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

Abstract: This article describes minimally invasive treatments for managing chronic low back pain (LBP) related to lumbar spinal stenosis, facetogenic LBP, vertebrogenic LBP, or discogenic LBP. We also propose a clinical decision-making tool to guide clinicians in appropriate patient selection for various treatments.

Abstract: More than 1.6 million US adults identify as transgender (that is, a gender different than the one traditionally associated with the biologic sex assigned to them at birth). These patients suffer from healthcare inequity and lack of access to healthcare, causing a public health crisis. This article seeks to raise awareness of this issue and encourage clinicians and healthcare systems to make meaningful changes to reduce healthcare stigma for transgender patients.

Objective: The Hospital Readmissions Reduction Program (HRRP), started under the Patient Protection and Affordable Care Act and administered by the Centers for Medicare and Medicaid Services, was created with the intention to improve healthcare quality and costs. However, research on disparities in healthcare demonstrates the HRRP's protocolized risk-adjustment calculations neglect social factors, which consequently harms disadvantaged patient populations and unfairly contributes to clinician and hospital penalties.

Methods: A PRISMA literature review was conducted using PubMed and Cochrane Library to explore the inclusion of social factors such as socioeconomic status on risk-adjustment calculations, and their relation to healthcare disparities, penalties, and outcomes. Fifteen articles published in the past 10 years were reviewed.

Results: Eleven (73%) of the 15 articles in this systematic review indicated that the HRRP potentiated healthcare disparities based on risk-adjustment calculation.

Conclusions: This review strongly suggests modifying the HRRP risk-adjustment calculations to include social risk factors has the potential to equalize reimbursement for hospitals that serve the most vulnerable patients and reduce negative unintended consequences of the HRRP. Future studies are needed to produce more conclusive, consistent evidence on the effect of social risk factors in risk-adjustment calculations and associated outcomes and to determine how HRRP's risk-adjustment calculations can be modified to reduce disparities in healthcare.

Objectives: To identify the leadership styles, strengths, strategies, and key factors of PA leaders in healthcare executive, clinical, and academic settings.

Methods: An exploratory, qualitative study was completed through the American Academy of Physician Associates 2023 Practice Survey to answer seven qualitative questions. Of the 1,423 PAs who responded to the survey invitation, 348 PA leaders in formal and informal roles chose to answer, for a 24.4% response rate.

Results: For PA leaders' styles and strengths, collaborative and emotional intelligence emerged as themes. For key factors of PA leadership, balancing expectations and giving and receiving critical feedback emerged as themes. For skills or qualities PA leaders wish they had before starting to lead, project management skills and increased confidence emerged as themes.

Conclusions: Leadership development training needs to be in the didactic and clinical curriculum of PA programs for the future of PA leadership. Leadership pathways for PA leaders in healthcare executive, clinical, and academic settings need to be created and established more widely.

Abstract: Bile leakage is a serious early postoperative complication of cholecystectomy. A leak in the duct of Luschka, though rare, can cause significant patient morbidity after a cholecystectomy. Early recognition of this uncommon complication allows for early therapeutic intervention.

Abstract: Polycystic ovary syndrome (PCOS) is a complex, heterogeneous reproductive endocrinopathy affecting 8% to 13% of women in their reproductive years. PCOS has a vast array of clinical manifestations, including metabolic complications, biochemical and phenotypical hyperandrogenism, menstrual cycle dysfunction, and anovulation resulting in infertility. Understanding the relationship of the disorder's pathophysiologic and clinical manifestations is key to successfully managing patients with PCOS. Patients may have different prenatal, perinatal, and postnatal experiences than those who do not have PCOS, and may require a higher level of care or treatment plan adjustments.