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Physician assistants and quality of care

Anita H Clayton, Sheryl A Kingsberg, Irwin Goldstein
INTRODUCTION: Hypoactive sexual desire disorder (HSDD) often has a negative impact on the health and quality of life of women; however, many women do not mention-let alone discuss-this issue with their physicians. Providers of gynecologic services have the opportunity to address this subject with their patients. AIM: To review the diagnosis and evidence-based treatment of low sexual desire in women with a focus on strategies that can be used efficiently and effectively in the clinic...
March 6, 2018: Sexual Medicine
JaBaris D Swain, Colleen Sinnott, Suellen Breakey, Rian Hasson Charles, Gita Mody, Napthal Nyirimanzi, Ceeya Patton-Bolman, Patricia Come, Gapira Ganza, Emmanuel Rusingiza, Nathan Ruhamya, Joseph Mucumbitsi, Jorge Borges, Martin Zammert, Jochen D Muehlschlegel, Robert Oakes, Bruce Leavitt, R Morton Bolman
OBJECTIVE: Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease...
February 27, 2018: Journal of Thoracic and Cardiovascular Surgery
Patricia Pittman, Brandi Leach, Chris Everett, Xinxin Han, Debra McElroy
As hospitals' interest in nurse practitioners (NPs) and physician assistants (PAs) grows, their leadership is eager to know how their medical staffing privileging policies for these professionals compare to peer hospitals. This study assesses the extent of variation of these policies in four clinical areas and examines whether the differences are associated with state scope of practice laws for NPs and PAs. We also examine the relationship of NP and PA privileging policies to each other. Our analysis finds no evidence that hospital privileging is associated with state scope of practice, and indeed within-state variation is more significant than cross-state variation...
February 1, 2018: Medical Care Research and Review: MCRR
Nagy Mekhail, Ogi Visnjevac, Gerges Azer, Diana Sue Mehanny, Priya Agrawal, Victor Foorsov
To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization...
February 23, 2018: Regional Anesthesia and Pain Medicine
Chase Bennett, Grace Xiong, Serena Hu, Kirkham Wood, Robin N Kamal
BACKGROUND: Value-based healthcare models rely on quality measures to evaluate the efficacy of healthcare delivery and to identify areas for improvement. Quality measure research in other areas of health care has generally shown that there is a limited number of available quality measures and that those that exist disproportionately focus on processes as opposed to outcomes. The purpose of this study was to assess the current state of quality measures and candidate quality measures in spine surgery...
February 14, 2018: Clinical Orthopaedics and related Research
Jamie K Fujioka, Raza M Mirza, P Lynn McDonald, Christopher A Klinger
RESEARCH AIMS: With the growing interest in Medical Assistance in Dying (MAiD), understanding health care professionals' roles and experiences in handling requests is necessary to evaluate the quality, consistency and efficacy of current practices. This scoping study sought to map the existing literature on health care providers' perspectives of their involvement in MAiD. METHODS: A scoping review was conducted to address the following: (1) What are the roles of diverse health care professionals in the provision of MAiD? and (2) What professional challenges arise when confronted with MAiD requests? A literature search in electronic databases and grey literature sources was performed...
February 22, 2018: Journal of Pain and Symptom Management
Victor Ng, Allyn Walsh, Nandani de Silva, Eleni Politi, Heather Grusauskas
While all physicians must continue to learn new knowledge through their careers, their post-training continuing professional development (CPD) has received less attention. Problems include lack of support for physicians, frequent deviations from best practices such as mandatory participation, focus on community need, and clear conflicts of interest amongst providers. Additionally, specialists from other disciplines catering to different patient populations often provide CPD for family doctors. The Working Party on Education of the World Organisation of Family Doctors (WONCA) sought to develop global standards in CPD for family doctors...
February 23, 2018: Education for Primary Care
Meghan J Reading, Jacqueline A Merrill
Objective: This integrative review identifies convergent and divergent areas of need for collecting and using patient-generated health data (PGHD) identified by patients and providers (i.e., physicians, nurses, advanced practice nurses, physician assistants, and dietitians). Methods: A systematic search of 9 scholarly databases targeted peer-reviewed studies published after 2010 that reported patients' and/or providers' needs for incorporating PGHD in clinical care...
February 17, 2018: Journal of the American Medical Informatics Association: JAMIA
Sean Orzol, Rosalind Keith, Mynti Hossain, Michael Barna, G Greg Peterson, Timothy Day, Boyd Gilman, Laura Blue, Keith Kranker, Kate A Stewart, Sheila Hoag, Lorenzo Moreno
BACKGROUND: The Center for Medicare & Medicaid Innovation (CMMI) tests new models of paying for or delivering health care services and expands models that improve health outcomes while lowering medical spending. CMMI gave TransforMED, a national learning and dissemination contractor, a 3-year Health Care Innovation Award (HCIA) to integrate health information technology systems into physician practices. This paper estimates impacts of TransforMED's HCIA-funded program on patient outcomes and Medicare parts A and B spending...
February 16, 2018: Medical Care
Anthony E Brenneman, Constance Goldgar, Karen J Hills, Jennifer H Snyder, Stephane P VanderMeulen, Steven Lane
Physician assistant (PA) admissions processes have typically given more weight to cognitive attributes than to noncognitive ones, both because a high level of cognitive ability is needed for a career in medicine and because cognitive factors are easier to measure. However, there is a growing consensus across the health professions that noncognitive attributes such as emotional intelligence, empathy, and professionalism are important for success in clinical practice and optimal care of patients. There is also some evidence that a move toward more holistic admissions practices, including evaluation of noncognitive attributes, can have a positive effect on diversity...
March 2018: Journal of Physician Assistant Education
Venetia L Orcutt, Kassidy James, Carolyn Bradley-Guidry, P Eugene Jones
PURPOSE: The purpose of this study was to examine the concordance of US physician assistant (PA) program mission statements with those of US public- and private-sponsored medical schools. With the exception of a broader medical school focus on research, the authors hypothesized that little difference in mission statement congruence would be found in a comparison of medical schools and PA programs. METHODS: Mission statements of 209 of the 210 accredited US PA programs as of May 2016 were obtained and analyzed...
March 2018: Journal of Physician Assistant Education
Emily L Clarke, Jennifer R Evans, Liam Smeeth
BACKGROUND: Visual problems in older people are common and frequently under-reported. The effects of poor vision in older people are wide reaching and include falls, confusion and reduced quality of life. Much of the visual impairment in older ages can be treated (e.g. cataract surgery, correction of refractive error). Vision screening may therefore reduce the number of older people living with sight loss. OBJECTIVES: The objective of this review was to assess the effects on vision of community vision screening of older people for visual impairment...
February 20, 2018: Cochrane Database of Systematic Reviews
Shiyin Jiao, Irene B Murimi, Randall S Stafford, Ramin Mojtabai, G Caleb Alexander
OBJECTIVE: Nurse practitioners (NPs) and physician assistants (PAs) have increasingly broad prescribing authority in the United States, yet little is known regarding how the quality of their prescribing practices compares to that of physicians. The objective of this study was to compare the quality of prescribing practices of physicians and non-physician providers. METHODS: A serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) was performed...
February 19, 2018: Pharmacotherapy
Elisabeth Sybilla Johanna van Gils-van Rooij, Sjoerd Michael Broekman, Dingenus Herman de Bakker, Berthold Rudy Meijboom, Christoffel Joris Yzermans
BACKGROUND: In an attempt to redirect patients who are inappropriately attending hospital emergency departments (ED) and in doing so provide the right care at the right place, out-of-hours GP (General Practitioner) services and EDs increasingly collaborate in Urgent Care Collaborations (UCCs). Work satisfaction is an important factor in analysing the impact of this organisational change. The objective of this study is, firstly, to discover if there is a difference in the employee experiences between those working in UCCs and those in traditional out-of-hours services in which EDs and out-of-hours GP services operate separately (i...
February 17, 2018: BMC Health Services Research
Stacy Newbern
GENERAL PURPOSE: To provide information to enable better assessment and management of patients with lower extremity vascular disease (LEVD) chronic wound pain. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you will be able to: ABSTRACT: A lack of wound pain validation and provider understanding about the effect of pain on quality of life are the biggest barriers to pain management for patients with chronic wound pain...
March 2018: Advances in Skin & Wound Care
Chrysanta Patio, Nabilah Ali, Jill Ketner, Candy Young, Esther Chou, Carrie Chong, Wanchi Su
This chapter explores the role of advanced practice clinicians (APCs) and patient care coordinators in the head and neck cancer setting. APCs, which include physician assistants (PAs) and nurse practitioners (NPs), are licensed professional healthcare providers who diagnose and treat illnesses, order and interpret diagnostic tests, and prescribe pharmaceutical and non-pharmaceutical therapies. Although the training, education, and licensure differ between PAs and NPs, their roles are quite similar in head and neck surgery...
2018: Cancer Treatment and Research
Meng-Ping Wu, Chao-Ming Huang, Wen-Jung Sun, Chih-Yuan Shih, Su-Hsuan Hsu, Sheng-Jean Huang
The home-based medical care integrated plan under Taiwan National Health Insurance has changed from paying for home-based medical care, home-based nursing, home-based respiratory treatment, and palliative care to paying for a single, continuous home-based care service package. Formerly, physician-visit regulations limited home visits for home-based nursing to providing medical related assessments only. This limitation not only did not provide practical assistance to the public but also caused additional problems for those with mobility problems or who faced difficulties in making visits hospital...
February 2018: Hu Li za Zhi the Journal of Nursing
Kenneth J Klassen, Reena Yoogalingam
Healthcare providers can benefit from adding less costly capacity to their existing resources in order to satisfy demand while maintaining the quality of patient care. The addition of mid-level service providers (MLSPs) such as physician assistants or nurse practitioners that carry out portions of patient care provides a viable alternative for adding physician capacity. This research considers the circumstances under which adding an MLSP to a single-physician outpatient office becomes the best strategy for the clinic, and determines how scheduling policies from the widely-researched single-stage environment should be adjusted for a multi-stage environment...
February 5, 2018: Health Care Management Science
Matthew G Huddle, Nyall R London, C Matthew Stewart
OBJECTIVES: To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation. METHODS: This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June 2014. Staged interventions included adding fellow coverage (July 2007 onward), intermittent hospitalist coverage (July 2010 onward), and a physician assistant (October 2011 onward)...
February 2018: Southern Medical Journal
I H Zaal-Schuller, D I Willems, F Ewals, J B van Goudoever, M A de Vos
BACKGROUND: In children with profound intellectual and multiple disabilities (PIMD), discussions about end-of-life decisions (EoLDs) are comparatively common. Nurses play a crucial role in the care for these children, yet their involvement in EoLD discussions is largely unknown. The objective of this research was to investigate the involvement in the hospital of nurses in discussions with parents and physicians about EoLDs for children with PIMD. METHOD: In a retrospective, qualitative study, we conducted semi-structured interviews with the nurses of 12 children with PIMD for whom an EoLD was made within the past 2 years...
January 31, 2018: Journal of Intellectual Disability Research: JIDR
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