PAs in India: A survey report on qualifications, deployment, specialties, and job satisfaction.

BACKGROUND: This report is based on a 2023 nationwide survey and literature review of physician associates/assistants (PAs) in India. The National Commission for Allied and Healthcare Professions Act, 2021, which is being implemented in India, included guidelines for PA licensing, creating a unified national curriculum, and preventing malpractice. METHODS: Using a purposive sampling strategy, we surveyed 536 PAs in India between February 10 and April 30, 2023. The survey collected data on demographics, academic qualifications, specialties, salaries, job satisfaction, and future outlooks through an online questionnaire. RESULTS: The survey showed that most PAs are below age 30 years, and most graduated PAs were involved in clinical practice in 2023. PAs work in almost all clinical specialties; most practice in private hospitals. States in southern India continued to dominate educating and employing PAs, with a nationwide representation of more than 14 states. More than 80% of practicing PAs are satisfied with their profession; however, the majority are unsatisfied with their wages. CONCLUSIONS: This first formal survey on India's PAs illustrates the challenges of PA professional practice and standardization of education and licensure in the Indian healthcare system.

Sacrocolpopexy: Patient Outcomes Support the Use of Non-Crosslinked Acellular Dermal Matrix as an Alternative to the Synthetic Polypropylene Mesh.

Objective: This study was conducted to evaluate the use of non-crosslinked acellular dermal matrix (ADM) in laparoscopic sacrocolpopexy by analyzing clinical outcomes and patient-satisfaction surveys. Materials and Methods: Two hundred and eleven patients underwent laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) between January 6, 2012, and December 31, 2017. Each patient had her pelvic-floor measurements diagrammed with the POP-Q [Quantification] system using the interactive tool provided by the American Urogynecologic Society. The Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7), used to make comprehensive assessments of women with urogynecologic problems, were mailed to all patients. If responses were not received, the patients were contacted by telephone. Patients who were not reached by either mail or telephone had their charts individually reviewed to extract the information. Trained surveyors scored the PFDI-20 and the PFIQ-7 questionnaires. The de-identified data were analyzed for patient satisfaction and outcomes. This information was obtained by a review of patient charts at 4-week postoperative and annual examinations; any phone calls with complaints and/or problem office visits were noted. Biopsies from the sacrocolpopexy area were taken if a patient had another incidental gynecologic procedure unrelated to the prolapse or at the time of repeat sacrocolpopexy for POP and the paraffin cell block was sent to McGowan Institute for Tissue Regeneration. Results: One hundred and five patients responded to the survey. Charts were completed for 106. The majority of interviewed patients stated that they were doing a "little better" or "much better" (77/88; 87.5%). The third-quartile PFDI-20 score was 93 with a median of 60 and the PFIQ-7 score was 43 with a median of 29. Five patients underwent reoperations (4.76%). The most-common postoperative complaint was overactive bladder symptoms, followed by vaginal discharge. Histology showed either a lack of regenerative healing tissue at the failure site or good results showing neovascularization and a presence of connective and ligamentous tissue around the matrix. No intense fibrosis or neoplastic formation was reported. Conclusions: A non-crosslinked ADM patch can be a good alternative to synthetic polypropylene mesh in patients undergoing sacrocolpopexy for POP.

Physicians in Kentucky Perceive Physician Assistants to Be Competent Health Care Providers.

PURPOSE: The use of certified physician assistants (PA) has increased throughout the US health care system. The purpose of this study was to objectively evaluate physicians' perceptions of PAs' mastery of specific skills. It is important to understand stakeholders' perceptions of PAs' capabilities to support future changes in policies for better utilization of PAs in our health care system. METHODS: From 2014 to 2015, randomly chosen "active" physicians listed with the Kentucky Board of Medical Licensure were surveyed about their perceptions of competencies of certified PAs. Six competency domains (medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning, and improvement and systems-based practice) were rated using a Likert scale. Each competency-derived skill-based question was ranked by the number of physicians giving the highest scores on the Likert scale (a score of 4 or 5) and by effect size. Cronbach's alpha for the survey was calculated. RESULTS: An overwhelming majority of the physicians perceived certified PAs to be competent (n ≥ 161, ≥ 60%) for specific skills. The survey had internal consistency with Cronbach's alpha ranging from 0.75 to 0.87 for competency domains. Effect size ranged from 0.44 to 0.98 for scores given by physicians with, versus without, experience with PAs. CONCLUSIONS: For the first time, there is objective evidence of physicians' perceptions of PAs' mastery of specific competency-derived PA skill sets. This study will help guide effective utilization of PAs throughout the health care system and future PA education.

Managing chest pain in patients with concomitant left bundle-branch block.

Diagnosis and timely management of acute myocardial infarction (MI) relies heavily on the ST-segment elevation sum. Presence of concomitant left bundle-branch block (LBBB) in patients presenting with possible acute MI presents a diagnostic dilemma. The LBBB pattern distorts ST-segment changes, delaying or preventing accurate diagnosis. This article reviews the Sgarbossa criteria and ST/S ratio and presents a treatment algorithm that may help improve patient care and reduce morbidity and mortality.

Outbreak of Tsukamurella species bloodstream infection among patients at an oncology clinic, West Virginia, 2011-2012.

OBJECTIVE: To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility. DESIGN: Epidemiologic investigation of the outbreak with a case-control study. METHODS: A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed. RESULTS: Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy. CONCLUSION: Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.