PAs' perspective on leadership in medicine.

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.

Multisystem inflammatory syndrome in children.

ABSTRACT: Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening syndrome that emerged soon after the start of the COVID-19 pandemic. This case report focuses on the general overview, case definition, epidemiology, pathogenesis, clinical findings, and management of MIS-C.

A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial.

BACKGROUND: Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children. METHODS: A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling. RESULTS: Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing. CONCLUSIONS: The high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting.

Enhancing Physician Assistant Psychiatry Interviewing Skills Using Standardized Patients.

INTRODUCTION: The aim of this pilot study was to assess whether supplemental psychiatry training in the didactic year increases the scores on the Physician Assistant Education Association (PAEA) Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation. METHODS: Data were obtained from the physician assistant (PA) students on PAEA Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation for a single institution. Then, a comparison was performed for PA students who did not participate in supplemental psychiatry/behavioral health training (Cohort 1/historical control group; n = 62) and PA students who participated in supplemental psychiatric and behavioral health training (Cohort 2/experimental group; n = 63) to determine the effects of the groups. RESULTS: An independent t test demonstrated that the experimental group performed significantly better than the control group on both the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation {control group (M = 83.4) and experimental group (M = 86.3; t [117] = 2.8; P < .05)} and the preceptor evaluation {control group (M = 90) and experimental group (M = 92.6; t [112] = 2.1; P < .05)}. In addition, both analyses demonstrated a moderate effect size (End of Rotation examination, d = 0.51; preceptor, d = 0.62). A multiple regression analysis was used to control for age, sex, grade point average (GPA), and training intervention. Age, sex, and GPA were found not to affect the results. However, treatment intervention was statistically significant for both the End of Rotation examination and preceptor evaluation scores. DISCUSSION: Supplemental training in behavioral health and psychiatry, which included a standardized patient encounter and an interactive session dedicated to psychiatry interviewing techniques, resulted in students performing better on the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation.

[Post-treatment surveillance for potentially curable malignancies]. / Surveillance des cancers en rémission complète.

Through an enormous research effort over the past five decades and especially due to early screening, an increasing number of cancers are potentially curable. Patients expand immeasurable energy in adhering to treatment plans and supportive care. Unfortunately, nothing prepares them for the anxiety that often comes with completion of therapy. More importantly, physicians are not properly equipped with data from controlled trials to define appropriate post-treatment surveillance, data with which they could educate patients and allay their fears. The goal of post-treatment surveillance is to enable the early detection of relapses and thus enhance the possibility of subsequent cure. Accordingly special follow-up is appropriate only for patients who can receive a second-line therapy. Clinical trials support conservative, rather than aggressive, surveillance to detect curable local relapse of breast tumors and potentially surgically curable metastases (mainly in the liver) of colon cancer. For germ-cell tumors, second-line treatments are potentially curative in nearly all instances. Follow-up for other cancers depends on patients' anxiety levels and on the costs of surveillance.

Frequency of anticardiolipin, antinuclear and anti beta2GP1 antibodies is not increased in unselected epileptic patients: a case-control study.

UNLABELLED: In order to determine whether auto antibodies were restricted to some subtypes of epilepsy, we included 81 unselected epileptic patients and 81 controls, studied clinical data, EEG, neuroimaging, measured antinuclear (ANA), anticardiolipin (aCL) and beta2GP1 antibodies. RESULTS: Epilepsy was active in 74 patients, generalised in 78 and partial in 9. Auto antibodies were positive at the same frequency and the same level among patients and controls (ANA+ 17% vs. 11%; aCL+ 4% vs. 7%; beta2GP1 antibodies+ 5% vs. 6%). There was no increased frequency of auto antibodies among subgroups of epileptic patients except ANA which were more frequent when patients had more than 10 seizures per year. CONCLUSIONS: Positivity of ANA, aCL and beta2GP1 antibodies is not increased in all types of epilepsy and further studies are needed to determine exactly which kind of seizure is immune-mediated.

[Treatment of hot flashes in women with a previous diagnosis of breast cancer]. / Traitement des bouffées de chaleur associées au cancer du sein.

Due to the huge prescription of adjuvant chemotherapy and hormonotherapy, the number of breast cancer survivors with hot flashes is to raise. Hormone replacement therapy is typically withheld from women with previous breast cancer. Treatment should begin with a careful patient history, with specific attention to the frequency and severity of hot flashes and their effect on the individual's function. For mild symptoms that do not interfere with sleep or daily activity, behavioural changes or treatments like soy phyto-oetrogens or vitamin E could be a reasonable initial approach. For more severe symptoms, several alternative substances have therefore been investigated. The use of clonidine and gabapentine should be discouraged because of their modest efficacy and adverse effects. Newer antidepressants (selective serotonin reuptake inhibitors) that are the best studied drugs to date, appear promising as therapy for women with hot flashes. The decrease in hot flashes achieved with progestational agents is similar to that seen with oestrogen therapy but there is debate about the safety of long term use of progestational agents in patients with a history of breast cancer. If hot flashes are particularly troublesome and do not respond to alternative approaches, quality of life must be balanced against theoretical risk of tumour promotion before choosing to use hormone replacement therapy to control these symptoms.

[Malignant cardiac tumors]. / Tumeurs cardiaques malignes.

Cardiac neoplasms are a rare occurrence in clinical practice. The various frequencies of primary and secondary malignant tumors vary from report to report, approximately 1% in most autopsy series and 4% in cancer patient's autopsies. Cardiac malignancies account for less 1% of cardiac surgery and about for 0.1% of cardiac echographic studies. The presence of metastatic tumor to the heart usually indicates widespread metastases. Lung carcinomas are the most commonly encountered tumor followed by breast and pancreas cancer and melanoma. Apart from primary pericardial mesothelioma, primary cardiac tumors are high-grade sarcomas with a high metastatic potency that often becomes evident early after surgery. Symptoms are non specific, occur late in the disease and affect few patients; especially secondary neoplasms of the heart take their course so fast that they cannot become symptomatic. The signs of cardiac neoplasms are divided into systemic symptoms (fever, arthralgias and myalgias), cardiac symptoms (congestive heart failure, arrhythmia, chest pain) and uncommon embolisms. Diagnosis is actually made easier with cardiac echography. Cardiac RMI is helpful to estimate vessels and pericardium involvement. Due to its poor prognosis, treatment of cardiac metastases is restricted to best supportive care. For primary cardiac neoplasms, surgery must be carefully discussed because operative intervention is often followed by rapid widespread metastases that adjuvant chemotherapy cannot avoid in most cases.