Post stroke pain: Is there under-diagnosis in Black versus White patients?

Stroke incidence is higher and stroke outcomes are poorer in Black patients compared to White patients. Poststroke pain, however, is not a well understood stroke outcome. Using the National Institutes of Health All of Us Research Program database, we hypothesized that the dataset would demonstrate proportionately higher relative risk of poststroke pain in the Black poststroke patient population compared to the White poststroke patient population. However, our analysis showed that Black stroke patients were diagnosed with poststroke pain at a similar rate as White stroke patients. As our results are not consistent with other poststroke outcomes in the literature, this study identifies a potentially underdiagnosed patient population, highlighting the need for further research.

Racial disparities in pain management: Historical maleficence and solutions for equity.

ABSTRACT: Medical journals from the 1800s described differences in disease susceptibility, skin thickness, and pain tolerance among races. These misconceptions about biologic differences, the historical exploitation of minorities in research, and implicit biases among healthcare workers have all affected patient care. Discrepancies still exist in pain assessment and management for minority patients compared with their White counterparts and lead to poor health outcomes. By implementing specific changes in policy and practice, including standardization, implicit bias training, and building a diverse workforce, clinicians can begin to provide care that more equitably manages pain for all patients, regardless of race.

Physician Assistant Student Attitudes Toward Gamification of Cardiac Auscultation Instruction.

INTRODUCTION: Current physician assistant (PA) learners have a clear preference for interactive learning that is vibrantly present in new media technologies. At present, there is a paucity of research regarding use or acceptability of gamification in PA education. The purpose of this study was to examine PA students' experience with, attitudes toward, and outcomes of a gamified cardiac auscultation curriculum. METHODS: Faculty at one institution designed an interactive Mobile App Cardiac Auscultation Curriculum (MACAC). The MACAC incorporates independent and group learning using the Littmann Learning mobile app. Author-created surveys as well as knowledge and auscultation assessment tools were delivered to all students. RESULTS: Most of the students recommended the use of the app for future cohorts and reported confidence to accurately identify normal and abnormal heart sounds. Knowledge and auscultation assessment scores demonstrated proficiency in identification of normal and abnormal heart sounds. DISCUSSION: Gamification research is important because blended learning that incorporates new media technologies with traditional approaches can help overcome the limitations of passive learning environments. This study provides evidence that the use of a mobile app can be an effective and innovative method to teach cardiac auscultation to the 21st century PA learners.

The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey.

INTRODUCTION: There has been an increasing focus on improving value in health care and deimplementing the use of low-value services, such as prostate cancer (PC) screening for men aged >70 years. The objectives of this study are to (1) identify the proportion of primary care visits at which low-value PC screening is ordered, and (2) identify predisposing, enabling, and health care need characteristics associated with low-value PC screening in the United States. METHODS: This was a secondary analysis of the National Ambulatory Medicare Care Survey datasets from 2013 to 2016 and 2018. Andersen's Behavioral Model of Health Services Use guided independent variable selection. Weighted multivariable logit models were used to analyze data. RESULTS: There were 6.71 low-value prostate-specific antigens (PSAs) per 100 visits and 1.65 low-value digital rectal exams (DREs) per 100 visits. For each additional service ordered by primary care providers, the odds of ordering a low-value PSA increased by 49%, and the odds of performing a low-value DRE increased by 37%. CONCLUSIONS: The use of low-value PSAs and DREs was sizable during the observed time period. Organizations who want to reduce low-value PSAs and DREs may want to focus interventions on providers who order a high number of tests.

A Cross-Sectional, Mixed-Methods Analysis to Identify the Relative Importance of Factors Students and Providers Evaluate When Making a Job Choice.

Little is known about the relative importance of factors that contribute to job choices among health care providers. A convenience sample of 173 health care providers (N=134) and physician assistant students (N=39) completed a cross-sectional survey. Participants rated the importance of sixteen job- (e.g., work environment), community- (e.g., recreational opportunities), and personal-related factors (e.g., children) and one open-ended item. The highest rated item, on average, was an opportunity to make a difference in patient quality of life (mean (M)=4.57, standard deviation (SD)=0.63) while the lowest rated item was wealth/prestige of living in a certain area (M=2.43, SD=1.05). The average importance rating was similar across types of providers and between providers and students. While personal interest to positively affect patients' quality of life was rated as the most important factor, almost all the studied items were rated as important or very important by the majority of participants.

Attitudes and Beliefs of Pediatric Residents and Physician Assistant Students Toward Screening Adolescents for Suicide in Primary Care.

INTRODUCTION: The objectives of this study were to: (1) describe attitudes of health professional trainees for conducting routine screening for suicidal ideation with adolescents; (2) identify the relationship between intention to conduct suicide risk assessments and behavioral attitudes, norm referents, and behavioral control; and (3) investigate the relationship between intention to conduct these assessments and self-reported clinic behavior. METHODS: Second-year physician assistant (PA) students and pediatric residents (MD) at 3 universities voluntarily completed an anonymous cross-sectional questionnaire. The questionnaire was guided by the Theory of Planned Behavior and included items about previous experience with suicide. Pearson correlation and multivariable linear regression were used to analyze the data. RESULTS: There were usable and complete data for 105 respondents (n = 105). The sample included PA students (89.52%, n = 94) and pediatric residents (10.48%, n = 11). Trainees were significantly more likely to have higher intention to conduct suicide risk assessments when they reported greater behavioral control (Std. ß = 0.34, p <0.001) and reported suicide being discussed during previous clinic visits as a student/resident (Std. ß = 0.21, p = 0.03), controlling for profession, race, behavioral attitudes, and norm referents. Trainees were significantly more likely to report conducting suicide risk assessments when they had greater behavioral control (Std. ß = 0.27, p = 0.01) and greater intention to conduct these assessments (Std. ß = 0.21, p = 0.03), controlling for profession, race, behavioral attitudes, and norm referents. DISCUSSION: Second-year PA students and pediatric residents support screening adolescents for suicide risk. Training on methods to increase behavioral control may increase rates of screenings.

Job attributes valued by physicians, PAs, and NPs: A cross-sectional survey.

OBJECTIVE: This study evaluated the relative importance of job-, community-, and individual-related factors that contribute to job choice among physicians, physician assistants (PAs), and NPs, to inform policy options to recruit clinicians to rural areas. METHODS: A cross-sectional online survey of PA preceptors from three institutions in two states. Participants were asked to rate the importance of 16 job-, community-, and individual-related factors when choosing a job. RESULTS: We received responses from 45 physicians, 74 PAs, and 15 NPs (24.2% response rate), who rated most job-, community-, and individual-related factors as important; ratings were similar across clinicians. PAs rated loan repayment programs and work hours higher than physicians, though the magnitude of the difference was small. CONCLUSIONS: Clinicians similarly rated many factors as important. A better understanding of the tradeoffs clinicians are willing to make between these factors when making a job choice is critical to increase the attractiveness of rural positions.

Does Learner Self-Efficacy Influence Accurate Identification of Heart Sound Descriptions?

INTRODUCTION: Although physician assistant (PA) training includes cardiac instruction, there is a lack of theory-based research investigating skill and behavioral development in PA students. The objective of this study was to examine the relationship between self-efficacy and ability to correctly identify heart sounds. METHODS: A cross-sectional study was conducted among 2 cohorts of PA students at one institution. Students answered self-efficacy items using 5-point Likert-type answers and identified specific heart sounds from text descriptions. Data from 154 students were analyzed using Cronbach's alpha and bivariate statistical tests. RESULTS: Second-year students identified more heart sounds correctly than first-year students (8 v. 7, Z = -2.64, p = 0.01). Students with more confidence were more likely to correctly identify specific heart sounds. DISCUSSION: Results are consistent with social cognitive theory showing that self-efficacy may be related to outcome performance in PA students. Educational processes that cultivate self-efficacy may increase proficiency in cardiac auscultation.

Diagnosis and management of type 2 diabetes in children.

ABSTRACT: The incidence of type 2 diabetes in children has risen 4.8% over the past decade, correlating with steadily rising obesity rates in children. Updated guidelines from the American Academy of Pediatrics and the American Diabetes Association encourage early identification and pharmacologic intervention for children with type 2 diabetes. Because of the aggressive disease course in children, comprehensive treatment must include prevention of complications such as diabetic nephropathy and neuropathy as well as management of comorbidities such as cardiovascular disease and dyslipidemia. Because the highest incidence of type 2 diabetes is reported in patients from racial or ethnic minority groups and those of low socioeconomic status, clinicians must work with patients and families to identify socioeconomic disparities that could affect adherence to diabetes management plans and to connect patients with community resources.

COVID-19 and Physician Assistant Faculty Burnout: A Year into the Pandemic.

PURPOSE: The psychological effects of COVID-19 have been extensive and have affected health care workers and educators alike. The aims of this study were to evaluate how the COVID-19 pandemic has impacted PA faculty and their attitudes toward work. METHODS: Two quantitative, pre/post surveys were offered to 21 PA faculty at one institution prior to and then one year into the COVID-19 pandemic. PA faculty perceptions of workplace culture and burnout were included in the online surveys. RESULTS: Data were collected on 17 PA faculty (81% response rate). There was a statistically nonsignificant decrease in faculty disengagement (2.1 v 2.1, p = 0.87) and a statistically significant increase in faculty exhaustion (2.2 v 2.5, p = 0.005). There were statistically significant increases in communication, value, job satisfaction, and wellbeing workplace items. CONCLUSION: As many workplace protocols remain changed as a result of COVID-19, institutions should monitor and adjust processes to reduce the risk of burnout for faculty.

Can cardiac auscultation accuracy be improved with an additional app-based learning tool?

INTRODUCTION: Many institutions use simulation 'events' to instruct cardiac auscultation. Research shows that these 'one and done' events limit repetition, are costly and do not incorporate learning science techniques, such as spaced learning and retrieval practice. The Littmann Learning™ mobile app, which has unlimited access to a large library of real patient heart sounds, is a cost-effective tool that we considered could be leveraged by educators to provide this training. METHODS: This was a quasi-experimental pre- and post-design consisting of an intervention group (PA22) and a non-equivalent comparator group (PA21). The intervention group used a novel mobile app cardiac auscultation curriculum (MACAC), while the comparator group received standard didactic instruction. One-way analyses of variance were used to analyse the data. RESULTS: A total of 174 PA students participated in the study. There was a significant (p < 0.001) difference in knowledge and auscultation scores between those who did and did not complete the MACAC. PA22 didactic year knowledge scores were 4.11 and 2.96 points higher than PA21 didactic and clinical year knowledge scores (p < 0.001, d = 1.61 and p < 0.001, d = 1.32), respectively. On average, PA22 didactic year auscultation scores were 0.83 points higher than PA21 clinical year scores (p < 0.001, d = 0.6). CONCLUSION: Results indicate that students in their didactic year achieved proficiency in clinically identifying heart sounds, despite not having access to a mannequin simulator and not having an opportunity to identify these sounds bedside. Overall, a MACAC may be an effective method to teach cardiac auscultation to medical learners.

Impact of Peer-Assisted Learning on Ultrasound.

PURPOSE: The aim of this study was to understand how peer-assisted learning (PAL) could be utilized by physician assistant (PA) students in an ultrasound student interest group (USIG) as a means of developing cognitive confidence and practical competence with the imaging modality. METHODS: An observational study that included 3 USIG workshops was designed. Pre- and postworkshop surveys were administered. All first-year PA students, regardless of participation in the USIG workshops, were asked to complete the voluntary and anonymous surveys. RESULTS: A statistically significant difference between those who attended at least one workshop and those who did not attend any workshops on their postworkshop scores (p = 0.02) was seen. There was a statistically significant association between the number of workshops attended and the postworkshop difference (p = 0.03). CONCLUSION: Results show that, in the context of social cognitive theory, PAL is an efficacious learning modality that enhances learner and tutor performance in ultrasound.

Guidelines for screening and managing hypertension in children.

ABSTRACT: Pediatric hypertension has risen to an overall prevalence of 16.3%. If left untreated, hypertension in children and adolescents can have significant implications for cardiovascular and renal health into adulthood, including stroke, coronary artery disease, kidney disease, and heart failure. In 2017, the American Academy of Pediatrics (AAP) released updated guidelines for the screening, evaluation, and management of pediatric hypertension. This article reviews the definition of pediatric hypertension, describes why the guidelines were updated, and defines treatment protocol. By familiarizing themselves with and applying these guidelines, clinicians will be able to appropriately screen and manage hypertension in children to prevent morbidity into adulthood.

Evaluating low back pain in adolescents.

Low back pain in adolescents is a common complaint in primary care. With an average prevalence rate of 40%, adolescent low back pain correlates with greater healthcare use, higher incidences of adult back pain, and negative effects on overall well-being. A thorough history and physical examination can increase early detection and accurate diagnosis while ensuring the judicious use of diagnostic modalities. Although underlying serious pathology is rare in adolescents with low back pain, clinicians should recognize specific signs and symptoms that necessitate urgent evaluation and intervention. This article emphasizes the value of using a thorough history and physical examination to guide the initial diagnostic workup and to enhance the early detection and accurate diagnosis of adolescents who present with low back pain.