore requires intervention, as symptoms can be severely debilitating and eventually force patients to avoid any provoking activity. The purpose of this literature review is to take a closer look at both conservative and surgical management of CECS and compare which has greater effectiveness in treating and relieving the symptoms associated with this chronic condition. • Research Methods: Search databases were used including PubMed, ClinicalKey, and SportDiscuss. Literature was deemed inclusive if the study focused on and evaluated treatment options of CECS, specifically fasciotomy or conservative care measures. Reference articles were thoroughly examined and chosen based on the ability to fit beneath one of three themes: decreased pain, patient satisfaction, and/or return to activity. All searches were narrowed to the past 25 years. • Findings: Overall, this literature review revealed the success of fasciotomy as a treatment option in patients with CECS. It showed that surgical intervention made a significant difference in pain level, patient satisfaction, and return to activity in patients as opposed to conservative care. It would be beneficial to utilize prospective randomized controlled trials in future studies to help with some of the noted study limitations, including overall small sample size, disproportionate sample size between surgical and conservative groups, and higher initial ICP values in surgically treated patients versus conservatively treated.

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  Perimenopausal Depression Screening and Treatment Efficacy Between Antidepressants and/or Hormone Replacement Therapy

  Mandy Stenehjem

  During perimenopause, women are at increased risk of depression due to complex and multifactorial factors, such as HPA axis dysregulation and fluctuations in hormones, like estradiol. Antidepressants are currently used to treat depression, but hormone replacement therapy may also have comparable antidepressant effects based on hormonal mechanisms. Perimenopausal depression is a unique subtype of depression and needs to be routinely screened by OBGYNs and primary care providers. The literature review found mixed results on the efficacy of HRT, antidepressants, and a combination of both; all treatments have shown promising benefits and specific screening may be needed to tailor treatment.

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  Aspirin vs. Pravastatin for Prevention of Preterm Delivery in Patients at Risk for Pre-Eclampsia

  Mary Weisberg

  This literature review is an examination of the use of low-dose aspirin therapy versus the use of pravastatin therapy to prevent preterm delivery in women at risk of developing preeclampsia. Preeclampsia is defined as new onset hypertension after 20 weeks of gestation with evidence of maternal organ or uteroplacental dysfunction or proteinuria. Preeclampsia is a serious condition that affects pregnant women and their growing fetuses which may lead to maternal or fetal demise. The Prevention of preeclampsia with the use of low-dose aspirin in the first 12-16 weeks is currently the mainstay of treatment for women with moderate to severe risk factors predisposing them to develop preeclampsia. This literature review looks at the use of low-dose aspirin therapy to prevent preterm delivery and the potential side effects of this therapy on the mother and fetus. Additionally, this review provides some insight into new clinical trials using HMG-CoA reductase inhibitors, specifically pravastatin, and the risk and benefits of this potential treatment option.

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  Impact of Circadian Rhythm on ADHD

  Tyson Williams

  The purpose of this research and systematic literature review is to determine if altering the circadian rhythm in people with Attention-Deficit Hyperactivity Disorder (ADHD) improves their symptoms. Up to 75% of people with childhood-onset ADHD exhibit a delayed circadian rhythm phase. This can cause difficulty in initiating and maintaining sleep, which in turn can cause excessive daytime sleepiness and further exacerbating ADHD symptoms, especially hyperactivity. Journal articles were searched in the databases of PubMed that concerned treatment aspects that would affect circadian rhythm and ADHD. Topics were further divided into themes that included melatonin, light therapy (LT), sleep hygiene intervention, and stimulant therapy effects. The search yielded 126 articles. Exclusionary criteria were articles dated prior to 2000, not concerning all aspects used in search criteria, additional comorbidities, or those that compared participants with ADHD and those without ADHD. A total of ten articles were reviewed. The current literature revealed that advancing the circadian rhythm had improvements to both sleep and ADHD symptoms (subjectively) even when the duration of sleep time was not increased. However, most patients that were poor sleepers prior to treatment continued to be poor sleepers with treatment. Establishing good sleep hygiene showed benefits to most patients and should be addressed prior to the diagnosis of ADHD or starting therapy. Studies revealed that it can take more than eight weeks on ADHD medication to see benefits to sleep, as medication would commonly have a negative impact to sleep initially. More research needs to be conducted in this area, as most studies had more males versus females, and several were short in duration

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  Effectiveness of Knee Joint Injury Treatments in the Prevention of Post-Traumatic Osteoarthritis

  Jenna Zaeske

  The purpose of this research and systematic literature review is to determine the effectiveness of conservative versus surgical intervention following anterior cruciate ligament (ACL) or meniscus injuries. Short and long term studies were evaluated to compare the prevalence and progression of osteoarthritis after joint injury. Sources included for review had research on ACL or meniscus injuries specifically. Other knee injuries, non-knee injuries and non-human subjects were excluded. After inclusion and exclusion criteria were implemented, 11 articles remained. Patients with ACL and meniscus injuries have a high prevalence of post-traumatic osteoarthritis (PTOA). Studies have shown that trialing physical therapy, specifically neuromuscular strengthening exercises, prior to surgical intervention greatly reduces the need for surgery, and that surgical intervention of ACL or meniscus injuries may increase PTOA prevalence due to additional joint injury. In other studies, surgical intervention of ACL injuries with or without formal physical therapy shows advantages in functional outcomes over physical therapy alone. However, patients with meniscus injuries are shown to have better functional and osteoarthritis outcomes when avoiding surgical intervention and opting for physical therapy instead. Keywords: Knee injury and Osteoarthritis Outcome Score, post-traumatic osteoarthritis, knee injury, osteoarthritis, outcomes, conservative treatment, and surgical intervention

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  Platelet-Rich Plasma vs Corticosteroids in OA

  Joshua Zetocha

  - Millions of people around the world suffer from degenerative joint changes due to osteoarthritis (OA). - Traditional treatment includes corticosteroid intra-articular injections. - Platelet-rich plasma (PRP) is an alternative option for OA. - In all studies evaluated, PRP had no major side effects. - Patients saw a reduction in pain and improvement of functionality with both PRP and Corticosteroids. - PRP patients reported improvement that lasted longer than corticosteroid therapy. - More studies are needed on specific concentrations of PRP. - Results may vary depending on the joint being treated. - Price is a barrier for many as insurance does not usually cover PRP injections.

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  Cholinergic Antagonist use and the risk of Developing Dementia in persons aged 65 years and olders

  Heidi N. Artz Schmaltz

  Anticholinergic medications cause a therapeutic or negative effect in the human body by blocking neuronal cholinergic receptors, thereby inhibiting the binding of acetylcholine in the central nervous system and the peripheral nervous system. These medications have short-term side effects including dry mouth, constipation, visual impairments, or delirium; however, research regarding the long-term side effects is limited. The purpose of this systemic literature review is to determine the correlation between prolonged exposure to anticholinergic medications and the development of dementia. The literature databases PubMed, Cochrane Review, Science Direct (Elsevier), and DynaMed were utilized in this review. Journal articles published within the years 2010-2020 were considered in the literature search. Only 11 journal articles qualified for this study by eliminating articles that did not specifically address a populationaged ≥65 years, use of anticholinergic medications, and symptoms including dementia, impaired cognition, or Alzheimer’s disease. The results of this review concluded the Anticholinergic Cognitive Burden and Anticholinergic Drug Scale were superior at quantifying the anticholinergic burden of anticholinergic medication exposure compared to other scales. Employing these anticholinergic scales, it was determined that individuals using a medication with a higher anticholinergic activity of 2 or 3 have been found to be at greater risk for developing dementia compared to those who are not taking them. An increased anticholinergic burden was also associated with a risk for fall. Further research needs to be conducted regarding the rating system of anticholinergic medications by medical professionals and how to accurately measure the cumulative effects of anticholinergic medications

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  The Role of the Gut Microbiome in Autoimmune Disorders

  Sierra Baxter

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

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

  Rebecca R. Beyer

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

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  Buprenorphine Versus Methadone for Opioid Use Disorder

  Ben DeVries

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

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

  Cherie Dowell

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

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  Ketamine in Refractory Asthma Exacerbations

  Stephanie Frentzel

  Asthma is a chronic, non-curable respiratory disease that has multi-factorial effects on the bronchial mucosa. Despite optimal prevention and standardized first line asthma care the symptoms can deteriorate leading into an asthma exacerbation which is a medical emergency. Purpose:

  • To determine the efficacy of ketamine use as an adjunctive medication for acutes severe asthma exacerbations that had failed standard guideline directed treatments. Methods: • Relevant databases were searched looking for ketamine use in asthma exacerbations.

  • The inclusion material consists of pediatric and adult populations in available systematic reviews, randomized control trials, meta-analysis, pilot studies, case reports, and peer-reviewed journal articles. Findings:

  • Preliminary results showed no positive outcomes of improvement in asthma symptoms with low dose ketamine.

  • Several findings point to noteworthy positive outcomes with an intravenous ketamine high dissociative dosing administration.

  • In a small case report the use of nebulized ketamine showed promise at reversing the airway obstruction promptly. Implications:

  • Some experts feel strongly that the dose ranges and duration of treatment play a key role into the efficacy of ketamine used as a pharmacological option.

  • More research is needed with larger, high quality, randomized studies that addresses and objectively measures varying dosage regimens to form a consensus on the efficacy of ketamine use in refractory asthma exacerbations.

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  Treatment of MOSH and the Effects on Fertility

  Julie Harmon

  Male obesity-related secondary hypogonadism (MOSH) is often underdiagnosed in the young male population.

  The current standard of care for hypogonadism in the older male population typically includes testosterone replacement therapy (TRT).

  • The purpose of this study is to highlight available treatment options for MOSH in the younger population and the various effects on fertility.

  • The method utilized was a systematic review of the current literature that targeted studies of obese males below the age of 65 treated for secondary hypogonadism.

  • This review highlights some of the current recommendations, including lifestyle changes, and compares the use of TRT and selective estrogen receptor modulators (SERMs) and the effects on reproductive health.

  • Promisingly, SERMs were found to be more protective of sperm production than traditional testosterone replacement.

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  Comparison of Traditional Management of Heart Failure with CardioMEMS

  Quinn Jacobs

  The purpose of this research and literature review is to compare the efficacy of the implantable pulmonary artery pressure monitoring device, CardioMEMS, to traditional heart failure management in terms of reducing hospital readmissions. The data bases of Cochrane Library, PubMed, Clinical Key, and DynaMed Plus were utilized. Because the CardioMEMS device is relatively novel in the treatment of heart failure, the time frame of search results was expanded to 10 years to include research from the original clinical trials. A total of 17 peer reviewed works were chosen for this review which included meta-analyses, systematic reviews, randomized controlled trials, and longitudinal studies. Current literature indicates that the CardioMEMS device promotes earlier detection of worsening congestive heart failure than traditional management methods. Earlier detection of increasing pulmonary artery pressures allows for earlier corrective interventions, making CardioMEMS more effective in reducing heart failure related readmissions. The data also indicates that the device is cost-effective as well. However, CardioMEMS may not be appropriate or cost effective for patients with end stage heart failure or limited life expectancy. Additional studies are currently underway to examine the efficacy of the CardioMEMS device in a broader range of patients as it is currently only FDA approved for New York Heart Association class III heart failure patients

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  Comparison of Oral Glucose Tolerance and Hemoglobin A1c as an Initial Indicator of Type 2 Diabetes

  Shelby Knox

  The purpose of this review was to evaluate the diagnostic utility of hemoglobin A1c (HbA1c) compared to oral glucose tolerance testing (OGTT) for diagnosis of type 2 diabetes. Databases ClinicalKey, PubMed, Dynamed, and CINAHL withdrew a total of 17 peer-reviewed cross-sectional and retrospective studies, secondary and pooled data analyses, and meta-analyses. Inclusion criteria included human studies, studies < 10 years old, individuals > 15 years of age, fasting plasma glucose in conjunction with OGTT, and subjects without known diabetes. Exclusion criteria included alternative forms of diabetes, screening and diagnosis of prediabetes, comparisons in relation to specific medical conditions such as heart disease, pregnancy, and gestational diabetes, prior diabetes diagnosis, and children <15 years old. Discrepancies with sole utilization of HbA1c when used to screen and diagnose type 2 diabetes mellitus were found when compared to OGTT standards. Current literature proposes>race, gender, age, and obesity may be related to inaccurately low HbA1c compared to OGTT standards in patients who have not been diagnosed with diabetes. Of those, race and metabolic profiles appear to have the greatest impact in reduction of HbA1c’s sensitivity. An alternative to sole utilization of HbA1c may be increasing utilization of OGTT, especially in those with risk of erroneously low HbA1c and high risk for type 2 diabetes. Longitudinal data is needed to strengthen findings noted in this literature review

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  P.M. DOSING OUTCOMES OF ACE INHIBITORS OR ANGIOTENSIN II RECEPTOR BLOCKERS IN HYPERTENSION VERSUS P.M. DOSING IN HYPERTENSION WITH COMORBIDITIES

  Savana Kramer

  • Introduction: The purpose of this research is to compare P.M. dosing outcomes of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in those with hypertension and hypertension plus chronic kidney disease or diabetes.

  • Research Methods: Three databases were searched including PubMed, ClinicalKey, and DynaMed with a time frame of 15 years. Studies chosen for review were peer reviewed, and included randomized control trials, systematic reviews, meta-analyses, and a preclinical animal trial.

  • Discussion: The research shows evidence of reduced blood pressures throughout the night and into the next day, decreased proteinuria, and decreased cardiovascular events when dosing ACE inhibitors or ARBs at night, or dosing at least one antihypertensive medication at night. This research shows beneficial evidence and no documented adverse patient reactions when dosing ACE inhibitors or ARBs at night. However, further research needs to be conducted with larger patient populations to make official recommendations in those with hypertension and hypertension plus diabetes or chronic kidney disease.

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  Effects of Phototherapy in Patients with Atopic Dermatitis

  Stephanie Krogen

  Atopic dermatitis is a chronic remitting problem faced by many people in our communities of all ages. Atopic dermatitis (AD) presents as an erythematous and pruritic rash. There is no cure, only treatments that help alleviate symptoms. The purpose of this literature review is to help determine the best course of action for treatment for patients who suffer from AD. Phototherapy has been growing in popularity and research as an alternate treatment to systemic and pharmacologic therapies. This review was done using PubMed, Clinical Key, DynaMed, and Cochrane. Studies were included that reviewed the side effects and efficacy of each treatment option, as well as evaluated patient preference and adherence to treatment. There were also meta-analyses used that compared studies done on various treatment modalities safety and efficacy that were included. There were no restrictions on date of articles that were included. The review showed that phototherapy is an effective option to treat symptoms of AD but should be reserved as a second line option after a patient has tried and failed topical therapy. Systemic pharmacologic therapies are also considered a second line option. Systemic therapies have a greater side effect profile than phototherapy does. Phototherapy has been shown effective, but long term it is better and more sustainable to use systemic pharmacologic options to treat and control AD.

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  Active Therapies in the Management of Concussion and Post-Concussion Syndrome

  Breanna R. Krueger

  The purpose of this research and literature review is to evaluate the recently completed literature to provide guidance to medical providers in the safest and most efficacious treatment options for adolescent patients with concussion and post-concussion syndrome. The literature was searched for studies directly related to adolescents and active therapies such as physical therapy, vestibular rehabilitation, exertional therapy, and cognitive behavioral therapy. The search time frame implemented was studies completed within the last ten years. Ten studies met the final criteria. The research shows a substantial benefit for immediate cognitive and physical rest following a mTBI. The research suggests that 24-48 hours of immediate cognitive and physical rest provides the most benefit for patients. In addition, the research reviewed has shown that earlier implementation of active therapies such as aerobic exercise, physical therapy, and cognitive behavioral therapy can benefit patients recovering from a mTBI and those with post-concussion syndrome.

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  Invasive Needling Therapy for Myofascial Pain Syndrome

  Katelyn Krueger

  Myofascial pain syndrome (MPS) is one of the most common musculoskeletal conditions characterized by tight bands of fascia and muscle fibers known as myofascial trigger points (MTrP’s). Empirical evidence suggests that deactivation of MTrP’s is best accomplished with invasive needling therapy such as dry needling, trigger point injections (TPI’s), and botulinum toxin (BTX-A) injections. The objective of this systemic review is to compare the efficacy of various needling therapies on pain intensity and additionally determine if ultrasound guidance and obtaining an LTR improves clinical outcomes. A comprehensive search of five databases including PubMed, Science Direct, Google Scholar, Cochran, and CINHAL was completed using a variety of key terms. The 15 selected studies were peer-reviewed and included randomized control trials, pilot studies, quasi-experimental studies, retrospective cohorts, systemic reviews, and meta-analysis. Research suggests that all three therapies are effective for decreasing pain intensity associated with MPS, however, superiority is inconclusive. Dry needling and local anesthetics have similar short-term efficacy and are best indicated for treating regions of the shoulder and cervical muscles. Analgesic effects of BTX-A are delayed but tend to be longer-lasting and are more effective when treating regions of highly active muscles. Ultrasound guidance improves clinical outcomes by reducing localization errors and adverse events. Obtaining a local twitch response (LTR) inconsistently correlates with short-term pain relief but is not dependent upon it