Jaapa-Journal of the American Academy of Physician Assistants最新文献

Abstract: Emerging evidence confirms that menopausal hormone therapy (MHT) remains the most effective treatment for managing vasomotor and genitourinary symptoms of menopause, with a favorable risk-benefit profile in specific patient populations. Recent studies also indicate that initiating MHT in appropriate candidates is associated with reduced cardiovascular disease risk and lower all-cause mortality. This article provides a comprehensive overview of current guidelines for primary care providers, advocating for an evidence-based, patient-centered approach to enhancing menopausal care across diverse patient populations.

Abstract: Breast cancer is the most common type of cancer diagnosed in women, excluding skin cancer. It is one of the leading causes of cancer-related deaths and premature deaths in the United States. Given the latest data on breast cancer prevalence, most clinical practice guidelines recommend yearly screening with mammography for women age 40 years and older. However, some women's lifetime risk of breast cancer may be higher than average, requiring additional testing and more intensive screening. Currently, no standard approach to office-based risk assessment has been established in the United States. A woman's unidentified heightened risk can lead to missed opportunities and insufficient screening recommendations. Breast cancer risk assessment is thus critical for identifying women who are at higher-than-average risk for breast cancer and in need of a modified screening plan. This article aims to guide clinicians through assessing a woman's lifetime risk of breast cancer, identifying women at higher-than-average risk, determining which women need to be referred for genetic testing, and managing screening and counseling for patients with nonhereditary higher-than-average risk.

Abstract: Lymphadenopathy (LAD), characterized by abnormal enlargement of lymph nodes, is frequently encountered in clinical practice. Despite its prevalence, the condition's evaluation and management pose significant challenges due to its diverse etiologies, which range from benign conditions to serious malignancies. This article provides a comprehensive overview of LAD, including its etiology, pathophysiology, clinical presentation, and diagnostic evaluation to aid providers, particularly physician associates (PAs), in care of these patients. Through detailed discussions and practical guidance, the article equips PAs with the necessary tools to effectively navigate the complexities of LAD.

Objectives: The objectives of this study were to determine pathways, barriers, and support systems experienced by physician associates (PAs) in leadership.

Methods: Focus group interviews were conducted with 20 PA leaders. Thematic evaluation revealed inductive themes. Moderate interrater agreement was achieved.

Results: Most participants were female, White, and non-Hispanic, with 13 to 23 years of experience as a PA. Participants obtained leadership positions via training, dedication to service, and networking. Participants were motivated to pursue leadership roles by issues related to compensation, time, and autonomy. Biased perception of PA roles and corporate and legal issues were the most common barriers to achieving leadership positions. Participants recommended that PAs interested in leadership self-promote and that they embrace both altruism and a growth mindset.

Conclusion: PA leaders achieved leadership positions via dedication, networking, and training. Corporate, legal, and perceptual barriers exist. Employers and PA organizations can support PA leaders with training, compensation, protected time, and autonomy. Celebration of the value of PA leadership is needed.

Abstract: Granting medical staff membership to advanced practice registered nurses (APRNs) and physician associates (PAs) is a national trend endorsed by The Joint Commission in 1983 and by the Centers for Medicare & Medicaid Services in 2012. APRNs and PAs must participate in the system in which medical care policies are made and communicated. Medical staff privileges enable these clinicians to help develop and implement hospital and medical staff policies that improve the quality and appropriateness of patient care. Medical staff membership also encourages a culture that promotes interprofessional and collaborative practice, enhancing and strengthening clinician relationships. Through education and by updating bylaws, rules, and regulations, APRNs and PAs at our facility can now admit patients, and they have a voice and vote in medical staff governance committees that affect their practice.

Abstract: Immune checkpoint inhibitors have transformed oncologic practice, producing durable responses in many patients with advanced malignancies. However, these treatments can cause immune-related adverse reactions. This article describes a patient with metastatic non-small cell lung cancer who developed toxicities involving multiple organ systems shortly after receiving combined ipilimumab and nivolumab. Although toxicity is more common in just one organ system, multisystem adverse reactions are possible, and clinicians who recognize and manage these reactions promptly can improve patient outcomes.