Physician Assistants Research Articles

Correction to: The association of physicians of great britain & Ireland (AoPGBI) conference celebrates cutting-edge translational science.

Correction to: The association of physicians of great britain & Ireland (AoPGBI) conference celebrates cutting-edge translational science.

Barriers to HIV rapid start among New Jersey providers

Background Rapid Start ensures that persons with HIV initiate antiretroviral therapy in less than seven days after diagnosis. Benefits of Rapid Start include timely linkage to medical care, viral suppression in a shorter time and improved retention to medical care. Despite these benefits, there is a slow uptake of Rapid Start, in New Jersey. Objective Identify barriers to Rapid Start among New Jersey providers. Methods An electronic survey, consisting of 28 questions, with the following domains was administered to New Jersey providers, using Qualtrics: provider and practice characteristics (10), knowledge (1), barriers (8) and attitudes to diverse patient types (9). The results were analyzed using descriptive statistics due to small numbers over strata. Approval to conduct the survey was obtained from the William Paterson University Institutional Review Board. Results There were 69 responses to the survey. Providers were at least 45 years old (48%), female (44/60, 73%), nurse practitioners or physician assistants (41/59, 69%). Overall, 44/63 (70%) providers did not correctly identify that integrase inhibitors had the lowest prevalence of transmitted drug resistance. Newly diagnosed patients were referred for medical care in 37 (65%) of the medical sites. Only providers from Ryan White (federally funded clinics for persons with HIV) (64%) and non-Ryan White (73%) public sites reported co-located HIV testing sites. Seventy percent of medical sites offered same-day medical appointments. However, a lower proportion of private (62%), public Ryan White (55%), and other medical sites (36%) offered same-day appointments compared to public non-Ryan White sites (82%). Despite having staff available 40 h per week (91%), only 55% of Ryan White sites offered extended office hours in the early morning, evenings, or on Saturdays. When compared to providers in public non-Ryan White sites, a lower proportion of providers in Ryan White sites were comfortable doing Rapid Start either on the day of or within one week of diagnosis, 82% and 72%, respectively, or starting antiretroviral therapy before genotype results were available, 55% and 46%, respectively. Overall, providers were not comfortable with Rapid Start for persons engaging in condomless sex (60%). Conclusions Policy and administrative decisions are needed to eliminate barriers at the clinic level. An HIV clinical scholar program, to increase providers knowledge, may increase uptake of Rapid Start.

Exploring Potential Challenges in Implementing a Standardized Curriculum for the Physician Associate Program in India: Insights From Stakeholder Discussions

Introduction This article explores the potential challenges in implementing a national-level standardized curriculum for physician associate (PA) programs in India, an initiative under the directions of the National Commission for Allied and Healthcare Professionals Act of 2021. Methods Initiated in August 2023, a multistage process began with emailing a draft curriculum for review to key stakeholders, followed by a virtual meeting on September 3. Key stakeholders, including faculty from various universities, participated in focus group discussions (FGDs) at the International Association of Physician Associate Educators and the Indian Association of Physician Assistants annual conference on September 21, 2023, in Gandhinagar. Results Four major themes emerged: (1) faculty development, (2) faculty recruitment, (3) alignment with the National Educational Policy, and (4) the necessity of master's degree programs for PAs. Challenges identified included shortage of qualified faculty, uncompetitive salaries for academic roles, and low enrollment in master's programs. Recommendations included increasing financial compensation for teaching PAs, developing more PA educators through additional master's programs, encouraging hospitals to mandate clinical and teaching roles for recruits, and introducing pedagogical training for PAs interested in teaching. Discussion Implementing a standardized curriculum for PAs faces significant challenges, especially in faculty recruitment and retention. Engaging a broader range of stakeholders is essential for the successful rollout of the curriculum and for meeting India's evolving health care needs.

Evaluation of Skin of Color Curricular Content for Physician Assistant Education.

Physician assistants (PAs) are often members of dermatologic care teams. Adequate knowledge of dermatologic conditions in skin of color (SOC) is crucial to proper diagnosis, treatment, and patient satisfaction. The objective of this study was to increase PA students' objective knowledge of and comfort level with evaluating dermatologic conditions in SOC. Eligible participants included 36 PA students at a major metropolitan medical center during the 2022 to 2023 academic year. A preintervention survey, immediate postintervention survey, and 7-month follow-up postintervention survey were administered before and after a SOC lecture. The surveys concluded with a 10-question, image-based, multiple-choice examination. There was a significant increase in accurate diagnoses of acne scarring, eczema, psoriasis, rosacea, and seborrheic dermatitis in SOC (59.4% preintervention to 76.9% postintervention, P = .029). Student confidence, as rated on a scale of 1 (minimally confident) to 5 (extremely confident), in diagnosing these conditions increased from 2.97 to 3.52 (P = .036). Implementation of a SOC-specific dermatology lecture significantly increased the accuracy and confidence with which PA students diagnosed dermatologic conditions.

Burn Care in the Street: A Survey of the Current Landscape of Burn Care Provided by Street Medicine Teams.

People experiencing homelessness are at increased risk for serious burn injuries and face additional barriers to care such as inability to perform wound care and difficulty with follow-up. Although not burn-specific, street medicine programs provide direct medical care to people experiencing unsheltered homelessness in their own environment and may be well positioned to bridge this gap in burn care for this population. We conducted a cross-sectional survey to characterize the burn care experience of street medicine teams with providing burn care for people experiencing homelessness. The 60 respondents included 18 (30%) physicians, 15 (25%) nurse practitioners or physician assistants, 15 (25%) registered nurses, and 6 (10%) medical students, and 6 (10%) other team members. The most common reported barriers to care were prior negative experiences with emergency departments, and transportation to burn centers. There was regional variability in frequency of providing burn care, which was reflected in respondent comfort with assessing and treating burns. Burns were most often dressed with daily dressings such as a non-adherent dressing over silver sulfadiazine or bacitracin. Silver-based contact dressings were rarely used. Street medicine teams in the United States are treating burn injuries among people experiencing homelessness, though management practices and experience treating burns was variable. As street medicine programs continue to grow, burn-related education, training, and connections to local burn centers for team members is important. Through strengthened partnerships between burn centers and street medicine teams, these programs may be well positioned to bridge the gap in burn care for people experiencing homelessness.

Current status of lung cancer care in Germany in the context of treatment centralization and lack of personnel

Lung cancer is the malignancy with the highest mortality rate worldwide. In January 2025, the German public healthcare system will introduce a new regulation according to which a centre can offer surgery for lung cancer only if it carries out a minimum number of lung resections. The purpose of this directive is to reduce the number of centres offering surgical treatment for primary lung cancer, thus centralising and improving lung cancer care. It is expected that the introduction of this regulation will lead to a significant shift in the staffing of thoracic units. The purpose of this survey was to examine the current occupational structures behind the units of thoracic surgery and respiratory medicine. We performed an online survey through the German Society for Thoracic Surgery and the Association of Respiratory Physicians. The responding centres were divided in two groups, centres that were certified by the German Cancer Society or the Society for Thoracic Surgery and centres which were not certified. The response rate was 29.3% (respiratory physicians) and 31.9% (thoracic surgeons); 67% of the participating colleagues answered that their unit was an independent department. The majority of the participants reported having to share the on-call duty of the trainees with other departments in order to be able to cover the required shifts. 35% of the respiratory physicians and 57% of the thoracic surgeons reported having vacant job posts in their units. The introduction of the minimum quantity regulation will have significant consequences for the treatment of lung cancer in Germany. The current staff shortage in healthcare will lead to both medical and nursing staff needing to be redistributed in order to meet the needs that will arise in 2025. Operating lists, theatre days, and operative equipment will need to be redistributed as well, not only within hospitals but probably on a nationwide level. A negative impact of the new regulation is to be expected on research and academic activities since most university hospitals are not expected to reach the minimum number of lung resections that is required in order keep performing lung cancer surgery.

Prevention and Control of Rheumatic Fever in India – A Blue Print for Introduction of a Pragmatic Program with Limited Resources

“Eliminate rheumatic fever (RF) and minimize the burden of rheumatic heart disease by 2025” is the goal of World Heart Federation (WHF). The most important step to achieve the goal of WHF is the implementation of the prevention and control of RF in India. The program can be implemented with minimal fund allocation from government making use of the existing man power in the government and private health sector and schools with the concurrence of National Health Mission, Ministry of Health and Family Welfare, Ministry of Public Education and under the guidance of Cardiological Society of India, National Rheumatic Heart Consortium, Rheumatic Heart Club India, Association of Physicians of India, Indian Academy of Pediatrics, and Association of Otolaryngologists of India. By the successful implementation of this program, the children of 5–15 years in India can be protected from RF. India eradicated small pox in 1980 and Polio 2012. With this program, we can start our efforts to eliminate RF by 2025.

Understanding the Barriers to Clinical Trial Referral and Enrollment Among Oncology Providers Within the Veterans Health Administration.

Clinical trials are essential for advancing treatment options in oncology while providing cancer patients with innovative care; however, few cancer patients are referred to clinical trials. System-, provider-, and patient-level barriers to clinical trial participation have been described but have not been studied in the Veterans Health Administration (VHA). Although the VHA has engaged in several initiatives to improve Veteran's access to clinical trials, including the National Cancer Institute and VA Interagency Group to Accelerate Trials Enrollment program and VHA work on the White House Cancer Moonshot, further research is needed to understand the multifaceted challenges underlying limited enrollment for Veterans who receive care in the VHA system. This research aims to evaluate VHA oncology providers' attitudes toward and experiences with referral and enrollmentof Veterans with cancer into clinical trials, for the purpose of informing actions that could be taken to enhance Veterans' access to clinical trials as well as the VHA's contributions to clinical research. This research comprised the administration of an electronic 34-item survey and semistructured interviews among oncology care providers in the VHA nationally, between May 2022 and August 2023. The survey was introduced via a presentation at VHA Oncology Office Hours and aimed to capture VHA oncology care providers' perceptions of and experiences with referral and enrollment to clinical trials. The semistructured interviews explored providers' perceived barriers to clinical trial participation and recruitment bias, as well as inquired about potentially modifiable factors for improving clinical trial enrollment at the VHA, such as providers' concerns, motivations for and facilitators of enrollment of patients into clinical trials, and the manner in which they communicate about clinical trials with their patients. Thirty-eight oncology care providers completed the survey, and eight completed the semistructured interview, including 5 staff physicians, 1 fellow, 1 nurse practitioner, and 1 physician assistant. Thirty-four survey respondents identified their specialty as medical oncology, one respondent identified the specialty as radiation oncology, and three identified the specialty as hematology. Nineteen respondents identified as women and 14 as men; the remainder did not provide their gender. Three respondents identified as Hispanic or Latino individuals, 11 as Asians, 3 as Black individuals, and 17 as White individuals. Five interview participants reported holding an individual academic affiliation. Participants identified and described various barriers to clinical trial referral and enrollment at multiple levels, including lack of appropriate trials, strict patient eligibility criteria, difficulties in understanding and managing the referral process for trials outside the VHA system, challenges with obtaining information and identifying available clinical trials, Veterans' financial and logistical concerns, lack of trust in the medical establishment, lack of adequate social support, and Veterans' psychological and physical comorbidities. They also highlighted opportunities for system-level change that can overcome some of these barriers, including academic affiliations, patient support from internal and external nurse navigators, and dedicated research coordinators. The insights gleaned from this research can guide VHA in its efforts to optimize access to clinical trials for Veterans.

Advanced Practice Providers in Burn Care, 2013-2022.

This study evaluated the prevalence characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6,918 (43.3%) surgeons, 4,264 (26.7%) other physicians, and 4,783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2,502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of APPs providing services related to burns will increase by 56.7% from 2,502 in 2022 to 3,921 (95% CI, 3,541-4,303; R2=0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Predictive modelling of the UK physician associate supply: 2014–2038

IntroductionThe NHS Long Term Workforce Plan aims for 10,000 physician associates (PAs, formerly physician assistants) by 2036/7. This article uses three modelling approaches to project the UK PA supply from a baseline of 2014–2021 through to 2038 to forecast the profession's growth. MethodsThe number of cClinically available PAs’ (cPAs; qualified PAs either working clinically or seeking clinical employment) was estimated using raw data from the 2014–2021 Faculty of Physician Associates censuses. This provided baseline data for all models (linear regression (LRM), exponential regression (ERM) and time-series forecast (TSFM)). Attrition, using data from other healthcare professions, was also modelled. ResultsR2 values together with authors’ judgement ruled the LRM more realistic than the ERM. The LRM projected up to 8,232 cPAs by 2038, although attrition reduced this significantly. The TSFM optimistically projected an upper limit (95% confidence interval) of 13,922 cPAs by 2038. DiscussionThis article permits a wider view of potential PA numbers, with broad agreement between the LRM and the TSFM. It appears that future PA demand will be met, but factors such as attrition could impede this. Attrition itself may be mitigated through adequate resourcing, appropriate support mechanisms, and the development of a career structure. Professional regulation and legislation will further support PAs to work to their potential, subject to appropriate patient safety measures.

Single center experience developing sustainable genetics clinical care: a model to address workforce challenges in medical genetics

Purpose of review The national workforce shortage in genetics is being evaluated in order to identify a sustainable solution to the increasing demand for genomic services. An innovative solution to the short term needs is to integrate advanced practice providers (APPs) and embed genetic counselors into both outpatient and inpatient specialty care. Incorporating APPs into a genetic service is not unique in itself, but the method of implementation at Medical College of Wisconsin (MCW) was, at the time, unchartered. Recent findings There are >100 vacancies for board certified medical geneticists across the nation, training programs are not enrolling sufficient trainees to meet demand and more than a third of the current workforce plan to retire within the next 10 years. Summary The integration of advanced practice providers (nurse practitioners, midwives, physician assistants etc.) into both primary and specialty care has been an evolving practice since the mid-1900s and incorporating APPs into a genetic service was not unique in itself but the method of implementation was new at that time. This is a model to successfully develop a clinical practice model around a team-based structure incorporating nurse clinicians, advanced practice providers, genetic counselors, nutritionists, and physicians into an academic clinical genetics practice.

Exposure to ionizing radiation of medical staff performing vascular and interventional radiology procedures.

Vascular and interventional radiology procedures are characterized by high exposure of personnel to ionizing radiation. This study assessed the exposure of medical personnel to ionizing radiation during vascular radiology and mechanical thrombectomy procedures. During vascular radiology procedures, the exposure of 4 groups of workers participating in the procedures was analyzed, i.e., the main operating physician, an assistant physician, a sterile nurse, and a nurse. Measurements of exposure to ionizing radiation were performed using thermoluminescent dosimetry. The registered effective dose during 1 treatment in individual groups is, respectively: mean (M) ± standard deviation (SD) 75±15 μSv, 24±5 μSv, 13±3 μSv, and 8±2 μSv. During mechanical thrombectomy, the operating physician receives an effective dose of M±SD 9±2 μSv. The equivalent doses for the lenses for the operating physician and the doctor assisting during vascular radiology procedures are M±SD 1419±285 μSv and 987±198 μSv, respectively, and for the hands, including the left and right hands, M±SD 4605±930 μSv, 1420±284 μSv, 1898±380 μSv, 1371±274 μSv. If the principles of optimizing radiological protection are not applied during vascular radiology procedures, the permissible dose limits and operational limits equivalent to doses to lenses and hands may be exceeded. Exposure during vascular radiology procedures is comparable to exposure during nuclear medicine procedures in terms of the use of glucose labeled with radioactive fluorine. Int J Occup Med Environ Health. 2024;37(4).

Primary care team characteristics associated with video use: a retrospective national study at the Veterans Health Administration

ObjectiveTo examine primary care (PC) team members’ characteristics associated with video use at the Veterans Health Administration (VA).MethodsVA electronic data were used to identify PC team characteristics associated with any video-based PC visit, during the three-year study period (3/15/2019-3/15/2022). Multilevel mixed-effects logistic regression models on repeated yearly observations were used, adjusting for patient- and healthcare system-level characteristics, and study year. We included five PC team categories: 1.PC providers (PCP), which includes physicians, nurse practitioners, physician assistants, 2.Nurses (RN/LVN/LPN/other nurses), 3.Mental health (MH) specialists, 4.Social workers (SW), and 5.Clinical pharmacists (PharmD).Population54,494 PC care team members nationwide (61,728,154 PC visits; 4,916,960 patients), including 14,422 PCPs, 30,273 nurses, 2,721 MH specialists, 4,065 SWs, and 3,013 PharmDs.ResultsThe mean age was 46.1(SD = 11.3) years; 77.1% were women. Percent of video use among PC team members varied from 24 to 84%. In fully adjusted models, older clinicians were more likely to use video compared to the youngest age group (18–29 years old) (example: 50–59 age group: OR = 1.12,95%CI:1.07–1.18). Women were more likely to use video (OR = 1.18, 95%CI:1.14–1.22) compared to men. MH specialists (OR = 7.87,95%CI:7.32–8.46), PharmDs (OR = 1.16,95%CI:1.09–1.25), and SWs (OR = 1.51,95%CI:1.41–1.61) were more likely, whereas nurses (OR = 0.65,95%CI:0.62–0.67) were less likely to use video compared to PCPs.ConclusionsThis study highlights more video use among MH specialists, SWs, and PharmDs, and less video use among nurses compared to PCPs. Older and women clinicians, regardless of their role, used more video. This study helps to inform the care coordination of video-based delivery among interdisciplinary PC team members.

Adrien Rist (1841–1923), membre de la Société Médico-Psychologique (1881) et fondateur d’une maison de santé privée à Versailles « La Châtaigneraie » (1889) (Partie I)

Professor Edouard Rist (1871–1956), a former president of the Academy of Medicine (1948), wrote an unpublished text entitled “His Memories”. This text allows us to sketch the portrait of his father: Adrien Rist (1841–1923) and to review the professional career of this alienist doctor who always had a deep sense of loyalty and attachment to France and its culture. Coming from a family of surgeons, his grandfather Jean-Louis Rist (1769–1839) was a surgeon of the Grande-Armée like his uncle Côme Damien Rist (1760–1826) and their father Jean Népomucène Sébastien Rist (1725–1798) was too a surgeon in Wissembourg. It was under the July Monarchy that A. Rist (1841–1923) was born in Strasbourg. Raised in a Protestant family, he enrolled at the Military Health Service School in Strasbourg. He left the school after one year to enroll in the medical school of the same city. However, he finished his medical study in Paris. After his externship, he was accepted as an intern on December 26, 1864. Five years later (1869), he was a doctor of medicine and became the first one to make known in France the psychophysical law of Gustav Théodor Fechner (1801–1887), which bridges the gap between psychology and the exact sciences. Then, he returned to Strasbourg where he opened a medical practice and started to prepare for the aggregation in physics at the University of Göttingen (Germany). He stayed there long enough to fall in love with Emma Cornelia Gess (1848–1928), a native of Württemberg, to whom he married on April 5, 1870. Three months after his marriage, the war with Prussia broke out. During the conflict, his wife gave birth in Strasbourg to a boy named Edouard (1871–1956). Thus, his new family life and the Franco-Prussian war and its outcome deterred him from passing the aggregation. But also, A. Rist chooses to leave Alsace so as not to renounce his French nationality. After a brief stay in Le Havre (Normandy), he decided to expatriate to Switzerland. In order to be able to practice in this country, A. Rist passed the examinations in the canton of Vaud where he provided an important memorandum on the legislation of insane persons. In 1867, the Champ de l’Air Hospital for the insane was transferred to the Bois-de-Cery located near Lausanne where six years later (1873) a new hospital called “Asile de Cery” was inaugurated. Authorized to practice in Switzerland, A. Rist became in 1873 the first doctor-director of the Bois-de-Cery. A few years earlier, the first private psychiatric clinic in Romanisch Switzerland opened: La Métairie. In 1877, he became the director of this establishment located not far from the previous one at about forty kilometers away still on the banks of Lake Geneva. Board of Directors of this private establishment composed of a majority of Geneva bankers was able to receive about forty patients of well-to-do condition who came from all over the world. A. Rist lived there with his family and the organization at La Métairie was based on the participation of the insane in the family life of the doctor. A. Rist's children (Edouard, Charles, Elisabeth and Eve) founded the “Children's Society” which aimed to give concerts and theatrical performances to the patients of La Métairie. Also, they contributed when patients ran away. At the Métairie, A. Rist received the visit of Alexandrovitch Herzen (1839–1906) who was a professor of physiology at the medical faculty of Lausanne (1881) and whose father, Alexander Ivanovich Herzen (1812–1870) was the father of Russian populist socialism. However, the separation from his children who were studying in France and the tragic death of his daughter Elisabeth at the age of 17 were two factors that led to his return to France. In 1889, A. Rist and his wife decided to leave La Métairie. Rudolf Friedreich Fetscherin (1829–1892), a former assistant physician at the Waldau (Bern; 1859) succeeded him. A. Rist moved to Versailles near Paris where he opened a nursing home at 11 rue des Deux-Moulins: La Châtaigneraie.

Experience of Nurses in Carrying Out the Main Duties and Functions of Nurses at UPT Puskesmas Panamas, Kapuas Regency, in 2023 / 2024

This research explores the experiences of nurses in carrying out their main duties and functions at the Panamas Community Health Center. Qualitative methods with a phenomenological approach are used to gain an in-depth understanding of this phenomenon. Data was collected through in-depth interviews with 12 nurses selected by purposive sampling. Data analysis using the Colaizzi method produced five main themes: (1) Nurses' activities in health services, (2) Tasks carried out by community health center nurses, (3) The importance of good health program management, (4) Management of duties and authority in health services, and (5) Shortage of health and non-health personnel and multifunctionality in health services. Research results show that nurses often have to take over the roles of doctors, administrative staff, and pharmacists due to limited human resources even though these tasks should not be their responsibility. This causes nurses to lose focus in carrying out their main duties, nurses feel that their main role as care providers is disturbed. Nurses also run various health programs and serve as physician assistants, although these roles often exceed their duties. The importance of good health program management was emphasized, as many participants experienced difficulties in achieving targets, reporting and patient monitoring. Management of tasks and authority includes handover of tasks, delegation of daily tasks, and delegation of authority, however socialization to staff has not been comprehensive. Lack of human resources causes nurses to carry out multiple roles which hinders their professional development. This research recommends strengthening competency and further training for nurses, increasing legal awareness regarding the delegation of authority, integrating health management education in the nursing curriculum, as well as increasing the number and qualifications of human resources in community health centers.

Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013–2021

This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to2021. Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Broadening the View of Holistic Care: Integrating Arts and Humanities Into Physician Assistant Education.

The integration of arts and humanities (A&H) into physician assistant (PA) preclinical curriculum may enhance student performance and improve their patient rapport. Arts and humanities content could promote the personal and professional qualities we desire in clinicians including competence, compassion, and empathy. The aim of this research was to determine what PA students report learning from A&H modules designed to foster personal insight and perspective-taking. The "Introduction of Humanities & Arts into Physician Assistant Education" (IHAPAE) project is an intercampus collaboration between 2 Midwest Universities. The IHAPAE faculty collaboratively created and delivered A&H-based modules within first-year communication courses. Two cohorts of PA students (N = 130) participated in modules and subsequently attended exploratory focus groups to elicit their perceptions of the A&H curriculum. Using a constructivist grounded theory approach for data analysis, we found that PA students perceived multiple benefits. Specifically, module content promoted reflection and stress reduction, improved their continuity of care notes, provided utility in cultivating empathy in patient communication, and introduced students to A&H approaches they could recommend to patients. The process model that emerged from student perceptions fits well with existing emotional regulation theory and provides empirical evidence for cultivation of empathy and patient-centeredness. Given the positive outcomes of our project, PA programs should consider the value of incorporating the A&H activities into their curriculum to enhance the student experience and develop essential provider attributes and skills.

Gaining consensus on a protocol for general surgery physician assistants in the management of non-compressible abdominal haemorrhage in military austere environments: a Delphi study

BackgroundNon-compressible abdominal haemorrhage (NCAH) is a potentially preventable cause of death due to injury. Limited exploratory laparotomy by a non-surgeon is a temporary intervention to sustain life until definitive surgical...

Aversion to pragmatic randomised controlled trials: three survey experiments with clinicians and laypeople in the USA

ObjectivesPragmatic randomised controlled trials (pRCTs) are essential for determining the real-world safety and effectiveness of healthcare interventions. However, both laypeople and clinicians often demonstrate experiment aversion: preferring to implement either...

Wound Itch: An Update.

To present current evidence regarding the physiology, assessment, and management of wound itch. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Summarize current understanding of itch physiology.2. Apply current evidence to the management of wound itch.