Racial disparities in pain management: Historical maleficence and solutions for equity.

ABSTRACT: Medical journals from the 1800s described differences in disease susceptibility, skin thickness, and pain tolerance among races. These misconceptions about biologic differences, the historical exploitation of minorities in research, and implicit biases among healthcare workers have all affected patient care. Discrepancies still exist in pain assessment and management for minority patients compared with their White counterparts and lead to poor health outcomes. By implementing specific changes in policy and practice, including standardization, implicit bias training, and building a diverse workforce, clinicians can begin to provide care that more equitably manages pain for all patients, regardless of race.

Genetic testing for patients at risk of hereditary breast and ovarian cancer.

ABSTRACT: The field of cancer genetic testing has made great advances in correctly identifying patients at risk for hereditary cancer syndromes. These tests, used during a genetic consultation, promote earlier detection of cancer and potentially increase survival. Despite these advancements, a large number of persons at risk for BRCA1/2 mutations remain untested due to a shortage of genetic counselors and lack of clinician knowledge on how to properly screen, identify, and refer patients to genetic counseling. We suggest team-based practices that physician associates/assistants (PAs) and NPs can use in collaboration with genetic counselors. We also explore how PAs and NPs can alleviate the burden on genetic counselors by taking a comprehensive family history, providing elements of counseling, and ordering appropriate genetic tests. This approach maximizes the amount of time the patient spends receiving actual genetic counseling. By creating this collaborative relationship, PAs and NPs can help increase the number of qualifying patients who receive genetic testing and counseling for hereditary breast and ovarian cancer syndromes.

Diagnosis and management of type 2 diabetes in children.

ABSTRACT: The incidence of type 2 diabetes in children has risen 4.8% over the past decade, correlating with steadily rising obesity rates in children. Updated guidelines from the American Academy of Pediatrics and the American Diabetes Association encourage early identification and pharmacologic intervention for children with type 2 diabetes. Because of the aggressive disease course in children, comprehensive treatment must include prevention of complications such as diabetic nephropathy and neuropathy as well as management of comorbidities such as cardiovascular disease and dyslipidemia. Because the highest incidence of type 2 diabetes is reported in patients from racial or ethnic minority groups and those of low socioeconomic status, clinicians must work with patients and families to identify socioeconomic disparities that could affect adherence to diabetes management plans and to connect patients with community resources.

Guidelines for screening and managing hypertension in children.

ABSTRACT: Pediatric hypertension has risen to an overall prevalence of 16.3%. If left untreated, hypertension in children and adolescents can have significant implications for cardiovascular and renal health into adulthood, including stroke, coronary artery disease, kidney disease, and heart failure. In 2017, the American Academy of Pediatrics (AAP) released updated guidelines for the screening, evaluation, and management of pediatric hypertension. This article reviews the definition of pediatric hypertension, describes why the guidelines were updated, and defines treatment protocol. By familiarizing themselves with and applying these guidelines, clinicians will be able to appropriately screen and manage hypertension in children to prevent morbidity into adulthood.

Evaluating low back pain in adolescents.

Low back pain in adolescents is a common complaint in primary care. With an average prevalence rate of 40%, adolescent low back pain correlates with greater healthcare use, higher incidences of adult back pain, and negative effects on overall well-being. A thorough history and physical examination can increase early detection and accurate diagnosis while ensuring the judicious use of diagnostic modalities. Although underlying serious pathology is rare in adolescents with low back pain, clinicians should recognize specific signs and symptoms that necessitate urgent evaluation and intervention. This article emphasizes the value of using a thorough history and physical examination to guide the initial diagnostic workup and to enhance the early detection and accurate diagnosis of adolescents who present with low back pain.

Clinical utility of next-generation sequencing in precision oncology.

The Precision Medicine Initiative (PMI) aims to change the way diseases are diagnosed and treated by taking into account a patient's genome, lifestyle, and environment. This type of research also uncovers potential biomarkers that can lead to the development of novel targeted therapies. Next-generation sequencing (NGS) is a new technology that facilitates collection of this genetic information by processing large amounts of DNA in an efficient and cost-effective way. NGS is particularly useful in oncology and has already begun to transform cancer management.

Smartphone imaging for the ophthalmic examination in primary care.

Direct ophthalmoscopy is an integral part of the physical examination and is the most widely used technique to assess the fundus, especially in primary care. The gold standard slit-lamp technique is used in specialty clinics and in some EDs. Most medical professionals own smartphones, and a smartphone ophthalmoscope could bring the quality of a slit-lamp examination into primary care. Imaging techniques with smartphones are easy to learn and use, providing a significant step toward reversing the lack of confidence that students and clinicians have in traditional methods. Current evidence supports the potential of smartphone imaging to replace direct ophthalmoscopy in primary care settings.

Current and future uses of probiotics.

The relationship between host and gut microbiota has been the topic of research in recent decades, with particular emphasis on various species of bacteria and their distinct role in health promotion. Early promising research led to the new term probiotic, coined to describe these beneficial bacteria. This early research has laid the foundation for various proposed mechanisms of probiotic effects on health. This article describes current areas of established probiotic use and introduces areas of current investigation, including psychobiotics, which may help patients suffering from psychiatric illness.

The effects of physical activity on survival in patients with colorectal cancer.

Mortality from colorectal cancer has been declining over the past 20 years due to improvements in screening and treatment. Physical activity improves patient quality of life, slows functional decline, and reduces all-cause mortality. Although some patients may have difficulty participating in physical activity, clinicians should always try to incorporate exercise into a management plan for patients who have survived colorectal cancer.

The effects of obesity on pulmonary function in children.

The prevalence of obesity has risen rapidly in the United States in the past 20 years. Up to 25% of US children are obese, and obesity can be directly correlated with immediate and long-term health consequences. Pediatric obesity can harm multiple body systems and is a public health issue. This article focuses on how obesity affects a child's respiratory system, including pulmonary function, exercise intolerance, gas exchange, and airway musculature.

Practical applications of physical activity for successful cognitive aging.

As patients lose cognitive function, they lose autonomy and increasingly use fiscal, social, and medical resources. Healthcare costs for Americans older than age 65 years are three to five times higher than for the remaining population, and dementia is the third most costly disease in the United States. Interventions that promote successful aging can help patients and reduce the financial, workforce, and treatment resource burdens on the population. Because a relationship between physical activity, particularly aerobic exercise, and cognitive decline has been established, physical activity interventions may prove practical, affordable, and effective. Attention to empiric research and knowledge of evidence-based strategies for prescribing physical activity are critical for PAs to embrace.

Promoting preconception health in primary care.

Recommendations that all women of reproductive age have preconception care integrated into their primary care visits have been made since 1990. By looking at every premenopausal woman as a potential mother and advising her accordingly, primary care PAs can help women improve both their health and pregnancy outcomes.

Radiofrequency catheter ablation for atrial fibrillation.

Antiarrhythmic drugs are the first-line treatment for atrial fibrillation (AF); as a result, catheter ablation usually is not considered until a patient is experiencing symptomatic AF refractory to at least one antiarrhythmic medication or is intolerant to medical therapy. For these patients, catheter ablation is shown to be more effective than medical therapy for controlling AF. This article reviews catheter ablation and its indications.

Training physician assistants for rural Appalachia: an academic partnership for interprofessional collaboration.

Wake Forest School of Medicine and the College of Health Sciences at Appalachian State University are partnering to train physician assistants to practice as primary care providers in medically underserved parts of Western North Carolina. The partnership will also develop interprofessional education and team-based training activities for health professions students.

Cardiorenal syndrome: understanding the connections between cardiac and renal disease.

Renal and cardiac diseases are nearly ubiquitous in hospitalized patients and common causes of morbidity in outpatients. Although the connection between the heart and kidneys is relatively well known in the medical community, a more formal classification for the clinical interplay of the two systems has been developed only recently. Cardiorenal syndrome was described by Italian nephrologist Claudio Ronco in 2008. This classification allows for justification of management strategies in these complex patients and will guide further research studies.