Clinical ladders: A potential solution for retaining and promoting PAs.

ABSTRACT: As the need for more healthcare providers increases, so does the need for leaders in the healthcare setting. Physician associates/assistants (PAs) are primed to step into these positions, given their key role in the clinical setting. Clinical ladder models are an established system for clinical, administrative, and academic advancement for healthcare providers. Although more research is needed, clinical ladders provide the opportunity for career advancement while helping to promote professional development and improve retention. Moreover, the opportunity for advancement via clinical ladders may help to prevent clinician burnout and turnover by providing more opportunities and career directions.

A 20-year perspective on the Ottawa Ankle Rules: Are we still on solid footing?

ABSTRACT: The Ottawa Ankle Rules, finalized in 1995, are a clinical decision directive for the use of radiographs in patients with traumatic ankle and foot injuries. The researchers who developed the rules defined clinically insignificant ankle fractures as distal fibular or malleolar chip fractures of 3 mm or less. They concluded that at least one-third of all ankle and foot radiographs could be eliminated by using their rules, which have since been adopted as the standard of care in EDs. This article explores whether, after more than 20 years in use, the Ottawa Ankle Rules are still valid, and whether they should continue to be used or be replaced by a superior protocol.

Weight Loss and Maintenance Related to the Mechanism of Action of Glucagon-Like Peptide 1 Receptor Agonists.

Obesity is a chronic disease associated with many complications. Weight loss of 5-15% can improve many obesity-related complications. Despite the benefits of weight reduction, there are many challenges in losing weight and maintaining long-term weight loss. Pharmacotherapy can help people with obesity achieve and maintain their target weight loss, thereby reducing the risk of obesity-related complications. The prevalence of obesity in the USA has been increasing over the past few decades, and despite the availability of approved anti-obesity medications (AOMs), people with obesity may not be accessing or receiving treatment at levels consistent with the disease prevalence. Reasons for low levels of initiation and long-term use of AOMs may include reluctance of public health and medical organizations to recognize obesity as a disease, lack of reimbursement, provider inexperience, and misperceptions about the efficacy and safety of available treatments. This article aims to inform primary care providers about the mechanism of action of one class of AOMs, glucagon-like peptide 1 receptor agonists (GLP-1RAs), in weight loss and longer-term maintenance of weight loss, and the efficacy and safety of this treatment class. GLP-1RA therapy was initially developed to treat type 2 diabetes. Owing to their effectiveness in reducing body weight, once-daily subcutaneous administration of liraglutide 3.0 mg has been approved, and once-weekly subcutaneous administration of semaglutide 2.4 mg is being investigated in phase III trials, for obesity management. Considerations regarding adverse effects and contraindications for different drug classes are provided to help guide treatment decision-making when considering pharmacotherapy for weight management in patients with obesity.

Obesity is a growing public health issue that increases the risk of developing heart disease, type 2 diabetes, and osteoarthritis. Weight loss can reduce the risk of developing these health problems but, despite this, levels of obesity remain high. Achieving and maintaining weight loss is challenging for many individuals. There is therefore a need for some patients to take medications to help them lose weight and prevent weight regain. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are a type of medication originally developed to treat type 2 diabetes, but are now being used for the treatment of obesity because they are effective at helping people to lose weight. One GLP-1RA, liraglutide, has been approved to treat obesity, and another, semaglutide, is in clinical trials. GLP-1RAs work by reducing the appetite and feelings of hunger, slowing the release of food from the stomach, and increasing feelings of fullness after eating. Most people can tolerate GLP-1RAs well. The most common side effects (nausea, vomiting, and diarrhea) are usually mild and occur in the first few weeks of treatment, reducing over time. Because of the difficulties many people face in maintaining weight loss, lifelong treatment may be needed. In clinical trials, GLP-1RAs were well tolerated and effective at helping people prevent weight regain, and may be a good option for long-term weight control and lowering patients' chances of serious health problems.

Alzheimer's Disease in Primary Care: The Significance of Early Detection, Diagnosis, and Intervention.

The field of Alzheimer's disease (AD) is undergoing a profound and rapid change: clinical trials have been redesigned to focus on individuals in the earliest stages of the disease and are including more sensitive measurement tools to better capture changes in cognition and other outcomes. (Online access: http://courses.elseviercme.com/adwebcast/674http://courses.elseviercme.com/alzheimer/593e). Trial participants undergo PET imaging for amyloid load as a hallmark for dementia, as well as genetic testing to determine likelihood of disease progression and response to therapeutic intervention. Large national and international registries have been established to capture those at risk and to follow their development of cognitive changes longitudinally. Understanding that the disease process starts at least a decade or more before the onset of symptoms has prompted the development of therapeutic interventions acting very early in the disease cascade. For all these reasons, recognizing and diagnosing AD early offers affected individuals and their caregivers the best chance for care planning, access to available symptomatic treatment and community resources, as well as involvement with clinical trials and access to new therapies when they become available. Primary care clinicians play a pivotal role in the early recognition of cognitive impairment in their patients.

Shedding Light on Shingles: The Power of Prevention.

Shingles, or herpes zoster (HZ), is a common secondary infection caused by a reactivated varicella zoster virus (VZV). More than 95% of immunocompetent individuals aged at least 50 years are seropositive for VZV and are therefore at risk for developing HZ. Age-related increased incidence of HZ and its complications are thought to be related to the decline in cell-mediated immunity. Complications of HZ, which create a significant patient and economic burden, may be neurological, ophthalmological, dermatological, or visceral. HZ vaccination is essential for the prevention of HZ and its consequences. This CME activity reviews the clinical presentations and complications of HZ as well as discusses strategies for prevention (Online access: http://courses.elseviercme.com/shingles/626).

The CardioMetabolic Health Alliance: Working Toward a New Care Model for the Metabolic Syndrome.

The Cardiometabolic Think Tank was convened on June 20, 2014, in Washington, DC, as a "call to action" activity focused on defining new patient care models and approaches to address contemporary issues of cardiometabolic risk and disease. Individual experts representing >20 professional organizations participated in this roundtable discussion. The Think Tank consensus was that the metabolic syndrome (MetS) is a complex pathophysiological state comprised of a cluster of clinically measured and typically unmeasured risk factors, is progressive in its course, and is associated with serious and extensive comorbidity, but tends to be clinically under-recognized. The ideal patient care model for MetS must accurately identify those at risk before MetS develops and must recognize subtypes and stages of MetS to more effectively direct prevention and therapies. This new MetS care model introduces both affirmed and emerging concepts that will require consensus development, validation, and optimization in the future.

A framework for physician assistant intervention for overweight and obesity.

Overweight and obesity compose a chronic disease process of epidemic proportions that presents on a continuum, likely affecting nearly two out of every three patients treated by physician assistants (PAs). However, meaningful and actionable definitions, including but not limited to anthropometric and clinical descriptors, are needed. The effective treatment of overweight and obesity requires an efficient and timely process of screening, diagnosis, evaluation of complications, staging, and clear algorithmic management. PAs are trained as primary care providers and can diagnose and treat overweight and obese patients regardless of practice setting and across the spectrum of the disease and patient's age.

Volunteer cleft surgery in Colombia: an 18-year perspective.

PURPOSE: To report the clinical findings and sociologic impressions of a volunteer surgical group's 18-year experience in Colombia. METHODS: Data were collected originally on hard copy and later in a customized database from the epidemiologic, anatomic, and surgical particulars of 2,410 patients with cleft undergoing 2,558 surgeries and analyzed retrospectively. RESULTS: This population exhibited an unusually high incidence of isolated soft palate compared with complete cleft palate and the highest incidence yet reported of bilateral cleft defects. Only 11 potentially life-threatening anesthesia or surgical urgencies or emergencies ensued in the 2,727 total operations, and no fatalities occurred. The sociologic and interprofessional gains of these volunteer efforts have been significant, but actual measurement of the speech, nutritional, psychological, and sociological gains of cleft surgery in this population are yet to be determined. CONCLUSION: This review shows the imperfect, but nonetheless overwhelmingly beneficial benefits that can be provided by volunteer surgical groups in developing nations.

Comparison between Nintendo Wii Fit aerobics and traditional aerobic exercise in sedentary young adults.

Exergaming is becoming a popular recreational activity for young adults. The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit, an active video game console, vs. an equal duration of moderate-intensity brisk walking. Twenty-one healthy sedentary college-age students (mean age 23.2 ± 1.8 years) participated in a randomized, double cross-over study, which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill vs. 30 minutes playing Nintendo Wii Fit "Free Run" program. Physiologic parameters measured included heart rate, rate pressure product, respiratory rate, and rating of perceived exertion. Participants' positive well-being, psychological distress, and level of fatigue associated with each exercise modality were quantified using the Subjective Exercise Experience Scale. The mean maximum heart rate (HRmax) achieved when exercising with Wii Fit (142.4 ± 20.5 b·min(-1)) was significantly greater (p = 0.001) compared with exercising on the treadmill (123.2 ± 13.7 b·min(-1)). Rate pressure product was also significantly greater (p = 0.001) during exercise on the Wii Fit. Participants' rating of perceived exertion when playing Wii Fit (12.7 ± 3.0) was significantly greater (p = 0.014) when compared with brisk walking on the treadmill (10.1 ± 3.3). However, psychologically when playing Wii Fit, participants' positive well-being decreased significantly (p = 0.018) from preexercise to postexercise when compared with exercising on the treadmill. College students have the potential to surpass exercise intensities achieved when performing a conventional standard for moderate-intensity exercise when playing Nintendo Wii Fit "Free Run" with a self-selected intensity. We concluded that Nintendo Wii Fit "Free Run" may act as an alternative to traditional moderate-intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity.

Perceptions of physician assistants regarding direct-to-consumer advertising.

Of 1,254 practicing physician assistants (PAs) who completed a survey, 91% were familiar with direct-to-consumer advertising (DTCA). When asked about their general perception, 96% of PAs were neutral or unfavorable towards DTCA. PAs felt that DTCA encouraged patients to make atypical medication requests, overlook the PA's medical opinion, and seek other health care providers.

The use of prescription stimulants to enhance academic performance among college students in health care programs.

PURPOSE: Prescription stimulant use as academic performance enhancers is increasingly widespread among college students. The purpose of this study was to evaluate the prevalence of prescription stimulant use among health care students attending a university in the northeastern United States. The study investigated the specific stimulants being used and the frequency of usage. It also examined the rates of nicotine, alcohol, and drug abuse versus dependence. METHODS: A web-based survey was administered to medical and health profession students regarding prescription stimulant use for nonprescribed purposes. Tobacco, alcohol, and recreational drug use were also surveyed. RESULTS: Approximately 10.4% (32) of students surveyed have either used a stimulant or are currently using prescription stimulants illegally. The most common reason for stimulant use was to focus and concentrate during studying (93.5%). Of the 308 students, 45.2% were female, 83.9% were Caucasian, and amphetamine-dextroamphetamine was the most commonly abused stimulant (71.4%). CONCLUSIONS: Results from this study are consistent with previous research of undergraduate students regarding prescription stimulant use for nonprescribed purposes, specifically for academic performance enhancement. Data from the study support that alcohol abuse and dependence among students is a pertinent concern, suggesting that substance abuse in general must be addressed. Substance abuse and awareness programs combined with stress management programs in an overall substance-abuse reduction strategy, including the use of prescription stimulant use beyond the originally intended purpose, may be beneficial. Because of the lack of research focusing on graduate health care students, further investigations should use similar populations.