Annual Physician Assistant Studies Program Capstone Projects // Carolina Digital Repository

Works (34)

11. The Non-Operative Management of Symptomatic Knee Osteoarthritis

Title Tesim:: The Non-Operative Management of Symptomatic Knee Osteoarthritis
Creator:: Joyner, Katlyn
Date of publication:: 2017
Abstract Tesim:: BACKGROUND: The knee is the largest synovial joint in the body and is a common cause of lower-limb disability in patients over the age of 60. One of the most common ailments affecting the knee is osteoarthritis, an inflammatory process that leads to pain and altered joint function. Osteoarthritis (OA) of the knee affects a large number of Americans and is a common cause of disability in older adults. The prevalence of arthritis in the U.S. is high with 29.3% of persons aged 45-64 and 49.6% of persons over 65 reporting a doctor-diagnosed arthritis. It is estimated that by the year 2030, the number of people over 65 with osteoarthritis will reach more than 70 billion. This high prevalence combined with the potential of knee osteoarthritis to lead to permanent disability places a large burden on the healthcare system. Osteoarthritis was once thought of as a “wear and tear” process but over the years, medical research has shown that the pathogenesis of OA is multifactorial and includes biomechanical factors, proinflammatory mediators, and proteases. Progressive destruction of joint cartilage in regions prone to maximal joint loading, leads to an increase in chondrocyte activity. Chondrocytes maintain joint cartilage through a variety of anabolic and catabolic activities. The upregulation of chondrocyte activity leads to an increase in the production of proinflammatory cytokines and proteases, which ultimately leads to matrix degradation. Damage to the extracellular matrix leads to cartilage loss and OA symptoms including pain, swelling, grinding, catching and locking, all of which are suggestive of internal derangement of the knee caused by cartilage damage and bony fragments. Sclerosis of the bone, osteophyte formation, and synovial inflammation are also important characteristics of OA. OA of the knee is classified based on its etiology as either primary or secondary. Primary knee OA is idiopathic meaning there is no known cause while secondary knee OA can result from previous surgery, previous trauma, congenital malformations, or even metabolic (ex: Rickets, chondrocalcinosis, etc.) or endocrine (ex: hyperparathyroidism, acromegaly, etc.) disorders. Modern advances in healthcare are allowing patients to live longer and as a result, the number of patients suffering from osteoarthritis will only continue to increase. As the number or patients suffering from OA increases, so will the burden on physicians and advanced practice providers (APPs) to care for these patients. Therefore, physicians and APPs should make themselves aware of the various modalities that are available to patients to help them manage their symptoms. While one approach or modality might work for one patient, it may not work for the next and so it is vital that we offer each patient an individualized treatment plan. Treatment plans should focus on each patient’s current symptoms, their normal activity level, and the outcomes they hope to achieve. Patient-centered outcomes include decreased pain, fewer limitations in their daily life, and less morning stiffness. The definitive treatment of knee OA is total knee arthroplasty (TKA) or total joint replacement. TKA is indicated only in patients with advanced OA when conservative treatment has been tried without success. The purpose of this paper is to discuss the non-surgical management of knee OA and to compare stem cell injections vs. platelet-rich plasma injections to corticosteroid or hyaluronic acid injections in decreasing pain and improving function in patients over the age of 60 with knee osteoarthritis.
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Health Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 03017bbf-d2c5-4c32-b5ff-fb580cd5f16e
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/nrtf-sr77
Graduation Year:: 2017
Keyword:: knee osteoarthritis and non-operative
Language Label:: English
ORCID:
Other Affiliation:
Person:: Aldred, Stephanie, Williams, Todd, and Joyner, Katlyn
Rights Statement Label:: In Copyright

12. Feasibility Assessment: Implementing a Mobile Integrated Provider Program in Alamance County. Addressing Healthcare Shortcoming, Overuse Burdens and Developing New Collaborative Relationships Among Healthcare Providers

Title Tesim:: Feasibility Assessment: Implementing a Mobile Integrated Provider Program in Alamance County. Addressing Healthcare Shortcoming, Overuse Burdens and Developing New Collaborative Relationships Among Healthcare Providers
Creator:: Little, Traci
Date of publication:: 2017
Abstract Tesim:: INTRODUCTION: Emergency Medical Services (EMS) traditionally provides emergent care and transport of community members to emergency departments. However, the past several years has demonstrated the baseline skill set of a Paramedic proves to be an excellent foundation to be trained and function as a Mobile Integrated Healthcare Practice (MIH) provider also referred in literature as a Community Paramedic. The MIH practitioner delivers a unique perspective of interaction and treatment of community members by identifying health care needs beyond emergencies typically treated in the pre-hospital environment but having the skill level to do so. There by reducing 9-1-1 call volumes, unnecessary transports, potentially unnecessary ED visits and subsequent hospital admissions. The thought process behind employing the MIH practitioner will be to transform EMS from a strictly emergency care service to a value-based mobile healthcare provider that is fully integrated with an array of healthcare and social services partners to improve the health status of the community. Often Paramedics are often overlooked as a valuable members of the healthcare team, incorporating the MIH role allows the Paramedic to remain active and visible healthcare team member...
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Health Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 03017bbf-d2c5-4c32-b5ff-fb580cd5f16e
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/s8q8-je26
Graduation Year:: 2017
Keyword:: Alamance County, provider program, and overuse burdens
Language Label:: English
ORCID:
Other Affiliation:
Person:: Powell, Doug, Vipperman, Ray, and Little, Traci
Rights Statement Label:: In Copyright

13. Operative vs. Non-Operative Treatment of Acute Appendicitis

Title Tesim:: Operative vs. Non-Operative Treatment of Acute Appendicitis
Creator:: Pressley, Alexandra
Date of publication:: 2018
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: caa64af1-784b-4c73-846b-f794ed34bd43
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/xvc8-3402
Graduation Year:: 2018
Keyword:: non-operative, antibiotics, physician assistant, appendicitis, and surgery
Language Label:: English
ORCID:
Other Affiliation:
Person:: Campbell, Shanelle, Bludorn, Janelle, and Pressley, Alexandra
Rights Statement Label:: In Copyright

14. Clinical Review of Incretin Based Therapies: Their Role in the Management of Type 2 Diabetes Mellitus

Title Tesim:: Clinical Review of Incretin Based Therapies: Their Role in the Management of Type 2 Diabetes Mellitus
Creator:: Barajas-Graham, Eulalia
Date of publication:: 2017
Abstract Tesim:: Type 2 Diabetes has become an epidemic in the United States; a disease that according to the CDC, in 2013, was the 7th leading cause of death among Americans. Even though there are various treatments available, it is not very clear when these agents are appropriate for individuals. Some agents have unfavorable side effects and can cause hypoglycemia. Newer agents, incretin based therapies, offer an alternative to controlling hyperglycemia. These agents not only help lower Hemoglobin A1C (HbA1C) values, but they also have the added benefits of weight loss, blood pressure control, and very low risks of hypoglycemia. There are two classes of incretin based therapies, GLP-1 Agonists and DPP-4 Inhibitors. Though these treatments have been on the market for several years, the use and knowledge of these drugs is still not prevalent. This review will discuss the role of incretins in diabetes treatment, the unique benefits these agents offer, their therapeutic efficacy, safety, side effects and reasons why these agents are not being utilized.
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Health Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 03017bbf-d2c5-4c32-b5ff-fb580cd5f16e
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/2fjk-y383
Graduation Year:: 2017
Keyword:: Incretin and Diabetes
Language Label:: English
ORCID:
Other Affiliation:
Person:: Faurot, Keturah, Beal, Meg, and Barajas-Graham, Eulalia
Rights Statement Label:: In Copyright

15. Fresh Whole Blood Transfusions: Efficacy, Limitations, and the Future

Title Tesim:: Fresh Whole Blood Transfusions: Efficacy, Limitations, and the Future
Creator:: Difronzo, Marc
Date of publication:: 2017
Abstract Tesim:: Background: Loss of blood from traumas suffered on the battlefield is the most common cause of death among potentially treatable injuries in frontline military operations (Keenan and Riesberg 2017). Cessation of blood loss and fluid repletion have been major driving factors that can reduce battlefield casualties. Once the hemorrhage has been stopped, the next step is to replace lost volume to decrease cardiac failure or shock (Eastridge et al. 2012; Butler 2017). Uncontrolled hemorrhage can lead to the "trauma triad of death", which consists of hypothermia, acidosis, and impaired coagulation (Howard et al. 2017). Hemostatic resuscitation involves the blood components resembling whole blood. The goals are to avoid metabolic acidosis, hypothermia, treating coagulopathy and stabilizing the patient as soon as possible (Nickson n.d.). The resuscitation fluids of choice for casualties in hemorrhagic shock, listed from most to least preferred are: whole blood; plasma, RBCs and platelets in 1:1:1 ratio; plasma and RBCs in 1:1 ratio; plasma or RBCs alone, and crystalloid fluids (Nickson n.d.). Between October 2001 and June 2011, 4,596 battlefield fatalities were analyzed. Non-compressible hemorrhage is the cause of over 2/3 of battlefield deaths, which makes hemorrhages the leading cause of potentially survivable deaths in combat (Keenan and Riesberg 2017). The major body region bleeding focus accounting for mortality were torso 48%, extremities 31%, and neck/groin/ axilla region 21% (Eastridge et al. 2012). Casualties with severe hemorrhagic injury, the odds of KIA mortality were 83% lower for casualties who needed and received pre-hospital blood transfusion (Shackelford et al. 2017). Evaluating the influences on mortality is helpful for planning efforts that optimize placement, proximity, and provision of timely and effective transport and treatment capabilities to minimize casualty risk (Malsby et al. 2013). Combat wounded on today’s battlefield experience the highest survival rate in history. Advances in battlefield medicine during the conflicts in Iraq and Afghanistan have included the effective use of tourniquets, damage control resuscitation, trauma system development, en route care, use of tranexamic acid, and advanced topical hemostatic dressings (Malsby et al. 2013). In 2008, there was a mandate that all the injured personnel evacuation to surgeon must occur in less than 60 minutes, “The Golden Hour”, that contributed to the lowest mortality rate of any conflict in history (Keenan and Riesberg 2017). Component therapy remains the mainstay in trauma resuscitation. In prolonged field care, access to packed red blood cells, platelets, and fresh frozen plasma is often limited (Keenan and Riesberg 2017). Transfusion of fresh whole blood has been used when access to CT in these settings are limited or have been fully utilized . The process of separating and reconstituting blood can lessen its effectiveness. Current Prolonged Field Care standards identified that the best practice for transfusions would be to maintain a stock of pRBC and FFP and have type-specific donors identified for immediate FWB draw (Keenan and Riesberg 2017). PICOT Question: What are the limitations of Fresh Whole Blood transfusions or administration of blood products in prolonged point of injury care on the battlefield?
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Health Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 03017bbf-d2c5-4c32-b5ff-fb580cd5f16e
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/gb6m-3v09
Graduation Year:: 2017
Keyword:: Whole blood, efficacy, and transfusions
Language Label:: English
ORCID:
Other Affiliation:
Person:: Williams, Todd, Faurot, Kim, and Difronzo, Marc
Rights Statement Label:: In Copyright

16. Peri-Procedural Stroke Risk: Cartoid Artery Stenting Versus Carotid Endarteretomy

Title Tesim:: Peri-Procedural Stroke Risk: Cartoid Artery Stenting Versus Carotid Endarteretomy
Creator:: Neri-Mynatt, Gabrielle
Date of publication:: 2017
Abstract Tesim:: STROKE is the 5th leading cause of death in the United States, killing about 130,000 Americans a year. The prevalence of stroke is roughly 3% of the population per year. There are two types of stroke: hemorrhagic and ischemic. Hemorrhagic stroke is caused by bleeding into the cranial cavity while ischemic involves occlusion or restriction of blood flow to an area of the brain. Potential pathophysiologic mechanisms of ischemic stroke include decreased perfusion due to a systemic cause or due to stenosis of a vessel that feeds the brain. Decreased perfusion due to a systemic cause, like persistent hypotension, causes global cerebral hypo perfusion. Vascular occlusion can occur due to plaque or embolization and causes decreased perfusion in the associated vascular bed. Cardioembolism is the most common cause representing about 37% of ischemic strokes. Carotid artery atherosclerosis is a major risk factor and causes 10-15% of ischemic stroke. Atherosclerosis can cause a gradual change in the vessel causing a narrowed area that restricts flow and can accumulate platelets which lead to an acute episode. Risk of stroke from carotid artery stenosis depends on the severity of the stenosis among other risk factors including diabetes and hypertension. Carotid endarterectomy (CEA) is an open surgical procedure was established in 1954 as a reliable treatment for carotid stenosis. In approximately 1990, a clinical trial supported the use of endarterectomy over aspirin alone. Carotid artery stenting is a more recent procedure developed in the 1980s as a less invasive alternative treatment. It is important to compare and contrast each method of treatment to further identify the long-term outcomes associated with each option.
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Health Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 03017bbf-d2c5-4c32-b5ff-fb580cd5f16e
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/03cp-y165
Graduation Year:: 2017
Keyword:: stroke and carotid artery
Language Label:: English
ORCID:
Other Affiliation:
Person:: Faurot, Keturah, Royster, Chad, and Neri-Mynatt, Gabrielle
Rights Statement Label:: In Copyright

17. The Role of Ketamine in Depression

Title Tesim:: The Role of Ketamine in Depression
Creator:: Garner, Mary
Date of publication:: 2017
Abstract Tesim:: Background: Introduction: The average person has up to 15% lifetime risk for developing depression. Major depressive disorder symptoms can include a depressed mood, such as feeling sad or having more anger than normal, changes in appetite, loss of interest in activities or hobbies, psychomotor agitation or retardation, loss of energy, feelings of worthlessness or guilt, decreased ability to think or concentrate, sleep disturbance, an/or having suicidal thoughts. To make the diagnosis of major depressive disorder, according to the DSM-V, Diagnostic and Statistical Manual of Mental disorders, a person must have at least 5 or more of these 9 symptoms during a continuous two-week period which causes significant impairment in functioning. Depression is treated in a variety of ways including medications and psychotherapy either as monotherapy or in tandem. When a patient has failed 2 or more medication treatments they are considered treatment resistant or as having refractory depression. Treatment resistant depression or refractory depression has several standard therapies, which include combination pharmacotherapy, electroconvulsive therapy, or ECT, transcranial magnetic stimulation, or TMS, vagal nerves stimulation and deep brain stimulation. Current research does support that a novel therapy, such as ketamine infusions, may help patients in the short-term with their depressive symptoms, including suicidal ideation. The focus of this paper is to review the clinical trials involving ketamine use in refractory depression for the alleviation of depressive symptoms, including suicidal ideation, and to examine the benefits, limitations, and future potential for ketamine as a treatment for refractory depression.
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Health Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 03017bbf-d2c5-4c32-b5ff-fb580cd5f16e
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/m7nw-fg52
Graduation Year:: 2017
Keyword:: Ketamine and depression
Language Label:: English
ORCID:
Other Affiliation:
Person:: Casey, David, Beal, Meg, and Garner, Mary
Rights Statement Label:: In Copyright

18. Intra-Articular Injections for Analgesia in Knee Osteoarthritis: “Placebo” Normal Saline vs Corticosteroids

Title Tesim:: Intra-Articular Injections for Analgesia in Knee Osteoarthritis: “Placebo” Normal Saline vs Corticosteroids
Creator:: Wells, Steven
Date of publication:: 2018
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 71f7f163-3f01-49d7-b9d7-175b5dd148a4
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/c9z0-5m75
Graduation Year:: 2018
Keyword:: intra-articular injections, saline, physician assistant, osteoarthritis, and corticosteroid
Language Label:: English
ORCID:
Other Affiliation:
Person:: Bludorn, Janelle, Lane, Nicole, and Wells, Steven
Rights Statement Label:: In Copyright

19. Use of Reiki for pain control in post-surgical patients: a critical review of the literature.

Title Tesim:: Use of Reiki for pain control in post-surgical patients: a critical review of the literature.
Creator:: Jones, Jeremy
Date of publication:: 2018
Abstract Tesim:: This critical review was conducted in order to evaluate the effect of Reiki on postoperative pain given the increasing popularity of Integrative medicine and growing need for unconventional approaches to pain control. The review was conducted at the University of North Carolina at Chapel Hill. Online databases were searched in Spring 2018 and identified five randomized controlled trials meeting inclusion criteria. Risk of bias was evaluated with the Cochrane risk of bias 2.0 tool. Four of five studies, with some concern for bias, showed a statistically significant decrease in post-operative pain in Reiki groups compared to sham-Reiki or control groups. There is evidence, with some concerns for bias, that Reiki attunements can effectively reduce post-operative pain.
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: aab0ab11-8f5b-4024-ad0b-10fde9d76105
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/4m7s-b466
Graduation Year:: 2018
Keyword:: Reiki, post-operative pain, physician assistant, and pain management
Language Label:: English
ORCID:
Other Affiliation:
Person:: Faurot, Kim, Gaylord, Susan, and Jones, Jeremy
Rights Statement Label:: In Copyright

20. Human Immunodeficiency Virus and Latency Reversing Agents A Path to Cure?

Title Tesim:: Human Immunodeficiency Virus and Latency Reversing Agents A Path to Cure?
Creator:: Shah, Riti
Date of publication:: 2017
Abstract Tesim:: Background: Human immunodeficiency virus (HIV), as its namesake implies, is a virus that ultimately causes a deficient immune system that can lead to Acquired Immune Deficiency Syndrome (AIDS). Since the discovery of this cytopathic virus in 1983, there have been many scientific advances in regards to its identification and treatment. In 1985, a diagnostic serologic test was developed, and shortly after, in 1987, antiretroviral drugs were introduced. Since these breakthroughs, further improvements in diagnosis and management have been made for individuals afflicted with HIV, including the revolutionary development of combination antiretroviral therapy (cART) in 1996. Despite these advances, in 2014, there were an estimated 1.2 million people in the United States living with HIV, and an estimated 44,073 new HIV diagnoses. Treatment with cART does not completely eradicate HIV, and interruption of therapy leads to prompt increase in viral load, therefore lifelong therapy is required for viral suppression. This viral rebound upon therapy cessation indicates the presence of an anatomical reserve where HIV continues to replicate, better known as latent reservoirs. These reservoirs are the main hindrance to complete viral remission, or cure. The purpose of this paper is to explore this problem and address the clinical question: Do latency-reversing agents (LRAs) eradicate human immunodeficiency virus (HIV) in patients with latent HIV on highly active antiretroviral therapy (HAART)? This paper will explore relevant epidemiology, pathophysiology, and innovative research on this topic and then address the question of LRAs’ role in the eradication of HIV.
Resource type:: Masters Paper
Affiliation Label Tesim:: Physician Assistant Program
Degree:: Master of Health Science
Degree Granting Institution:: University of North Carolina at Chapel Hill
Deposit Record:: 03017bbf-d2c5-4c32-b5ff-fb580cd5f16e
Type:: http://purl.org/dc/dcmitype/Text
DOI:: https://doi.org/10.17615/smy8-ck70
Graduation Year:: 2017
Keyword:: human immunodeficiency virus
Language Label:: English
ORCID:
Other Affiliation:
Person:: Bludorn, Janelle, Patel, Saachi, and Shah, Riti
Rights Statement Label:: In Copyright