Physician Assistant Scholarly Project Posters

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  Pelvic Examinations for Ovarian Cancer Screening in Asymptomatic Adult Women

  Riann Collar

  There is discrepancy amongst organizations and the medical community whether bimanual pelvic examinations should be performed in asymptomatic women for routine screening. The purpose of this literature review was to determine whether bimanual pelvic examinations are beneficial for screening for ovarian cancer in comparison to no screening. In addition, research was conducted to see if healthcare providers’ professional beliefs align with the evidence and national recommendations, to determine women’s thoughts and beliefs regarding pelvic examinations, and identify other screening methods if bimanual pelvic exams are determined to be an invalid screening tool. Throughout reviewing peer reviewed articles and high quality evidence, it was found that bimanual pelvic exams have low sensitivity for screening, which is not ideal due to false positives; however, several researchers still feel this is an important screening tool. Also, many providers still consider the pelvic exam beneficial when performed annually on asymptomatic women as part of a well woman exam and continue to perform them routinely in the office. Research also shows that the majority of women do not feel uncomfortable or pain during a pelvic exam and the majority wish to continue having them performed on a regular basis. Combinations of different screening methods such as pelvic examination with serum CA 125 annually and serum CA 125 with transvaginal ultrasound annually were found to be effective in screening for ovarian cancer in asymptomatic women.

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  Pelvic Examinations for Ovarian Cancer Screening in Asymptomatic Adult Women

  Riann Collar

  There is discrepancy amongst organizations and the medical community whether bimanual pelvic examinations should be performed in asymptomatic women for routine screening. The purpose of this literature review was to determine whether bimanual pelvic examinations are beneficial for screening for ovarian cancer in comparison to no screening. In addition, research was conducted to see if healthcare providers’ professional beliefs align with the evidence and national recommendations, to determine women’s thoughts and beliefs regarding pelvic examinations, and identify other screening methods if bimanual pelvic exams are determined to be an invalid screening tool. Throughout reviewing peer reviewed articles and high-quality evidence, it was found that bimanual pelvic exams have low sensitivity for screening, which is not ideal due to false positives; however, several researchers still feel this is an important screening tool. Also, many providers still consider the pelvic exam beneficial when performed annually on asymptomatic women as part of a well-woman exam and continue to perform them routinely in the office. Research also shows that the majority of women do not feel uncomfortable or pain during a pelvic exam and the majority wish to continue having them performed on a regular basis. Combinations of different screening methods such as pelvic examination with serum CA-125 annually and serum CA-125 with transvaginal ultrasound annually were found to be effective in screening for ovarian cancer in asymptomatic women.

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  The Impact of Medical Marijuana on the Opioid Crisis

  Carl David Eastep

  The opioid crisis dictates the need for research into alternative treatments for acute and chronic pain. • Comprehensive literature review was conducted to determine if medical marijuana might play a role in the treatment of acute and chronic pain. • The addiction profiles of medical marijuana and prescription opiates were compared along with the adverse effects and quality of life. • No use for medical marijuana for the treatment of acute pain. • Likely some benefits from medical marijuana for chronic pain. • Addictive profile • Marijuana – marijuana withdrawal syndrome. • Prescription Opiates – highly addictive • Adverse Effects • Prescription Opiates > Marijuana

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  The Impact of Medical Marijuana on the Opioid Crisis

  Carl David Eastep

  • The opioid crisis dictates the need for research into alternative treatments for acute and chronic pain.

  • Comprehensive literature review was conducted to determine if medical marijuana might play a role in the treatment of acute and chronic pain.

  • The addiction profiles of medical marijuana and prescription opiates were compared along with the adverse effects and quality of life.

  • No use for medical marijuana for the treatment of acute pain.

  • Likely some benefits from medical marijuana for chronic pain.

  • Addictive profile

  • Marijuana – marijuana withdrawal syndrome.
  • Prescription Opiates – highly addictive

  • Adverse Effects

  • Prescription Opiates > Marijuana

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  Intermittent Fasting in Weight Management

  Alse Engen

  Obesity is associated with a variety of medical conditions that adversely affect metabolic and cardiovascular health. In order for health care providers to adequately educate and promote weight management, they need to be aware of the various dietary regimens and the efficacy and adverse effects associated with each. This literature review assesses the efficacy, metabolic benefits, and cardiovascular benefits of both intermittent energy restriction and continuous energy restriction from ten articles found on various databases within the past five years. The findings indicate that although not proven superior or inferior, intermittent energy restriction provides statistically similar results to continuous energy restriction when assessing efficacy of weight loss. There are also similar metabolic and cardiovascular benefits when comparing intermittent energy restriction and continuous energy restriction, although continuous energy restriction may have a benefit in the diabetic population due to potential adverse side effects in diabetics adhering to intermittent energy restriction. The result of this literature review allows providers to recommend an alternative weight management technique in patients who are unsuccessful or unable to adhere to a continuous energy restriction diet

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  Intermittent Fasting in Weight Management

  Alyse Engen

  Obesity is associated with a variety of medical conditions that adversely affect metabolic and cardiovascular health. In order for health care providers to adequately educate and promote weight management, they need to be aware of the various dietary regimens and the efficacy and adverse effects associated with each. This literature review assesses the efficacy, metabolic benefits, and cardiovascular benefits of both intermittent energy restriction and continuous energy restriction from ten articles found on various databases within the past five years. The findings indicate that although not proven superior or inferior, intermittent energy restriction provides statistically similar results to continuous energy restriction when assessing efficacy of weight loss. There are also similar metabolic and cardiovascular benefits when comparing intermittent energy restriction and continuous energy restriction, although continuous energy restriction may have a benefit in the diabetic population due to potential adverse side effects in diabetics adhering to intermittent energy restriction. The result of this literature review allows providers to recommend an alternative weight management technique in patients who are unsuccessful or unable to adhere to a continuous energy restriction diet.

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  Embolus Prevention: Anticoagulant Therapy in Comparison to Watchman's Procedure in Patients with Atrial Fibrillation

  Erik Fladmo

  • Atrial fibrillation or A-fib is a common cardiac disease that occurs as individuals get older.

  • A risk factor of atrial fibrillation is blood clot formation and dislodgement or ‘embolus’ in the left atrium.

  • Current treatment methods to prevent clot formation include anticoagulants, as well as a left atrial appendage closure device, The Watchman’s device is the only FDA approved left atrial appendage closure device.

  • Study results confirm the rising efficacy and cost effectiveness of Watchman’s device versus long term anticoagulant therapy as well as their adverse effects regarding placement and post procedure; however further randomized control trials are needed to compare both therapies particularly novel oral anticoagulants head to head rather than through extrapolation.

  • Long term effects of Watchman’s device need to be studied.

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  Embolus Prevention: Anticoagulant Therapy In Comparison To Watchman’s Procedure In Patients With Atrial Fibrillation

  Erik Fladmo

  • Atrial fibrillation or A-fib is a common cardiac disease that occurs as individuals get older.

  • A risk factor of atrial fibrillation is blood clot formation and dislodgement or ‘embolus’ in the left atrium.

  • Current treatment methods to prevent clot formation include anticoagulants, as well as a left atrial appendage closure device, The Watchman’s device is the only FDA approved left atrial appendage closure device.

  • Study results confirm the rising efficacy and cost effectiveness of Watchman’s device versus long term anticoagulant therapy as well as their adverse effects regarding placement and post procedure; however further randomized control trials are needed to compare both therapies particularly novel oral anticoagulants head to head rather than through extrapolation.

  • Long term effects of Watchman’s device need to be studied.

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  Exercise Compared to SSRIs in the Treatment of Major Depressive Disorder

  Tiffany Fletschock

  Major Depressive Disorder (MDD) is a common disease seen every day by primary care providers across the United States. According to the Centers for Disease Control and Prevention (CDC, 2018), eight percent of all adults over the age of 20 suffer from depression, and a study by the American Psychological Association found depressive disorders to cost roughly $71 billion annually. Today, psychotherapy is the recommended first-line therapy for treating MDD, but pharmacotherapy is more commonly used. Alternative forms of therapy are also being researched in order to avoid the use of medication while adequately treating the symptoms of MDD. For this review, seven databases were searched including PubMed, Cochrane Database of Systematic Reviews, PsycInfo, Cinahl, DynaMed, ClinicalKey, and ScienceDirect from September 1 to November 21, 2018. Works chosen for review were published after the year 2000 and included randomized controlled trials (RCTs), systematic reviews, and meta analyses. This review found several benefits of using exercise to treat MDD while reducing risks, but exercise alone is not superior in effectiveness to psychotherapy or pharmacotherapy. Overall, exercise offers the greatest benefit in reducing MDD symptoms when used as an augmented therapy to either psychotherapy or pharmacotherapy. Limitations of this literature review include lack of studies with longevity or large sample sizes.

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  Exercise Compared to SSRIs in the Treatment of Major Depressive Disorder

  Tiffany Fletschock

  Major Depressive Disorder (MDD) is a common disease seen every day by primary care providers across the United States. According to the Centers for Disease Control and Prevention (CDC, 2018), eight percent of all adults over the age of 20 suffer from depression, and a study by the American Psychological Association found depressive disorders to cost roughly $71 billion annually. Today, psychotherapy is the recommended first-line therapy for treating MDD, but pharmacotherapy is more commonly used. Alternative forms of therapy are also being researched in order to avoid the use of medication while adequately treating the symptoms of MDD. For this review, seven databases were searched including PubMed, Cochrane Database of Systematic Reviews, PsycInfo, Cinahl, DynaMed, ClincalKey, and ScienceDirect from September 1 to November 21, 2018. Works chosen for review were published after the year 2000 and included randomized controlled trials (RCTs), systematic reviews, and meta analyses. This review found several benefits of using exercise to treat MDD while reducing risks, but exercise alone is not superior in effectiveness to psychotherapy or pharmacotherapy. Overall, exercise offers the greatest benefit in reducing MDD symptoms when used as an augmented therapy to either psychotherapy or pharmacotherapy. Limitations of this literature review include lack of studies with longevity or large sample sizes.

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  The Impact of Shift Work on Health and Wellbeing

  Stephanie Gagelin

  Many of today’s industries require workers to perform shift work (typically during 1600-0700). If workers are awake during this time period, circadian misalignment occurs. This scholarly project uses research studies and metaanalyses to provide information about increased health risks associated with circadian misalignment, focusing on the categories of glucose metabolism, cardiovascular system, carcinogenesis, and mental health and acuity.

  • Shift work has been found to increase BMI and waist circumference of employees, as well as increase blood glucose levels to “prediabetic” levels in previously euglycemic individuals.

  • Shift work has been proven to increase high-sensitivity C-reactive protein (hs-CRP), an acute phase reactant that indicates inflammation and has been found to be a precursor to cardiovascular disease. Additionally, shift work has been demonstrated to increase risk for several cardiovascular diseases, including myocardial infarction and ischemic stroke.

  • Men who work shift work are at higher risk for developing prostate cancer, and women who have performed shift work for over 30 years are at increased risk for breast cancer development.

  • Working a night shift job and its associated sleep deprivation was proven to make medical interns more susceptible to developing depression, as well as more likely to make medical errors due to their sleep deprivation.

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  The Impact of Shift Work on Health and Wellbeing

  Stephanie M. Gagelin

  • Many of today’s industries require workers to perform shift work (typically during 1600-0700). If workers are awake during this time period, circadian misalignment occurs. This scholarly project uses research studies and meta- analyses to provide information about increased health risks associated with circadian misalignment, focusing on the categories of glucose metabolism, cardiovascular system, carcinogenesis, and mental health and acuity.

  • Shift work has been found to increase BMI and waist circumference of employees, as well as increase blood glucose levels to “prediabetic” levels in previously euglycemic individuals.

  • Shift work has been proven to increase high-sensitivity C-reactive protein (hs-CRP), an acute phase reactant that indicates inflammation and has been found to be a precursor to cardiovascular disease. Additionally, shift work has been demonstrated to increase risk for several cardiovascular diseases, including myocardial infarction and ischemic stroke.

  • Men who work shift work are at higher risk for developing prostate cancer, and women who have performed shift work for over 30 years are at increased risk for breast cancer development.

  • Working a night shift job and its associated sleep deprivation was proven to make medical interns more susceptible to developing depression, as well as more likely to make medical errors due to their sleep deprivation.

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  Reducing the Health Care Burden Caused by Undocumented Immigrants

  Juan Carlos Garcia Ramirez

  • Uncompensated health care and Emergency Department (ED) overcrowding are a national crisis in the United States, and uninsured patients are a major contributor. Undocumented Immigrants (UIs) are a large component of the uninsured patient population.

  • The purpose of this study is to evaluate for efficacy and taxpayer value two large-scale potential solutions: Federally Qualified Health Centers (FQHCs), and expanded Medicaid.

  • The method of research included a variety of key terms in electronic search databases such as CINAHL Complete, PubMed, and Google Scholar, and only articles published between 2014 and 2018 by peer- reviewed journals or gray literature (.gov) were included.

  • A Limitation of this study was the inability to conduct a single or limited number of systematic searches of related studies or articles and filter the results using a prescribed set of inclusion or exclusion criteria.

  • Data results suggest that while expanded Medicaid does reduce uncompensated health care, it has been shown to increase ED use and overcrowding, at least in the short-term. Therefore, the notion that expanded Medicaid successfully reduces ED overcrowding, was found to be false. FQHCs are a reasonable solution, but there are too few, and relatively unheard of among the target population.

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  Comparison of Rivaroxaban and Warfarin in the Prevention of Recurrent Venous Thromboembolism

  Philip J. Heiden

  The purpose of this systematic literature review is to determine the efficacy and safety of rivaroxaban (Xarelto) compared to warfarin (Coumadin), for the long term prophylaxis of recurrent venous thromboembolism (VTE). Rivaroxaban was chosen as the primary representative of factor Xa inhibitors because of its simplistic once a day dosing regimen. The PubMed database was extensively searched, using a variety of key terms, from September 10 to November 30, 2018. Works chosen include propensity-matched cohorts, retrospective studies, systematic reviews, and meta-analyses. All of which were published within the last 10 years; sources dated prior to 10 years were excluded. Studies with poor design or dual antiplatelet therapies were also grounds for exclusion. For this review, 11 resources were selected for analysis; 7 additional resources were included for contextual information. Much of the research revealed that rivaroxaban is an adequate alternative for VTE prophylaxis, but the purpose of this research was to determine if its efficacy and safety is superior to that of warfarin. Despite statistically superior results for several aspects of rivaroxaban, an absence of distinct recommendations remain. The following results are intended to make the difficult decision of choosing an anticoagulant clearer for medical professionals and patients.

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  Comparison of Rivaroxaban and Warfarin in the Prevention of Recurrent Venous Thromboembolism

  Phillip J. Heiden

  The purpose of this systematic literature review is to determine the efficacy and safety of rivaroxaban (Xarelto) compared to warfarin (Coumadin), for the long term prophylaxis of recurrent venous thromboembolism (VTE). Rivaroxaban was chosen as the primary representative of factor Xa inhibitors because of its simplistic once a day dosing regimen. The PubMed database was extensively searched, using a variety of key terms, from September 10 to November 30, 2018. Works chosen include propensity-matched cohorts, retrospective studies, systematic reviews, and meta-analyses. All of which were published within the last 10 years; sources dated prior to 10 years were excluded. Studies with poor design or dual antiplatelet therapies were also grounds for exclusion. For this review, 11 resources were selected for analysis; 7 additional resources were included for contextual information. Much of the research revealed that rivaroxaban is an adequate alternative for VTE prophylaxis, but the purpose of this research was to determine if its efficacy and safety is superior to that of warfarin. Despite statistically superior results for several aspects of rivaroxaban, an absence of distinct recommendations remain. The following results are intended to make the difficult decision of choosing an anticoagulant clearer for medical professionals and patients.

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  Parenteral Ascorbic Acid for Treatment of Sepsis

  Lindsey Hiatt

  Sepsis kills nearly 1 million people each year in the United States and sepsis-related hospitalizations cost approximately $24 billion annually (Paoli, Reynolds, Sinha, Gitlin, & Crouser, 2018). Current treatment guidelines are limited to targeted antibiotics and hemodynamic support. While antibiotics are the definitive treatment to eradicate the infectious pathogen, there are currently no standard-of-care treatments that consistently and successfully attenuate the damage sustained to the body by its own inflammatory response to infection. Many different treatments have been trialed and failed to show improved outcomes. Vitamin C, or ascorbic acid, has long been associated with supporting immune function, and has been studied in the past in various related capacities. More recently, a study initiated by Dr. Paul Marik has spurred much discussion and additional research regarding the potential use of ascorbic acid as an adjunctive treatment for sepsis patients. Research suggests that it may reduce damage by reducing oxidative stress, regulate the body’s immune response, and facilitating the production of endogenous vasopressin. Discussion will include the mechanism of action of ascorbic acid in the body, its potential role, efficacy, and safety in the treatment of sepsis, as well as additional treatment components. Also discussed is the cost in both dollars and mortality, of waiting to implement the widespread use of what appears in some studies to be a low-cost, low-risk, high reward treatment.

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  Parenteral Ascorbic Acid for Treatment of Sepsis

  Lindsey Hiatt

  Sepsis kills nearly 1 million people each year in the United States and sepsis-related hospitalizations cost approximately $24 billion annually (Paoli, Reynolds, Sinha, Gitlin, & Crouser, 2018). Current treatment guidelines are limited to targeted antibiotics and hemodynamic support. While antibiotics are the definitive treatment to eradicate the infectious pathogen, there are currently no standard-of-care treatments that consistently and successfully attenuate the damage sustained to the body by its own inflammatory response to infection. Many different treatments have been trialed and failed to show improved outcomes. Vitamin C, or ascorbic acid, has long been associated with supporting immune function, and has been studied in the past in various related capacities. More recently, a study initiated by Dr. Paul Marik has spurred much discussion and additional research regarding the potential use of ascorbic acid as an adjunctive treatment for sepsis patients. Research suggests that it may reduce damage by reducing oxidative stress, regulate the body’s immune response, and facilitating the production of endogenous vasopressin. Discussion will include the mechanism of action of ascorbic acid in the body, its potential role, efficacy, and safety in the treatment of sepsis, as well as additional treatment components. Also discussed is the cost in both dollars and mortality, of waiting to implement the widespread use of what appears in some studies to be a low-cost, low-risk, high- reward treatment.

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  Outcomes in Treatment of Major Depressive Disorder: Pharmacogenomic Testing vs. Treatment as Usual

  Zachary Horoshak

  The goal of this scholarly project was to evaluate the efficacy of pharmacogenomic testing (PGx) versus treatment as usual (TAU) in the treatment of major depressive disorder (MDD). According to Huang & Lin (2015), MDD is characterized by multiple signs and symptoms consisting of mood, vegetative, cognitive, and even psychotic behaviors that may cause substantial impairment in the functioning and quality of life in an affected individual. This literature review consisted of articles found in PubMed, Cochrane, and PsychINFO which were extensively reviewed. Articles prior to 2008 were excluded due to the ever-changing landscape of PGx testing. In this review, 18 articles and studies were analyzed. This review found favorable outcomes when treatment was guided by PGx versus TAU while examining response and remission rates. Although data varied, cost effectiveness suggested some positive results with PGx although further investigations are needed due to limitations and lack of studies. Despite many favorable outcomes, more evidence of the effectiveness of PGx is needed to make a concrete recommendation that PGx guided treatment is superior to TAU. Information in this review will help clinicians decide if this is an appropriate option for the treatment of MDD. With continued research and ongoing studies this biotechnology is becoming more available to the mainstream

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  Outcomes in Treatment of Major Depressive Disorder: Pharmacogenomic Testing vs. Treatment as Usual

  Zachary Horoshak

  • The goal of this scholarly project was to evaluate the efficacy of pharmacogenomic testing (PGx) versus treatment as usual (TAU) in the treatment of major depressive disorder (MDD). According to Huang & Lin (2015), MDD is characterized by multiple signs and symptoms consisting of mood, vegetative, cognitive, and even psychotic behaviors that may cause substantial impairment in the functioning and quality of life in an affected individual. This literature review consisted of articles found in PubMed, Cochrane, and PsychINFO which were extensively reviewed. Articles prior to 2008 were excluded due to the ever-changing landscape of PGx testing. In this review, 18 articles and studies were analyzed. This review found favorable outcomes when treatment was guided by PGx versus TAU while examining response and remission rates. Although data varied, cost effectiveness suggested some positive results with PGx although further investigations are needed due to limitations and lack of studies. Despite many favorable outcomes, more evidence of the effectiveness of PGx is needed to make a concrete recommendation that PGx guided treatment is superior to TAU. Information in this review will help clinicians decide if this is an appropriate option for the treatment of MDD. With continued research and ongoing studies this biotechnology is becoming more available to the mainstream.

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  Early Aggressive Insulin Therapy in Type 2 Diabetes

  Bryan Johnson

  Metformin has been proven beneficial for the first-line treatment of type 2 diabetic mellitus (T2DM) due to its efficacy and low adverse effect profile. Current US guidelines do not address the use of early intensive insulin use in T2DM. Treatment plans are slowly adjusted over the months until the A1C goal is met. Insulin is initiated several years after the time of T2DM diagnosis and utilized as second-line therapy. Dual therapy of insulin and metformin have shown regression of T2DM in certain patient populations. However, the linear relationship between diabetes and cardiovascular disease does not show greater improvement with dual aggressive therapy. The ACCORD study found intensive insulin use has led to an increase in mortality in diabetic patients. The purpose of this literature review is to gather data using clinical studies and peer-reviewed articles that can determine if metformin and insulin should be used intensively to lower A1C aggressively compared to using standard therapy of metformin to decrease the long-term effects of abnormal A1C levels.

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  Pharmacotherapy for Impulsivity-hyperactivity Behaviors in Autism Spectrum Disorder

  Jenna Katnis

  Hyperactivity is a shared behavior with ASD and Attention Deficit Hyperactivity Disorder (ADHD). Medications such as Methylphenidate (MPH) and α 2-a adrenergic receptor agonists are used to modify hyperactivity behavior in ADHD and thus have been used as management in ASD. A review of literature was done to evaluate the use of medications typically used for ADHD in the use of ASD. The databases searched included PubMED, PsycINFO, Cochrane, and Clinical Key. After reviewing the literature, it was found that both MPH and 2-a adrenergic receptor agonist have a potential role in pharmacotherapy for ASD. MPH may be slightly more effective at reducing hyperactivity-impulsivity behaviors than 2-a adrenergic receptor agonist, however the side effect profile in MPH has led to more discontinuations over 2-a adrenergic receptor agonist. More studies would need to be conducted to validate the findings of this review.

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  Pharmacotherapy for Impulsivity-hyperactivity behaviors in autism spectrum disorder

  Jenna Katnis

  Hyperactivity is a shared behavior with ASD and Attention Deficit Hyperactivity Disorder (ADHD). Medications such as Methylphenidate (MPH) and α 2-a adrenergic receptor agonists are used to modify hyperactivity behavior in ADHD and thus have been used as management in ASD. A review of literature was done to evaluate the use of medications typically used for ADHD in the use of ASD. The databases searched included PubMED, PsycINFO, Cochrane, and Clinical Key. After reviewing the literature, it was found that both MPH and 2-a adrenergic receptor agonist have a potential role in pharmacotherapy for ASD. MPH may be slightly more effective at reducing hyperactivity-impulsivity behaviors than 2-a adrenergic receptor agonist, however the side effect profile in MPH has led to more discontinuations over 2-a adrenergic receptor agonist. More studies would need to be conducted to validate the findings of this review.

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  Glucagon-Like Peptide-1s Compared to Sulfonylureas in the Treatment of Adults Diagnosed with Type II Diabetes Mellitus in Primary Care

  Tracy Kirchner

  Type II diabetes mellitus (T2DM) is a prevalent disease in our country. Bullard et al. (2018) report approximately 21 million adults have T2DM in the United States. “The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity” (Yang et al., 2018). Treatment of T2DM is individualized to each patient based on their co-morbidities, fiscal responsibility, and route of administration options. Sulfonylureas and Glucagon-like Peptide-1s (GLP-1) are two classes of antidiabetic drugs that are available for use as second line treatment options after metformin. This review of literature is from articles published in 2008 or later found in the following electronic databases: PubMed, Cochrane Database of Systematic Reviews, DynaMed Plus, ClincalKey, and Scopus. Articles included randomized control trials, systematic reviews, and meta analyses with participants being at least eighteen years old. The review found several benefits of GLP-1s for the treatment of T2DM. The risks of GLP-1s are not found to be as serious as the risks associated with sulfonylureas. Sulfonylureas demonstrate historical data for their use and are available in oral forms as opposed to GLP-1s which is newer but in an injectable form only. Overall, GLP-1s offer greater benefits with minimal side effects that are less severe than sulfonylureas. Limitations to this literature review include lack of articles having direct reviews of GLP-1s and sulfonylureas.

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  Glucagon-Like Peptide-1s Compared to Sulfonylureas in the Treatment of Adults Diagnosed with Type II Diabetes Mellitus in Primary Care

  Tracy Kirchner

  Type II diabetes mellitus (T2DM) is a prevalent disease in our country. Bullard et al. (2018) report approximately 21 million adults have T2DM in the United States. “The total estimated cost of diagnosed diabetes in 2017 is $327 billion, in-cluding $237 billion in direct medical costs and $90 billion in reduced productivi-ty” (Yang et al., 2018). Treatment of T2DM is individualized to each patient based on their co-morbidities, fiscal responsibility, and route of administration options. Sulfonylureas and Glucagon-like Peptide-1s (GLP-1) are two classes of antidiabetic drugs that are available for use as second line treatment options after metformin. This review of literature is from articles published in 2008 or later found in the fol-lowing electronic databases: PubMed, Cochrane Database of Systematic Reviews, DynaMed Plus, ClincalKey, and Scopus. Articles included randomized control tri-als, systematic reviews, and meta analyses with participants being at least eighteen years old. The review found several benefits of GLP-1s for the treatment of T2DM. The risks of GLP-1s are not found to be as serious as the risks associated with sul-fonylureas. Sulfonylureas demonstrate historical data for their use and are available in oral forms as opposed to GLP-1s which is newer but in an injectable form only. Overall, GLP-1s offer greater benefits with minimal side effects that are less severe than sulfonylureas. Limitations to this literature review include lack of articles hav-ing direct reviews of GLP-1s and sulfonylureas.

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  Comparing Rates of Macrosomia and Neonatal Hypoglycemia of Differing Treatment Modalities of Gestational Diabetes Mellitus

  Ashleigh Milbrath

  Gestational diabetes mellitus (GDM) is a known potential complication that can occur during pregnancy. Unmanaged GDM can result in maternal hyperglycemia, which can cause increased neonatal complications, two of which are macrosomia and neonatal hypoglycemia. To prevent maternal hyperglycemia, treatment of GDM typically begins with dietary changes, home glucose monitoring, increased exercise patterns and other lifestyle modifications. However, if maternal hyperglycemia persists after two weeks of maternal lifestyle modifications, there are not current best practice guidelines established for the treatment of GDM. Historically, subcutaneous multiple daily dosed insulin (MDI) has been the gold standard for treatment after lifestyle modification. However, in more recent years oral antihyperglycemic medications, glyburide and metformin, have seen increased use for the treatment of GDM. Additionally, with advancing technology and the development of continuous subcutaneous insulin infusion (CSII), there is discussion regarding which insulin delivery method will achieve more consistent rates of euglycemia to help reduce rates of neonatal hypoglycemia and macrosomia. This scholarly literature review will provide a general overview of GDM, compare treatment modalities (subcutaneous multiple daily dosages of insulin, continuous subcutaneous insulin infusion, metformin and glyburide) of GDM in terms of rates of neonatal hypoglycemia and macrosomia, and compare the safety of differing treatment modalities.