Recognizing and treating endometriosis.

ABSTRACT: Endometriosis, defined as endometrium-like tissue located outside the uterine cavity, is a chronic and frequently painful disease that affects about 10% of reproductive-aged women worldwide. The ectopic endometrial tissue, which is still hormonally responsive, generates a chronic inflammatory state resulting in an array of sometimes debilitating symptoms as well as subfertility. Despite its prevalence and significant effect on a woman's health and quality of life, receiving a diagnosis of endometriosis often takes years. This article reviews the epidemiology, pathophysiology, clinical presentation, and treatment options for managing endometriosis in women who do not desire pregnancy and in those who do, and includes information on the newest treatment option, the oral gonadotropin-releasing hormone (GnRH) antagonist elagolix.

An interprofessional education approach to fall prevention: preparing members of the interprofessional healthcare team to implement STEADI into practice.

An aging population benefits from healthcare providers trained in the care of older adults. Interprofessional education (IPE) and service-learning activities focused on geriatric conditions like falls may address this need. A fall prevention IPE activity using the Centers for Disease Control and Prevention (Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative was implemented to prepare health sciences students to manage older adult falls. Students (N = 31) and faculty (N = 10) from five health sciences programs and local older adults (N = 27) participated. Students were trained in STEADI and conducted a fall risk screening, assessment, and intervention activity with older adults using STEADI tools. We observed a statistically significant improvement in student knowledge of fall prevention and STEADI as assessed by pre and postactivity measures. Student surveys indicated improved understanding of the roles and responsibilities of participating disciplines, related to management of falls in older adults. The CDC's STEADI initiative may provide an effective framework and resources for fall prevention IPE activities and geriatric health sciences education.

A fresh look at memory loss: Reexamining frontotemporal dementia.

Frontotemporal dementia is a neurodegenerative disease affecting cognition and behavior in multiple devastating ways. This article highlights diagnostic features helpful in differentiating frontotemporal dementia from other dementias, most commonly Alzheimer disease.

An unusual cause of hoarseness and recurrent laryngeal nerve palsy.

Recurrent laryngeal nerve palsy and thyroid disease suggest locally invasive thyroid malignancy. In contrast, recurrent laryngeal nerve palsy caused by benign multinodular goiters or ectopic thyroid tissue accounts for only 1% of cases. This article describes an unusual case of recurrent laryngeal nerve palsy secondary to a benign ectopic retrosternal thyroid tissue mass. Recurrent laryngeal nerve palsy should be considered in the differential diagnosis of patients presenting with progressive voice weakness and hoarseness.

Colorectal cancer screening: The role of the noninvasive options.

Recommended screening options for colorectal cancer are divided into noninvasive stool-based options, and invasive procedure-based options. Because multiple screening strategies are effective, efforts to reduce deaths from colorectal cancer should focus on maximizing the number of patients who are screened. This article reviews noninvasive stool-based screening options.

HPV Vaccine Communication Competency Scale for Medical Trainees: Interdisciplinary Development Study.

BACKGROUND: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap. OBJECTIVE: The specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients. METHODS: Using a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software. RESULTS: A valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach α indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport (α=.796), patient respect or empathy (α=.737), provider interview or intake (α=.9), patient counseling or education (α=.935), provider communication closure (α=.896), and provider knowledge (α=.824). CONCLUSIONS: Pharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee's individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates.

Student Self-Assessments and Peer Assessments of Video Recordings of Physical Examination Practicums in a Physical Diagnosis Course.

PURPOSE: Self-assessments and peer assessments of video recordings of performance have been used in a variety of educational and professional training programs; however, there is no literature on the application of such performance assessments in physician assistant (PA) education. The purpose of this pilot study was to both explore the feasibility of adding video recordings of existing practicum examinations to a physical diagnosis course and evaluate students' self-assessments and peer assessments of the activity. METHODS: Fifty first-semester students who were enrolled in a 7-semester PA program participated. Three 15-minute practicums were recorded on students' personal smartphones and uploaded to a private YouTube channel. Students completed self- and peer-review questionnaires after each practicum, as well as a separate reflective questionnaire at the end of the course to garner their feedback of the video-recorded practicums on their physical examination (PE) performance. RESULTS: Students assessed their peers' performances more favorably than their own. Students reported increased awareness of their own verbal and nonverbal communication strengths and weaknesses with the use of video-recorded practicums, as well as increased motivation to practice. The majority of students found these sessions to have improved their performance and decreased their anxiety with performing a complete PE at the end of the course. CONCLUSIONS: The use of periodic video recordings of PE practicums with both self-assessments and peer assessments increased the students' level of practice of these important skills, enhanced students' awareness of nontechnical aspects of patient examination, was well received by the majority of students, and may be implemented with minimal expense.