Physician assistant (American Academy of Physician Assistants)最新文献

Medical professionals are ethically obligated to document the quality of the care they provide for patients. Society's demands and patients' expectations make quality assurance an issue of concern to all health care providers. The Joint Commission on Accreditation of Healthcare Organizations has formulated a detailed process for monitoring clinical activities and evaluating quality. This report reviews the rationale for and recommended approach to monitoring and evaluating quality assurance.

Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS.

Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS.

Patient-controlled Analgesia (PCA) permits patients to treat their postoperative pain by activating a pump to deliver doses of intravenous narcotic. This technique was developed in response to the undertreatment of postoperative pain with conventional intramuscular therapy. PCA allows patients to balance pain control with sedation, and permits nurses to implement other aspects of patient care once pain is controlled. Concerns regarding PCA include mechanical errors, overdosage, and inadequate patient instruction. Careful patient screening and preoperative teaching are essential. While data regarding cost-effectiveness are limited, increasing use and patient satisfaction could make PCA the standard of care in the future.

As professional impairment issues have gained increasing recognition, a multitude of resources have been established for dealing with them. The most common source of impairment is chemical dependence-especially involving alcohol. The PA working with an impaired supervisor should understand the disease process associated with chemical dependence, come to terms with his or her own personal views on impairment, and seek support from colleagues. Every state has some form of physician impairment mechanism. With increasing availability of support systems, the prospects are good for successful rehabilitation of impaired professionals.

Once the immediate visceral reaction to being slapped with a malpractice suit has subsided, it's time to assess the situation and prepare for the impending legal battle. A successful outcome is more likely if you remain calm; call your insurance company immediately; familiarize yourself with your rights and obligations; cooperate fully with your lawyer; and help to secure credible, credentialed experts to testify on your behalf.

Physician assistants are required to take the clinical skills problems (CSP) portion of the National Certifying Examination administered by the National Commission on Certification of Physician's Assistants (NCCPA). No comparable section exists in entry-level physician certification examinations because studies have shown that this type of examination is neither a valid nor a reliable indicator of clinical competence. A published account of the studies used to implement the CSP portion of the National Certifying Examination contained serious flaws, calling the research into question. Denial of certification based solely on failure on the CSP portion of the National Certifying Examination could be challenged legally. The CSP is invalid and unreliable, and should be eliminated.

Operating without residents or fellows in continuous attendance, The University of Iowa Hospitals and Clinics Pediatric Bone Marrow Transplant Unit utilizes PAs to assume primary responsibility for patients and to assure continuity of care. Major tasks assigned to the PAs include evaluation and assessment, writing notes and orders, and clinic follow-up. Basic PA training in pharmacology, physiology, and pathology has proved to be a sufficient background, supplemented by extensive on-the-job training; a knowledge of hematology is helpful. Severity of illnesses being treated contributes to burnout, which is addressed by staff support groups. This PA utilization model is strongly recommended for other such wards.

Interpersonal violence has reached epidemic proportions in the United States. Principles of preventive medicine can be applied to help curb the growing rates of assault, murder, and rape. Health care providers should become leaders in the fight against violence. Physician assistants can encourage their national, state, and local organizations to develop specific educational programs. Individual PAs should become involved at the community level, as well as maintain a high index of suspicion with patients, and be prepared to offer counseling as needed.