Early and aggressive treatment for Crohn disease using biologics and immunomodulators.

ABSTRACT: Traditionally, medical providers have used the step-up approach to manage patients with Crohn disease, starting with 5-aminosalicylic acid derivatives, progressing to corticosteroids, and eventually to immunomodulators and biologics. However, a new top-down approach focuses on early and aggressive therapy with biologics and immunomodulators to reduce the rate of mucosal and intestinal damage. This article describes early and aggressive biologic and immunomodulator therapies and new therapeutic parameters compared with traditional step-up treatment for patients with Crohn disease.

A clinician's guide to pulmonary hypertension.

ABSTRACT: Despite advances in diagnosis and treatment, pulmonary hypertension has high morbidity and mortality. The presenting symptoms often are vague and may mimic other more common diseases, so patients can be misdiagnosed or missed early in the disease process. Early detection of pulmonary hypertension by primary care providers can play an important role in patient outcomes and survival. Identifying signs and symptoms, understanding the causes and classifications, and knowing the systematic approach to evaluating and diagnosing patients with suspected pulmonary hypertension are key to preventing premature patient decline.

An update on treatments for autosomal dominant polycystic kidney disease.

ABSTRACT: Autosomal dominant polycystic kidney disease (ADPKD) is less common than primary hypertension or diabetes but should be considered as a possible cause of end-stage renal disease, especially in young patients without comorbidities. Because of ADPKD's nonspecific symptoms, the diagnosis, treatment, and pertinent patient education may be delayed. This article describes ADPKD and its management, including tolvaptan, a new treatment with the potential to reduce or delay morbidity. However, only a subset of patients qualifies for this expensive treatment.

Antibiotic use and bacterial resistance in patients with acne vulgaris.

ABSTRACT: Acne vulgaris is a prevalent chronic skin disease caused by obstruction and/or inflammation of pilosebaceous follicles. Each year, about 50 million people in the United States are affected. The use of topical and oral antibiotics to manage acne has been associated with the development of bacterial resistance. This article reviews concerns about antimicrobial use, current treatment recommendations, and emerging research in unconventional treatments.

Longitudinal Integration of Oral Health Training Into Physician Assistant Education.

PURPOSE: The purpose of this study was to evaluate physician assistant (PA) student knowledge after integrating an oral health curriculum longitudinally into a PA program and to assess student perceptions of the oral health curriculum. METHODS: This study was a 2-group longitudinal study comparing differences between the groups at 2 points in time. Cohort I (n = 60) took an oral health pretest and then, after completing oral health training, took a posttest. Cohort II (n = 49), which had not received oral health training, took identical testing on the same time interval. The students in Cohort I assessed the value of the oral health curriculum by answering a standardized perception survey. RESULTS: Cohort I had a statistically significant increase (p ≤ .0001) in posttest assessment scores compared to Cohort II (control group). The students who were exposed to the oral health curriculum reported a deeper understanding and appreciation of oral health disease and increased confidence in oral health clinical application. CONCLUSIONS: A greater awareness of the importance of oral health and chronic disease has evolved within PA education over the past 2 decades. Despite this progress, there is still a need to expand this curriculum and improve PA students' depth of knowledge in oral health. This study presents a novel and effective approach to incorporating an oral health curriculum into a PA program.

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.