Immune checkpoint inhibitors have transformed oncologic practice, producing durable responses in many patients with advanced malignancies. However, these treatments can cause immune-related adverse reactions. This articl...Immune checkpoint inhibitors have transformed oncologic practice, producing durable responses in many patients with advanced malignancies. However, these treatments can cause immune-related adverse reactions. This article describes a patient with metastatic non-small cell lung cancer who developed toxicities involving multiple organ systems shortly after receiving combined ipilimumab and nivolumab. Although toxicity is more common in just one organ system, multisystem adverse reactions are possible, and clinicians who recognize and manage these reactions promptly can improve patient outcomes.
Oral contraceptive pills have been a cornerstone of contraception for more than 6 decades. Oral contraceptives are highly effective in preventing unintended pregnancy, making them the most utilized reversible contracepti...Oral contraceptive pills have been a cornerstone of contraception for more than 6 decades. Oral contraceptives are highly effective in preventing unintended pregnancy, making them the most utilized reversible contraceptive method. Daily oral contraceptive pills have traditionally required a prescription from a healthcare provider due to potential risks and adverse reactions associated with use. The need for prescription creates significant barriers to accessibility and convenience for patients who may resort to less effective but more readily available nonprescription methods. Opill® (norgestrel) is the first and only FDA-approved daily oral contraceptive for over-the-counter use. This article examines Opill's place in the current US contraceptive market.
Breast cancer is the most common type of cancer diagnosed in women, excluding skin cancer. It is one of the leading causes of cancer-related deaths and premature deaths in the United States. Given the latest data on brea...Breast cancer is the most common type of cancer diagnosed in women, excluding skin cancer. It is one of the leading causes of cancer-related deaths and premature deaths in the United States. Given the latest data on breast cancer prevalence, most clinical practice guidelines recommend yearly screening with mammography for women age 40 years and older. However, some women's lifetime risk of breast cancer may be higher than average, requiring additional testing and more intensive screening. Currently, no standard approach to office-based risk assessment has been established in the United States. A woman's unidentified heightened risk can lead to missed opportunities and insufficient screening recommendations. Breast cancer risk assessment is thus critical for identifying women who are at higher-than-average risk for breast cancer and in need of a modified screening plan. This article aims to guide clinicians through assessing a woman's lifetime risk of breast cancer, identifying women at higher-than-average risk, determining which women need to be referred for genetic testing, and managing screening and counseling for patients with nonhereditary higher-than-average risk.
OBJECTIVES: The objectives of this study were to determine pathways, barriers, and support systems experienced by physician associates (PAs) in leadership. METHODS: Focus group interviews were conducted with 20 PA leader...OBJECTIVES: The objectives of this study were to determine pathways, barriers, and support systems experienced by physician associates (PAs) in leadership. METHODS: Focus group interviews were conducted with 20 PA leaders. Thematic evaluation revealed inductive themes. Moderate interrater agreement was achieved. RESULTS: Most participants were female, White, and non-Hispanic, with 13 to 23 years of experience as a PA. Participants obtained leadership positions via training, dedication to service, and networking. Participants were motivated to pursue leadership roles by issues related to compensation, time, and autonomy. Biased perception of PA roles and corporate and legal issues were the most common barriers to achieving leadership positions. Participants recommended that PAs interested in leadership self-promote and that they embrace both altruism and a growth mindset. CONCLUSION: PA leaders achieved leadership positions via dedication, networking, and training. Corporate, legal, and perceptual barriers exist. Employers and PA organizations can support PA leaders with training, compensation, protected time, and autonomy. Celebration of the value of PA leadership is needed.
Lymphadenopathy (LAD), characterized by abnormal enlargement of lymph nodes, is frequently encountered in clinical practice. Despite its prevalence, the condition's evaluation and management pose significant challenges d...Lymphadenopathy (LAD), characterized by abnormal enlargement of lymph nodes, is frequently encountered in clinical practice. Despite its prevalence, the condition's evaluation and management pose significant challenges due to its diverse etiologies, which range from benign conditions to serious malignancies. This article provides a comprehensive overview of LAD, including its etiology, pathophysiology, clinical presentation, and diagnostic evaluation to aid providers, particularly physician associates (PAs), in care of these patients. Through detailed discussions and practical guidance, the article equips PAs with the necessary tools to effectively navigate the complexities of LAD.
A prostate-specific antigen (PSA) test is a simple blood test that is used to screen for prostate cancer. Over the last 30 years, the benefit of screening with a PSA test has been a matter of significant debate because o...A prostate-specific antigen (PSA) test is a simple blood test that is used to screen for prostate cancer. Over the last 30 years, the benefit of screening with a PSA test has been a matter of significant debate because of its association with overscreening, overdiagnosis, and overtreatment of prostate cancer. Although most prostate cancer screening guidelines recommend a shared decision-making approach between the patient and provider, these recommendations are contradictory in terms of screening initiation, frequency, and discontinuation as well as screening recommendations for high-risk populations. This article describes a literature review comparing screening guidelines with newer research in order to determine which guideline aligns most closely with the latest findings. Results show that the related American Urological Association and National Comprehensive Cancer Network guidelines, for example, may lead to over- or underscreening, whereas the American Cancer Society (ACS) guideline seems most closely in alignment with recent research. By following the ACS guideline, most clinically significant prostate cancer should be captured with less risk of overscreening and overdiagnosis.
One of seven circadian rhythm disorders, delayed sleep-wake phase disorder (DSWPD) commonly occurs in adolescents and young adults. The disorder is frequently confused with insomnia and can be a presenting complaint, as...One of seven circadian rhythm disorders, delayed sleep-wake phase disorder (DSWPD) commonly occurs in adolescents and young adults. The disorder is frequently confused with insomnia and can be a presenting complaint, as the individual is often stressed about being unable to fall asleep at the desired time. The underlying disruption occurs due to a shift between when the individual wants to sleep and when the individual can. Unlike patients with insomnia, patients with DSWPD can achieve sleep easily at later times, leading to later wake-up times. The inability to adapt to the societal norm in terms of the standard school, work, or social schedule leads to stressors, further complicating the disorder. Sleep questionnaires, sleep diaries, and actigraphy have improved identification of individuals with delayed sleep. Treatment of DSWPD involves the use of scheduled melatonin, scheduled sleep-wake times, and bright light therapy. If identified early, the disorder can be successfully managed.
BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US, with screening rates at 65% to 70%. This quality improvement project in a Southeast Minnesota health system (SMHS) aimed to enha...BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US, with screening rates at 65% to 70%. This quality improvement project in a Southeast Minnesota health system (SMHS) aimed to enhance CRC screening using multitarget stool DNA (mt-sDNA) test kit delivery. METHODS: Of 13,561 eligible patients ages 45 to 75 years in the SMHS, 12,032 were offered home delivery of mt-sDNA kits through the electronic patient portal. RESULTS: Within 90 days, 1,953 kits (16.2%) were returned, with 158 (8.1%) showing abnormal results, leading to colonoscopy referrals. Communication channels included the electronic portal, postal mail messages, and phone calls. CONCLUSION: Implementing mt-sDNA screening resulted in a 4.13% adherence increase, compared with a 0.04% adherence increase without intervention. However, disparities in return rates revealed unexpected challenges in addressing racial and ethnic disparities, as White patients and native English speakers showed higher return rates.
Marjolin ulcers are aggressive, cutaneous malignancies typically arising from chronic, nonhealing wounds. The presence of an obvious defect often masks this potentially life-threatening condition, making detection diffic...Marjolin ulcers are aggressive, cutaneous malignancies typically arising from chronic, nonhealing wounds. The presence of an obvious defect often masks this potentially life-threatening condition, making detection difficult and frequently leading to delayed diagnosis. Most cases of Marjolin ulcers are squamous cell carcinoma (SCC) in histology. Unlike for other common cutaneous malignancies, no clear guidelines or protocols are in place for early surveillance and management of Marjolin ulcers. Given the aggressive nature of this malignancy when associated with metastasis, early diagnosis and intervention are imperative. We present a unique case describing an immunocompromised patient with an extensive surgical abdominal history who had developed a cutaneous mass determined to be well-differentiated invasive SCC on final histology. The mass was superimposed over a chronic enteroatmospheric fistula that was present for more than 20 years.
The American physician associate (PA) profession is evolving and now includes the potential for postgraduate doctorates that align with other healthcare disciplines. This educational trend is expanding: The number of PA...The American physician associate (PA) profession is evolving and now includes the potential for postgraduate doctorates that align with other healthcare disciplines. This educational trend is expanding: The number of PA doctoral degree programs doubled between 2022 and 2024. A census assessment of postgraduate doctoral degrees was conducted to document this movement. In 2024, we identified 28 postprofessional PA doctoral degree programs, most conferring a Doctor of Medical Science. Tuition for an online PA doctorate ranges from $15,240 to $47,880, and most programs require at least 12 months to complete. Nearly all are online and designed for working PAs. Within these 28 doctoral programs for PAs, the most common areas of study include PA education, healthcare administration, leadership, management, and several clinical and administrative concentrations. All programs are accredited by one of six federally recognized agencies. The social, professional, economic, and financial factors pertinent to a PA considering a clinical doctorate are of interest to PA graduates, educators, and social scientists.
Artificial intelligence (AI) is everywhere, but how is this expansive technology being used in cardiovascular care? This article explores common AI models, how they are transforming healthcare delivery, and important rol...Artificial intelligence (AI) is everywhere, but how is this expansive technology being used in cardiovascular care? This article explores common AI models, how they are transforming healthcare delivery, and important roles for clinicians, including advanced practice providers, in the development, adoption, evaluation, and ethical use of AI in cardiovascular care.