The physician associate (PA) profession was introduced in Switzerland through an informal hospital-based training program in 2014. In 2016, a formal education process was instituted at Zurich University of Applied Scienc...The physician associate (PA) profession was introduced in Switzerland through an informal hospital-based training program in 2014. In 2016, a formal education process was instituted at Zurich University of Applied Sciences (ZHAW) Institute of Public Health. ZHAW remains the only university with a PA curriculum in Switzerland. Presently, PAs are trained through a multi-tiered certification program with an option to complete a master's degree. Approximately 300 PAs practice in Switzerland as of 2025. As the number of PAs steadily increases, professional organizations, academic institutions, medical leaders, and Swiss authorities are working to develop policies for governance of the PA profession and to establish consistent expectations for PA education, training, and scope of practice.
INTRODUCTION: Limited research explores dermoscopy use among physician associates (PAs), outside of one prior study examining dermoscopy in PA student education. This study sought to investigate dermoscopy use among prac...INTRODUCTION: Limited research explores dermoscopy use among physician associates (PAs), outside of one prior study examining dermoscopy in PA student education. This study sought to investigate dermoscopy use among practicing PAs and its impact on their overall diagnostic confidence, including in darker skin tones, when differentiating between benign and malignant skin lesions. METHODS: An anonymous survey was developed in 2023 with input from experts in dermoscopy and survey creation to assess PA confidence in skin lesion evaluation as well as PA dermoscopy knowledge and use, perceptions, barriers to use, and prior education. The dermoscopy survey was included as an optional module in the 2024 American Academy of Physician Associates (AAPA) Salary Survey. RESULTS: Of 3174 invited PAs, 995 (31.4%) responded. Most had never used dermoscopy in practice (81%) but knew or recognized the term (71%). A majority (53%) believed PAs should be trained in dermoscopy during PA school, and 26% reported no interest in future dermoscopy use. Dermatology PAs reported more frequent dermoscopy use and generally greater confidence in evaluating skin lesions, both overall and in darker skin tones, than PAs in other specialties. PAs in surgical (OR = 0.2, 95% CI 0.1-0.6) and medical (OR = 0.3, 95% CI 0.2-0.5) subspecialties were less likely to use dermoscopy at least annually compared with PAs in primary care. PAs in rural areas were more likely to feel confident in differentiating skin lesions than those in urban areas (OR 2.9, 95% CI 1.7-5.0). CONCLUSION: Dermoscopy use is associated with higher overall skin lesion assessment confidence. Wider adoption, especially outside dermatology, requires training, increased advocacy, and expanded education.
Diabetic myonecrosis, also referred to as diabetic muscle infarction, is an uncommon complication of uncontrolled diabetes mellitus. This diagnosis typically occurs in patients who have chronic, poorly controlled diabete...Diabetic myonecrosis, also referred to as diabetic muscle infarction, is an uncommon complication of uncontrolled diabetes mellitus. This diagnosis typically occurs in patients who have chronic, poorly controlled diabetes; patients often experience additional diabetic complications. The presentation of diabetic myonecrosis involves an acute onset of swelling and pain in the affected area, typically involving a unilateral lower extremity. Diagnosis is often delayed due to the rarity of the condition, along with the need for advanced diagnostic testing such as MRI or muscle biopsy for confirmation. This case report describes a patient with a history of poorly controlled type 2 diabetes who experienced persistent left thigh pain and swelling that was ultimately diagnosed as diabetic myonecrosis, highlighting the importance of recognizing these symptoms.
Now withdrawn from the US market, andexanet alfa was initially approved by the FDA in 2018 to reverse life-threatening bleeds associated with factor Xa (FXa) inhibitors, specifically apixaban and rivaroxaban. Observed ef...Now withdrawn from the US market, andexanet alfa was initially approved by the FDA in 2018 to reverse life-threatening bleeds associated with factor Xa (FXa) inhibitors, specifically apixaban and rivaroxaban. Observed effects of andexanet alfa include a reduction in anti-FXa activity resulting in hemostatic efficacy. However, thrombotic events including myocardial infarction and deep venous thrombosis, typically occurring 6 to 30 days after infusion, have also been observed. This case presents the first known patient to develop an ST-segment elevation myocardial infarction while actively receiving infusion of andexanet alfa, which was an approved therapy at the time of the patient's treatment.
Implementation science bridges the gap between research and practice by using structured strategies to integrate evidence-based interventions into clinical care. Physician associates, with their unique roles in team-base...Implementation science bridges the gap between research and practice by using structured strategies to integrate evidence-based interventions into clinical care. Physician associates, with their unique roles in team-based care, are well suited to address gaps in delivery of evidence-based interventions and to lead change initiatives. The purpose of this article is to introduce key principles of implementation science and identify opportunities for PA-driven practice change. Clinical vignettes illustrate both practical application of implementation science and the deimplementation of low-value care. By understanding implementation science principles, physician associates can enhance patient outcomes and drive system-level improvements.
Type 1 diabetes (T1D) is a chronic autoimmune disease that disproportionately affects children and adolescents and is associated with substantial medical and psychosocial burden. Despite advances in insulin delivery syst...Type 1 diabetes (T1D) is a chronic autoimmune disease that disproportionately affects children and adolescents and is associated with substantial medical and psychosocial burden. Despite advances in insulin delivery systems and continuous glucose monitoring, most patients do not achieve optimal glycemic control and remain at risk for diabetic ketoacidosis, long-term microvascular and macrovascular complications, and premature mortality. Increasing evidence demonstrates that T1D is a progressive disease characterized by years of asymptomatic autoimmunity and gradual pancreatic beta-cell loss, creating an opportunity for early disease-modifying intervention. This review summarizes the genetic and immunologic foundations of T1D, the disease classification system, and emerging strategies aimed at preserving endogenous insulin production. Particular focus is given to teplizumab (Tzield), an anti-CD3 monoclonal antibody that is the first FDA-approved therapy shown to delay progression from stage 2 to stage 3 T1D in individuals ages 8 years and older. Disease-modifying immunotherapies such as teplizumab represent a paradigm shift in T1D management, with the potential to delay disease onset and reduce long-term complications.
In the United States, postmenopausal women represent the largest group affected by recurrent urinary tract infections (rUTIs). Limited evidence supports long-term use of antibiotics for rUTI prophylaxis in this populatio...In the United States, postmenopausal women represent the largest group affected by recurrent urinary tract infections (rUTIs). Limited evidence supports long-term use of antibiotics for rUTI prophylaxis in this population. In addition to being expensive, repeated antibiotic use contributes to antimicrobial resistance, posing additional concerns for postmenopausal women who may be at higher risk for serious infection or complications from resistant infections. Topical estrogen, which directly addresses the pathophysiologic changes associated with rUTIs in this population, offers an effective and cost-efficient option for postmenopausal patients while avoiding the dangers of antimicrobial resistance.
Heart failure (HF) is one of the most common and consequential conditions encountered in clinical practice. It frequently coexists with chronic kidney disease (CKD), a highly prevalent and economically burdensome conditi...Heart failure (HF) is one of the most common and consequential conditions encountered in clinical practice. It frequently coexists with chronic kidney disease (CKD), a highly prevalent and economically burdensome condition. The presence of CKD in patients with HF is an independent risk factor for HF-related hospitalization and death. Clinicians often face significant challenges when treating this patient population because many standard, guideline-directed medical therapies for HF can worsen kidney function. As a result, evidence-based HF treatments are frequently underutilized. Moreover, patients are often referred back and forth between cardiologists and nephrologists in attempts to optimize therapy and control symptoms, often without significant improvement in their condition. The purpose of this article is to examine the safety and efficacy of standard HF treatments among patients with CKD based on the available evidence, with the goal of supporting clinical decision-making and emphasizing the importance of an interdisciplinary approach.
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation. Despite the availability of comprehensive, evidence-based guidelines from the Global Initiative for Chronic Obstr...Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation. Despite the availability of comprehensive, evidence-based guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), utilization of these recommendations remains limited in clinical practice. COPD contributes substantially to global morbidity, mortality, and economic burden and is projected by the World Health Organization to become the third leading cause of death worldwide by 2030. Early recognition and diagnosis, adherence to guideline-based pharmacologic management, smoking cessation, vaccination, and pulmonary rehabilitation are mainstay strategies to slow disease progression and prevent exacerbations. Understanding the pathophysiology and systemic complications is essential for improving outcomes and enhancing quality of life in patients with COPD.
Advanced heart failure (AHF) poses a significant challenge in modern cardiology, often necessitating surgical interventions to alleviate symptoms and improve patient outcomes. This article provides an overview of surgica...Advanced heart failure (AHF) poses a significant challenge in modern cardiology, often necessitating surgical interventions to alleviate symptoms and improve patient outcomes. This article provides an overview of surgical interventions available for treating AHF, with a primary focus on established procedures such as heart transplantation, ventricular assist device implantation, and emerging techniques including minimally invasive approaches and novel device therapies. The efficacy, indications, and potential complications of these interventions are discussed, along with their roles in the comprehensive management of patients with AHF. Recent advancements in surgical techniques, patient criteria, and perioperative care strategies are highlighted. Within a multidisciplinary approach encompassing surgical expertise, medical management, and supportive care, surgical interventions play a crucial role in the holistic management of AHF, offering hope and improved prognosis for affected patients.
Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating condition characterized by persistent shoulder pain and restricted movement that begins within 48 hours of vaccine administ...Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating condition characterized by persistent shoulder pain and restricted movement that begins within 48 hours of vaccine administration into the deltoid region. Improper vaccine injection into the subacromial/subdeltoid region of the shoulder or glenohumeral joint can cause immune-mediated inflammatory response, adhesive capsulitis, rotator cuff tendonitis or tears, and septic subacromial bursitis or lytic lesions, among other injuries and reactions. The literature to date focuses on SIRVA prevention and early recognition, emphasizing proper vaccine administration techniques. With the aid of a formulated process that includes focused clinical history collection and thorough physical examination, clinicians can facilitate timely diagnosis and effective management of SIRVA, mitigating possible long-term complications. We present a case that illustrates the diagnostic challenge of SIRVA and highlights how affected patients may exhaust all nonoperative modalities, fail to find relief, and eventually require surgery. Literature is limited on surgical management of SIRVA; however, this case raises awareness of surgery as a management option in unusually refractory cases.
Acute immune system-mediated neuropathy, referred to as Guillain-Barré syndrome, is a common etiology of acutely acquired weakness that often presents with proximally spreading initial distal extremity weakness and paral...Acute immune system-mediated neuropathy, referred to as Guillain-Barré syndrome, is a common etiology of acutely acquired weakness that often presents with proximally spreading initial distal extremity weakness and paralysis. Less common manifestations include delayed facial nerve palsy and weakness, occurring in approximately 15% of patients. This case report highlights a rarer initial presentation of Guillain-Barré syndrome in a 43-year-old man initially presenting with unilateral upper facial weakness whose symptoms progressed to bilateral hand and foot numbness over a 2-week period.