Physician Assistant Scholarly Project Posters

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  The Impact of Hormone Therapy on Cardiovascular and Bone Health in Women with Premature or Early Menopause

  Traci L. Leitheiser

  Objective: • The Women's Health Initiative (WHI) studies were a catalyst for the dramatic decline in the number of postmenopausal women being prescribed hormone therapy (HT). • The WHI published the largest randomized, double-blind, placebocontrolled trial regarding the use of HT in postmenopausal women with a mean age of 63 years. • One group of women thought to benefit from HT but have often been denied HT based on the WHI studies’ results is premature and early menopausal women. • The purpose of this literature review was to compare the WHI studies’ results to studies that reviewed coronary heart disease (CHD) benefits, bone health benefits, and risks of HT in premature and early menopause.

  Methods: • Articles published in the last 22 years were initially incorporated to include the WHI studies. • Articles were then further eliminated if they did not discuss CHD or osteoporosis in postmenopausal women less than the age of 45 years.

  Results: • This literature review recommends individualizing the use of HT in premature and early menopausal women by evaluating their risk factors and performing a thorough review of their family history. • Further randomized controlled trials and longitudinal studies need to be completed specifically on premature and early menopausal women to confidently substantiate the benefits of HT in the prevention of chronic diseases.

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  Effectiveness of Diet/Exercise in Prevention of Gestational Diabetes Mellitus and Associated Cesarean Section Delivery

  Jonathyn Marx

  Gestational diabetes mellitus (GDM) is becoming a more common diagnosis during pregnancy. GDM is defined as glucose intolerance diagnosed during pregnancy. Women diagnosed with GDM during pregnancy are at an increased risk for emergent or planned cesarean section delivery and the development of overt diabetes mellitus post pregnancy. Complications related to GDM include eclampsia, macrosomia, shoulder dystocia, stillbirth, and cesarean section delivery. Initial treatment consists of diet and exercise and if glucose can not be controlled then pharmacotherapy is introduced. A literature review was performed utilizing scientific databases, mesh terms, and keywords to gather statistically relevant research to analyze the effects of diet and exercise on the prevention of GDM and cesarean section delivery. Studies that met criteria for inclusion analyzed the effects of diet and exercise individually, as well as, combined on GDM prevention and cesarean section delivery. The current data available indicates that exercise is safe during pregnancy and when combined with diet prove beneficial in prevention of GDM and cesarean section delivery

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  Efficacy of Pharmacologic Treatment for Orthostatic Hypotension in the Elderly Population

  Abigail Moeller

  The purpose of this literature review is to determine the efficacy and safety of pharmacologic treatments for orthostatic hypotension (OH), with an emphasis on researching the elderly population. In this review, three electronic search databases were utilized including PubMed, Google Scholar, and Dynamed from the years 1997 to 2019. Several keywords were used during the search. The specific pharmacologic agents researched for the treatment of OH included midodrine, droxidopa, pyridostigmine, and fludrocortisone. Although midodrine is the most researched and utilized pharmacologic treatment of OH, this drug may not be the best option when it comes to treatment in the elderly population due to an increase in supine hypertension. Pyridostigmine in combination with low-dose midodrine was found to be effective in relieving OH symptoms without increasing supine hypertension, but this evidence is based on limited randomized trials. More research is needed in order to evaluate the efficacy and safety of these pharmacologic measures in the treatment of OH specifically in the elderly population and over a long period of time.

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  Effect of a Ketogenic Diet on Glycemic Control in Type 2 Diabetics

  Steven Moore

  With the increasing rate of patients diagnosed with type 2 diabetes mellitus (T2DM) and the serious complications associated with this disease, there continues to be controversy surrounding the most effective way to manage glycemic control in this population. The intention of this meta-analysis is to determine the effect of a ketogenic diet as a first-line treatment option on glycemic control in type 2 diabetic patients. Effectiveness was determined by comparing the ketogenic diet to other popular diets recommended to diabetics by practitioners following guidelines set forth by the American Diabetes Association. Several high-quality studies were selected utilizing PubMed, Dynamed plus, Cochrane Library, CINAHL, and Clinical Key databases with keyword and MeSH terms to narrow search results. These studies provide data of the diet's effects on HbA1c along with other parameters such as body weight, lipids, blood glucose levels of which can increase the risk of complications and associated diseases in T2DM patients. According to several studies, initiation of a ketogenic diet does not improve health parameters more than the current recommended diets for T2DM patients. With multiple diet plans providing health benefits in type 2 diabetics, the main component of success was adherence. The research does show promise, but the treatment plan will need to be individualized based on the patient’s readiness and willingness to implement lifestyle changes.

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  Comparative Research of Effective Treatment Measures for Postpartum Depression

  Aunica Novacek

  Postpartum depression is a mood disorder that includes depressive symptoms during the time period following childbirth. There are various possibilities for what may cause this disorder, but the drastic change in hormones after delivery can play a role. With the chance this disorder may be fatal to both the mother and child, an appropriate, effective, and safe treatment is necessary to control depressive symptoms. The standard, first line pharmacotherapeutic option is a selective serotonin reuptake inhibitor (SSRI) antidepressant. SSRI antidepressants are well understood, but these medications may take time to become effective. Knowing this, medical professionals can find a more rapid option that would be appropriate; thus, hormone replacement therapy is an alternative. In this review, numerous scientific databases were evaluated, including PubMed, Cochrane, and DynaMed. Keywords and mesh terms were searched to obtain a total of 384 studies. After various exclusion criteria were evaluated, a final total of 19 research articles were included. The results of this literature review showed that both treatment options of SSRI antidepressants and hormone replacement therapy are effective, and various side effects, risks, and contraindications are present with both therapy options. Currently, Brexanolone, an endogenous hormone, is the only FDA approved indicated medication for postpartum depression. Clinically, psychotherapy and SSRIs are used as first line options. Further research is necessary to evaluate the effectiveness and possible adverse effects with all options of antidepressants, hormone replacement therapy, and the possibility of a bridge therapy to decrease depressive symptoms.

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  Integration of Palliative Care in Chronic Obstructive Pulmonary Disease Management

  Christina Rasanen

  The purpose of this scholarly project is to determine if the integration of palliative care (PC) into COPD management provides an improvement in symptom burden associated with quality of life and end of life care when compared to the standard of care. A review of the literature was performed using the following electronic databases, and the use of keywords and mesh terms were used to define the set of literature that would be critically analyzed. A total of 16 articles achieved the necessary criteria for review and critical assessment. The literature reviewed various aspects related to symptom burden and symptom management associated with the disease, advanced care planning documentation, integration of palliative home care, and challenges surrounding integrating palliative care into standard care plans. The data shows that there was little statistical support for integrating palliative care to improve quality of life through more appropriate management of symptom burden associated with the disease. The literature did find support for the addition of palliative home care for improvements in advanced care planning. The scholarly project concluded that more research is needed to truly assess if palliative care has increased benefits in COPD management because there continues to be challenges that surround the integration of this specialty.

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  Comparison of Functional Capacity and Outcomes of Patients with Rotator Cuff Injury: Surgery Versus Non-Invasive Methods

  Brian Schiller

  Rotator cuff tears are acute or chronic tears of one or more of four specific muscles that encompass the glenohumeral joint. These tears can cause pain, decrease range of motion, and affect an individual for many years if not treated appropriately. The purpose of this literature review is to assess the most appropriate means of treatment between surgery, physical therapy, and injection therapies. The literature review was performed using electronic search databases CINAHL, PubMed, Clinical Key, Cochrane Library, Embase, SPORTDiscus and Research Gate.Studies were included if they directly evaluated the efficacy of surgical rotator cuff methods, physical therapy, corticosteroid injections, mesenchymal stem cell injections, or platelet rich plasma injections. Studies were excluded if they compared different variations of repairs (single row versus double row, etc.). Other non-operative methods of treatment including acupuncture, alternative therapies, or experimental solutions were also not considered. No anecdotal reports or single case studies were included. Studies were narrowed down by currency, only taking literature from 2015 to current date. The review showed that there are specific variables to consider that will aid in which management route will be most effective. Age, tear size, and patient activity level are three factors which influence outcomes. Conservative measures in chronic rotator cuff tear cases are first line, these include physical therapy and corticosteroid injections. If these therapies fail, then surgery is warranted and is an effective treatment for this injury.

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  Effect of CFTR Modulators on Respiratory Function in Adults with Cystic Fibrosis

  Melissa Severson

  CysticFibrosis(CF)isanautosomalrecessivedisorderthatshortensone’slifeduetoitseffectonthecysticfibrosistransmembraneregulator(CFTR)gene.CFTRmodulatormedicationscancorrecttheCFTRgeneandconsistofapotentiator(ivacaftor),andcorrector(lumacaftor,tezacaftorandelexacaftor).ThisresearchandliteraturereviewsoughttoevaluateiflungfunctionimprovedinanindividualwithgeneticallyconfirmedCFafterbeingstartedonCFTRmodulatormedications.Tocompletethereview,sixdatabasesweresearched:CINAHL,PubMed,ClinicalKey,CochraneLibrary,EmbaseandDynamedPlus.BothkeywordandmeshtermswereusedtodefineasetoftheliteraturediscussingCFandCFTRmodulatoruse.Atotalof24studieswereincludedandmettheinclusioncriteriaof:peerreviewed,publishedwithinthepastsixyears,greaterthan20studyparticipants,andwerenotlimitedcasereports.Phase2studieswereincludedforelexacaftor-tezacaftor-ivacaftorandtezacaftor-ivacaftor,duetolimitedresearchinthisarea.Researchindicatedthativacaftorimprovedpercentpredictedforcedexpiratoryvolumeinonesecond(ppFEV1)inindividualswithG551D,non-G551Dgatingmutations,Gly-Asp-CFTRandARG117HISmutations.Elexacaftor-tezacaftor-ivacaftorimprovedppFEV1inheterozygousandhomozygousPhe508delgreaterthanivacaftororlumacaftor-ivacaftor.Ivacaftorandlumacaftor-ivacaftormayhaveagedependentchangesonppFEV1.IndividualswithppFEV1<40%appeartohaveapositiveresponsetotreatment,howevertheymayhaveincreasedsideeffectsandresponsemaybedelayed.Additionalresearchisneededonagedependent,longitudinalresponse,andefficacyoftreatment.

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  Decreasing Suicidal Risks among Military Veterans with Posttraumatic Stress Disorder or Major Depression

  Manpreet k. Sheabat

  Suicide is a major cause of death in US. Military personnel are at a higher risk of committing suicide compared to the general population. The risk is exacerbated by Posttraumatic Stress Disorder (PTSD) and major depression.

  • Few reviews have explored the effects of the recommended psychotherapeutic interventions on suicidal ideations and suicide rates for these two disorders, focusing on the veteran population. To address this, a literature search was performed through electronic databases to identify appropriate journal articles.

  • Treatment with CPT and PE for PTSD has been found effective in decreasing suicidal thoughts, intents, and attempts. On the other hand, CBT has been found effective in decreasing suicidal thoughts among veterans with various symptoms of depression. It is important for clinicians to always assess the risk of suicide for veterans diagnosed with these conditions.

  • Future research should seek to explain the mechanism by which the explored psychotherapeutic interventions decrease suicidal thoughts, intents, and attempts in patients with PTSD or depression

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  Comparison of Conjunctive Probiotic Use Versus No Probiotic Use in Outcomes of Antibiotic-Associated Diarrhea

  Samantha simley

  Antibiotics are utilized in the medical community for the treatment of bacterial infections. Consequently, the use of antibiotics may result in certain gastrointestinal side effects. Antibiotic-associated diarrhea is one side effect that can be seen in patient populations that are on an antibiotic regimen. Due to this side effect profile, patient compliance on an antibiotic regimen may be compromised. This lack in patient compliance led to increased interest to determine if there are treatment options available to prevent or reduce instances of antibiotic-associated diarrhea. One treatment option of interest includes the use of probiotics. The purpose of this literature review is to determine if conjunctive use of probiotic supplementation during an antibiotic regimen demonstrates protective effects in preventing or reducing the instance of antibiotic-associated diarrhea. Studies that were included analyzed probiotic use versus a placebo in treatment of antibiotic-associated diarrhea in pediatric, adult, and elderly populations in an outpatient or inpatient clinical setting. The data available at this time suggests that supplementing with probiotics during an antibiotic regimen may be effective in prevention and reduction of antibiotic-associated diarrhea in pediatric and adult populations

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  The Efficacy of Testosterone Replacement vs Aromatase Inhibitors and SERMs in the Presence of Hypogonadism

  Tobias C. Steen

  The prevalence of male hypogonadism increases with age, although it can occur in any age group. Patients with hypogonadism can experience a wide range of symptoms, including mood changes, decreased libido, decreased muscle mass, erectile dysfunction, and bone loss. Most men with hypogonadism are commonly treated with testosterone replacement therapy (TRT). While TRT has proven effective at attenuating the symptoms of hypogonadism, it is not without side effects. TRT can be expensive, painful, cause gynecomastia, acne, water weight gain, and infertility. Recently, medications such as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) have gained favor as alternative treatments for secondary hypogonadism. After a thorough literature review that included searches of Clinical Key, Dynamed Plus, Cochrane Library, PubMed, and CINAHL databases, multiple studies were reviewed to determine the aforementioned treatment modalities' effectiveness. Works chosen for the review were published after 2007 and included randomized control trials (RCTs) and metanalyses. After all exclusions, this literature review included 9 journal articles. The literature review results discovered that TRT and SERMs are efficacious at raising testosterone levels, improving libido, lean muscle mass, strength, and endurance. SERMs appear to have one advantage over TRT in that they preserve male fertility. The efficacy of the co-administration of AIs and TRT results lacked enough evidence to determine its efficacy. With the addition of off-label therapies such as SERMs, providers can customize a treatment plan for their patients that provides a continuous steady level of testosterone while preserving fertility with the same benefits as TRT.

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  Childhood Obesity: Adding Metformin to Lifestyle Modification for Weight Reduction

  Kelli Strege

  One of the most challenging health conditions primary care providers face is combating the ever-rising incidence of obesity, especially among children. The objective of this literature review is to determine the effects of metformin implemented in addition to lifestyle modification for the treatment of childhood obesity. Efficacy, to include change in weight, BMI, insulin resistance, and overall safety of metformin was studied. The online databases searched in this review were PubMed, Cochrane Library, Embase, and CINAHL. Literature chosen for review included randomized control trials, meta-analysis, and systematic reviews published between 2015 and 2020. Much of the studied research indicates positive effects of metformin for weight loss when added to a structured lifestyle modification plan, however, improvement in insulin resistance remains controversial. Safety analysis reveals metformin to be mostly well-tolerated among pediatric patients, with known gastrointestinal side effects being the most common adverse event. While some current research exhibits promising results for weight management, more research must be done to determine the most effective dose and treatment program length.

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  Comparing Outcomes of Online Application Therapy Versus Standard Psychotherapy in Patients Suffering from Mental Illness

  Jenna Zwiers

  The purpose of this research was to determine the effectiveness of internet-delivered cognitive behavioral therapy (iCBT) in comparison to standard cognitive behavioral therapy in the treatment of depression and anxiety. The quality, safety, therapist-response, and cost of internetdelivered cognitive behavioral therapy was also studied. This review utilized multiple databases including PubMed, CINAHL, Clinical Key, Cochrane Review, and PsychINFO from 2015 to 2020. The literature reviewed consisted of peer-reviewed studies, randomized controlled trials, and systematic reviews. Sources that were excluded from the study included those prior to 2015, studies with small sample sizes, and those that involved children. Thirteen resources were selected for review. Much of the research suggested that iCBT is as effective as standard face-to-face therapy. Many authors thought it would be most useful as an adjunct to standard therapy which could ease accessibility issues. Other factors in considering the use of iCBT include therapeutic alliances, costeffectiveness, and the varying qualities of the many different options. Internet-delivered cognitive behavioral therapy could be a viable alternative for cognitive behavioral therapy, but further research is needed.

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  The Effects of Initiating Metformin, to Prevent or Delay Type II Diabetes, in Patients with Prediabetes

  Kelsey K. Abraham and Jeanie McHugo

  The purpose of this literature review is to explore metformin’s role in the treatment of patients with prediabetes within the primary care setting. The efficacy of metformin versus lifestyle modifications will be compared as well as metformin, as adjunctive therapy, to lifestyle modifications. Along with efficacy, a systematic analysis will examine the three above mentioned therapies regarding diabetes risk reduction. Lastly, this review will examine the safety and tolerability of metformin, specifically in patients with prediabetes. The data presented shows evidence that lifestyle modifications are first line treatment for prediabetes while metformin use should be reserved for those who fail lifestyle modifications or are considered to be high risk and/or patients that have shown more effective results with metformin therapy: BMI ≥ 35 kg/m 2 , patients less than 60 years old, and women who have a prior history of gestational diabetes mellitus. Decades of research show that metformin is an effective and safe treatment option for patients with prediabetes. However, the combined efficacy of lifestyle modifications and metformin use in prediabetic patients needs to be further studied to find out why additive benefits are not demonstrated.

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  The Gut-Brain Axis: Treating Depression Through Microbiome Alterations

  Alexandria Bachman-Williams

  • The purpose of this study is to explore the role of gut microbiome alterations in the treatment of anxiety and depression. • There are multiple pathological pathways that lead to the development of anxiety and depression. • Research shows a link between pathologic bacteria and low grade inflammation. This causes a disruption of neurotransmitters that are current targets of pharmacological treatment of depression and anxiety. • Transfer of “pathogenic” bacteria caused increased symptoms of anxiety and depression. • Treatment with probiotics and “protective” bacteria showed decreased BDI scores and improved symptoms. • Studies were small but show need for further research

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  The Effect of Proton Pump Inhibitors on Normal Gastrointestinal Flora Leading to Weight Change

  Emi L. Binstock

  The goal of this literature review was to determine what effects proton pump inhibitors (PPIs) have on the normal gastrointestinal (GI) flora and how that may lead to weight loss or weight gain. A literature search was performed using the database PubMed. Only articles from the last ten years (2009-2019) were included in this review. Keywords used in the search are listed below. After exclusion criteria was applied, 30 articles were relevant and used in this review. Five themes were identified in the literature review. An investigation of normal GI flora associated with weight loss and weight gain identified a common conclusion that the ratio of Firmicutes to Bacteroidetes was higher in obesity. The investigation of PPIs effects on the normal GI flora was less conclusive; however, a common finding was an increase in Streptococcaceae (phylum Firmicutes), which can commonly be found in the oral cavity. This finding suggests that oral flora may have a greater survival rate in lower parts of the GI system with treatment of PPIs due to the decreased gastric acidity. The final investigation, which looked into the association between PPI use and weight change revealed a greater likelihood that PPIs will cause weight gain with four studies supporting weight gain and two studies supporting weight loss. Alternative treatments such as H2 receptor antagonists, laparoscopic Roux-en-Y gastric bypass, probiotics, and lifestyle management were also explored. Although further research needs to be completed, it appears that PPIs are associated with an increase in Streptococcaceae of the phylum Firmicutes, which has been linked to weight gain.

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  Efficacy of Bariatric Surgery Compared to Non-Surgical Treatments for Morbid Obesity

  Erica Donovan

  The purpose of this research is to show the efficacy of Roux-en-Y gastric bypass and sleeve gastrectomy as compared to traditional diet and exercise models. Finding ways to combat morbid obesity has resulted in invasive surgical techniques because traditional diets and exercise work infrequently and often fail. Systematic reviews, metaanalysis, randomized controlled trials and retrospective studies were found using the data base of CINAHL, SportsDiscus, PsycInfo, Embase, and PubMed. All of the studies were published no later than 2014 and used human adult subjects ages 19-65. The studies reviewed show that bariatric surgery is a safe and effective obesity treatment with low risk of post-operative complications and mortality related to surgery. The reviewed studies find that patients who undergo the Roux-en-Y gastric bypass can lose 80% or more of excess weight and those who undergo sleeve gastrectomy can lose 60% or more of excess weight. The data supports that the bariatric surgeries discussed here help people maintain weight loss for up to ten years.

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  Use of Marijuana in Those with Anxiety and Depression

  Heather Flaa

  The purpose of this research and literature review was to compare the use of marijuana to SSRIs in reducing anxiety and depression symptoms.

  • This literature review searched databases Cochrane, PubMed, Clinical Key, PsycINFO, and DynaMed Plus from the year 1990 and on. Keywords: cannabis, marijuana, anxiety, generalized anxiety disorder, depression, and selective serotonin reuptake inhibitors.

  • Many meta-analyses show SSRIs continue to be first line treatment in those with anxiety and depression in reducing symptoms.

  • Patients with marijuana use showed an increased odds ratio of developing anxiety and depression or increasing symptoms in several studies.

  • No studies that examined marijuana use were randomized controlled studies. As well as having many limiting factors.

  • Overall, more well-controlled longitudinal studies are needed to form a complete association between marijuana and its effects on anxiety and depression.

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  Cannabis Effectiveness on the Motor Symptoms of Parkinson’s Disease

  Austin Fridrich

  Fueled by news media reports, cannabis use has been ever growing in popularity for the treatment of both motor and non-motor symptoms of Parkinson’s disease (PD). The purpose of this literature review is to evaluate the safety and efficacy of using cannabis to treat the motor symptoms and levodopa-induced dyskinesia of PD. In this literature review electronic databases were searched and included PubMed, CINAHL, Embase, DynaMedPlus, Cochrane Library, Academic Search Premier, and Clinical Key. A variety of keywords and mesh terms, as listed below, were used to define a set of literature. There were 16 studies chosen for review that were completed within the last 20 years, included only human subjects, and were excluded if it was a case study with only one subject. Much of the research displayed discrepancies on the evidence for cannabis use to treat the motor symptoms and dyskinesia of PD; however, a large amount of the research deems cannabis safe for use in most PD patients. The current research available does not conclusively provide enough quality evidence to suggest using cannabis is an effective treatment for motor symptoms and dyskinesia in PD. Furthermore, there is a significant need for more quality research on the effects of cannabinoids for PD, to better comprehend the pharmacology, therapeutic benefits, and adverse effects of various cannabis formulations.

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  Comparison of Buprenorphine-Naloxone and Buprenorphine Monotherapy in Opioid Dependent Pregnant Women

  Ellie Gillund

  •The purpose of this literature review is to compare the use of buprenorphine-naloxone combination therapy to buprenorphine monotherapy as medication assisted therapy (MAT) for opioid dependent pregnant women.

  •Outcomes compared in this study include maternal and neonatal safety, neonatal abstinence syndrome, and peripartum pain management.

  •This review included electronic search databases: PubMed, Clinical Key, and Cochrane Library from September 1, 2019 to March 1, 2020. The search included randomized control trials, systematic reviews, and meta-analysis. Sources excluded included those published >25 years ago, those with poor study design, and those with primary focus on methadone.

  •Current research shows evidence to support both buprenorphine monotherapy and buprenorphine-naloxone combination therapy as MAT in opioid dependent pregnant women, however at this time there is insufficient evidence to declare one therapy superior compared to the other. Many studies discuss the complications and limitations of medication trials in pregnant and opioid dependent populations.

  •Ultimately, more research and clinical trials are needed in order to claim the one buprenorphine product preferable, in terms of safety and efficacy, as medication assisted therapy in pregnant women with opioid dependence.

  •Key terms: buprenorphine in pregnancy, buprenorphinenaloxone in pregnancy, naloxone in pregnancy, buprenorphine safety, suboxone, Subutex, buprenorphine and neonatal abstinence syndrome, pain management buprenorphine, peripartum pain management buprenorphine.

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  Treatment of Clostridioides Difficile with Fecal Microbiota Transplantation

  Brenton Green

  Research was performed to discuss the epidemiology and current guidelines of Clostridioides difficile infection (CDI), recurrent C. difficile infection (rCDI), the different modalities of fecal microbiota transplantation (FMT), the donor screening process, as well as the safety and efficacy of treatment.

  • Utilizing Clinical Key, NCBI database, Dynamed Plus, Cochrane Review, and the websites for the CDC and FDA, a literature review encompassing recent research and human studies relating to CDI.

  • Recent studies within five years were preferred, however since C. difficile has sparsely changed, older data was utilized with updates applied accordingly.

  • Oral antibiotics are intended for initial infection with C. difficile; while FMT has been shown to reduce recurrence after multiple infections.

  • Similar results exist with efficacy and safety for FMT in regards to oral, fresh versus frozen stool, or rectal administration of therapy. With proper screening, FMT is relatively safe and efficacious.

  • The need for long-term studies on the safety of FMT has been established and are underway

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  Comparison of Anterior Cruciate Ligament Graft Materials and Risk of Rupture/Reinjury in Young Athletes

  Matt Hockert

  The anterior cruciate ligament tear is a standard surgical injury seen with young athletes competing at elite, amateur, and recreational capacities. The purpose of this literature review is to determine the rehabilitation guidelines and risks associated with anterior cruciate ligament reconstruction, as well as determining the role of rehabilitation in graft rupture. This literature review also serves to determine if graft choice for surgical repair plays a role in an increased risk of rupture or reinjury. This literature review used various online databases, including Dynamed, Cochran, and PubMed, with the utilization of MeSH terms listed below in “keywords” in order to identify applicable data. A systematic review of the literature was then completed. Data showed that athletes near or younger than the age of 25 were at a higher risk of graft rupture. The patellar tendon graft shows a decreased risk of rupture and instability when compared to hamstring grafts. Allografts were found to have an increased risk of rupture in young athletes when compared to hamstring grafts and should not be considered for young athletes. Failure to complete a rehabilitation program was also determined to play a role in graft rupture.

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  Comparing Romosozumab and Alendronate in the Treatment of Osteoporosis in Postmenopausal Women

  Taylor Johnshoy

  The purpose of this literature review is to determine if there is a statistical difference in the safety and efficacy between romosozumab, the prototypical drug in the new drug class sclerostin inhibitors, versus alendronate, the prototypical bisphosphonate, in the treatment of postmenopausal osteoporosis. A comprehensive literature review was performed searching PubMed, EMBASE, and Access Medicine from the last five years. Works chosen for review were limited to articles published in English, full-text articles, clinical trials, randomized control trials, systematic reviews, and meta-analyses. Items were excluded after reviewing abstracts due to material not directly comparing the treatment modalities. The research presented shows beneficial evidence of bone formation and retention of bone density with treating postmenopausal women with osteoporosis with romosozumab for two years, followed by bisphosphonate therapy. However, the risks and benefits of this treatment regimen must be taken into consideration for each patient. Providers should take extra caution in starting romosozumab treatment in patients with cardiovascular health issues. Healthcare providers must take a thorough medical history and decide in collaboration with the patient about their treatment for osteoporosis. Current research on romosozumab does show promise in the treatment of osteoporosis. However, studies do show potential cardiovascular risk in starting romosozumab. Therefore, providers must take cation in starting this medication in patients with pervious cardiovascular co-morbidities

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  Surgical Innovations for GERD: Comparing Outcomes of Magnetic Sphincter Augmentation and Nissen Fundoplication

  Steffani n. Johnston Mack

  Gastroesophageal reflux disease (GERD) is a common chronic upper gastrointestinal disease with both objective and subjective components. While most cases of GERD are uncomplicated and can be managed with oral medication, refractory cases require surgical intervention. The purpose of this study is to compare the efficacy of GERD’s gold standard surgical technique, the Nissen fundoplication, with a new surgical technique, magnetic sphincter augmentation.

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  Review of Anticoagulation Therapy in Unprovoked Pulmonary Embolism

  Christopher D. Klucas

  The purpose of this research was to identify the best course of action in response to a diagnosis of unprovoked pulmonary embolism.

  •The evidence demonstrates non-inferiority status of new direct oral anticoagulants (DOAC) when indirectly compared to conventional warfarin therapy.

  •Aspirin was also found effective in mitigating the risk of recurrence, but to a lesser extent than both DOAC agents and warfarin.

  •DOACs are reasonable alternatives to conventional therapy. Attention to individual comorbidities may allow providers to find advantage with one therapy over another.

  • The research, thus far, has not been able to identify a universally safe and an effective agent for all patients experiencing a first-time unprovoked pulmonary embolism.

  •Additional research is needed to evaluate the duration of therapy and generate more robust data to recommend a specific therapeutic agent for all patients.