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

Abstract: Black and African American individuals continue to face a wide range of healthcare disparities compared with White non-Hispanic individuals. Research suggests that one effective way to improve health equity for Black people is to provide access to racially concordant healthcare providers-that is, Black patients receiving care from Black providers. This article briefly reviews the evidence showing that patient-provider racial concordance is associated with better outcomes for Black patients, indicating its potential in addressing health inequities. Despite this compelling evidence, many studies and population data reveal a persistent shortage of Black healthcare providers in the United States. Given the rapid growth and high demand for physician associates (PAs) in the United States, the PA profession is uniquely positioned to address this need. The article concludes with recommendations to increase diversity in the PA profession and broader healthcare workforce.

Abstract: Low back pain is among the most common conditions treated by physician associates in family medicine, internal medicine, and emergency medicine clinics. Inflammatory low back pain is the most frequent manifestation of axial spondyloarthritis (axSpA). AxSpA has a prevalence of 1.0% to 1.4% in the United States. The diagnosis of axSpA includes both clinical and radiographic components. With the advancement of biologic pharmacologic agents, the American College of Rheumatology, Spondylitis Association of America, and Spondyloarthritis Treatment Network have provided updated recommendations for the pharmacologic and nonpharmacologic management of axSpA. The recognition of axSpA and comorbid peripheral spondyloarthropathies is important, as the management of axSpA differs from routine musculoskeletal back pain. Treatment guidelines focus on symptom management, functionality, and disease progression.

Objective: This pilot study assesses diagnostic agreement between correctional advanced practice providers (APPs) and physicians in interpreting 12-lead ECG results for STEMI diagnosis, with the aim of determining whether APPs offer comparable care to adult correctional populations that decreases ED burden.

Methods: This study compared the diagnostic accuracy of APPs with that of physicians in identifying STEMI through an online 12-lead ECG assessment based on current guideline criteria. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated for each profession. Unadjusted odds ratio (OR) with 95% CI were used to compare groups.

Results: Of the 37 total completed submissions, no statistically significant difference was observed in overall 12-lead ECG STEMI diagnostic accuracy among the groups.

Conclusions: Correctional APPs and physicians had comparable accuracy in using 12-lead ECGs to identify STEMI, and evaluation by an APP in the correctional setting does not increase the likelihood of ED evaluation. However, a quality improvement study entailing use of larger sample sizes and proctor-controlled assessments is needed to accurately determine APP 12-lead ECG STEMI competency.

Abstract: Every 3 seconds worldwide, a fracture due to osteoporosis occurs. Yet approximately 80% of individuals who have sustained a fragility fracture are not identified as having osteoporosis or treated for the condition. Many misconceptions and barriers plague care for this "silent" condition, contributing to a health care gap with catastrophic consequences. Importantly, clear guidance on screening, prevention, and treatment is available, paving the way for clinicians who are willing to "own the bone" and narrow the gap. Most recently, the US Preventive Services Task Force (USPSTF) published updated guidance for osteoporosis screening in early 2025. This guidance largely supports previous recommendations, strengthening the firm foundations clinicians use to address this critical need.

Abstract: Measles cases are increasing across the United States, with infants under age 12 months at increased risk as they are not yet eligible for routine measles, mumps, and rubella (MMR) vaccination. The current MMR vaccination schedule is based on decades-old data from an era of widespread natural maternal immunity and low measles prevalence. Today, most mothers have vaccine-derived immunity, and recent studies show these maternal antibodies wane by 3 to 6 months of age, leaving many infants vulnerable to infection until they receive their first MMR vaccine at the currently recommended age of 12 to 15 months. Evidence demonstrates, however, that MMR vaccination between ages 6 and 11 months provides partial protection during outbreaks and does not impair the immune response to later doses. Safety data also support vaccination in younger infants. Although early MMR vaccination is currently recommended before international travel, it should also be offered domestically during outbreaks as a risk-based strategy. National guidance should be updated to reflect current epidemiology and close this gap in infant protection.

Abstract: Xylazine is a veterinary drug that has become a common adulterant in opioids, particularly heroin and fentanyl. This article provides a comprehensive review of the drug, including its history, pharmacology, toxicology, pathophysiology, withdrawal, medical management, associated wound care, and harm reduction strategies, so that physician associates and other clinicians may be better equipped to recognize possible xylazine misuse in their patients and provide adequate treatment for xylazine-related harms.

Abstract: Physician associates (PAs) have featured among multidisciplinary care teams in the Scottish health care system for the last 19 years and have gradually become an established profession. Despite this, there remains no clear pathway for career progression for experienced PAs. This study used an original questionnaire, in addition to publicly available workforce and education data, to gain insight into the current education, deployment, and career development aspirations of this professional group in Scotland. The questionnaire was sent to all contactable PAs in Scotland before data were thematically analyzed.We found that Scottish PAs are experienced and keen to develop within the National Health Service Scotland workforce; however, they require a better career structure and improved support to allow them to work to their full potential. The establishment of a career progression framework, along with the infrastructure to support it, is urgently needed to support the development of this profession.

Abstract: Hemoptysis, defined as the expectoration of blood originating from the lower respiratory tract, is a clinical symptom with a wide differential diagnosis that ranges from benign to life-threatening causes. Common causes vary by geographic region and care setting, with respiratory infections, malignancy, bronchiectasis, and chronic obstructive pulmonary disease being predominant in resource-rich countries and tuberculosis remaining the leading cause in resource-limited areas. Though most cases are mild and self-limited, hemoptysis can be a life-threatening medical emergency; these cases are associated with a mortality exceeding 50%, primarily due to asphyxia. Management strategies are informed by severity, with outpatient care appropriate for stable patients with non-life-threatening hemoptysis and intensive interventions-such as bronchial artery embolization or surgical resection-reserved for those with high-risk features or life-threatening hemoptysis. This article provides an evidence-based approach to hemoptysis evaluation and management, emphasizing the importance of early risk stratification, identification of underlying causes, and timely intervention. By integrating a structured diagnostic and therapeutic approach, clinicians can improve outcomes and reduce the risk of recurrence and complications.