Physician Assistant Scholarly Project Posters

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Benefits of 3D Breast Tomosynthesis Combined with 2D Digital Mammography in Screening Women for Breast Cancer

Danielle M. Swanson

• Breast cancer screening imaging options have progressed greatly over • the years in sensitivity, specificity, and image quality. According to DynaMed Plus, in 2012 there were 522,000 deaths by breast cancer and 1,677,000 total cases of breast cancer documented (Dynamed, 2018). For years, traditional screening for breast cancer involved 2D digital mammography which obtains two views of each breast. With advances in technology, the use of 3D breast tomosynthesis has become an advantageous addition to routine breast cancer screening protocols at many health care facilities.

• My literature review of articles was found in PubMed, DynaMed Plus, Cochrane Library, and Clinical Key from the year 2011 and on. The benefits of 2D digital mammography alone, 3D breast tomosynthesis alone, and 2D digital mammography combined with 3D breast tomosynthesis are compared. This study also compares the differences in radiation dose of each imaging option. The research demonstrated that 2D digital mammography combined with 3D breast tomosynthesis offers the • lowest recall rates, the highest sensitivity and specificity, and increases the effectiveness of breast cancer screening.
Benefits of HPV Vaccination in Adolescent Males

Budd Theriot

HPV is the most common sexually transmitted infection in the United States, affecting approximately 75-80% of young adults at some point in their lives, and it is also known to be directly related to several forms of cancer including cervical, vaginal, penile, anal, oral, and oropharyngeal cancer. Vaccination against several high-risk strains of HPV first became available in the U.S. in June of 2006 and has been proven to be effective in creating antibodies against several strains of high-risk HPV, potentially decreasing and preventing more than 30,000 new cases of HPV related cancers each year. Despite this fact, HPV vaccination rates remain low. Although vaccination is recommended for both female and male adolescents, male vaccination rates remain lower than female, likely due to the fact that HPV is most commonly associated with cervical cancer. However; evidence shows that among certain male populations, such as homosexuals, HPV related cancer rates may be as high in males as cervical cancer rates in females, demonstrating the potential impact of HPV vaccination in males. Lack of knowledge, and a perception of a lack of necessity for male vaccination are substantial barriers for achieving targeted vaccination rates. There is evidence demonstrating that proper education, or simply having meaningful conversation with patients, can help to increase patient compliance of receipt of HPV vaccination. Additionally, there is an abundance of unverified information attempting to link HPV vaccination to severe adverse reactions. There is minimal evidence to support such a correlation, but some studies do suggest it. A need for further investigation is warranted.
Benefits of HPV Vaccination in Adolescent Males

Budd Theriot

HPV is the most common sexually transmitted infection in the United States, affecting approximately 75-80% of young adults at some point in their lives, and it is also known to be directly related to several forms of cancer including cervical, vaginal, penile, anal, oral, and oropharyngeal cancer. Vaccination against several high-risk strains of HPV first became available in the U.S. in June of 2006 and has been proven to be effective in creating antibodies against several strains of high-risk HPV, potentially decreasing and preventing more than 30,000 new cases of HPV related cancers each year. Despite this fact, HPV vaccination rates remain low. Although vaccination is recommended for both female and male adolescents, male vaccination rates remain lower than female, likely due to the fact that HPV is most commonly associated with cervical cancer. However; evidence shows that among certain male populations, such as homosexuals, HPV related cancer rates may be as high in males as cervical cancer rates in females, demonstrating the potential impact of HPV vaccination in males. Lack of knowledge, and a perception of a lack of necessity for male vaccination are substantial barriers for achieving targeted vaccination rates. There is evidence demonstrating that proper education, or simply having meaningful conversation with patients, can help to increase patient compliance of receipt of HPV vaccination. Additionally, there is an abundance of unverified information attempting to link HPV vaccination to severe adverse reactions. There is minimal evidence to support such a correlation, but some studies do suggest it. A need for further investigation is warranted.
The Use of DHEA In the Treatment of Depression

Bryan Tipton
The Use of DHEA in the Treatment of Depression

Bryan Tipton

Dehydroepiandrosterone (DHEA) and its sulfated ester (DHEA-S) are important pre-hormones that also have direct neurohormonal effects on the central nervous system. Over the last twenty years, data have revealed that serum DHEA peaks in a person’s mid-20s and steadily declines throughout their lifetime. In addition, women tend to have lower values than men. This is of note because lower serum values tend to be correlated with increased risk of depression, worse depressive symptoms, and increased risk of relapse into depression. A review of literature concerning DHEA’s age related values, its association with depression, and its use in the treatment of depression was performed. It was found that supplementation with DHEA appears to alleviate the symptoms of depression even though a dose-response relationship nor a clear mechanism have been established. For providers who choose to use DHEA to alleviate the symptoms of depression, they should consider that even the best studies concerning its effectiveness are underpowered, it lacks FDA approval, and, if given as a supplement, may lack any active ingredient. Despite those warnings, the AAPA, CANMAT, and Dynamed all agree that evidence exists as to its efficacy.
Delaying Diabetes in the Native American Population

Seth Tramm

Diabetes is a debilitating disease process caused by the body’s inability to control blood glucose levels. With over 30 million diabetics in the United States and another 85 million prediabetics, the effects of this disease are wide-spread and farreaching. Native American/Alaska Native populations have a nearly two-fold increase in prevalence of diabetes when compared to non-native populations. Risk factors for diabetes in all populations include modifiable risks such as obesity, diet, and physical inactivity as well as non-modifiable factors such as age, family history, and ethnicity. Studies have shown that early identification of symptoms, coupled with proper and intentional treatment can delay the onset of diabetes. The purpose of this project is to determine the efficacy of currently recognized bestpractice therapies in Native American patients and to identify barriers to successful implementation of such practices in the Native American population. A thorough review of the available literature shows that research of this topic specific to the Native American population is lacking. However, evidence suggests that the broad, general population recommendations made by the American Diabetes Association in their Standards of Medical Care in Diabetes (2018) will be equally effective in the Native American population when applied objectively. It is also recognized that Native Americans face additional barriers in the effort to identify and treat diabetes. These include geographic, economic, and social factors that inhibit treatment efficacy and ultimately lead to increased morbidity in this population.
Delaying Diabetes in the Native American Population

Seth Tramm

Diabetes is a debilitating disease process caused by the body’s inability to control blood glucose levels. With over 30 million diabetics in the United States and another 85 million prediabetics, the effects of this disease are wide-spread and far-reaching. Native American/Alaska Native populations have a nearly two-fold increase in prevalence of diabetes when compared to non-native populations. Risk factors for diabetes in all populations include modifiable risks such as obesity, diet, and physical inactivity as well as non-modifiable factors such as age, family history, and ethnicity. Studies have shown that early identification of symptoms, coupled with proper and intentional treatment can delay the onset of diabetes. The purpose of this project is to determine the efficacy of currently recognized best-practice therapies in Native American patients and to identify barriers to successful implementation of such practices in the Native American population. A thorough review of the available literature shows that research of this topic specific to the Native American population is lacking. However, evidence suggests that the broad, general population recommendations made by the American Diabetes Association in their Standards of Medical Care in Diabetes (2018) will be equally effective in the Native American population when applied objectively. It is also recognized that Native Americans face additional barriers in the effort to identify and treat diabetes. These include geographic, economic, and social factors that inhibit treatment efficacy and ultimately lead to increased morbidity in this population.
Comparison of Pharmacologic Treatments for Postmenopausal Osteoporosis

Kaitlyn Wirtz

The prevalence of osteoporosis in the United States in adults > 50 years of age is “more than 10 million people overall and 33 million have low bone mineral density (BMD) at the hip” (DynaMed Plus, 2018).

 To combat postmenopausal osteoporosis, two treatment options include bisphosphonates and the anti-receptor activator of nuclear factor kappa β ligand (RANKL) agent (denosumab).

 The purpose of this scholarly project is to determine if there is a statistical significance regarding safety, efficacy, and preference between bisphosphonates and denosumab.

 Three databases were searched: PubMed, CINAHL, and Cochrane Database of Systematic Reviews. Topics researched included: postmenopausal osteoporosis, bisphosphonates, antiRANKL agent, treatment outcome, adverse effects, and efficacy. Research was conducted from September 12, 2018 to January 29, 2019. All works published within the last 10 years.

 The most effective treatment for postmenopausal osteoporosis is denosumab. It is just as safe, more efficacious, better adhered to, and more preferred than bisphosphonates.

 This scholarly project compares the treatment options available to providers and allows them to choose the best option based on the patient’s needs, safety, efficacy, preference, and cost
Comparison of Pharmacologic Treatments for Postmenopausal Osteoporosis

Kaitlyn Wirtz

• The prevalence of osteoporosis in the United States in adults > 50 years of age is “more than 10 million people overall and 33 million have low bone mineral density (BMD) at the hip” (DynaMed Plus, 2018).

• To combat postmenopausal osteoporosis, two treatment options include bisphosphonates and the anti-receptor activator of nuclear factor kappa β ligand (RANKL) agent (denosumab).

• The purpose of this scholarly project is to determine if there is a statistical significance regarding safety, efficacy, and preference between bisphosphonates and denosumab.

• Three databases were searched: PubMed, CINAHL, and Cochrane Database of Systematic Reviews. Topics researched included: postmenopausal osteoporosis, bisphosphonates, anti-RANKL agent, treatment outcome, adverse effects, and efficacy. Research was conducted from September 12, 2018 to January 29, 2019. All works published within the last 10 years.

• The most effective treatment for postmenopausal osteoporosis is denosumab. It is just as safe, more efficacious, better adhered to, and more preferred than bisphosphonates.

• This scholarly project compares the treatment options available to providers and allows them to choose the best option based on the patient’s needs, safety, efficacy, preference, and cost.
Treatment of Undifferentiated Connective Tissue Disease by Primary Care Providers Using csDMARDs

Leslie A. Anderson

•Undifferentiated connective tissue disease (UCTD) is an autoimmune disease that presents similarly to other rheumatic conditions but fails to meet laboratory requirements which indicate a specific disease such as rheumatoid arthritis, systemic lupus erythematous, Sjogren's or scleroderma.

•UCTD presentation can include arthralgias, myalgias, fatigue, fever, Raynaud’s phenomenon and sicca like symptoms with a positive antinuclear antibody (ANA) test.

•Patients with UCTD symptoms are normally referred to rheumatology but a shortage exists leaving primary care providers to treat UCTD patients.

•Using disease modifying antirheumatic drugs (DMARDs) such as hydroxychloroquine is an option but it is not commonly prescribed by PCPs.

•The study’s purpose is to determine if PCPs can effectively initiate and appropriately manage UCTD patients using DMARDs, such as hydroxychloroquine, to reduce the patient’s symptoms and functional impairment.

•Using DMARDs, NSAIDs and low dose corticosteroids in UCTD patients provided by PCPs can improve arthralgias, myalgias, fever, and functional limitations.

•Majority of rheumatologists and PCPs feel UCTD patients should be referred to rheumatology for treatment, yet there is some evidence that PCPs can also initiate and manage the treatment effectively.

•In the absence of rheumatology, PCPs using DMARDs such as hydroxychloroquine can safely and effectively provide treatment for these patients
Comparing Prevalence of Medication-Related Osteonecrosis of the Jaw (MRONJ) Due to Denosumab and Bisphosphonates as a Side Effect of Osteoporosis Treatment

Kendra Apland

As the baby boomer generation continues to age, the diagnosis of osteoporosis and its side effects will continue to increase. Denosumab and bisphosphonates (BPs) are some of the most common medication classes used to treat osteopenia and osteoporosis, but it is believed that both medications have the possible side effect of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this paper is to uncover if MRONJ is a side effect of osteoporosis treatment and which medication carries the highest incidence rate. Through a review of several electronic databases and several peer reviewed research articles, a wide range of reported incidence rates of MRONJ for both medications were uncovered, along with many compounding possible risk factors. There is a wide range of reported incidence rates among different studies. My research found that denosumab carries a slightly higher risk of MRONJ versus bisphosphonates, but the difference was found to be statistically insignificant. Uncovered risk factors include increasing age, gender, recent dental procedures, history of oral disease, and corticosteroid use. My research is impactful in the fact that as providers, we can be better informed about the differences between denosumab and bisphosphonates and the possible risk factors of MRONJ. We can use the information, along with possible other risk factors and our patient’s history, to make joint decisions about what osteoporosis medication is right for our patients.
The Efficacy and Safety of Statins in the Primary Prevention of Cardiovascular Disease

Kayla M. Ashton

Atherosclerotic plaques can form in the blood vessels from particles of cholesterol. These plaques are a major cause of cardiovascular disease and have the ability to result in fatal cardiovascular events. In researching this topic, PubMed, the Cochrane Library, DynaMed, and ClinicalKey were all utilized in finding articles published from 2002 to 2018. There are several organizations with conflicting guidelines recommending the use of statin medications in the primary prevention of cardiovascular disease. The research evaluated discovers data is inconclusive on the benefit of statin medications in this primary prevention as well as the safety of long-term statin use. Some experts have suggested statins are over-prescribed as it is one of the most commonly prescribed medications in the United States. Statin medications continue to be extremely beneficial in the secondary prevention of cardiovascular events, but caution should be applied by providers when prescribing this medication to their patients for primary prevention when referring to conflicting population based guidelines. Providers should identify key risk factors and have conversations with their patients on the risks and benefits of statin medications when they are being utilized for the primary prevention of cardiovascular disease.
The Safety and Efficacy of Creatine Supplementation in the General Public

Cody Baxter

The purpose of this study was to determine whether supplementation with creatine monohydrate is efficacious beyond the realm of its most popular use, which is in athletics. This study investigated the safety of creatine supplementation in the general population. References were collected through a review of PubMed and Scopus databases. Initial keywords searched were creatine supplementation and creatine safety. Where possible, trials with human subjects were utilized. Studies focused on creatine’s effects in athletes or weightlifting parameters were eliminated. Topics were further narrowed down by conditions with the most amount of research and medical concerns recognized as common to primary care.Creatine supplementation showed potential benefits in treatment for major depressive disorder, diabetes, bone density, and osteoarthritis. Mild weight gain due to the osmotic effect of creatine was the only side effect noted in the evidence. Kidney function is not affected by creatine supplementation. Creatine supplementation has potential benefits for many different patient populations, with the only side effect of creatine supplementation being mild weight gain due to the osmotic effect of increased creatine saturation in the body. Clinicians should consider creatine supplementation without fear of potential serious adverse effects based on the available evidence.
Childhood Trauma: An Analysis of Associated Co-Morbidities and Various Psychotherapies

Brittney L. Benson

American and European studies suggest that anywhere from 14 to 67% of children have experienced at least one traumatic event throughout their life. Furthermore, about 13.4% of them go on to develop post-traumatic stress disorder (PTSD) or symptoms (Diehle, J., Opmeer, B.C., Boer, F., Mannarino, A.P., & Lindauer, R.J., 2015). One study suggests that as many as 63.9% of adults suffer from ACEs (Adverse Childhood Experiences) (CDC, 2016). The 4th Edition of the Diagnostic and Statistical Manual (DSM-IV) states that PTSD is the most common Axis I disorder in children that are victims of abuse with statistics ranging from 20% (PTSD only) to 53% (PTSD or complex PTSD)(Chard, 2005). First line treatment for PTSD includes psychotherapy. Cognitive Behavioral Therapy (CBT) has been established as the “gold standard” for the treatment of PTSD. However, a good percentage of children still present with symptoms post treatment. Therefore, a need for other forms of psychotherapy has been made apparent. This paper attempts to highlight the various detrimental effects of childhood trauma, explore the various types of psychotherapies used to treat PTSD in children as well as adults {CBT, Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), and Prolonged Exposure}, and determine which therapy is most effective. The research gathered mostly supports the use of CPT in adults suffering from ACEs. However, in children, the most supported therapy for the treatment of PTSD is CBT, followed by prolonged exposure and EMDR.
Integrative Medicine in Primary Care

Ashley M. Bjornerud

Integrative medicine (IM) is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health (Rakel, 2017). Commonly, IM is associated with complementary and alternative medicine therapies (CAM). These are two separate entities. CAM is one of the modalities used in integrative medicine.
Screening Techniques for Alzheimer's Disease

Christina Nicole Brooks

Alzheimer’s disease is a neurodegenerative disease that affects more than 55 million Americans. By the year 2050, experts project this disease will have increased three fold. Many screening techniques have been investigated to detect this disease early and begin treatment to slow its progression. The purpose of this study was to explore which medical modalities are the most effective for screening of Alzheimer’s disease. This literature review includes three databases, including PubMed, CINHAL, and Cochrane Database of Systematic Reviews. Topics that were researched include: cognitive screening tests, neuroimaging, laboratory diagnostic testing, DNA, and combined studies. Research was conducted from October 8, 2017 to January 3, 2018. All resources were published within the last ten years. Limitations and strengths were considered within each modality. In each category, the following were found to be the most effective in screening for Alzheimer’s disease: cognitive screening tests: MOST and MoCA testing; neuroimaging: PET scanning; laboratory diagnostic testing: biomarkers; DNA: DNA methylation and APOE genotyping; and combined studies: PET scanning. This review demonstrates that there are many screening modalities available to providers. This allows providers to choose their screening technique based on their site’s availability, provider preference, and cost.
A Bridge Too Far? Risks and Benefits of Perioperative Bridging Therapy

Jordan Buchholz

The long-term use of oral anticoagulants is common among certain high-risk patient populations for the prevention of thromboembolic events such as stroke, pulmonary embolism (PE), and other systemic events. According to Garwood et al. (2017) it is estimated that 15-20% of chronically anticoagulated patients will undergo a surgery or procedure that will require anticoagulation interruption annually. During this interruption period, “bridging” anticoagulant therapy is often utilized with unfractionated heparin or low-molecular weight heparin to ensure adequate anticoagulation is achieved (Ayoub et al., 2016). However, there has been an ongoing debate whether or not the benefits of perioperative anticoagulant bridging therapy outweigh its risks.

This literature review focuses on whether or not forgoing anticoagulant bridging therapy increases the risk of postoperative thromboembolic events. It also focuses on the whether or not initiating bridging therapy places patients at a higher risk for postoperative bleeding. Finally, it focusses on the current recommendations and whether or not utilization of individualized risk assessment tools increases efficacy and safety in regards to determining appropriate bridging therapy.

The results of this literature review conclude that in low risk patients there is sufficient evidence to support the statement that non-bridging therapy is equally as efficacious to bridging therapy in the prevention of peri/postoperative thromboembolic events. There is also evidence to support the statement that traditional bridging therapy may place low risk patients at an increased risk for peri/postoperative bleeding events. Finally, there appears to be sufficient support to encourage the use of individualized risk assessment tools to help guide clinicians in their decisions to use or forgo anticoagulant bridging therapy.
Obesity: Modern Medicine vs. Lifestyle

Jenny Christianson

Obesity is a rising epidemic, and is one of the most common, costly and preventable health problems the world is experiencing today (Center for Disease Control and Prevention, [CDC], 2017).

 From this, it is important to establish an effective treatment plan that can be implemented across the nation for maximum patient benefit.

 Lifestyle changes such as diet and exercise are important to any health care plan and are equally necessary to reduce health risks. However, in certain patients, lifestyle changes are not enough due to the maladaptive biologic process in their brain. Thus, additional treatment options need to be available to these patients.

 Both medical therapies, pharmacological and surgical, were found to be beneficial in augmenting lifestyle changes in multiple studies. Therefore, it was concluded that pharmacologic and surgical therapies are valid options in resistant obesity in addition to lifestyle changes such as diet and exercise.

 This study was a systematic literature review which evaluated studies from CINAHL, Clinical Key, Cochrane Library, and PubMed to formulate a conclusion. Research focused on two pharmacotherapy options, phentermine and orlistat, in addition to two surgical options, gastric bypass and sleeve gastrectomy, for added weight loss treatment when compared to lifestyle alone.
Exercise Therapy for Chronic Low Back Pain

Jeanmarie Dahl

Chronic low back pain (CLBP) is currently ranked as the 13th most frequent diagnosis in family practice (DynaMedPlus, 2017). The severe nature of the pain in this condition often leads providers to prescribe narcotics. While effective in the short term, opiates have significant side effects when used chronically. Other forms of management for CLBP need to be identified and utilized. The purpose of this review was to determine the role exercise therapy plays in the management of CLBP.

Four databases were searched in order to find high quality systematic reviews, meta-analyses, and randomized controlled trials (RCT) looking at exercise therapy in the management of CLBP. These databases included SPORTDiscus, Cochrane Database of Systematic Reviews, CINAHL, and PubMed. Studies chosen for this review were adult-only populations and included pain as an outcome measurement. All of the studies were published between 2010 and 2017.

After reviewing the current literature on the effects of exercise therapy in the management of CLBP, it does appear that certain forms of exercise are efficacious for pain control. The most effective forms of exercise therapy seem to be those that include a strengthening component. This is encouraging data regarding the future of CLBP management.
Glycemic Control and Type 1 Diabetes Mellitus: Current Standard Treatment vs. Closed-Loop Insulin Pumps

Kelsey Daley

As of 2015, 9.4% of the US population had a diagnosis of Diabetes Mellitus (DM). Although most of the data sets studied encompass type 1 (T1) and type 2 (T2) DM data in all ages of patients, the focus of this project will be primarily on T1DM.

There are effective methods currently available for the management of T1DM patients. These methods include: closed-loop insulin pumps that integrate a continuous glucose monitor (CGM) and insulin pump into one effective system that calculates the needed insulin doses through complicated algorithms, CGM with self-blood glucose monitoring calibrations (SBGM) and insulin administration, and SBGM with insulin administration.

Literature reveals that closed-loop insulin pumps have the potential to provide better disease management and improved disease outcomes for those patients who are motivated to use them as directed and find them a desirable option.

When patients can effectively manage their blood glucose, and practice healthy lifestyle and dietary choices, they can avoid unnecessary hospitalizations and long-term diabetic complications. This will simultaneously reduce healthcare-related costs, increase longevity and can improve the patient’s quality of life.
Exercise in the Treatment of Major Depressive Disorder

Larissa Ann Haug

Objective

The purpose of this systematic literature review is to determine how exercise can be incorporated into the treatment of major depressive disorder (MDD) and its efficacy.

Methods

In this review, four databases were searched including SportDiscus, Pubmed, Cochrane Database of Systematic Reviews, and PsycInfofrom October 1 to January 5, 2018. A variety of key terms were used when searching. Works chosen for review were published after the year 2000, were peer reviewed, and included randomized control trials (RCTs), pilot studies, systematic reviews, and meta-analyses. Sources that were excluded included those published prior to the year 2000, had poor study design, and included comorbid psychiatric conditions varying from MDD.

Results

For this review, 17 resources were selected. Much of the research presented shows evidence for the use of exercise in the treatment of MDD. However, most of the research points to exercise as more of a beneficial augmentation strategy for MDD versus a first line therapy involving pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and psychotherapy in disease treatment.

Conclusion

Current research on the topic of exercise as therapy for MDD does show promise; however, more research still needs to be done in order to place exercise as an equivalent treatment to pharmacotherapy or psychotherapy.
Treatment Options for Hidradenitis Suppurativa: Efficacy, Risks, Benefits

Katherine A. Hennager

Hidradenitis suppurativa is a chronic, recurrent follicular occlusion disease with painful, sometimes debilitating, cutaneous draining lesions and subcutaneous abscesses (DynaMed Plus, 2016). Hidradenitis suppurativa is understood to be a multifactorial disease that is hard to treat in some patients, especially those with a severe form of the disease. For this project, the efficacy of adalimumab for hidradenitis suppurativa was assessed and whether it is more beneficial than traditional treatments used. Adalimumab is a TNF-alpha inhibitor which belongs to the biologic DMARDs drug class. Kimball et al. (2012) found that at week 16 of their trial 3.9% of the placebo patients, 9.6% of every other week (EOW) dosing of adalimumab patients, and 17.6% of every week dosing of adalimumab patients achieved clinical response. Patient response reports on pain and outcomes were significantly greater in the weekly dosed patients vs. placebo group. A study by Miller et al. (2011) showed a significant reduction in Sartorious score after 6 weeks and an almost significant reduction seen after 12 weeks when compared to the placebo group (-10.7 vs. 7.5, P=0.024 and -11.3 vs. 5.8, P=0.07). Kimball et al. (2016) showed clinical response rates at week 12 were significantly higher for the groups receiving adalimumab weekly than for the placebo groups: 41.8% versus 26.0% in PIONEER I (P=0.003) and 58.9% versus 27.6% in PIONEER II (P<0.001). DynaMed Plus, PubMed, and Cochran Library were searched with key words: hidradenitis suppurativa, adalimumab, and treatment.
Superior Capsular Reconstruction in the Active Population with a Massive Irreparable Rotator Cuff Tear

Emmanuel Hernandez

The prevalence of rotator cuff tears is a leading cause of upper extremity functional disability and affects people across the lifespan. The primary age groups that are diagnosed include young adults as well as the elderly population. Approximately one-fifth of rotator cuff tears (RCT) are diagnosed as “massive” and prove to be difficult for orthopedic surgeons to repair. If the massive RCT is also diagnosed as “irreparable”, surgical intervention is technically difficult and can be extremely challenging. Historically, treatment options have been limited for the young population to invasive surgical intervention or conservative measures such as physical therapy and pharmacologic measures. Surgical approaches to treatment may include a reverse shoulder arthroplasty (RSA) or a superior capsular reconstruction (SCR). The purpose of this study is to determine if a superior capsular reconstruction is a better surgical alternative than a reverse shoulder arthroplasty in the young, active population with a massive irreparable rotator cuff tear. An SCR has shown successful short-term outcomes and utilizes an anatomical approach. Each surgical option is feasible; however, the postoperative degree of functionality is the substantial difference between either surgical technique. Research has proven the efficacy of the SCR versus the RSA. Although there is limited current evidence-based research in the field of longevity and its potential outcomes, the SCR is the leading surgical option for massive irreparable RCT repairs in the young, active population.
The Neuroprotective Effects of Targeted Temperature Management on Post-Cardiac Arrest Patients

Timothy Hovde

Novel methods of ensuring survival following cardiac arrest and resuscitation are of supreme importance to the medical community. Targeted temperature management (TTM) has become increasingly utilized pre-hospital, in emergency departments, and within intensive care units to increase the likelihood of survival to hospital discharge. TTM has further been used to attempt to improve neurological functioning. The efficacy and mechanism behind TTM remains poorly understood. In several patient populations it also remains unproven. The purpose of this study is to assess the physiological mechanism, survival, neurological recovery and methodology of TTM use and implementation.

Literature review was utilized to assess the physiological mechanism by which TTM elicits its neuroprotective effects. Statistics on neurological outcomes and survival rates were further examined. Finally, the proposed method to safely and efficiently induce and maintain TTM in appropriate patients was also assessed through literature review.

TTM was found to improve survival and neurological functioning in adults suffering cardiac arrest both in-hospital and out-of-hospital. No improvement has been noted in studies on pediatric patients, thus TTM is not indicated in pediatric patients. Animal studies demonstrate a decrease in cerebral edema and mitochondrial apoptosis of neuronal cells with TTM application. Serum biomarkers of brain injury and disfunction of the endothelial lining constituting the brain blood barrier (BBB) have also been found to be decreased in patients undergoing TTM. Finally, serum assay of antioxidants demonstrates a decrease in oxidative damage and increase in antioxidant protection following reperfusion.
Limb Salvage for Diabetic Patients with Peripheral Arterial Disease

Jamie Jesse Johnson

•According to the Center for Disease Control (CDC) (2017), the total number of patients diagnosed with diabetes is exceeding 30.2 million and rapidly increasing.

•According to the CDC (2016), approximately 8.5 million people in the United States have peripheral artery disease (PAD), which includes 12-20% of individuals who are older than age 60.

•According to a study performed by Swaminathan et al. (2014), 186,000 patients underwent lower extremity amputation (LEA). Data also shows that patients undergoing LEA have a mortality rate of 20% noted within one year, and a 40% to 50% mortality rate indicated within 18 months.

•The review of literature analyzed studies that compared vascularization procedures to determine whether early diagnosis and intervention provide benefit to reduce lower extremity amputation in diabetic patients with PAD and critical limb ischemia (CLI), and to determine cost effectiveness.

•Research suggests that limb salvage is cost efficient with early detection, proper patient compliance and use of a multidisciplinary approach. However, unpredictable factors such as poor patient compliance may skew cost analyses and validate claims to dispute reduction of costs.