Physician Assistants Research Articles

A Comparison of Telesimulation Using the Virtual Resus Room and In Situ Simulation in Pediatric Emergency Medicine.

During the COVID-19 pandemic, there was a marked shift toward telesimulation in medical education. Limited studies exist comparing the effectiveness of online and offline simulation education. The goals of this study are to evaluate active learners' perceived effectiveness of telesimulation versus in situ simulation and to identify potential shortcomings of existing online teaching platforms. Through participant evaluations after a simulation, we compared telesimulation using the Virtual Resus Room (VRR) to in situ simulation in the domains of (1) self-efficacy, (2) fidelity, (3) educational value, and (4) teaching quality. Study subjects included medical and pharmacy residents and medical students completing their pediatric emergency medicine rotation at two children's hospitals as well as nurses, nurse practitioners, and physician assistants who were recently hired and orienting to their new roles in the emergency department. Learners used a modified Michigan Standard Simulation Experience Scale to evaluate either a telesimulation or in situ simulation case. Survey responses were compared using Wilcoxon rank sum tests with Bonferroni correction for multiple comparisons. In overall assessment, in situ simulation was rated higher than telesimulation. There were significant differences noted related to perceived realism, utility in training device-related skills, and utility in training team-building skills. All P values were less than 0.0036. There were no significant differences between simulation types in perception of physical examination fidelity, instructor adequacy, or self-efficacy. Telesimulation using the VRR is comparable to in situ simulation in learners' perception of improvement in self-efficacy and of teaching quality for pediatric emergency medicine topics. However, participants felt less able to practice tactile and communication skills virtually. Further innovation is needed to improve learners' experience with fidelity and educational value.

Nephrology Provider Engagement in Comprehensive Shared Decision-Making Discussions With Older Adults: Results of a Cross-Sectional Survey.

Background: The largest patient group initiating dialysis for end-stage renal disease is persons over 75 years. Evidence indicates pre-dialysis shared decision-making discussions between nephrology providers and older adults are infrequent and often do not include an option for conservative management of symptoms without dialysis. Aims: To assess and compare behavioral determinants of nephrology providers' use of comprehensive pre-dialysis shared decision-making discussions with older adults. A secondary aim was to prepare the bases for tailored behavioral intervention(s) for nephrology providers by identifying the determinant(s) that should be targeted to elicit change in comprehensive shared decision-making intentions and the resulting behavior. Methods: A cross-sectional survey based on the Theory of Planned Behavior was completed by nephrologists from a state organization and nephrology advance practitioners from a national organization, either in person or online via Qualtrics. Results: Survey respondents included nephrologists (n=29), and nurse practitioners (n=37) and physician assistants (n=7), combined, were predominantly female (83%) and White American (67%). Spearman rho correlation results showed attitude, social norm, and perceived behavioral control were correlated with shared decision-making behavior for one or both groups. Significant differences were present between the two groups for determinants and behaviors. Conclusion: Based on the determinants predominantly influencing SDM behavior of nephrology advance practitioners, behavioral interventions targeting the determinants of Social Norm and Perceived Behavioral Control are warranted. All determinants can be utilized in behavioral interventions for nephrologists.Opportunity exists for collaboration between providers to develop consistent and effective methods of SDM discussion that fit into a typical workday.

A Pilot Interprofessional Education Curriculum for Optimizing Mental Health in Chronic Pain Treatment and Understanding Interprofessional Practice.

With the urgent need for clinicians capable of responding to the opioid crisis, an interprofessional education (IPE) pilot curriculum was launched to assess trainee self-efficacy in managing chronic pain and mental health conditions, and attitudes toward interprofessional practice among resident physicians, family nurse practitioners (FNP), and physician assistant (PA) students. This study involved the implementation of a pilot curriculum consisting of five interactive IPE sessions. All invited trainees across two academic institutions were asked to complete the assessments. Self-efficacy in managing chronic pain and mental health was measured at baseline and following IPE training using a researcher-developed tool, while attitudes toward interprofessional practice were measured with the Attitudes Toward Health Care Teams scale. Resident physicians were compared to FNP/PA students to examine differences between groups and within groups over time. The final analysis involved 25 trainees who attended at least one IPE training session and completed pre-session and post-session surveys. The total pre-session survey and post-session survey response rate was 37.5% (n=36). Self-efficacy in chronic pain management improved among the resident physician (mean=3.85 ±0.40) and FNP/PA groups (mean=3.84±0.46) (p=0.05 and p=0.001), respectively. Self-efficacy in mental health management was not significantly improved among resident physicians (mean=3.41±0.49, p=0.48), but improved among FNP/PA students (mean=3.46±0.31, p<0.001). There was no difference in attitudes toward interprofessional practice. While IPE training did not result in attitudinal changes toward interprofessional practice, it shows potential for improving self-efficacy in managing chronic pain and mental health, particularly among FNP/PA trainees. This study was limited by a small sample size of trainees included in the finalanalysis.

DECNet: Left Atrial Pulmonary Vein Class Imbalance Classification Network.

In clinical practice, the anatomical classification of pulmonary veins plays a crucial role in the preoperative assessment of atrial fibrillation radiofrequency ablation surgery. Accurate classification of pulmonary vein anatomy assists physicians in selecting appropriate mapping electrodes and avoids causing pulmonary arterial hypertension. Due to the diverse and subtly different anatomical classifications of pulmonary veins, as well as the imbalance in data distribution, deep learning models often exhibit poor expression capability in extracting deep features, leading to misjudgments and affecting classification accuracy. Therefore, in order to solve the problem of unbalanced classification of left atrial pulmonary veins, this paper proposes a network integrating multi-scale feature-enhanced attention and dual-feature extraction classifiers, called DECNet. The multi-scale feature-enhanced attention utilizes multi-scale information to guide the reinforcement of deep features, generating channel weights and spatial weights to enhance the expression capability of deep features. The dual-feature extraction classifier assigns a fixed number of channels to each category, equally evaluating all categories, thus alleviating the learning bias and overfitting caused by data imbalance. By combining the two, the expression capability of deep features is strengthened, achieving accurate classification of left atrial pulmonary vein morphology and providing support for subsequent clinical treatment. The proposed method is evaluated on datasets provided by the People's Hospital of Liaoning Province and the publicly available DermaMNIST dataset, achieving average accuracies of 78.81% and 83.44%, respectively, demonstrating the effectiveness of the proposed approach.

Factors That Influence Clinician Prescribing of Corticosteroids for Acute Idiopathic and Multiple Sclerosis-Associated Optic Neuritis: A Qualitative Study.

Treatment with corticosteroids is common for patients with idiopathic and multiple sclerosis-associated optic neuritis (I/MS-ON). Yet, the Optic Neuritis Treatment Trial and meta-analyses confirm that few patients benefit and that visual benefit is of questionable clinical significance, short-lived, and comes with potential harms. The purpose of this study was to uncover the breadth of factors that underlie clinicians' treatment decisions and determine how these factors may influence corticosteroid use for I/MS-ON. We performed semistructured, one-on-one, qualitative interviews with neurologists, neuro-ophthalmologists, and emergency department clinicians at 15 academic and private practices across the United States. The interview guide used the Theoretical Domain Framework and a vignette to explore numerous factors that might influence decision making for definite I/MS-ON. We analyzed transcripts using inductive thematic analysis to generate themes. A total of 22 clinicians were interviewed before thematic saturation was reached: 8 neuro-ophthalmologists, 8 neurologists, and 6 emergency medicine (EM) clinicians (2 physician assistants, 4 physicians). All neuro-ophthalmologists and nearly all neurologists (7 of 8) were aware of risks/benefits of corticosteroid treatment for I/MS-ON. However, neuro-ophthalmologists varied in their corticosteroid treatment recommendation (n = 3 recommended treatment, n = 2 recommended observation, n = 3 recommended shared decision making), whereas all neurologists recommended corticosteroids, indicating that knowledge of corticosteroid risk/benefit alone does not drive decision making. EM clinicians were not aware of risk/benefits of corticosteroid treatment for I/MS-ON and relied on the treatment recommendations of neurologists. Clinicians recommending corticosteroids held personal beliefs that corticosteroids benefit those with worse vision loss, relieve pain, allow earlier return to work, or have easily mitigated side effects. They also perceived that prescribing steroid was the principal method of "doing something," which fit a key provider role. Clinicians who did not recommend corticosteroids or were neutral perceived the risks as nontrivial, considered discussing treatment trade-offs as "doing something" and incorporated patient preferences. Knowledge of risk/benefits of corticosteroids are necessary but not sufficient for evidence-based I/MS-ON practice. Variation in how clinicians treat patients with acute I/MS-ON is influenced largely by psychosocial factors, such as beliefs about corticosteroid risk/benefit trade-offs and the role of the clinician to provide treatment. Interventions to support evidence-based decision making for I/MS-ON treatment will need to provide risk/benefit information to support clinicians with varying levels of expertise, incorporate patient preference, and normalize the option to observe.

Colonoscopy Training on Virtual-Reality Simulators or Physical Model Simulators: A Randomized Controlled Trial

This study employed a randomized controlled trial to assess the efficacy of virtual-reality (VR) simulators and physical model simulators on colonoscopy training to explore the optimal and evidence-based simulation training. Forty participants were divided into 2 groups and randomized as dyads: the VR simulator group and the physical model simulator group. All the participants performed a baseline test through porcine colonoscopy. After a 6 h simulation training, each participant underwent a post-test on a pig after bowel preparation, and the procedures were video-recorded. Both the baseline test and the post-test were blindly assessed by 2 experienced assistant director physicians based on the GAGES-C scoring system. Simulation center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai. Forty surgical residents without colonoscopy experience. Both the VR simulator group and the physical model simulator group improved significantly over the baseline test. The VR simulator group performed significantly better than the physical model simulator group, p=0.042. The participants in both groups expressed a high level of simulator satisfaction. Novice residents can benefit from both VR simulators and physical model simulators. The VR simulator was shown to be more effective for colonoscopy training. VR simulators were more recommended for novices conducting basic colonoscopy training.

Potential US Health Care Savings Based on Clinician Views of Feasible Site-of-Care Shifts

Shifting care to alternative sites when clinically appropriate may be associated with reduced US health care spending, improved access, and, in some cases, improved care outcomes. To fill 2 main gaps in the current literature on site-of-care shifts: (1) understanding the clinician perspective on appropriateness of alternative care sites, given the central role they play in referrals and patient trust and (2) considering all potential sites where care could shift and calculating net savings potential. In this survey study, physicians (MDs and DOs), nurse practitioners, physician assistants, nurse anesthetists, radiology and imaging technicians, and psychologists were surveyed from September 17 to November 22, 2021, about potential shifts of care from the hospital setting to alternative sites. Participants were selected by the survey firm Intellisurvey to provide broad representation across all specialties of interest. A minimum of 34 clinicians responded to each question. Data were analyzed from April 2022 through October 2023. More than 5000 individual diagnostic and procedural codes were reviewed and sorted into 312 distinct care activities by an expert panel of physicians. Survey respondents were then provided with the 2019 claims-based distribution across sites of care for each care activity and were asked, "based on your clinical judgment, what portion of [care activity] could safely occur in each of the following sites of care, without compromising clinical outcomes?" Based on clinician-reported distributions, the total potential shift of volume from hospital-based settings to alternative sites and the associated net savings were estimated. Survey respondents included 1069 practicing clinicians (386 female [36.1%]; mean [SD] years since residency of physicians, 21.0 [9.7] years; mean [SD] age of nonphysicians, 45.3 [9.4] years) across specialties, all of whom practiced more than 20 clinical hours per week. There were 794 physicians (74.3%), and the remaining 275 respondents were midlevel professionals, such as physician assistants. Among 312 care activities surveyed, respondents indicated that 10.3 percentage points (95% CI, 10.0-10.5 percentage points) of commercial and 10.9 percentage points (95% CI, 10.7-11.1 percentage points) of Medicare volume currently taking place in hospital-based settings could shift to alternative sites with today's technology without compromising clinical outcomes. Across the entire US health care system, these shifts could be associated with a reduction in overall health care consumption spending ($3 562 339 000 000 000) by approximately $113.8 billion ($113 767 446 087 174 [3.2%]) to $147.7 billion ($147 661 672 284 263 [4.1%]) annually. In this study, a substantial net savings opportunity was estimated. However, realizing this potential will require ongoing alignment among organizations, clinicians, and policymakers to overcome barriers to these shifts.

Establishing a Contextualized Intervention Program for Noise Reduction in a Neonatal Intensive Care Unit.

Objective: This study aimed to examine the effect of a contextualized intervention program on the level of noises in the neonatal intensive care unit (NICU) in Konya, Turkey. Background: For the healthy development of preterm infants, NICUs should have noise levels within safe limits. Methods: A single-center, before-and-after study design was employed. Participants included one head nurse, four physicians, 42 nurses, six physician assistants, and 14 other staff members. The contextualized intervention program involved environmental modification, behavioral modification, and resource management. Sound level measurements were recorded at two-hour intervals over a week before the program's initiation, after the first cycle, and following the installation of central monitor screens. Data analysis utilized SPSS 25, employing percentile calculations, one-way analysis of variance, and Bonferroni tests. Results: The evaluations in the second level of NICU showed that the noise level recorded on weekday mornings and evenings was significantly lower for the third measurement compared to the first and second measurements. However, at the weekend the noise level recorded in the morning was higher in the second measurement than the first, with no significant difference found for the third measurement. The evaluations in the third level of NICU showed that on weekdays the noise level recorded in the third measurement was significantly lower than in the first and second measurements (p < .05). Conclusion: The implementation of a contextualized noise reduction program in our NICU led to significant improvements in noise levels, particularly during morning and evening shifts.

Implications of Requiring the Physician Assistant College Admissions Test on Physician Assistant Program Applicant Pool: Lessons Learned.

To present a physician assistant (PA) program's experience and lessons learned by requiring a new standardized test as an admissions requirement. A state academic PA program changed an admission requirement by requiring the Physician Assistant College Admissions Test (PA-CAT) instead of the Graduate Record Examination. The admissions requirement change correlated with a 72% drop in the applicant pool. Data from previous literature present background information on standardized testing and predictors of student success. The program-specific data retrospectively evaluate changes in application numbers. Several studies have evaluated various preadmission metrics and their correlation to student success. However, the PA-CAT and its predictor of student success in the program and passing the Physician Assistant National Certifying Exam still need to be evaluated. Requiring standardized testing increases the barrier to applicant PA school admissions. Despite its potential, the PA-CAT has yet to be extensively studied to predict success in matriculated PA students and should be used cautiously. The implications of using the PA-CAT as an admissions requirement are a potential decrease in the strength of applicants, the number of total applicants, and the overall decline in the quality of graduating PAs. This cautionary note is crucial for maintaining the quality and integrity of our PA programs.

2144 Improving PA students confidence in managing geriatric patients with a bespoke teaching programme and a novel bleep simulation

Abstract Introduction BGS reports in its ‘Case for more Geriatricians’ that the number of people age over 85 is set to double by 2045. As well as Geriatric specific policies in the Ageing Well programme of the NHS Longterm Workforce Plan there are plans to expand the number of allied health professionals including Physician Associates (PA). We set out to improve PA students’ knowledge of and confidence in managing geriatric patients with a bespoke teaching programme culminating in a novel bleep simulation. Methods We identified the students’ needs with a preliminary survey and then created a teaching programme on medical topics and issues common to geriatric wards with weekly lectures and small group work. The programme culminated in a bleep simulation where students were contacted via bleep to come to different parts of the medical education centre and respond to scenarios which would be common on geriatric wards. These included reviewing unwell patients and issues such as aspiration, constipation and urinary retention. The students were required to amend or create prescriptions and interpret test results with access to the BNF and relevant local guidelines. Results Students were asked how useful the simulation was and how much it had improved their confidence in working on geriatric wards. The average score for both statements was greater than 9/10. The students were asked before and after the simulation how confident they were responding to bleeps and managing clinical scenarios in geriatric patients. Both scores doubled following the simulation to 6.7/10 (from 2.5 and 3.3 respectively). Conclusion The Faculty of Physician Associates curriculum does not necessitate placements in geriatrics and its matrix of core clinical conditions does not include any specific to geriatrics. Through a bespoke teaching programme and a novel bleep simulation we increased PA students’ confidence in managing geriatric patients.

Primary Care Use and 90-Day Mortality Among Older Adults Undergoing Cancer Surgery

Multimorbidity and postoperative clinical decompensation are common among older surgical patients with cancer, highlighting the importance of primary care to optimize survival. Little is known about the association between primary care use and survivorship among older adults (aged ≥65 years) undergoing cancer surgery. To examine primary care use among older surgical patients with cancer and its association with mortality. In this retrospective cohort study, data were abstracted from the electronic health record of a single health care system for older adults undergoing cancer surgery between January 1, 2017, and December 31, 2019. There were 3 tiers of stratification: (1) patients who had a primary care practitioner (PCP) (physician, nurse practitioner, or physician assistant) vs no PCP, (2) those who had a PCP and underwent surgery in the same health system (unfragmented care) vs not (fragmented care), and (3) those who had a primary care visit within 90 postoperative days vs not. Data were analyzed between August 2023 and January 2024. Primary care use after surgery for colorectal, head and neck, prostate, ovarian, pancreatic, breast, liver, renal cell, non-small cell lung, endometrial, gastric, or esophageal cancer. Postoperative 90-day mortality was analyzed using inverse propensity weighted Kaplan-Meier curves, with log-rank tests adjusted for propensity scores. The study included 2566 older adults (mean [SEM] age, 72.9 [0.1] years; 1321 men [51.5%]). Although 2404 patients (93.7%) had health insurance coverage, 743 (28.9%) had no PCP at the time of surgery. Compared with the PCP group, the no-PCP group had a higher 90-day postoperative mortality rate (2.0% vs 3.6%, respectively; adjusted P = .03). For the 823 patients with unfragmented care, 400 (48.6%) had a primary care visit within 90 postoperative days (median time to visit, 34 days; IQR, 20-57 days). Patients who had a postoperative primary care visit were more likely to be older, have a higher comorbidity burden, have an emergency department visit, and be readmitted. However, they had a significantly lower 90-day postoperative mortality rate than those who did not have a primary care visit (0.3% vs 3.3%, respectively; adjusted P = .001). These findings suggest that follow-up with primary care within 90 days after cancer surgery is associated with improved survivorship among older adults.

Two Decades of Medical Spanish Education: A Narrative Review

Purpose : Education on medical Spanish, defined as the use of Spanish by clinicians for communication with patients, has proliferated rapidly since the first guidelines were published in 2008. This study aims to characterize the scope of the field, identify gaps, and propose emerging questions for future study. Method : The authors conducted a narrative review of the medical Spanish education literature published from 2000 to 2023. First, a comprehensive search algorithm was developed across three databases (Medline, Scopus, and Web of Science Core Collection) and conducted on August 2, 2023. Two reviewers then independently assessed articles for inclusion/exclusion and subsequent categorization of included articles. Results : The search identified 1,303 articles, and authors added ten articles from other sources. A total of 138 individual articles were included in the final categorization and sub-analysis. There has been an upward trend in the number of articles published yearly since 2000. Most publications were educational interventions (67/138, 49%), followed by commentaries/perspectives (27/138, 20%), proficiency testing (17/138, 13%), needs assessments (16/138, 12%), reviews (6/138, 4%), and vocabulary analyses (5/138, 4%). Slightly over half of publications (72/138, 52%) were centered on physicians or physicians-in-training, with 23 (17%) articles applicable across health professions, and a few focused on pharmacists, nurses, physical therapists, psychologists, physician assistants, and genetic counselors. The vast majority (119/138, 86%) were published in medical/scientific journals and 19 (14%) in language/humanities journals. All but two first authors were affiliated with United States institutions, representing 30 states and Puerto Rico. Conclusions : Over the past two decades, many medical Spanish educational interventions have been published, and several assessment tools have been developed and validated. Gaps remain in evaluation data to demonstrate course effectiveness, the use of pedagogical frameworks to guide curricula, faculty development opportunities, and the role of heritage Spanish learners. Future work should address medical Spanish gaps in health professions and medical specialties, explore patient-engaged approaches to research, and evaluate longitudinal outcomes.

Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model.

To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS). Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway. A large tertiary referral academic cardiac surgery ICU. There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase. Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model. Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (P = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (P = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (P = .30). Overall, implementation of an NP/PA-led postcardiac surgical ICU team (rapid recovery pathway) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.

Scope‐of‐practice laws and the practice patterns of nurse practitioners and physician assistants

Scope‐of‐practice laws and the practice patterns of nurse practitioners and physician assistants

Clinical Characteristics and Inciting Agents for Pseudoporphyria: The Mayo Clinic Experience, 1996-2020.

To raise awareness regarding the clinical presentations of patients with pseudoporphyria. 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. Describe the clinical presentation of pseudoporphyria.2. Identify the differential diagnoses of blistering lesions on hands and feet.3. Outline the management options for patients with porphyria.

Emmery Blin (1863–1930). Un aliéniste d’enfants, pionnier de la psychologie expérimentale et membre de la Société Médico-Psychologique (1889)

Emmery Eugène Blin (1863–1930) was born in Paris where he studied medicine at the Paris Medical School. After serving as an extern in hospitals (1887) and then as an intern in the asylums in the former department of Seine (1888), he won first prize in the competitive examination for the administration of Parisian psychiatric hospitals in 1890. That same year, he successfully defended his doctoral dissertation in medicine. From December 1890 to September 1891, he was assistant physician at the Evreux asylum before being promoted to assistant physician at the Vaucluse asylum, an establishment created in 1876, and where he would remain until his retirement in 1920. An alumnus of the École des Hautes Études and a member of learned societies (Société médico-psychologique 1889; Société de médecine 1891; Société clinique de médecine mentale 1909), Blin was the first, prior to the Binet and Simon test, to use a questionnaire to differentiate between morons, imbeciles and profound idiots. Together with Théodore Simon he designed a campylogram (1900), and always attributed great importance to the use of the test method in child clinical practice. Following in the footsteps of Itard, Seguin, Bourneville and his colleagues, Blin thus contributed to improving the pedagogical education of retarded children and can be considered the leader of the Perray-Vaucluse school of child psychiatry (Théodore Simon, Maurice Brissot, André Beley). In addition to his medical activities, Blin was introduced to sculpture by Paul Richer (1849–1933) and became a student of Denys Puech (1854–1942); he was a member of the Society of French Artists in the sculpture section (1903). An experienced navigator, he was a member of the crew of one of Jean-Baptiste Charcot's (1867–1936) ships that were christened the “Pourquoi pas?”. The same year that Th. Simon succeeded him at the Vaucluse asylum (1920), Blin was convicted of trafficking in morphine. He died in Paris on March 23, 1930.

Management of Hypertension in Patients with Type 2 Diabetes Mellitus: Indian Guideline 2024 by Association of Physicians of India and Indian College of Physicians.

In India and the Southeast Asian population, hypertension and type 2 diabetes mellitus (T2DM) are the leading lifestyle-related diseases, responsible for a majority burden of morbidity and mortality. Multiple population-spanning studies have revealed the staggering prevalence of both diseases in India, and the prevalence of both will only increase further due to factors such as an aging population, rapid urbanization, increased obesity, and sedentary lifestyles. More than 50 percent of hypertensive patients in India are also diagnosed with T2DM, and a detailed management protocol for the same is required, especially when a major portion of the disease is managed at the primary care level. The Association of Physicians of India (API) guidelines for the management of hypertension in patients with T2DM have been formulated based on consultation with leading physicians, cardiologists, diabetologists, and endocrinologists of India and Southeast Asia, keeping in mind the challenges faced by the patients in these countries and the appropriate management protocols that will be beneficial. While standard office-based blood pressure (BP) measurement forms the cornerstone of hypertension diagnosis and demands a uniform methodology to be followed, home blood pressure monitoring (HBPM) is recommended for long-term follow-up with validated devices. Ambulatory blood pressure monitoring (ABPM) offers comprehensive insights crucial for cardiovascular (CV) risk stratification. The complications of diabetic hypertension can span from increased CV risk, heart failure (HF), and renal dysfunction, and nonpharmacological and pharmacological management should be aimed toward not only control of the BP values but also protecting the end organs. While nonpharmacological measures include a focus on nutrition and diet, they also focus on approaches to weight loss, including a novel section covering the benefits of yoga. The guideline also focuses on a novel section of factors influencing CV risk, especially in the Indian population. For the pharmacological management, the guidelines address each of the categories of antihypertensive drugs, emphasizing the significance of combination therapies in the management of diabetic hypertension. In line with leading global guidelines for the management of hypertension in T2DM, for diabetic patients who often struggle with BP management and carry a high CV risk, the recommended dual combination antihypertensive therapy is particularly crucial and should be considered as first-line management therapy. While angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) play a highly beneficial role in the management of diabetic hypertension, a combination of ACEi or ARB with dihydropyridine calcium channel blockers (DHP-CCBs) is recommended to reduce the risk of complications and enhance patient adherence. To achieve the target of effective BP control and end-organ protection, it is beneficial and recommended to include newer CCBs (e.g., cilnidipine) in the management protocol in combination with ACEi/ARBs. Combination therapy including ARBs and DHP-CCBs should be preferred over β-blockers and thiazides. Among the CCBs, cilnidipine, a novel molecule, is a more effective and safer option for diabetic hypertensive patients in India. β-blockers should be used if there is a history of myocardial infarction (MI), HF, coronary artery disease (CAD), or stable angina along with the initial hypertensive regimen. The guideline also focuses on the novel reno- and cardioprotective molecules such as finerenone and sodium-glucose cotransporter 2 inhibitors (SGLT2i) and their benefits in the management of diabetic hypertension.

Perceptions of telehealth use by PAs post-COVID-19.

Use of telemedicine and remote patient monitoring can provide significant cost savings through improved disease control and reduced exacerbations. This study investigated physician associates'/assistants' (PAs') perceptions of telemedicine to inform future use and expansion of these programs. The Telehealth Usability Questionnaire was completed by 30 PAs recruited via social media. Data were coded and analyzed through an electronic spreadsheet program. PAs generally felt that telemedicine was a helpful tool to increase access to care (M = 4.129) but did not replace in-person visits. Variation in responses related specifically to the platform indicated PAs' varying experiences about ease of use. Findings demonstrated that PAs from a variety of practice settings found telemedicine to be a helpful tool to reduce barriers and improve access to care. However, PAs did not feel that telemedicine replaces in-person visits.

Impact of Biopsychosocial Pain Education on Physician Assistant Students' Pain Knowledge, Pain Attitudes, and Recommendations for Lower Back Pain

Introduction Physician assistants treat patients with chronic musculoskeletal pain on a regular basis. This pilot study implemented a pain education module in the first semester of didactic training and evaluated changes in knowledge, attitudes, and recommendations for lower back pain. Methods The biopsychosocial pain education module, focused on the social, cultural, psychological, and biological complexities of pain and incorporated online training and in-person case based discussions. Students completed surveys on pain knowledge, attitudes, and recommendations for a case scenario before and after the module and at a one-year follow-up. Results Physician assistant students' pain attitudes and beliefs demonstrated statistically significant shifts toward a biopsychosocial perspective immediately after the educational module (P &lt; 0.001) and at one-year follow-up compared with pretest levels (P = .034). Pain knowledge demonstrated statistically significant improvements immediately after the module (P = .006). At one-year follow-up, pain knowledge was not statistically significantly different from pretest levels (P = .530). Clinical recommendations for the case-based scenario trended toward increased agreement with clinical practice guideline recommendations after the module and persisted at the one-year follow-up. Discussion Implementing a pain education module with emphasis on the multidimensional nature of pain using a case-based approach can improve pain knowledge, attitudes, and recommendations for care.

Reimagining Faculty Development: A 5-Year Journey of Outcomes and Lessons Learned of a Physician Assistant Faculty Fellowship

Introduction Faculty sufficiency remains one of the major bottlenecks in health workforce development. There is a need for effective models for practicing clinicians to successfully transition to academic teaching roles. This article describes outcomes and lessons learned at the 5-year mark for a statewide faculty development workforce initiative for the physician assistant (PA) profession at the PA Leadership and Learning Academy (PALLA) in Maryland. Methods The PALLA PA faculty fellowship is a state-funded workforce initiative that consists of a 10-month training program that includes synchronous workshops, asynchronous learning modules, experiential teaching opportunities, and completion of an individual project in the realm of scholarship/service under longitudinal mentorship. Programmatic outcomes were longitudinally tracked using the Kirkpatrick model of training evaluation to evaluate the faculty training program at 4 levels of criteria: reaction (level 1), learning (level 2), behavior (level 3), and results (level 4). Key performance indicators for the fellowship include the ability for fellow graduates to provide educational support to Maryland PA programs, engage in, and promote scholarship in the PA profession and build an academic portfolio. Results To date, 4 cohorts of PAs (23 individuals) have completed the fellowship. Learner reaction (level 1) evaluated through surveys, and interviews reveal a positive fellowship experience, with fellows noting benefits of the longitudinal nature of the experience and individualized mentorship and fellows self-report high level of achievement of fellowship learning goals (level 2). Local and national PA review of fellow curricular and scholarly products has been positive (level 3). After graduation, 9 fellows are engaged in faculty roles, providing academic support to local PA programs; 11 fellows have had scholarly products accepted; all fellow graduates have generated an academic portfolio; and 2 fellows have provided new service to PA organizations (level 4). Discussion Four years of fellowship data demonstrate positive impact across Kirkpatrick 4 levels of training evaluation. Nearly, all participants have new contributions in teaching, scholarship, or service roles because of the fellowship. Key lessons learned were the benefits of the longitudinal nature of the experience for scaffolding of learning and ongoing, individualized mentorship.