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

Abstract: The healthcare industry is in the midst of unprecedented change as hospitals and health systems nationwide balance the need to increase patient access to services with managing costs. Nurse practitioners and physician associates are well-positioned, and often overlooked, members of the healthcare team who can serve as resources for organizations to improve care access. Using an intentional and data-driven process, one academic medical center both improved patient access and increased revenue through a holistic care model redesign in three specialty areas, as described in this organizational case report.

Abstract: A 32-year-old man diagnosed with type 1 diabetes mellitus presented to the ED following loss of consciousness and was ultimately diagnosed with acute invasive fungal sinusitis (AIFS). AIFS is a disease that most commonly affects people with immunocompromise such as those with a hematologic malignancy, diabetes, or HIV; those on immunosuppressant drugs posttransplant; and those on chemotherapy or long-term corticosteroids. In this case, the patient's diabetic ketoacidosis put him in a high-risk physiologic state. Following presentation, the patient was managed in the ICU to reverse his immunocompromise. He underwent six surgical debridements and received systemic broad-spectrum antifungal and antibacterial therapies. Ultimately, the patient developed intracranial arteritis, thromboses, and subsequent infarction, which were incompatible with meaningful life. This case highlights the variable presentation and mortality of AIFS, showing that an absence of sinonasal symptoms does not rule out the condition and that, though outcomes are generally thought to be more favorable in diabetes mellitus than other immunocompromised states, AIFS is a serious diagnosis for any individual with immunosuppression. The patient's clinical picture correlated well with radiologic progression of the disease; however, this is not always the case.

Abstract: Hypothermia is characterized by an abnormally low body temperature, typically resulting from prolonged cold exposure. However, hypothermia has a broad differential diagnosis that may require thorough evaluation for various etiologies beyond cold exposure. This case report describes a 34-year-old man who presented to the ED with confusion and weakness, ultimately found to be due to hypothermia and hypoglycemia following an episode of binge drinking alcohol and dietary fasting. The pathophysiology and interplay among alcohol use, nutrition, hypoglycemia, and hypothermia is explored, emphasizing the importance of appropriate history collection in cases of hypothermia as well as consideration of conditions within the differential diagnosis beyond environmental exposure.

Abstract: Cytomegalovirus (CMV) is the most common congenital infection in the United States and a leading cause of nongenetic sensorineural hearing loss (SNHL). This article reviews the epidemiology and diagnosis of CMV infection, with an emphasis on the effects of congenital infection on fetal and neonatal health. Recognition of early signs of infection and prompt testing in the neonate are imperative to prevent or decrease the severity of long-term sequelae, including SNHL. This article also highlights the importance of congenital CMV screening and audiology follow-up in infants, and it provides an overview of specialty interventions, possible treatment, related education, and prevention in women of reproductive age.

Abstract: Determining volume status at the bedside is an essential skill clinicians must possess. Unfortunately, traditional bedside assessments, including measuring vital signs, obtaining a history, and performing a physical examination, are often unreliable and limited by patient body habitus. Point-of-care ultrasound (POCUS) is a valuable and accurate adjunct to aid in determination of a patient's volume status. POCUS of the lungs, heart, inferior vena cava, and internal jugular vein can add valuable data for clinicians when determining volume status. Specifically, lung ultrasound is more accurate than physical examination and chest radiography in detecting pulmonary edema and pleural effusions; cardiac POCUS allows for qualitative estimations of left ventricle and right ventricle function and can confirm the presence or absence of clinically significant pericardial effusions; and POCUS of the inferior vena cava and internal jugular vein can estimate right atrial pressure, and in the appropriate clinical context, help to determine intravascular volume status.

Abstract: In the US, approximately 40 million people, or 12% of the nation's population overall, suffer from migraine. Globally, the prevalence of migraine is estimated at 1.1 billion cases; the condition ranks as the second leading cause of disability-adjusted life years behind chronic lower back pain and is the top cause of years lived with disability among women ages 15 to 49 years worldwide. Studies have shown that people with migraine lose an average of 3.51 ± 0.1 hours of productive time per week, thereby impacting their ability to work and achieve financial stability or success. The burden of disease extends to other key aspects of life, including personal relationships and overall well-being. Given migraine's prevalence and burden, it is prudent for clinicians to be aware of the variety of potentially effective strategies to relieve the condition. This article provides an update on clinical evidence for the use of cannabidiol in the prevention and treatment of migraine headaches as an adjunct or alternative to primary treatment modalities.