Physician Assistant

The face of health care in America is in a state of constant change. Remaining flexible in the face of these rapid changes is critical to the ability of health care providers in general, and PAs in specific, to provide the highest quality health care in a timely fashion to the general public. Studies show that PAs give high-quality medical care, and that patients view non-physician clinicians similarly to physicians. PAs are “one of the most cost-effective health care clinicians to employ," yet many barriers continue to remain in place that limit the ability of these high- quality health care practitioners to get the care to the people that need it.

Recommendations: 1. The requirement to execute delegation agreements between PAs and physicians should be removed. 2. Early career PAs require mentoring until they achieve a satisfactory level of clinical competence. 3. Existing insurance legislation should be updated to compel all insurance payers to reimburse PAs directly.

Lifestyle factors (eg, smoking, diet) and compliance with screening recommendations play a role in cancer risk, and emerging technologies (eg, new vaccines, genetic testing) hold promise for improved risk management. However, optimal outcomes from cancer control efforts require better preparation of health professionals in risk assessment, risk communication, and implementing health behavioral change strategies that are vitally important to cancer control. Although physician assistants (PAs) are substantively engaged in cancer-related service delivery in primary care settings, few models exist to facilitate integration of cancer control learning experiences into the curricula used in intense, fast-paced, 24- to 30-month PA training programs.

In 2002, the Dutch Euthanasia Act came into effect, which made euthanasia available to individuals from the age of 12 and above. The objective of our study was to gain insight into how Dutch paediatricians and other physicians treating children feel about the regulation of physician-assisted dying. We interviewed 63 paediatricians, 125 general practitioners and 208 clinical specialists about their views on physician-assisted dying and the Euthanasia Act. Of the paediatricians, 44% agreed with the age limit of 12 years, and 52% agreed with the requirement that parents be involved. Somewhat more than half thought the Act could contribute to the disclosure of end-of-life practices (52%), the quality of the review procedure (61%), careful decision making (54%) and the reporting rate (65%). These percentages were comparable for other physicians. A minority of the physicians in all groups indicated that, with this Act in place, they would be more willing to report such practices. The most optimistic in this respect were the paediatricians, of whom 39% expected such an effect. About half of Dutch paediatricians support the Euthanasia Act and expect it to achieve its aims, which is the same percentage as was found for other clinical specialists and general practitioners. However, most physicians do not foresee an increase in willingness to report cases of physician-assisted dying.

The College of Health Professions of Pacific University in collaboration with the Jessie F. Richardson Foundation, a non-profit organization, completed its fourth annual visit to Nicaragua in December 2010. During their ten-day stay, an interdisciplinary team of students and faculty from the dental health, occupational therapy, pharmacy, physical therapy, and physician assistant programs provided direct care to Nicaraguan elders, educated

In a question about the future of the Indian physician assistant (PA), association president R. Shivakumar replied, " Basically, it's whether the chicken came from the egg or the egg came from the chicken, whether to produce more PAs and go for recognition or whether to get recognition and produce more PAs-that's the billion dollar question. " One could say the chicken of course comes first, and the egg is retroactively posited. In other words, the chicken " lays " the very egg from which it hatches: only once the PA profession is fully established will the contingent path toward that end become necessary. In 2017, I toured the world capturing on film PA-like professionals and programs, old and new, in nine countries on five continents. Like the coyote who placed the constellation of others in the sky before his own, I had hoped to capture this unsung profession, responsible for a large part of world health.

To examine the differences in patient satisfaction with care provided by nurse practitioners (NPs), physician assistants (PAs), and physicians in the Veterans Health Administration (VHA) system. Secondary data was obtained from the VHA's Survey of Healthcare Experience of Patients (SHEP), a monthly survey designed to measure patient satisfaction. Descriptive statistics were calculated and categorical variables were summarized with frequency counts. Of the 2,164,559 surveys mailed to the veterans, 1,601,828 (response rate 64%) were returned. The study found that satisfaction scores increased by 5% when the number of NPs was increased compared to 1.8% when the number of physicians was increased and slightly increased or remained the same when the number of PAs was increased. Physician to PA/NP ratio was 7:3. The VHA is the largest healthcare system and the single largest employer of NPs and PAs in the country. This study shows that a majority of the primary care clinic patients prefer to see NPs as compared with PAs and physicians. Besides clinical care, NPs focus on health promotion, disease prevention, health education, attentiveness, and counseling. Physicians and PAs should be educated on these characteristics to promote patient satisfaction and expected outcomes.

Hypospadias is a relatively common genital condition in which the urethral opening forms on the underside of the penis, as opposed to at the tip of the glans. Patients with hypospadias are typically referred for surgery during infancy or early childhood. Recent evidence, however, indicates that many individuals with hypospadias do not experience the functional or psychosocial difficulties that are commonly attributed to the condition, and that surgical intervention for hypospadias carries substantial risk of adverse outcomes. In this article, we review published outcomes data and conduct an in-depth analysis of the typical rationales for hypospadias surgery, taking into consideration both the potential benefits and harms of the procedure, as well as the existence of non-surgical alternatives. We argue, firstly, that most childhood surgeries for hypospadias are performed for anticipated future problems concerning function and cosmesis, rather than extant problems that serve to undermine the child’s well-being. Secondly, we contend that the surgery can be safely performed after an age of consent without increasing the absolute risk of surgical complications to an ethically meaningful degree. We conclude that surgery for hypospadias should typically be performed only if requested by the affected individual, under conditions of informed consent.

When provided by a skilled, multidisciplinary team, palliative care is highly effective at addressing the physical, psychological, social, and spiritual needs of dying patients and their families. However, some patients who have witnessed harsh death want reassurance that they can escape if their suffering becomes intolerable. In addition, a small percentage of terminally ill patients receiving comprehensive care reach a point at which their suffering becomes severe and unacceptable despite unrestrained palliative efforts; some of these patients request that death be hastened. This paper presents terminal sedation and voluntary refusal of hydration and nutrition as potential last resorts that can be used to address the needs of such patients. These two practices allow clinicians to address a much wider range of intractable end-of-life suffering than physician-assisted suicide (even if it were legal) and can also provide alternatives for patients, families, and clinicians who are morally opposed to physician-assisted suicide. This paper will define the two practices, distinguish them from more standard palliative care interventions and from physician-assisted suicide, illustrate them with a real clinical scenario, provide potential guidelines and practicalities, and explore their moral and legal status. Although medicine cannot sanitize dying or provide perfect answers for all challenging end-of-life clinical problems, terminal sedation and voluntary refusal of hydration and nutrition substantially increase patients' choices at this inherently challenging time.

This chapter is theoretical and will briefly discuss the role of environmental epigenetics, and the vulnerability to physical and mental health-related disease passed down from the horrors of African slavery and what this racial history means for generations of black people in the United States.

OBJECTIVE:  Vaping has been marketed as a “safe” or “safer” alternative to smoking.  It has become a very lucrative market and has experienced a surge of interest, especially among the younger generations.  There are many who theorize that there is a health benefit in switching from smoking to vaping, and numerous studies seem to corroborated this.  However, few studies have gone into any depth on the possible harmful effects that vaping can have on individuals.  This paper reviews three studies that were designed to analyze the possible harmful effects of vaping.

DESIGN: Case based, multi-study review of three randomized control trials.

METHODS:  Keyword searches performed in Scopus, TRIP Database, and PubMed to find up-to-date information and clinical trials.

RESULTS: Review of three randomized control trials reveals that at present there is still not sufficient information to determine the unique harms and health risks posed by vaping.  Present evidence, at best, is inconclusive.

We investigated the relation between value orientations and attitudes toward physician-assisted suicide (PAS) in 267 United States college students. We predicted that individual-istic values, especially those having to do with control and self-determination, would lead to ...

As an important step in analyzing the role of nurse practitioners (NPs) and physician assistants (PAs), we examined their prescribing behavior. The intent is to study the characteristics of providers and patients, and the type of prescriptions written by NPs and PAs in primary care and to compare these activities to physicians. The National Ambulatory Medical Care Survey (NAMCS) database was examined for prescriptions written by primary care clinicians (family and general medicine, internal medicine, and general pediatrics). A representative sample of 88,346 primary care visits over a 6-year period (1997-2002) was analyzed in which a prescription was written by an NP, a PA, or a physician in an urban or rural setting. The characteristics of all the patients seen were similar for geographical region of visit, age, and gender, but differed by ethnicity and race. An NP or a PA was the provider of record for 5% of the primary care visits in the NAMCS database. The three clinician types were likely to write at least one prescription for 70% of all visits, and the mean number of prescriptions was 1.3-1.5 per visit (range 0-5) depending on the provider. PAs were more likely to prescribe a controlled substance for a visit than a physician or an NP (19.5%, 12.4%, 10.9%, respectively). Only in nonmetropolitan settings did differences emerge. In rural areas, NPs wrote significantly more prescriptions than physicians and PAs. We suggest that NPs and PAs may provide a role that is similar to that of physicians in primary care based on prescribing behavior. The prescribing behavior of PAs and NPs parallels that of physicians by the number of medications per visit, the types of therapeutic classes, and the type of patient. However, in nonmetropolitan areas, prescribing differences emerge between the three types of providers that bear further exploration.

BACKGROUND: Although primary care physicians understand the importance of preventive services for patients with multiple risk factors (MRF) for coronary heart disease, physician intervention is limited. This study investigated (1) physicians' views of challenges faced in managing patients with MRF; (2) the counseling and management methods they utilize; and (3) possible strategies to enhance MRF intervention in the primary care