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

Abstract: Respiratory syncytial virus (RSV) is a respiratory virus that accounts for more than 100,000 ED visits per year. RSV causes the greatest morbidity in infants and children; however, older adults with chronic comorbidities have increased risk of hospitalization due to complications of RSV compared with those who do not have chronic conditions. Typical symptoms of RSV in older adults include cough, rhinorrhea, and sore throat; however, in more serious cases, wheezing, difficulty breathing, or shortness of breath may be present, potentially prompting ED visits. Infections due to other viruses, such as cytomegalovirus, Epstein-Barr virus, and hepatitis B and C, are known to cause angioedema, but no case studies to date have reported RSV-induced uvulitis or angioedema. This article describes a novel case of an adult patient with RSV-induced uvulitis.

Abstract: Postprofessional doctoral programs for physician associates (PAs) have expanded rapidly, offering diverse and specialized tracks that reflect the evolving roles of PAs in health care, education, and leadership. Institutional accreditation provides rigorous oversight of these programs and ensures academic quality across them without necessitating uniformity. In early 2025, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) proposed a centralized accreditation model for these programs that would impose prescriptive requirements pertaining to their curricula, faculty qualifications, and student outcomes. A centralized accreditation model, however, would serve to hamper these programs' innovation and diversity by enforcing uniform standards that conflict with the flexible, career-focused nature of postprofessional education. This article advocates for the current decentralized approach-continued use of which is being championed by the Consortium of DMS/DMSc Programs-as essential to supporting the continued growth and specialization of the PA profession.

Abstract: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood. Adults may first receive a diagnosis in primary care, sometimes after previously unrecognized childhood symptoms. Reports of de novo "adult-onset ADHD" remain controversial and, when scrutinized, are most often explained by previously subthreshold childhood symptoms, alternative psychiatric or medical causes, or measurement error. If an adult presents with symptoms of ADHD but onset cannot be substantiated before age 12 years, providers should systematically rule out mimics-which include mood and anxiety disorders, substance use disorder, sleep disorders, traumatic brain injury, thyroid disorders, and medication side effects-before labeling the presentation as adult-onset ADHD. This article outlines the epidemiology, pathophysiology, clinical features, diagnostic strategies, and evidence-based treatments for ADHD presentations in adults. Primary care clinicians play a key role in recognizing symptoms, initiating evaluation, and implementing multimodal treatment plans to improve patient outcomes.

Abstract: Opioid use disorder (OUD) is a pervasive, undertreated condition best managed with medications. Buprenorphine is a partial agonist with high affinity for the mu opioid receptor. It is particularly effective in treating OUD, resulting in reduced opioid use, risk of overdose, and all-cause mortality. Buprenorphine induction in the emergency department (ED) is an evidence-based practice for initiating OUD treatment while managing opioid withdrawal symptoms. Current guidelines from the Substance Abuse and Mental Health Services Administration recommend following a standard-dose induction regimen implemented over 2 days. However, variability exists among ED-initiated protocols in terms of timing, dose, duration, and formulation. ED providers should use their clinical judgment when approaching buprenorphine induction for opioid withdrawal management and OUD treatment. This article reviews current evidence and practical strategies for initiating buprenorphine in the ED, with an emphasis on patient evaluation, buprenorphine dosing, and continuity of care.