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

Abstract: Worldwide, gastric cancer is the fifth most diagnosed malignancy, with more than 1 million diagnoses annually, and it also represents the fourth leading cause of cancer death, with approximately 770,000 deaths each year. Relative 5-year survival rates are as high as 95% to 99% when the disease is diagnosed early in its course, but that rate drops to less than 30% when diagnosed in advanced stages. South Korea and Japan, two countries where gastric cancer is endemic, have implemented screening programs that successfully support earlier detection. No routine gastric cancer screening guidelines exist for practice in the United States. This article examines current evidence in support of gastric cancer prevention and screening measures. Two measures are buoyed by the literature: first, prevention of the disease by targeting modifiable risk factors, namely the eradication of Helicobacter pylori , and second, early detection among high-risk groups through endoscopic screening.

Abstract: Syncope is a common clinical syndrome that is typified by loss of consciousness and has several etiologies ranging from benign to potentially life-threatening. To differentiate syncope from other conditions, a detailed history is crucial. Several key historical components that aid in establishing the etiology of syncope include frequency, identifiable triggers, and prodromal symptoms. The differential diagnosis of syncope includes mechanical fall, seizure, narcolepsy, intoxication, and psychiatric conditions. Meticulous review of a patient's past medical conditions and medication list must be completed when evaluating syncope etiologies, as this information may aid in the elucidation of a cause or contributing factor. This case report illustrates the importance of history collection, as the underlying cause of syncope is not always easily identified.

Abstract: Rotator cuff impingement was suspected when a 23-year-old male police officer presented to the orthopedic clinic with gradual-onset left shoulder pain and weakness; however, conservative management did not improve the patient's symptoms. Subsequent imaging revealed a lytic lesion in the left humeral head, with CT-guided biopsy findings consistent with Rosai-Dorfman disease, an extremely rare histiocytic disorder. Typically self-limiting and benign, Rosai-Dorfman disease is characterized by overproduction and accumulation of rare non-Langerhans cell histiocytes, a type of immune cell, in various tissues. These histiocytes most commonly proliferate in the lymph nodes, causing hallmark lymph node enlargement. In cases that do not spontaneously resolve, individualized treatment may be required. The patient in this case report returned to normal activity following improvement without intervention.

Abstract: Fifth metatarsal base (FMB) fractures are among the most common fractures of the foot. Time to healing and time to return to activity depend on the location of the fracture, the presence of certain features or complications, and use of conservative or surgical management. This article provides a comprehensive overview of FMB fractures, including their classification by location or zone, diagnosis, and management based on fracture characteristics and complications. It emphasizes the role of advanced practice providers in recognizing cases requiring surgical intervention, and it provides management recommendations based on the current evidence base and the authors' practice experience to ensure optimal patient healing.