Intrathecal hydromorphone as an analgesia option for gynecology patients.

Enhanced recovery after surgery (ERAS) is a multimodal perioperative strategy originally developed to attenuate the postsurgical stress response in patients after colorectal surgery. Patients undergoing gynecologic surgery who had ERAS had significantly shorter hospital length of stay, reduced hospital-related costs, and acceptable pain management with reduced opioid use, without compromising patient satisfaction. Intrathecal hydromorphone is an effective alternative ERAS protocol analgesia for these patients and will not compromise patient outcomes or healthcare costs.

Preventing kidney injury by avoiding fluid overload in patients with sepsis.

The global epidemiologic burden of sepsis is difficult to ascertain. Sepsis affects more than 31.5 million people worldwide every year, potentially resulting in 5 million deaths. Up to one-third of patients with sepsis also develop sepsis-associated acute kidney injury. This article describes the need for restraint in fluid resuscitation in patients with sepsis, in order to mitigate end-organ damage and ultimately to save lives.

Nitrous oxide for labor analgesia.

Inhaled nitrous oxide (N2O) has been used worldwide for over 100 years as labor analgesia but has not gained widespread use in the United States. Nitrous oxide provides a noninvasive option for laboring women. This article outlines its efficacy and safety as an analgesic compared with epidural and IV pain medications.

Evaluating and managing chronic idiopathic urticaria in adults.

Chronic idiopathic urticaria (CIU), also known as chronic spontaneous urticaria, is characterized by the presence of hives on most days of the week, for 6 weeks or longer, and without an identifiable or consistent cause. Evaluation is clinical and based on the presence of episodic urticarial lesions. Although patients are subject to overtesting during the diagnosis of CIU, guidelines suggest starting with three basic laboratory tests. Treatment is a stepwise approach, involving second-generation antihistamines, histamine2 antagonists, leukotriene receptor antagonists, first-generation antihistamines, and potent antihistamines. Refractory CIU requires adding alternative agents such as omalizumab, anti-inflammatory agents, and immunosuppressants.

Recognizing primary effort thrombosis in primary care.

Primary effort thrombosis is a noniatrogenic deep vein thrombosis of the upper extremity. The incidence of this condition is 1 to 2 in 100,000 per year. The risk factors and typical patient population differ from other thrombotic events. Patients with primary effort thrombosis are typically young, athletic, and lack comorbidities. Due to its low incidence and unique risk factors, primary effort thrombosis often is misdiagnosed as a musculoskeletal injury. However, early recognition, initial testing with Doppler ultrasound, and immediate referral to a vascular center is essential to achieve optimal outcomes. This article reviews risk factors, pathogenesis, presentation, diagnosis, and acute management of primary effort thrombosis for primary care providers.

Early introduction of peanuts.

Peanut allergy is the most common food allergy and the leading cause of anaphylaxis and death due to food allergy. Despite previous guidelines created by the American Academy of Pediatrics in 2003, peanut allergy has continued to significantly increase over the past decade. Therefore, further research has been done to help clinicians provide more evidence-based recommendations about the timing of introduction of peanuts. The LEAP study, published in February 2015, demonstrated the value of much earlier introduction of peanuts to nonallergic patients than previously suggested. These findings have altered current practice, and recommendations supported by the American Academy of Pediatrics now allow the introduction of peanuts as early as age 4 months to reduce the likelihood of developing peanut allergy.

Riociguat for pulmonary hypertension.

Riociguat is newly approved by the FDA for treatment of patients with groups 1 or 4 pulmonary hypertension. Although several vasodilators are on the market for the treatment of pulmonary hypertension group 1, none have been shown to be invariably effective in the treatment of chronic thromboembolic pulmonary hypertension.

Understanding the new pregnancy and lactation drug labeling.

Recent changes to the FDA's drug labeling rules clarify the risk of drugs for patients who are pregnant or lactating and remove A, B, C, D, and X as risk categories. Drugs are now categorized by risk for pregnancy, lactation, and women and men of reproductive potential. Risk summaries and clinical considerations in the new labeling can help prescribers and patients make informed decisions about medication use.

Fenestrated endovascular aortic repair grafts.

Endovascular repair of AAAs has been embraced by the vascular surgery community. Fenestrated endovascular repair of AAAs is the logical next step to repairing those aneurysms whose anatomy does not provide a secure landing area for the graft below the renal and other visceral vessels. While the early morbidity and mortality reported with endovascular repair is less than with open procedures, additional monitoring and endovascular interventions are necessary with EVAR. Those same issues are presumed to persist with interventions utilizing f-EVAR, along with the additional concern for end-organ ischemia. In addition to fenestrated grafts, grafts with scallop, "chimney," and side branch configurations are being developed. PAs need to keep abreast of developments and understand the benefits and concerns associated with these applications in order to guide and monitor patients whose conditions are suitable for these emerging interventions.

Methodology Applied by a Physician Assistant Program to Evaluate the New ARC-PA 5 th Edition Diversity and Inclusion Standard.

ABSTRACT: Diversity and inclusion in higher education are a top priority for institutions. In 2020, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), in its 5 th edition of the Accreditation Standards for Physician Assistant Education, implemented a standard specifically designed to require programs to demonstrate their commitment to diversity and inclusion. Through a protocol-driven methodology, consistent with the ARC-PA's 4 key elements of analysis, one PA program demonstrates and explains how it examines ongoing compliance with diversity and inclusion within their program.

Basic skills workshop for physician assistant educators: effects of participation on perceived mastery of teaching skills and job satisfaction.

PURPOSE: The study examined participation in the Basic Skills Faculty Development Workshops (BSW) offered by the Physician Assistant Education Association (PAEA). The aim was to determine the effects of participation on perceived mastery of teaching skills and job satisfaction. METHODS: The 1,290 faculty and program director members of PAEA were invited to complete an electronic survey regarding their past participation in a BSW, levels of satisfaction with various aspects of their work, and their perception of their level of mastery of various teaching skills. Additionally, those who had participated in these workshops completed a section on colleague relationships that were developed or strengthened through workshop participation. RESULTS: Approximately half (n = 248) of the 493 respondents had participated in a BSW. Mean scores for satisfaction with salary, rank, position, and overall satisfaction did not differ significantly according to BSW participation. Perceived mastery of various teaching skills was significantly higher for nonattendees of BSW. However, controlling for "years in physician assistant education" nullified that association. Attendees reported a mean of 1.02 (SD = 1.47) new mentoring relationships and 2.45 (SD = 2.97) new peer relationships. Satisfaction with current position was significantly positively correlated with the number of colleague relationships. The number of new and strengthened mentor relationships correlated significantly with perceived mastery of advising students. CONCLUSIONS: Basic Skills Workshop attendees experience acceleration in their perceived mastery of teaching skills, closing the proficiency gap between them and their more-experienced colleagues who did not attend a Basic Skills Workshop. Also, participation is associated with an increased number of colleague relationships, which has a positive effect on satisfaction.