RESUMEN
OBJECTIVE: This study evaluated physician associate/assistant (PA) training and confidence in leadership and leadership skills, as well as where best to incorporate leadership training for the profession. METHODS: A quantitative survey was administered to assess PAs' perceptions of leadership and degree of leadership training during their primary PA education. The study also solicited where in the career trajectory leadership training is perceived to be most effective. Of the 284 participants who responded to the survey, 207 had complete responses that were used in the analysis. RESULTS: Nearly 92% of PAs agreed that they aspire to be leaders, and 93.2% agreed or strongly agreed that leadership training would be beneficial during PA school. Additionally, more than 50% of PAs agreed that they had no training but desired more regarding personal mastery, teaching, administration, ideals of a healthy workforce, vision and goal setting, getting results, coalitions, and system transformation. CONCLUSIONS: This study demonstrated that PAs desired supplemental training in leadership to cultivate career goals and reported that formal leadership training would be useful to cope with and overcome adversity in clinical practice.
Asunto(s)
Liderazgo , Asistentes Médicos , Humanos , Asistentes Médicos/educación , Femenino , Masculino , Adulto , Encuestas y Cuestionarios , Persona de Mediana Edad , Actitud del Personal de SaludRESUMEN
ABSTRACT: Coronary artery disease (CAD) is the number one cause of death in the United States, and it is estimated that every 40 seconds one person experiences a heart attack. Among patients with chronic CAD, many will experience a potentially fatal complication known as acute coronary syndrome (ACS). Wellens syndrome is a rare form of ACS that indicates critical left anterior descending coronary artery occlusion and can be identified by its characteristic T-wave patterns on ECG. This syndrome also may go unrecognized by clinicians because of a lack of familiarity with the ECG findings. This article describes the Wellens ECG pattern and its significance in patients with chest pain.
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Síndrome Coronario Agudo , Enfermedad de la Arteria Coronaria , Humanos , Electrocardiografía/efectos adversos , Angiografía Coronaria/efectos adversos , Dolor en el Pecho/etiología , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnósticoRESUMEN
Social determinants of health (SDOH) are conditions in which individuals are born, live, work, learn, play, and age that affect health, risks, functioning, and outcomes. SDOH are recognized barriers to care, risk factors for certain diseases, and associated with poorer health outcomes. Screening for SDOH in physician practices and hospitals is reportedly low. The accessibility of pharmacists and established relationships with patients make pharmacy settings ideal for identifying and mitigating social needs. An evaluation of the impact of SDOH on health outcomes and opportunities for pharmacists to embed screening into practice is warranted.
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Servicios Farmacéuticos , Farmacias , Farmacia , Humanos , Farmacéuticos , Determinantes Sociales de la SaludRESUMEN
ABSTRACT: Acute diverticulitis is a common condition in Western society with the potential for substantial patient morbidity. Depending on the severity, the patient's clinical presentation and treatment options vary considerably, leaving uncertainty about optimal management. Traditionally, surgery was recommended to prevent complications, persistent symptoms, and recurrent episodes. Improvements in the understanding of the disease's natural history, diagnostic imaging, and long-term outcomes have prompted changes to diagnosis and treatment guidelines.
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Diverticulitis del Colon , Diverticulitis , Diverticulitis del Colon/diagnóstico , Diverticulitis del Colon/diagnóstico por imagen , HumanosRESUMEN
ABSTRACT: Hypogonadism is a clinical syndrome of testosterone deficiency that presents with nonspecific symptoms of sexual dysfunction, fatigue, and decreased strength or muscle mass. Men with obesity, diabetes, and other comorbidities are at higher risk for hypogonadism. Patients presenting with symptoms should be tested for low testosterone and treated with testosterone replacement. Testosterone therapy carries risks and must be closely monitored. Patients treated for hypogonadism may experience improvement of symptoms and quality of life.
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Terapia de Reemplazo de Hormonas , Hipogonadismo , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/tratamiento farmacológico , Hipogonadismo/etiología , Masculino , Obesidad/etiología , Calidad de Vida , Testosterona/fisiología , Testosterona/uso terapéuticoRESUMEN
A major outcome of cardiology research over the last 2 decades is the finding that intensive medical management of patients with stable ischemic heart disease is as effective as revascularization procedures in preventing cardiac events and death. This finding has generated management guidelines that often are overlooked because of misplaced enthusiasm for revascularization procedures.
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Isquemia Miocárdica/cirugía , Isquemia Miocárdica/terapia , Intervención Coronaria Percutánea/métodos , Guías de Práctica Clínica como Asunto , Cateterismo Cardíaco , Hemorragia , Humanos , Isquemia Miocárdica/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Riesgo , Medición de Riesgo , Stents , Procedimientos InnecesariosRESUMEN
Celiac disease (CD) is a T-cell mediated genetically inherited autoimmune disease affecting approximately 1% of the population. Research suggests that CD impacts executive functioning (EF) and social phobia (SP). However, most of the literature in this area focuses on age groups outside of the traditional college age range and has never measured EF and SP together. This descriptive study compared traditional age female college students with CD to age- and sex-matched college students without CD on measures of EF and SP. Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), the Social Anxiety Questionnaire for Adults-Short Form (SAQ-A30), and a demographic questionnaire. Results indicated that participants with CD reported lower grade point averages; scored lower on BRIEF-A measures of working memory, planning/organization, and organization of materials; and scored higher on SAQ-A30 measures involving interactions with the opposite sex and strangers. Implications for nursing practice are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(2), 25-34.].
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Enfermedad Celíaca/complicaciones , Función Ejecutiva/fisiología , Fobia Social , Adulto , Estudios Transversales , Femenino , Humanos , Memoria a Corto Plazo , Pruebas Neuropsicológicas , Encuestas y Cuestionarios , Universidades , Adulto JovenRESUMEN
Anorectal pain is common but often misdiagnosed, and patients may suffer in silence if they are too uncomfortable discussing the topic with their healthcare provider. This article reviews rectal anatomy and the signs and symptoms of several common anorectal conditions and how to manage them.
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Canal Anal , Dolor/etiología , Asistentes Médicos , Enfermedades del Recto/complicaciones , Enfermedades del Recto/diagnóstico , Recto , Absceso/complicaciones , Absceso/diagnóstico , Absceso/terapia , Adulto , Canal Anal/anatomía & histología , Diagnóstico Diferencial , Femenino , Fisura Anal/complicaciones , Fisura Anal/diagnóstico , Fisura Anal/terapia , Humanos , Masculino , Persona de Mediana Edad , Relaciones Profesional-Paciente , Enfermedades del Recto/terapia , Fístula Rectal/complicaciones , Fístula Rectal/diagnóstico , Fístula Rectal/terapia , Recto/anatomía & histología , Adulto JovenRESUMEN
Autism spectrum disorder (ASD), previously called autism, is a developmental condition that can cause significant social, communication, and behavioral challenges. Early symptoms of ASD can easily be overlooked. Clinicians who can recognize the symptoms of ASD can help children get prompt referral to specialists and early intervention, which is key to improving developmental outcomes for children with ASD.
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Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/fisiopatología , Trastorno del Espectro Autista/psicología , Trastorno del Espectro Autista/terapia , Comunicación , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Conducta Social , Conducta EstereotipadaRESUMEN
Although glucose-6-phosphate dehydrogenase (G6PD) deficiency is less known in Western countries than in the Middle East and Africa, global migration and immigration are bringing ethnic groups with the highest incidence of this inherited genetic disorder into the US healthcare system. The G6PD enzyme is critical to protecting erythrocytes against oxidative stress, and deficiency may lead to hemolysis in the presence of certain environmental factors such as infection and some medications and foods. Neonatal jaundice, favism, and hemolysis are associated with exposure to increased oxidative stressors in patients with G6PD deficiency. By recognizing the potential for G6PD deficiency, clinicians can screen for the disorder and teach affected patients how to avoid triggers that result in harmful clinical manifestations.
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Deficiencia de Glucosafosfato Deshidrogenasa/epidemiología , Glucosafosfato Deshidrogenasa , Deficiencia de Glucosafosfato Deshidrogenasa/fisiopatología , Humanos , Estrés Oxidativo , Estados Unidos/epidemiologíaRESUMEN
Sudden infant death syndrome, a type of sleep-related sudden unexpected infant death (SUID) is the leading cause of postneonatal mortality in the United States and the third leading cause of infant death overall. Despite the evidence-based risk-reduction strategies and the highly publicized campaigns for a safe sleep environment, some infants continue to sleep in unsafe sleep conditions. Clinicians need to know the current best practices to reduce the incidence of sleep-related SUID and be knowledgeable to counsel caregivers who may resist adhering to these recommendations. This article describes the different types of SUID, associated risk factors, and highlights recommendations to help parents and caregivers ensure safe sleep environments for infants.
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Educación en Salud , Muerte del Lactante/etiología , Muerte del Lactante/prevención & control , Sueño , Muerte Súbita del Lactante/etiología , Muerte Súbita del Lactante/prevención & control , Cuidadores , Consejo , Ambiente , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Padres , Factores de Riesgo , Seguridad , Muerte Súbita del Lactante/epidemiología , Posición SupinaRESUMEN
Anal intraepithelial neoplasia (AIN) and anal squamous cell carcinoma (ASCC) are on the rise in the United States, especially among men who have sex with men, HIV-positive or other immunocompromised patients, and women with a history of cervical, vaginal, or vulvar cancer. Strong evidence supports the human papillomavirus as the causative factor in anal dysplasia; reducing the risk of HPV infection can reduce rates of ASCC. High-risk patients should be screened for AIN, but no universal screening guidelines exist, and more studies are needed to develop a national protocol for screening and management of patients with AIN.
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Canal Anal/patología , Neoplasias del Ano/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Infecciones por VIH/complicaciones , Infecciones por Papillomavirus/complicaciones , Lesiones Precancerosas/diagnóstico , Neoplasias del Ano/prevención & control , Carcinoma de Células Escamosas/prevención & control , Femenino , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Humanos , Masculino , Tamizaje Masivo , Infecciones por Papillomavirus/diagnóstico , Lesiones Precancerosas/prevención & control , Estados UnidosRESUMEN
Liver transplantation is a cure to many devastating acute and end-stage liver diseases. In the immediate postoperative period, patients are prone to graft, end-organ, and immunosuppressive complications. This article reviews the causes, diagnosis, and treatment of acute postoperative liver transplant complications.
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Manejo de la Enfermedad , Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado/efectos adversos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/terapia , Humanos , Complicaciones Posoperatorias/etiología , Periodo PosoperatorioRESUMEN
Limited research exists on PAs and use of point-of-care (POC) ultrasound. This pilot survey sought to determine current views on and use of POC ultrasound in a small group of PAs. METHODS: The authors developed an anonymous voluntary survey on PA views and use of POC ultrasound. The survey was entered into Qualtrics and e-mailed three times. RESULTS: Nearly 27% of the subjects use ultrasound with 62% feeling confident in their ability to use ultrasound. The top reason for not using ultrasound was lack of access to a machine (50%). Only 35.3% of those without access to a machine were interested in bringing ultrasound into their practices. Sixty-seven percent of respondents felt that PAs should have standardized ultrasound training. CONCLUSIONS: Results demonstrate that more research is needed into the applicability of POC ultrasound to all PA practice areas as well as how PAs should be trained in POC ultrasound.
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Asistentes Médicos/estadística & datos numéricos , Sistemas de Atención de Punto/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Ultrasonografía/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Encuestas y Cuestionarios , Ultrasonografía/métodosRESUMEN
Diabetic retinopathy is prevalent among American adults with diabetes. Tight control of glycemic levels, BP, and lipids can help reduce patients' risk of developing diabetic retinopathy, which can lead to severe visual loss and blindness if not treated. Teleophthalmology done in primary care offices can increase the number of patients who are screened, saving patients' vision through early detection and treatment of diabetic retinopathy.
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Retinopatía Diabética/terapia , Oftalmología/métodos , Atención Primaria de Salud/métodos , Telemedicina/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Sandifer syndrome is a rare complication of gastroesophageal reflux disease that may be more common than reported. This syndrome was first mentioned more than 50 years ago with minimal documentation in the medical literature. Because of the presentation, the patient may be referred for lengthy, expensive, and unnecessary neurologic testing. This may lead to a missed or delayed diagnosis, mismanagement, and the use of inappropriate medication. Providers should be aware of Sandifer syndrome when evaluating a child with torticollis or unusual posturing that is not associated with neuromuscular disease or injury.
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Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/terapia , Tortícolis/etiología , Tortícolis/terapia , Niño , Preescolar , Diagnóstico Diferencial , Fundoplicación , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico/fisiopatología , Hernia Hiatal , Antagonistas de los Receptores Histamínicos/administración & dosificación , Humanos , Lactante , Estilo de Vida , Postura , Inhibidores de la Bomba de Protones/administración & dosificación , Convulsiones , Tortícolis/diagnóstico , Tortícolis/fisiopatologíaRESUMEN
Renal transplantation is the treatment of choice for patients with end-stage renal disease. Improved success of renal transplantation has led to a growing number of US patients waiting for a transplant and longer waits to obtain kidneys. This article discusses the process and challenges of getting on the wait list, kidney organ allocation, and areas being explored to increase available organs for renal transplantation.
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Aloinjertos/provisión & distribución , Determinación de la Elegibilidad , Trasplante de Riñón/tendencias , Asignación de Recursos , Listas de Espera , Humanos , Fallo Renal Crónico/cirugía , Obtención de Tejidos y ÓrganosRESUMEN
Clinicians commonly see patients with pleural effusions requiring thoracentesis. The latest evidence-based guidelines for thoracentesis recommend real-time ultrasound guidance for the safest outcomes from this procedure. This article reviews real-time ultrasound guidance for thoracentesis to help referring clinicians understand the technique and the guidelines for the performance of thoracentesis.
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Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Pleura/patología , Derrame Pleural/patología , Toracocentesis/métodos , Drenaje/métodos , Humanos , Ultrasonografía Intervencional/métodosRESUMEN
Bacterial vaginosis is a common vaginal infection that causes discharge, odor, and irritation. It can predispose women to sexually transmitted infections (STIs) including HIV. Recurrent bacterial vaginosis may require prolonged treatment to return the vaginal flora to a normal predominately lactobacilli-dominated environment.
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Antibacterianos/uso terapéutico , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/tratamiento farmacológico , Femenino , Humanos , Microbiota/efectos de los fármacos , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Recurrencia , Vagina/microbiología , Vaginosis Bacteriana/microbiologíaRESUMEN
Primary care clinicians have an important role in the health and wellness of transgender and gender-diverse (TGD) adults and need to know best practices of health maintenance and disease prevention interventions. This article focuses on how exogenous use of sex steroids provided as hormone therapy and gender-affirming procedures affect screening and prevention. Hormone therapy can affect the heart, liver, lipids, bones, brain, skin, and reproductive organs; likewise, behaviors and gender-affirming procedures may alter the risks, prevalence, and screening techniques of sexually transmitted infections. Where applicable, modifications accounting for those differences should be incorporated into the primary care of TGD adults.