Measles cases are increasing across the United States, with infants under age 12 months at increased risk as they are not yet eligible for routine measles, mumps, and rubella (MMR) vaccination. The current MMR vaccinatio...Measles cases are increasing across the United States, with infants under age 12 months at increased risk as they are not yet eligible for routine measles, mumps, and rubella (MMR) vaccination. The current MMR vaccination schedule is based on decades-old data from an era of widespread natural maternal immunity and low measles prevalence. Today, most mothers have vaccine-derived immunity, and recent studies show these maternal antibodies wane by 3 to 6 months of age, leaving many infants vulnerable to infection until they receive their first MMR vaccine at the currently recommended age of 12 to 15 months. Evidence demonstrates, however, that MMR vaccination between ages 6 and 11 months provides partial protection during outbreaks and does not impair the immune response to later doses. Safety data also support vaccination in younger infants. Although early MMR vaccination is currently recommended before international travel, it should also be offered domestically during outbreaks as a risk-based strategy. National guidance should be updated to reflect current epidemiology and close this gap in infant protection.
Xylazine is a veterinary drug that has become a common adulterant in opioids, particularly heroin and fentanyl. This article provides a comprehensive review of the drug, including its history, pharmacology, toxicology, p...Xylazine is a veterinary drug that has become a common adulterant in opioids, particularly heroin and fentanyl. This article provides a comprehensive review of the drug, including its history, pharmacology, toxicology, pathophysiology, withdrawal, medical management, associated wound care, and harm reduction strategies, so that physician associates and other clinicians may be better equipped to recognize possible xylazine misuse in their patients and provide adequate treatment for xylazine-related harms.
Postprofessional doctoral programs for physician associates (PAs) have expanded rapidly, offering diverse and specialized tracks that reflect the evolving roles of PAs in health care, education, and leadership. Instituti...Postprofessional doctoral programs for physician associates (PAs) have expanded rapidly, offering diverse and specialized tracks that reflect the evolving roles of PAs in health care, education, and leadership. Institutional accreditation provides rigorous oversight of these programs and ensures academic quality across them without necessitating uniformity. In early 2025, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) proposed a centralized accreditation model for these programs that would impose prescriptive requirements pertaining to their curricula, faculty qualifications, and student outcomes. A centralized accreditation model, however, would serve to hamper these programs' innovation and diversity by enforcing uniform standards that conflict with the flexible, career-focused nature of postprofessional education. This article advocates for the current decentralized approach-continued use of which is being championed by the Consortium of DMS/DMSc Programs-as essential to supporting the continued growth and specialization of the PA profession.
OBJECTIVE: This pilot study assesses diagnostic agreement between correctional advanced practice providers (APPs) and physicians in interpreting 12-lead ECG results for STEMI diagnosis, with the aim of determining whethe...OBJECTIVE: This pilot study assesses diagnostic agreement between correctional advanced practice providers (APPs) and physicians in interpreting 12-lead ECG results for STEMI diagnosis, with the aim of determining whether APPs offer comparable care to adult correctional populations that decreases ED burden. METHODS: This study compared the diagnostic accuracy of APPs with that of physicians in identifying STEMI through an online 12-lead ECG assessment based on current guideline criteria. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated for each profession. Unadjusted odds ratio (OR) with 95% CI were used to compare groups. RESULTS: Of the 37 total completed submissions, no statistically significant difference was observed in overall 12-lead ECG STEMI diagnostic accuracy among the groups. CONCLUSIONS: Correctional APPs and physicians had comparable accuracy in using 12-lead ECGs to identify STEMI, and evaluation by an APP in the correctional setting does not increase the likelihood of ED evaluation. However, a quality improvement study entailing use of larger sample sizes and proctor-controlled assessments is needed to accurately determine APP 12-lead ECG STEMI competency.
Low back pain is among the most common conditions treated by physician associates in family medicine, internal medicine, and emergency medicine clinics. Inflammatory low back pain is the most frequent manifestation of ax...Low back pain is among the most common conditions treated by physician associates in family medicine, internal medicine, and emergency medicine clinics. Inflammatory low back pain is the most frequent manifestation of axial spondyloarthritis (axSpA). AxSpA has a prevalence of 1.0% to 1.4% in the United States. The diagnosis of axSpA includes both clinical and radiographic components. With the advancement of biologic pharmacologic agents, the American College of Rheumatology, Spondylitis Association of America, and Spondyloarthritis Treatment Network have provided updated recommendations for the pharmacologic and nonpharmacologic management of axSpA. The recognition of axSpA and comorbid peripheral spondyloarthropathies is important, as the management of axSpA differs from routine musculoskeletal back pain. Treatment guidelines focus on symptom management, functionality, and disease progression.
Every 3 seconds worldwide, a fracture due to osteoporosis occurs. Yet approximately 80% of individuals who have sustained a fragility fracture are not identified as having osteoporosis or treated for the condition. Many...Every 3 seconds worldwide, a fracture due to osteoporosis occurs. Yet approximately 80% of individuals who have sustained a fragility fracture are not identified as having osteoporosis or treated for the condition. Many misconceptions and barriers plague care for this "silent" condition, contributing to a health care gap with catastrophic consequences. Importantly, clear guidance on screening, prevention, and treatment is available, paving the way for clinicians who are willing to "own the bone" and narrow the gap. Most recently, the US Preventive Services Task Force (USPSTF) published updated guidance for osteoporosis screening in early 2025. This guidance largely supports previous recommendations, strengthening the firm foundations clinicians use to address this critical need.
Physician associates (PAs) have featured among multidisciplinary care teams in the Scottish health care system for the last 19 years and have gradually become an established profession. Despite this, there remains no cle...Physician associates (PAs) have featured among multidisciplinary care teams in the Scottish health care system for the last 19 years and have gradually become an established profession. Despite this, there remains no clear pathway for career progression for experienced PAs. This study used an original questionnaire, in addition to publicly available workforce and education data, to gain insight into the current education, deployment, and career development aspirations of this professional group in Scotland. The questionnaire was sent to all contactable PAs in Scotland before data were thematically analyzed.We found that Scottish PAs are experienced and keen to develop within the National Health Service Scotland workforce; however, they require a better career structure and improved support to allow them to work to their full potential. The establishment of a career progression framework, along with the infrastructure to support it, is urgently needed to support the development of this profession.
Physician associates (PAs) and nurse practitioners (NPs) are vital members of the healthcare team. Increasing opportunities for leadership roles have emerged for PAs and NPs in the past decade. PAs and NPs often utilize...Physician associates (PAs) and nurse practitioners (NPs) are vital members of the healthcare team. Increasing opportunities for leadership roles have emerged for PAs and NPs in the past decade. PAs and NPs often utilize other health professions' frameworks for leadership, but no framework exists for PAs and NPs specifically. This article examines existing leadership structures and proposes a leadership framework specifically for PAs and NPs through the health systems science lens.
Resistant hypertension (RH) is defined as blood pressure (BP) that remains above goal despite treatment with three first-line pharmacologic classes or BP that requires four or more medications to obtain control. After ru...Resistant hypertension (RH) is defined as blood pressure (BP) that remains above goal despite treatment with three first-line pharmacologic classes or BP that requires four or more medications to obtain control. After ruling out secondary causes and implementing nonpharmacologic treatments, clinicians may encounter the question of which pharmacologic treatment options should be used next. This article discusses evidence-based second-line medication options for RH.
Pelvic floor disorders are a wide-ranging group of conditions arising due to abnormalities of the musculature of the pelvic floor. These conditions can include constipation, pelvic pain, urinary incontinence, and dyspare...Pelvic floor disorders are a wide-ranging group of conditions arising due to abnormalities of the musculature of the pelvic floor. These conditions can include constipation, pelvic pain, urinary incontinence, and dyspareunia. This article first provides an overview of key anatomy of the pelvic floor muscles before discussing pelvic floor physical therapy (PFPT), highlighting the goals of treatment and tactics used by physical therapists to achieve these goals. The article then explores the definition, diagnosis, and treatment of constipation, pelvic pain, and urinary incontinence caused by pelvic floor dysfunction. It is meant to help reduce the gap in this underdiagnosed and undertreated condition and identify key patient populations that may significantly benefit, including through improvements to quality of life, from PFPT.
Hemoptysis, defined as the expectoration of blood originating from the lower respiratory tract, is a clinical symptom with a wide differential diagnosis that ranges from benign to life-threatening causes. Common causes v...Hemoptysis, defined as the expectoration of blood originating from the lower respiratory tract, is a clinical symptom with a wide differential diagnosis that ranges from benign to life-threatening causes. Common causes vary by geographic region and care setting, with respiratory infections, malignancy, bronchiectasis, and chronic obstructive pulmonary disease being predominant in resource-rich countries and tuberculosis remaining the leading cause in resource-limited areas. Though most cases are mild and self-limited, hemoptysis can be a life-threatening medical emergency; these cases are associated with a mortality exceeding 50%, primarily due to asphyxia. Management strategies are informed by severity, with outpatient care appropriate for stable patients with non-life-threatening hemoptysis and intensive interventions-such as bronchial artery embolization or surgical resection-reserved for those with high-risk features or life-threatening hemoptysis. This article provides an evidence-based approach to hemoptysis evaluation and management, emphasizing the importance of early risk stratification, identification of underlying causes, and timely intervention. By integrating a structured diagnostic and therapeutic approach, clinicians can improve outcomes and reduce the risk of recurrence and complications.