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

Abstract: Wilms tumor, also known as nephroblastoma, is relatively rare but is the most common renal malignancy in children, accounting for about 5% of all childhood malignancies and 90% of all childhood renal malignancies. Advances in the understanding of the underlying cause and pathophysiology of Wilms tumor have significantly improved the prognosis and survival rates for children with Wilms tumor, but cases may occur sporadically and certain affected patients face higher rates of relapse and morbidity. The most common clinical presentation involves the identification of an abdominal mass or swelling without other signs or symptoms. The nonspecific nature of symptoms that can present can delay timely diagnosis and treatment. Numerous predisposing syndromes are associated with an increased risk for the development of Wilms tumor. Clinicians who recognize these syndromes and other conditions and understand the increased risk can provide the appropriate level of anticipatory guidance and use the optimal screening plan.

Objective: This study investigated educational debt, repayment strategies, and other factors potentially related to recently certified physician associates/assistants' (PAs') choice or preference for primary care versus all other specialties.

Methods: A national dataset from 2023 of recently certified PAs was used to conduct quantitative and qualitative analyses. Analyses were conducted separately for PAs who had accepted a clinical position and those who had not accepted a clinical position.

Results: Overall, 88% of respondents reported having educational debt, with 13.5% owing $200,000 or more. PAs from backgrounds underrepresented in medicine had accrued higher educational debt than their counterparts. Educational debt was significantly associated with specialty choices/preferences: PAs with higher debt were more likely to opt for nonprimary care specialties. Qualitative analyses revealed that PAs rely on different strategies for repaying their loans, depending on whether they choose or prefer primary care or nonprimary care specialties.

Conclusions: These results suggest that educational debt plays a role in specialty selection, but other factors also are significant.

Abstract: A 72-year-old man with progressive memory loss and confusion presented to a neurology clinic for evaluation. He initially had difficulty remembering names and misplaced objects; however, his memory deficits had progressed, and more recently he had numerous car accidents and difficulty managing his own medications and finances. Cognitive testing revealed significant memory deficits reflecting moderate-stage dementia, and his brain MRI showed several cortical microbleeds and an area of siderosis consistent with the diagnosis of cerebral amyloid angiopathy (CAA). This case report provides an overview of a classic case of CAA and its potential treatment options.

Abstract: Expert guidelines, meta-analyses, and multiple randomized controlled trials have demonstrated the effectiveness of long-acting inhaled antimuscarinic agents (LAMAs) as an additive medication for patients with poorly controlled moderate or severe persistent asthma. LAMAs play an essential role in blocking acetylcholine binding to muscarinic receptors and reducing bronchoconstriction and mucus production. By adding this medication to other combination inhalers, patients can use a triple inhaler to improve FEV1 values and reduce exacerbations.

Abstract: Helicobacter pylori is the most common chronic bacterial infection worldwide. Because of the risk for chronic gastritis, peptic ulcer disease, and gastric malignancy, all patients with H. pylori should be treated. Unfortunately, eradication rates remain low, and barriers to successful treatment include inadequate acid suppression, locoregional antibiotic resistance, and patient nonadherence to complicated treatment regimens. Vonoprazan, a new medication for the treatment of H. pylori infections, provides more potent acid suppression and is simpler to dose than proton pump inhibitors. This article provides a data-driven algorithm for incorporating vonoprazan into the treatment of patients with H. pylori infections.