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Physician's assistant

Wen Yea Hwong, Michiel L Bots, Sharmini Selvarajah, L Jaap Kappelle, Zariah Abdul Aziz, Norsima Nazifah Sidek, Ilonca Vaartjes
BACKGROUND: A shortage of computed tomographic (CT) machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging...
2016: PloS One
Joseph K Maddry, Alejandra G Mora, Shelia Savell, Lauren K Reeves, Crystal A Perez, Vikhyat S Bebarta
BACKGROUND: Medical evacuation (MEDEVAC) is the movement and en route care of injured and medically compromised patients by medical care providers via helicopter. Military MEDEVAC platforms provide lifesaving interventions that improve survival in combat. There is limited evidence to support decision making related to en route care and allocation of resources. The association between provider type and en route care is not well understood. Our objective was to describe MEDEVAC providers and identify associations between provider type, procedures performed, and outcomes...
November 2016: Journal of Trauma and Acute Care Surgery
Mary Anne Purtzer, Carol J Hermansen-Kobulnicky
PURPOSE/OBJECTIVES: To investigate oncology professionals' perspectives about, experience with, and envisioned feasibility of incorporating patient self-monitoring as a patient-centered practice. 
. RESEARCH APPROACH: An interpretive, descriptive study.
. SETTING: Four health systems and five cancer centers in three states. 
. PARTICIPANTS: 38 nurses, nurse practitioners, oncologists, physician assistants, and radiation therapists...
November 1, 2016: Oncology Nursing Forum
Sophia A Hayes, Dana Zive, Betty Ferrell, Susan W Tolle
BACKGROUND: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm records advance care planning for patients with advanced illness or frailty as actionable medical records. The National POLST Paradigm Task Force recommends that physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs) be permitted to execute POLST forms. OBJECTIVE: To investigate the percentage of Oregon POLST forms signed by APRNs, and examine the obstacles faced by states attempting to allow APRNs to sign POLST forms...
October 21, 2016: Journal of Palliative Medicine
Silvana Granado Nogueira da Gama, Elaine Fernandes Viellas, Jacqueline Alves Torres, Maria Helena Bastos, Odaléa Maria Brüggemann, Mariza Miranda Theme Filha, Arthur Orlando Correa Schilithz, Maria do Carmo Leal
BACKGROUND: The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections...
October 17, 2016: Reproductive Health
Mark Corbett
Conceivably, in an ideal world, all patients with a life-limiting illness would receive optimal hospice and palliative care so that no one would ever wish to hasten their own death. The reality, however, is that despite provision of optimal hospice and palliative care, individuals with terminal illness experience suffering, loss of meaning, or deterioration in quality of life to the extent where they express the desire to expedite the dying process. While there has been extensive discussion surrounding physician-assisted death (PAD), there has been less attention paid to the practice of voluntary stopping eating and drinking (VSED) near the end of life...
2016: Narrative Inquiry in Bioethics
Akira Ikumi, Shigeki Kubota, Yukiyo Shimizu, Hideki Kadone, Aiki Marushima, Tomoyuki Ueno, Hiroaki Kawamoto, Yasushi Hada, Akira Matsumura, Yoshiyuki Sankai, Masashi Yamazaki
CONTEXT: Recently, locomotor training with robotic assistance has been found effective in treating spinal cord injury (SCI). Our case report examined locomotor training using the robotic suit hybrid assistive limb (HAL) in a patient with complete C4 quadriplegia due to chronic SCI. This is the first report examining HAL in complete C4 quadriplegia. FINDINGS: The patient was a 19-year-old man who dislocated C3/4 during judo 4 years previously. Following the injury, he underwent C3/4 posterior spinal fusion but remained paralyzed despite rehabilitation...
October 20, 2016: Journal of Spinal Cord Medicine
Christopher J Rizzi, Timothy Ortlip, Jewel D Greywoode, Kavita T Vakharia, Kalpesh T Vakharia
OBJECTIVES/HYPOTHESIS: To describe a novel computer algorithm that can model mandibular fracture repair. To evaluate the algorithm as a tool to model mandibular fracture reduction and hardware selection. STUDY DESIGN: Retrospective pilot study combined with cross-sectional survey. METHODS: A computer algorithm utilizing Aquarius Net (TeraRecon, Inc, Foster City, CA) and Adobe Photoshop CS6 (Adobe Systems, Inc, San Jose, CA) was developed to model mandibular fracture repair...
October 20, 2016: Laryngoscope
Gilvandro Lins de Oliveira, Fernando Cesar Serralheiro, Fernando Luiz Affonso Fonseca, Onésimo Duarte Ribeiro, Fernando Adami, Denise Maria Christofolini, Bianca Bianco, Caio Parente Barbosa
Objective: To compare the anesthetic techniques using propofol and fentanyl versus midazolam and remifentanil associated with a paracervical block with lidocaine in performing ultrasound-guided transvaginal oocyte aspiration. Methods: A randomized double-blind clinical trial (#RBR-8kqqxh) performed in 61 women submitted to assisted reproductive treatment. The patients were divided into two groups: anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group, n=32), in comparison with anesthetic induction using 0...
July 2016: Einstein
Zaheed Damani, Gail MacKean, Eric Bohm, Brie DeMone, Brock Wright, Tom Noseworthy, Jayna Holroyd-Leduc, Deborah A Marshall
BACKGROUND: Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba...
October 18, 2016: Health Research Policy and Systems
Ezekiel J Emanuel, Bregje D Onwuteaka-Philipsen, Joachim Cohen
No abstract text is available yet for this article.
October 18, 2016: JAMA: the Journal of the American Medical Association
Daniel P Sulmasy, E Wesley Ely, Charles L Sprung
No abstract text is available yet for this article.
October 18, 2016: JAMA: the Journal of the American Medical Association
Kenneth R Stevens, William L Toffler
No abstract text is available yet for this article.
October 18, 2016: JAMA: the Journal of the American Medical Association
Aaron Pinkhasov, Deepan Singh, Benjamin Kashan, Julie DiGregorio, Theresa M Criscitelli, Scott Gorenstein, Harold Brem
GENERAL PURPOSE: To provide information about the effect of psychiatric comorbidities on wound healing in patients with diabetes mellitus (DM). 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 participating in this educational activity, the participant should be better able to:1. Discuss the connection between DM and the development of psychiatric comorbidities...
November 2016: Advances in Skin & Wound Care
Amos Grünebaum, Laurence B McCullough, Birgit Arabin, Joachim Dudenhausen, Brooke Orosz, Frank A Chervenak
INTRODUCTION: The objective of this study was to evaluate the underlying causes of neonatal mortality (NNM) in midwife-attended home births and compare them to hospital births attended by a midwife or a physician in the United States (US). METHODS: A retrospective cohort study of the Centers for Disease Control (CDC) linked birth/infant death data set (linked files) for 2008 through 2012 of singleton, term (≥37 weeks) births and normal newborn weights (≥2500 grams)...
October 18, 2016: Journal of Perinatal Medicine
Disa Dahlman, Åsa Palm, Christina Sunesdotter, Katja Troberg, Camilla Wallin
Low-threshold primary care for patients in opiate maintenance therapy. A pilot project in Malmö, Sweden, integrates primary care and OMT  This report illustrates how integration of primary care and opiate maintenance therapy (OMT) may improve OMT patients health and minimize obstacles for care seeking. OMT patients have poor health. Around 80 % have hepatitis C, a majority smoke tobacco, and socio-economic status is generally low. However, somatic health is often under-prioritized in this group. To improve OMT patients physical health', two OMT clinics and one primary care center in Malmö, Sweden, started a pilot project in 2014...
October 14, 2016: Läkartidningen
Myeong-Il Cha, Gi Woon Kim, Chu Hyun Kim, Minhong Choa, Dai Hai Choi, Inbyung Kim, Soon Joo Wang, In Sool Yoo, Han Deok Yoon, Kang Hyun Lee, Suck Ju Cho, Tag Heo, Eun Seog Hong
OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent...
September 2016: Clin Exp Emerg Med
William R Fox, Deborah B Diercks
Troponins are proteins commonly found in cardiac tissue that are released during myocardial ischemia or necrosis. These troponins can be detected by assays that can then be used to guide clinical decision-making and disposition, especially if the suspected insult is related to acute coronary syndrome. Timing of troponin measurement can be important as elevations may not be detectible immediately after an insult. New assays have been designed to detect troponin con-centrations previously too low to be detected by conventional assays...
March 2016: Clin Exp Emerg Med
Henrik Vase, Steffen Christensen, Aage Christiansen, Christian Juhl Therkelsen, Evald Høj Christiansen, Hans Eiskjær, Steen Hvidtfeldt Poulsen
INTRODUCTION: Mechanical circulatory support may be considered as a therapeutic option in selected patients with refractory cardiac arrest (rCA). Animal studies suggest a potential role for the Impella(®) left ventricular assist device in this setting, but so far no human data have been published. METHODS: Eight patients with rCA were treated with the Impella CP(®) device at our institution from November 2014 to October 2015. The Impella CP(®) was used at the discretion of the treating physicians in patients with rCA and pulseless electrical activity with presumed primary left ventricular failure...
October 14, 2016: Resuscitation
Emily Hopkins, David Moffat, Ian Parkinson, Peter Robinson, Hubertus Jersmann, Brendan Dougherty, Mohammed I Birader, Kate Francis, Phan Nguyen
BACKGROUND: Rapid on site examination (ROSE) is encouraged at endobronchial ultrasound transbronchial needles aspiration (EBUS-TBNA) to improve diagnostic yield. Due to new therapeutic options in lung cancer, it is not sufficient to merely distinguish between non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). Immunohistochemistry (IHC) distinction is now standard practice, as well as additional molecular testing where clinically indicated. We investigated the diagnostic yield of on-site smears vs...
September 2016: Journal of Thoracic Disease
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