The Perceived Intersection of Parenting and Physician Assistant Training Among Current Physician Assistant Students.

PURPOSE: Despite recent advancements in policies supporting pregnancy and parenting-related resources for physician assistant (PA) students, there remains a paucity of data on the perceptions of family planning or available resources during training. The purpose of this study was to explore the perceptions of support for, and impact on, family planning and parenting, including lactation, among PA students. METHODS: This cross-sectional study used data collected from the American Academy of Physician Associates Student Survey between January and March 2023. Descriptive and inferential statistics were performed. RESULTS: A total of 557 students (557/1353; 41.2%) completed the survey. Less than 15% of students (14.4%) believed their program provides resources to support parental leave, and many students (52.1%) remained unsure whether resources exist(ed). There was a significant difference for PA students (P = .005) by gender in whether family planning affected the decision to pursue PA training over another profession, with female students proportionately affected more than male students. Medical school was the most often considered aside from PA training. Most PA students (311/548; 56.8%) also felt pressure to wait until after training to have children. In addition, multiple students (26/554; 4.7%) admitted to being asked questions they believed were biased or inappropriate regarding pregnancy or parenting during the interview process for, or after beginning, PA school. CONCLUSION: Programs should seek opportunities to support students through all stages of family planning. Support will require both cultural and structural shifts beginning with peer stigma and extending through admissions interview question audits, faculty training, university policies, and accreditation requirements.

Acknowledging the risk of suicidal ideation, depression, and anxiety in PAs.

ABSTRACT: The prevalence of suicidal ideation is unknown and limited information exists about depression and anxiety among physician associates/assistants (PAs). We set out to understand the degree of depression, anxiety, and suicidal ideation in PAs and PA students. In total, 728 PAs and 322 PA students took an online survey. Risk of depression and anxiety were present at higher levels in PA students compared with employed PAs. PA students indicated higher levels of suicidal ideation compared with clinically active PAs. One-third of those with suicidal ideation did not reveal it to anyone; among those who did, 16.2% feared the results of disclosure. This study establishes that PAs and PA students are at risk for suicidal ideation and often bypass help. The COVID-19 pandemic may have led to elevated rates of emotional distress, and longitudinal studies are needed to understand the basis for such ideation and if it is transitory.

Clinical utility of ozone therapy and hyperbaric oxygen therapy in degenerative disc disease.

Ozone can be medically useful concerning healing wounds and relieving pain in various conditions, such as disc disease. The aspects of human blood ozonation have been reviewed, as well as potential complications that may arise. The mechanisms of ozone therapy are discussed in detail. It is imperative to recognize ozone as a useful proxy in oxidative-stress related diseases, consolidating other medical gases recognized for their therapeutic importance. The utility of hyperbaric oxygen therapy is also discussed. Disc herniation is very common, as more than 3 million cases are treated per year. Herein we review the medical, surgical, and gene-based therapies that ozone therapy can provide regarding disc disease.

Validation of a Dendritic Cell and CD4+ T Cell Restimulation Assay Contributing to the Immunogenicity Risk Evaluation of Biotherapeutics.

Immunogenicity, defined as the ability to provoke an immune response, can be either wanted (i.e., vaccines) or unwanted. The latter refers to an immune response to protein or peptide therapeutics, characterized by the production of anti-drug antibodies, which may affect the efficacy and/or the safety profiles of these drugs. Consequently, evaluation of the risk of immunogenicity early in the development of biotherapeutics is of critical importance for defining their efficacy and safety profiles. Here, we describe and validate a fit-for-purpose FluoroSpot-based in vitro assay for the evaluation of drug-specific T cell responses. A panel of 24 biotherapeutics with a wide range of clinical anti-drug antibody response rates were tested in this assay. We demonstrated that using suitable cutoffs and donor cohort sizes, this assay could identify most of the compounds with high clinical immunogenicity rates (71% and 78% for sensitivity and specificity, respectively) while we characterized the main sources of assay variability. Overall, these data indicate that the dendritic cell and CD4+ T cell restimulation assay published herein could be a valuable tool to assess the risk of drug-specific T cell responses and contribute to the selection of clinical candidates in early development.

Physician Assistants' Training and Self-Perceived Competencies to Work with Survivors of Intimate Partner Violence.

INTRODUCTION: The purpose of this research was to assess physician assistant (PA) education and training on the diagnosis, management, and treatment of survivors of intimate partner violence (IPV), as well as perceived current vs. desired skills in tasks related to the management and treatment of IPV. METHODS: Participants in 2 studies included a convenience sample of attendees at an annual PA conference (study 1) and PAs in the United States who were randomly selected to be administered an online survey related to their PA practice (study 2). RESULTS: In 2 studies, PAs reported low perceived competence to treat and manage patients who are survivors of IPV. More than half of the respondents (51.2%) had received training to work with survivors of IPV. Almost 3 in 5 indicated that they felt adequately prepared, and almost 3 in 10 regularly asked patients about IPV. Gaps between current and desired perceived skills to treat and manage survivors of IPV were larger among PAs who had previous training related to IPV compared with PAs with no prior training. DISCUSSION: Guidance for PA educators may improve PA education and increase competencies among new PAs. Without more substantial guidance from an accrediting body, PA programs are left responsible for implementing IPV curriculum. Professional associations as well as constituent and specialty organizations that provide continuing medical education have an equally important role in strengthening skills and abilities among PAs.

Diversity in the Physician Assistant Pipeline: Experiences and Barriers in Admissions and PA School.

INTRODUCTION: The purpose of this study was to identify perceived barriers faced by physician assistant (PA) students who identified as an underrepresented minority in medicine (URM-med), sexual or gender minority (SGM), coming from low socioeconomic status (low SES), or a person with a disability (PWD). METHODS: More than 2700 PA students across the United States provided information regarding their PA school application process and program experiences. This study examined differences among URM-med, SGM, low SES, and PWD compared to those who were not in those groups to determine the relationship between these factors and student concerns about bias in the application process, as well as a variety of experiences in PA school. RESULTS: Using ordinal logistic regression analyses to examine the odds of experiencing a variety of barriers or experiences in applying to PA school and postmatriculation experiences, results suggested that, among disadvantaged groups within the PA student body, barriers include concerns about bias in the application process, lack of belonging, and the lack of academic and social support. DISCUSSION: PA students who identified as URM-med, SGM, low SES, and/or PWD faced barriers as they navigated the path to becoming a PA. To decrease these barriers, emphasis on raising awareness and interest in pursuing a career as a PA should occur early. Programs should work to identify biases within admissions processes, diversify faculty, and identify ways to support minority students once matriculated. Ultimately, increasing the diversity of healthcare providers has the potential to increase access to and quality of care for patients.

The Role of Interpersonal Toxicity on Healthcare Students' Well-Being.

INTRODUCTION: Nearly half of all medical students suffer from burnout, which not only has detrimental effects on the students themselves but can transfer into the clinical realm. Yet, studies exploring burnout and interpersonal toxicity in physician assistant (PA) students are rare. This study examined the role that interpersonal toxicity and abuse play in PA student burnout. METHODS: Nearly 2500 PA students in the United States responded to a survey about well-being, stress, and experiences with interpersonal toxicity in PA school as part of a larger cross-sectional study on PA student experiences in their didactic and clinical years. The present research focuses on overall measures among all PA students, as well as differences between didactic and clinical students, including the extent to which experiences of interpersonal toxicity predict symptoms associated with burnout. RESULTS: Overall, PA students reported high levels of satisfaction and happiness in school and life, but enthusiasm for school decreased for clinical students. More than two-thirds of students reported moderate to high levels of life stress, and more than 9 in 10 reported moderate to high levels of school stress. Symptoms of burnout were reported by many students, with clinical students reporting interpersonal toxicity exposure more often than didactic students. Experiencing interpersonal toxicity or abuse predicted symptoms of burnout. DISCUSSION: While PA students report high levels of life and school satisfaction, given the high levels of stress also reported, burnout metrics and well-being programs are needed. PA programs should work to create a supportive and engaging educational environment to ensure students' long-term career success.

Do Physician Assistant Training Programs Adequately Prepare PAs to Address Nutritional Issues in Clinical Practice?

PURPOSE: The purpose of this study was to determine physician assistants' (PAs') current level of confidence to engage in nutrition-related tasks and their satisfaction with the nutrition education they received in PA school. METHODS: To achieve this goal, a mixed-methods approach that consisted of 3 data collection phases (qualitative online discussions, quantitative survey, and qualitative interviews) was used to explore and measure PAs' perceptions of the education they received in PA school and through other sources and how confident they felt addressing nutrition-related issues in clinical practice. RESULTS: While 80% of PAs endorse the idea that PAs should be more involved in providing nutritional care to patients, the majority reported basic or no knowledge of the nutritional implications of chronic conditions (69%), inflammatory bowel disease (69%), nutritional needs over the lifespan (67%), and food allergies and intolerances (64%). Barriers to patient care included knowledge-related challenges when selecting lab tests based on patient profile (46%) and identifying needs based on various gastrointestinal diseases (67%) and when using diagnostic data to identify deficiencies (74%). Overall, 59% of PAs reported being slightly or very dissatisfied with the nutrition-related content in the curricula used to formally train PAs. CONCLUSIONS: The primary goal of every PA program is to prepare its graduates to be competent to enter clinical practice. Regarding nutrition, these data indicate that programs are failing to do so. PAs lack the confidence and ability to provide optimal nutritional care, which is staggering considering that nutrition is the first line of treatment in the prevention and management of numerous chronic diseases.

PAs' skills in providing vision and ocular care.

OBJECTIVE: To evaluate characteristics, training, and self-reported skills and abilities in vision and ocular care among PAs not specializing in ophthalmology. METHODS: A survey on PA practice was administered to 5,763 randomly selected US-based PAs, and 537 respondents who completed the survey were invited to complete a separate vision and ocular care survey. Of those respondents, 382 completed the vision and ocular care survey. RESULTS: Among respondents, 23% of PAs were involved in eyecare by providing patient information, answering questions, and initiating discussions about vision care and ocular health more than once per month. More than 77% received vision and ocular care training in and/or outside PA training. PAs involved in eyecare had significantly greater odds of reporting higher desired and current skill and ability levels compared with PAs not involved in eyecare, in six of eight vision and ocular care domains. CONCLUSIONS: PAs who do not practice in ophthalmology provide vision and ocular care but have varying amounts of training and desire higher skill and ability levels. Ophthalmologists and PA institutions may develop vision and ocular care training for PA schools and continuing medical education.

Assay format diversity in pre-clinical immunogenicity risk assessment: Toward a possible harmonization of antigenicity assays.

A major impediment to successful use of therapeutic protein drugs is their ability to induce anti-drug antibodies (ADA) that can alter treatment efficacy and safety in a significant number of patients. To this aim, in silico, in vitro, and in vivo tools have been developed to assess sequence and other liabilities contributing to ADA development at different stages of the immune response. However, variability exists between similar assays developed by different investigators due to the complexity of assays, a degree of uncertainty about the underlying science, and their intended use. The impact of protocol variations on the outcome of the assays, i.e., on the immunogenicity risk assigned to a given drug candidate, cannot always be precisely assessed. Here, the Non-Clinical Immunogenicity Risk Assessment working group of the European Immunogenicity Platform (EIP) reviews currently used assays and protocols and discusses feasibility and next steps toward harmonization and standardization.

Depression, burnout, and professional outcomes among PAs.

OBJECTIVE: This study examined the effect of depression and burnout on PA professional fulfillment and medical errors. METHODS: Eight hundred eighty PAs completed an online survey containing the Professional Fulfillment Index, PHQ-2, GAD-7, and demographic questions. Two serial mediation models examined the relationship between depression, burnout, and professional outcomes. RESULTS: Burnout fully mediated the relationship between depression and outcomes in both models and the present research indicates that burnout plays a stronger role in job satisfaction than symptoms of depression. CONCLUSIONS: Understanding the underpinnings of professional satisfaction may mitigate clinician turnover, which in turn may lead to cost savings for the organization, better resilience and mental health for clinicians, and potentially better patient outcomes.

Reasons PAs leave their jobs.

PURPOSE: Employee turnover is an important indicator that carries a heavy financial cost for healthcare organizations. Although previous research has highlighted some factors associated with turnover, the reasons physician assistants (PAs) leave their jobs are not fully understood. This study aimed to determine the most common reasons behind PA turnover. METHODS: In 2019, the American Academy of PAs (AAPA) distributed a survey to all PAs with an eligible email address. The survey included a question asking respondents if they had left or changed their job in the past year. Respondents answering this question in the affirmative were asked a follow-up multiple-choice question to determine the reason behind this change. RESULTS: A total of 13,088 PAs responded to the AAPA salary survey; of these, 1,261 reported leaving a job within the past year. The most common reasons provided for leaving a job were: better work/life balance (n = 209, 16.8%), moved (n = 208, 16.7%), better management/leadership/environment (reasons related to toxic/abusive environment) (n = 170, 13.6%), and better compensation/benefits (n = 148, 11.9%). CONCLUSION: Employers should focus on common reasons for turnover that can be reasonably addressed. Of the top three reasons behind PA turnover, those related to toxic/abusive work environments may be the most practical and important to address.

Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management.

OBJECTIVE: Damage to the dura mater often occurs in trauma cases of the head and spine, surgical procedures, lumbar punctures, and meningeal diseases. The resulting damage from dural tears, or durotomy, causes cerebrospinal fluid (CSF) to leak out into the surrounding space. The CSF leak induces intracranial hypotension, which can clinically present with a range of symptoms not limited to positional headaches which can confound accurate diagnosis. Current methods of evaluation and management of dural tears are discussed herewith, as well as the present understanding of its etiology, which may be classified as related to surgery, procedure, trauma, or connective tissue disorder. METHODS: We piloted a MEDLINE® database search of literature, with emphasis on the previous five years, combining keywords such as "cerebrospinal fluid leak," "surgery," "procedure," and "trauma" to yield original research articles and case reports for building a clinical profile. RESULTS: Patients with suspected dural tears should be evaluated based on criteria set by the International Headache Society, radiological findings, and a differential diagnosis to accurately identify the tear and its potential secondary complications. Afflicted patients may be treated promptly with epidural blood patches, epidural infusions, epidural fibrin glue, or surgical repair. At this time, epidural blood patches are the first line of treatment. Dural tears can be prevented to an extent by utilizing minimally invasive techniques and certain positions for lumbar puncture. Surgical, trauma, lumbar puncture, and epidural injection patients should be observed very carefully for dural tears and CSF leaks as the presenting clinical manifestations can be highly individualized and misguiding. CONCLUSION: Because studies have demonstrated a high frequency of dural tears, particularly in spinal surgery patients, there is a need for prospective studies so that clinicians can develop an elaborate prevention strategy and response to avoid serious, unseen complications.

Reexamining the persisting wage gap between male and female PAs.

OBJECTIVE: To determine the magnitude of any difference in total compensation between male and female physician assistants (PAs) after controlling for personal and workplace factors related to compensation. METHODS: Using data from the 2019 AAPA Salary Survey, the authors conducted a sequential regression analysis to examine the relationship between a variety of personal and practice demographics and total compensation. RESULTS: After controlling for compensation-related factors, a wage gap between male and female PAs persisted: female PAs were paid almost $0.93 for every $1 male PAs were paid in the first year of work ($9,010 less). This wage gap widened by $201 for every year of work experience. CONCLUSIONS: A wage gap between male and female PAs persists even after including all compensation types and controlling for compensation-related factors that may differ between male and female PAs. Proposed policy implications could begin to mitigate the gap.

Psychosocial and Sexual Implications of Repaired Cleft Lip in an Adult Male.

We describe the case of a 32-year-old man with repaired cleft lip complaining of sexual difficulties, which were determined to be multifactorial in origin. A negative body impression, anatomical difficulty in engaging in sexual acts, the indirect impact of secondary complications of cleft lip, and the negative perception of his dysmorphia from potential sexual partners led to his current state. Cleft lip and palate (CLP) are the most common malformations of the craniofacial region. The malformations of anatomical structures involved in CLP can manifest through several variations of clinical features and phenotypes, typically affecting hearing, social integration, speech, and feeding. From birth to the end of growth, a multidisciplinary approach involving orthodontists, speech therapists, psychologists, and social workers is essential for adequate management, even after surgical repair. This case report illustrates the critical importance of the functionality of normal lips essential for sexual function and psychosocial issues encountered in a patient with repaired cleft lip, as this issue likely has a higher prevalence than the literature actually suggests. Adding a psychiatrist on the panel for pediatric reconstructive surgery teams and post-repair rehabilitation would be essential to managing potential sexual and psychological issues into adulthood.

Physician Assistants in Ophthalmology: A National Survey.

PURPOSE: To evaluate the scope of practice and training of current physician assistants (PAs) in ophthalmology and gauge their interest in further training and involvement in ophthalmology. DESIGN: Cross-sectional survey study. METHODS: An anonymous survey on vision and ocular care in the PA profession was administered to PAs in ophthalmology within the American Academy of Physician Assistants member database. All survey questions were optional. RESULTS: A total response rate of 47/94 (50.0%) was obtained. Respondents reported an average of 9.8 years (SD = 9.0) of experience as a PA in ophthalmology. Over half of the respondents (59.5%) did not have previous experience in vision and ocular health before becoming a PA. Most respondents (79.5%) reported that they are able to provide their primary clinical responsibilities for ophthalmic care independently. In addition to providing clinical ophthalmic care, many of the respondents have duties that involve consenting patients for ophthalmic surgery and procedures (62.5%) and assisting in ophthalmic surgery and minor procedures (65.0%). Only a minority of respondents independently perform procedures, such as intravitreal injections (23.1%) and minor lid procedures (38.5%). Most respondents reported interest in additional training in providing vision and ocular care (69.0%), in continuing their career as a PA in ophthalmology (87.5%), and in joining a specialty organization for PAs in ophthalmology (88.1%). CONCLUSIONS: The PAs participating in this survey provide a range of clinical and some procedural ophthalmic care. The development of formal PA postgraduate training programs in ophthalmology may expand the pool of PAs qualified to practice ophthalmology.

Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder.

PURPOSE: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers. METHODS: A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected. RESULTS: A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD. CONCLUSION: The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.

Physician Assistants Employed by the Federal Government.

OBJECTIVE: Physician assistants (PAs) are health professionals who have received advance medical training and are licensed to diagnose illness, develop and manage treatment plans, prescribe medications, and serve as principal health care provider. Although the U.S. federal government is the largest single employer of PAs, at the same time little is known about them across the wide array of diverse settings and agencies. The objective of this project was to determine the census of PAs in federal employment, their location, and personal characteristics. This included approximating the number of uniformed PAs. Taking stock of a unique labor force sets the stage for more granular analyses of how and where PAs are utilized and are deployed. METHODS: No one central database identifies all federally employed PAs. To undertake this project, three sources were examined. Data were derived from the U.S. Office of Personnel Management and the National Commission on Certification of Physician Assistants. Uniformed PA numbers were the result of networking with senior chiefs in the military services and the U.S. Public Health Service. The data were collolated and summarized for comparison and discussion. RESULTS: As of 2018, approximately 5,200 PAs were dispersed in most branches and agencies of the government that provide health care services, including the Departments of Defense, Veterans Affairs, Health and Human Services, Justice, and Homeland Security. Federally employed PAs are civil servants or hold a commission in the uniformed services (ie, Army, Navy, Air Force, Coast Guard, and Public Health Service). Most PAs are in clinical roles, although a few hundred are in management positions. Approximately 81% of civilian PAs have had less than 15 years of federal employment. CONCLUSION: The diverse utilization and deployment of PAs validate the importance of the role they serve as medical professionals in the federal government. From 2008 to 2019, PA employment in the federal government grew by approximately 50% supporting the forecast that substantial national PA growth is on track.

The Role of Diabetes Mellitus in Diseases of the Gallbladder and Biliary Tract.

BACKGROUND: The increasing prevalence of diabetes mellitus worldwide continues to pose a heavy burden. Though its gastrointestinal impact is appropriately recognized, the lesser known associations may be overlooked. OBJECTIVE: We aim to review the negative implications of diabetes on the gallbladder and the biliary tract. METHODS: A MEDLINE® database search of literature was conducted with emphasis on the previous five years, combining keywords such as "diabetes," "gallbladder," and "biliary". RESULTS: The association of diabetes to the formation of gallstones, gallbladder cancer, and cancer of the biliary tract are discussed along with diagnosis and treatment. CONCLUSION: Though we uncover the role of diabetic neuropathy in gallbladder and biliary complications, the specific individual diabetic risk factors behind these developments is unclear. Also, in addition to diabetes control and surgical gallbladder management, the treatment approach also requires further focus.