An Analysis of Mental Health Representation in the Technical Standards of Physician Assistant Programs.

ABSTRACT: The purpose of this descriptive research project was to examine the technical standards of physician assistant (PA) programs for mental health keywords, phrases, and themes. Each program's standards were analyzed, and keywords, phrases, and major themes were extracted and compared. The results demonstrate that most US PA programs include language related to mental health in their technical standards including theme areas of emotional health, emotional stability, mental health, emotional well-being, and stress management. No patterns between the wording of mental health content and accreditation status emerged. Given the increasing proportion of mental health diagnoses among the general population, and, by extension, applicants to PA training programs, institutions are encouraged to re-evaluate their technical standards to ensure they remain current and appropriate and contain language inclusive of mental health domains such as emotional stability, emotional health, and stress management.

Feasibility and Acceptability of Using Television Clips to Teach Communication Skills.

INTRODUCTION: The purpose of this study was to conduct an innovative seminar that was developed by using clips from the television program ER to teach/reinforce key concepts of effective communication for didactic phase physician assistant (PA) students. METHODS: Interactive, 2-hour , small group seminars were conducted as part of the PA curriculum. Demographic data, as well as information about prior exposure to medical-related television shows and interest in specific medical disciplines, were collected at baseline. The evaluation of this unconventional teaching strategy was completed via a post-activity self-administered, electronic survey. Descriptive statistics were calculated for closed-ended questions, and a thematic analysis approach was used to examine open-ended questions. RESULTS: Approximately two-thirds (n = 49) of the students who attended the seminars completed both the baseline and post-activity surveys. The seminars were well-received, with 94% of respondents indicating they would like to participate in similar trainings in the future. The primary suggestion was to use clips from multiple television programs. DISCUSSION: The results suggest that this instructional format was highly acceptable to modern PA students, who yearn for an amalgamation of education and entertainment. Future work could examine the influence of the seminar on students' communication in clinical environments.

Health Insurance Portability and Accountability Act Violations by Physician Assistant Students: Applying Laws to Clinical Vignettes.

Students enrolled in medical schools, nursing schools, and physician assistant (PA) programs are required to have instruction on patient privacy and protection of health-related information. The medical literature has several examples of breaches of patient privacy by clinicians, which likely represents only a fraction of the violations that occur. Patient privacy and the protection of health-related information constitute both an ethical issue and a legal issue and are associated with significant consequences. Medical, PA, and allied health students are required to comply with the same federal laws related to patient privacy and confidentiality as licensed professionals. Universities must work diligently to create a culture in which students are taught about the legal requirements of the federal Health Insurance Portability and Accountability Act (HIPAA) and are held accountable for compliance with such requirements. The Health Insurance Portability and Accountability Act must be considered part of standard classroom instruction and be embedded and upheld at all clinical training sites. We present a series of 7 HIPAA violations by PA students, along with a brief description of the HIPAA provisions associated with each case. These real-life examples provide a comprehensive overview of important HIPAA components and illustrate how easily violations can occur in clinical settings.

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men.

OBJECTIVE: The aim of this article is to determine whether HIV-infected (HIV+) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIV-) controls. DESIGN: Prospective observational study. SETTING: Multicenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University. PARTICIPANTS: Eight hundred and twenty-five men (541 HIV+ and 284 HIV-) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years). MAIN OUTCOME MEASURES: Incidence and progression of CAC assessed by cardiac CT. RESULTS: During follow-up, 21% of HIV+ men developed incident CAC compared with 16% of HIV- men. This association persisted after adjustment for traditional and HIV-associated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. CONCLUSION: In this large study of HIV+ and HIV- men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men.

Changes in the incidence and predictors of wasting syndrome related to human immunodeficiency virus infection, 1987-1999.

The authors examined the impact of potent antiretroviral therapy (ART) on the diagnosis of wasting syndrome in the Multicenter AIDS Cohort Study. Study time was divided into the periods 1988-1990, 1991-1993, 1994-1995, and 1996-1999 to correspond to different treatment eras. The proportion of acquired immunodeficiency syndrome diagnoses in which wasting was present increased from 5% in 1988-1990 to 7.1% in 1991-1993, 7.7% in 1994-1995, and 18.9% in 1996-1999. The incidence of wasting per 1,000 person-years increased from 7.5 in 1988-1990 to 14.4 in 1991-1993 and 22.1 in 1994-1995; it decreased to 13.4 in 1996-1999. Fewer patients with wasting had low hemoglobin and hematocrit levels and reported oral thrush in 1996-1999 than in any other period. Analysis of change in body mass index (weight (kg)/height (m)(2)) after wasting showed a faster return to prewasting levels in 1994-1995 and 1996-1999 than in earlier periods. Case-control analysis showed that wasting prior to 1996 was weakly associated with fatigue (p = 0.10), low hemoglobin (p = 0.11), and CD4-positive T-lymphocyte count (p = 0.04). During 1996-1999, wasting was weakly associated with diarrhea (p = 0.05) and potent ART (p = 0.097). Predictors of wasting have changed with potent ART. Further research is needed to determine whether lipodystrophy may be misdiagnosed as wasting syndrome.

Validity of self-reporting of episodes of external genital warts.

To determine whether men are able to self-diagnose external genital warts (EGWs), we studied data from 1115 men with and without human immunodeficiency virus infection. Men were largely unable to accurately assess the presence of EGWs. Self-reporting of EGWs was not a sensitive tool; only 38% of men who had EGWs diagnosed by a trained examiner who used bright light and visual inspection also reported having them. When we controlled for other covariates in a multivariate model, men who had EGWs diagnosed by an examiner were 14 times less likely to show concordance between examiner findings and self-report than were men who did not have EGWs diagnosed by an examiner (odds ratio, 0.07; 95% confidence interval, 0.06-0.09). Self-diagnosis and self-assessment may not accurately reflect the presence of EGWs, and self-diagnosis should not be used in place of an examiner's findings for epidemiologic studies that seek to determine the cause of disease.