Stroke is the fifth most common cause of death in the United States, and projections suggest that its incidence will increase in the coming decade. Of all stroke cases, 85% are caused by vascular occlusion, resulting in...Stroke is the fifth most common cause of death in the United States, and projections suggest that its incidence will increase in the coming decade. Of all stroke cases, 85% are caused by vascular occlusion, resulting in infarction to the brain, in a condition more specifically known as acute ischemic stroke (AIS). The American Heart Association (AHA)/American Stroke Association (ASA) guideline addresses early management of AIS for providers' use in ensuring rapid evaluation and imaging for patients suspected to be affected. The guideline also aids providers in determining and delivering the most appropriate interventions upon AIS diagnosis. This article reviews the AHA/ASA AIS guideline and highlights key components of care, such as patient evaluation, criteria for fibrinolysis and mechanical thrombectomy, postacute care, and hospital discharge with secondary prevention measures.
The West African country of Ghana boasts a stable democracy and diverse culture. Although strides have been made in education and healthcare access, challenges persist, particularly in rural communities. The physician as...The West African country of Ghana boasts a stable democracy and diverse culture. Although strides have been made in education and healthcare access, challenges persist, particularly in rural communities. The physician associate (PA) profession emerged in the 1960s to address healthcare shortages, with formal training programs established and accreditation overseen by the Ghana Tertiary Education Commission and the Medical and Dental Council. PAs play a critical role in healthcare delivery, providing services in both urban and rural areas. Ghana's healthcare system, while advancing, is concentrated in urban centers, necessitating task-sharing strategies for improved access. Health outcomes have improved, but maternal and child mortality remain high. PAs contribute significantly to Ghana's healthcare system, including reproductive health and primary care services, alongside efforts to combat epidemics such as COVID-19. Key concerns for PAs include career progression, resource allocation, and public understanding of their role. Despite challenges, PAs remain essential in providing care to underserved populations. Addressing concerns and supporting PAs are vital for sustainable and effective healthcare in Ghana.
Urea cycle disorders (UCDs) are rare genetic disorders affecting the urea cycle, a metabolic pathway that leads to the excretion of waste products such as ammonia. This case report describes a patient who developed acute...Urea cycle disorders (UCDs) are rare genetic disorders affecting the urea cycle, a metabolic pathway that leads to the excretion of waste products such as ammonia. This case report describes a patient who developed acute encephalopathy secondary to hyperammonemia. Following an extensive workup to determine the etiology of the hyperammonemia, the patient was found to have a UCD. Diagnosis of a UCD was challenging, not only due to the rarity of the disorder, but also in this case due to atypical presentation and multiple confounding clinical variables. However, after the UCD was identified and appropriately managed, the patient's clinical status improved.
Maintenance of certification (MOC) is a critical and self-regulated process in many professional organizations. MOC serves to protect the public and ensure that professionals enhance their knowledge and its application t...Maintenance of certification (MOC) is a critical and self-regulated process in many professional organizations. MOC serves to protect the public and ensure that professionals enhance their knowledge and its application to clinical practice as they pursue lifelong learning. For the physician associate (PA) profession, MOC involves continuing medical education and a recertifying examination. Longitudinal assessment (LA) is a recent MOC method that is being used by certifying bodies in the pursuit of recertification and advancement of knowledge. In 2023, the National Commission on Certification of Physician Assistants (NCCPA) launched the Physician Assistant National Recertification Examination-Longitudinal Assessment (PANRE-LA). Many PAs are transitioning to this format as their chosen pathway for recertification examination. LA is a testing method that promotes continuous acquisition and application of knowledge over time. Despite the trend toward LA in many professions, limited literature describes the impact of this tool for the PA profession. In the changing landscape of MOC with LA becoming a recertification standard, PAs benefit from understanding the history, educational advantages, and importance of LA as a MOC tool.
Hypertension (HTN) is a common condition that physician associates (PAs) encounter in clinical practice. Of patients with HTN, about 10% have secondary HTN, of which primary aldosteronism is one of the most common causes...Hypertension (HTN) is a common condition that physician associates (PAs) encounter in clinical practice. Of patients with HTN, about 10% have secondary HTN, of which primary aldosteronism is one of the most common causes. Primary aldosteronism is a condition in which the adrenal glands produce excess aldosterone, and it contributes to HTN development by inducing sodium and water retention. Primary aldosteronism is underdiagnosed, as it can be hard to identify due to its lack of specific signs and symptoms. Moreover, without proper treatment, patients are at higher risk of cardiovascular disease, chronic kidney disease, metabolic syndrome, osteoporosis, and lower quality of life. It is therefore critical for PAs to be aware of indicators for primary aldosteronism screening. This review discusses primary aldosteronism screening and treatment in primary care while highlighting appropriate specialist referral.
Drug-induced aseptic meningitis (DIAM) is a noninfectious meningitis related to a drug exposure. Diagnosis requires exclusion of infectious meningitis. Patients with DIAM will exhibit rapid improvement after discontinuat...Drug-induced aseptic meningitis (DIAM) is a noninfectious meningitis related to a drug exposure. Diagnosis requires exclusion of infectious meningitis. Patients with DIAM will exhibit rapid improvement after discontinuation of the offending drug. Most patients will develop recurrent symptoms after repeat exposure to the offending agent. The clinical features of DIAM are indistinguishable from infectious meningitis and the recurrent symptoms often are identical to previous episodes of DIAM. Nonsteroidal anti-inflammatory drugs, co-trimoxazole, and penicillin are the medications that most commonly cause DIAM with use. This article describes a patient who was admitted to the hospital with meningoencephalitis after taking prophylactic amoxicillin for a dental procedure.
The American Academy of Pediatrics (AAP) in 2023 released a guideline for evaluating and treating children and adolescents with overweight and obesity. The AAP advocated for a patient-centered, comprehensive ("whole chil...The American Academy of Pediatrics (AAP) in 2023 released a guideline for evaluating and treating children and adolescents with overweight and obesity. The AAP advocated for a patient-centered, comprehensive ("whole child") approach to evaluation and a treatment regimen that includes a foundation of both motivational interviewing and intensive health behavior and lifestyle therapy, along with adjunctive pharmacotherapy and referral of adolescents with severe obesity to bariatric surgery. This article reviews the diagnosis of pediatric obesity and provides an update on the latest evidence and expert recommendations for evaluation and treatment of this condition.
OBJECTIVE: This study benchmarked gender trends in research authorship in the physician associate (PA) profession. METHODS: A bibliometric analysis was conducted of the Journal of Physician Assistant Education and the Jo...OBJECTIVE: This study benchmarked gender trends in research authorship in the physician associate (PA) profession. METHODS: A bibliometric analysis was conducted of the Journal of Physician Assistant Education and the Journal of the American Academy of Physician Associates from January 2014 to September 2022. We collected data on instances of PA first, last, and solo authorship of clinical or research articles. Author gender was verified through professional websites. Simple proportions and the Mann-Kendall test are reported. RESULTS: Among 1,315 collected instances of PA authorship, women represented 65.6% (n = 863) of the population, comprising 67.8% of first authors and 60.7% of last authors. The proportion of authors categorized as women increased over time ( P = .04). Women were more likely to have only one publication compared with men. CONCLUSIONS: Although positive signs of increased research authorship by women are evident, women still lag behind men in overall publication numbers and in senior authorship roles compared with their representation in the PA profession.
Aplastic anemia (AA) is an inherited, idiopathic, or acquired syndrome of bone marrow failure characterized by pancytopenia and ineffective hematopoiesis. Diagnosis, while crucial, is often difficult due to required excl...Aplastic anemia (AA) is an inherited, idiopathic, or acquired syndrome of bone marrow failure characterized by pancytopenia and ineffective hematopoiesis. Diagnosis, while crucial, is often difficult due to required exclusion of numerous inherited or acquired diseases with similar phenotypes. Mortality from severe AA without treatment approaches 70% within 2 years. The diagnostic algorithm for AA has increased in complexity, now incorporating molecular and genetic testing, and AA treatment guidelines have evolved to optimize patient outcomes. For individuals younger than age 50 years, a matched sibling allogeneic hematopoietic stem cell transplant remains the treatment of choice, and possible cure, for AA. For those without a donor, immunosuppressive therapy (IST) utilizing equine antithymocyte globulin, cyclosporine A, and eltrombopag is the mainstay of treatment. This article explores updated AA guidelines, covering presentation, diagnostic workup, differential diagnosis, IST, supportive care, and monitoring for appropriate dosing and adverse events.
Acute hip fractures are common injuries evaluated in the ED. Emergency medicine clinicians are tasked with managing patients' severe pain while also trying to reduce harm caused by overuse of opioids. Multimodal analgesi...Acute hip fractures are common injuries evaluated in the ED. Emergency medicine clinicians are tasked with managing patients' severe pain while also trying to reduce harm caused by overuse of opioids. Multimodal analgesics, including peripheral nerve blocks, are crucial to pain management. This article reviews the fascia iliaca compartment block and the benefits of its early use.
This case report describes a telemedicine visit by a patient with fever, sore throat, and odynophagia. The patient had recently started taking propylthiouracil (PTU) for Graves disease. She was referred to the ED, where...This case report describes a telemedicine visit by a patient with fever, sore throat, and odynophagia. The patient had recently started taking propylthiouracil (PTU) for Graves disease. She was referred to the ED, where a complete blood cell count revealed agranulocytosis with a neutrophil count of 200 cells/mm3. PTU was promptly discontinued, and she received treatment with IV piperacillin-tazobactam, resulting in an improvement in her condition. With the rise of telemedicine, clinicians must prioritize thorough history-taking to detect uncommon complications of medications and to ensure patient safety.
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an important, often underrecognized working diagnosis. MINOCA is defined as an acute MI in a patient whose coronary angiography reveals no significa...Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an important, often underrecognized working diagnosis. MINOCA is defined as an acute MI in a patient whose coronary angiography reveals no significant obstructive coronary artery disease. A comprehensive diagnostic approach beyond the initial coronary angiogram is essential for identifying this heterogeneous infarction pathophysiology. Distinguishing disease-specific causes affects patient management and prognosis, especially in female patients. This article provides an evidence-based overview of the tailored management strategies and ongoing clinical research likely to shape future guidelines.