Do Physician Assistant Training Programs Adequately Prepare PAs to Address Nutritional Issues in Clinical Practice?

PURPOSE

The purpose of this study was to determine physician assistants' (PAs') current level of confidence to engage in nutrition-related tasks and their satisfaction with the nutrition education they received in PA school.

METHODS

To achieve this goal, a mixed-methods approach that consisted of 3 data collection phases (qualitative online discussions, quantitative survey, and qualitative interviews) was used to explore and measure PAs' perceptions of the education they received in PA school and through other sources and how confident they felt addressing nutrition-related issues in clinical practice.

RESULTS

While 80% of PAs endorse the idea that PAs should be more involved in providing nutritional care to patients, the majority reported basic or no knowledge of the nutritional implications of chronic conditions (69%), inflammatory bowel disease (69%), nutritional needs over the lifespan (67%), and food allergies and intolerances (64%). Barriers to patient care included knowledge-related challenges when selecting lab tests based on patient profile (46%) and identifying needs based on various gastrointestinal diseases (67%) and when using diagnostic data to identify deficiencies (74%). Overall, 59% of PAs reported being slightly or very dissatisfied with the nutrition-related content in the curricula used to formally train PAs.

CONCLUSIONS

The primary goal of every PA program is to prepare its graduates to be competent to enter clinical practice. Regarding nutrition, these data indicate that programs are failing to do so. PAs lack the confidence and ability to provide optimal nutritional care, which is staggering considering that nutrition is the first line of treatment in the prevention and management of numerous chronic diseases.

Panel 7: Treatment and comparative effectiveness research

BACKGROUND AND OBJECTIVES

Otitis media (OM) is one of the most common reasons for antibiotic treatment in children. Controversies regarding antibiotic treatment for OM have accumulated in the past decade, and there seem to be more dilemmas than certainties. The objectives of this article are to provide the state-of-the art review on achievements in treatment of all different stages of OM, including acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media, and to outline the future research areas.

DATA SOURCES

PubMed, Ovid Medline, the Cochrane Database, and Clinical Evidence (BMJ Publishing).

REVIEW METHODS

All types of articles related to OM treatment published in English between January 2007 and June 2011 were identified. A total of 286 articles related to OM treatment were reviewed by the panel members; 114 relevant quality articles were identified and summarized.

RESULTS

New evidence emerged on beneficial results of antibiotic treatment, compared with observation of AOM in young children who were diagnosed based on stringent criteria. In OME, the main results were related to a nonsignificant benefit of adenoidectomy versus tympanostomy tube placement alone in the treatment of chronic OME in younger children. Other modalities of OM treatment were studied and described herein.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Significant progress has been made in advancing the knowledge on the treatment of OM. Areas of potential future research have been identified and outlined.

Attitudes and practices of massage therapists as related to conventional medicine

Introduction

Research into opinions about complementary and alternative medicine (CAM) has focused on conventional medical practitioners with little exploration of CAM practitioners’ views.

Purpose

To survey attitudes and practices of massage therapists toward conventional medicine.

Research Design

An anonymous online survey consisting of Likert-type scales, fill-in answers, and multiple-choice questions was used.

Participants

Members of the Associated Bodywork & Massage Professionals (ABMP), the largest massage therapy association in the US with over 77,000 members.

Main Outcome Measures

Participants were asked about their years of practice and training, choice of health care practitioners, sources for information about CAM and Western/allopathic medicine, client referral patterns, optimal treatment approaches for various medical conditions, and overall impressions of CAM and Western/ allopathic medicine.

Results

Analysis of n = 3,148 responses indicated that while 66.9% of respondents had a neutral or worse impression of Western/allopathic medicine, 64.3% use a conventional medicine practitioner as their primary health care provider, 61.9% have referred clients to a conventional medicine practitioner in the past six months, and 90.5% seek out information on Western/allopathic medicine. The mode response of the best treatment approach to various medical problems was a mix of Western/allopathic medicine and CAM.

Conclusions

This study suggests that despite the ambivalence of many massage therapists towards conventional medicine, many use it, encourage clients to do so, and see involvement of both as crucial to health.

Influence of operator experience on canal preparation time when using the rotary Ni-Ti ProFile system in simulated curved canals

AIM

The aim of this study was to determine the influence of operator experience on the time needed for canal preparation when using a rotary nickel-titanium (Ni-Ti) system.

METHOD

A total of 100 simulated curved canals in resin blocks were used. Four operators prepared a total of 25 canals each. The operators included practitioners with prior experience of the preparation technique, and practitioners with no experience. The working length for each instrument was precisely predetermined. All canals were instrumented with rotary Ni-Ti ProFile Variable Taper Series 29 engine-driven instruments using a high-torque handpiece (Maillefer, Ballaigues, Switzerland). The time taken to prepare each canal was recorded. Significant differences between the operators were analysed using the Student's t-test and the Kruskall-Wallis and Dunn nonparametric tests.

RESULTS

Comparison of canal preparation times demonstrated a statistically significant difference between the four operators (P < 0.001). In the inexperienced group, a significant linear regression between canal number and preparation time occurred.

CONCLUSION

Time required for canal preparation was inversely related to operator experience.

Survey of rabies preexposure and postexposure prophylaxis among missionary personnel stationed outside the United States

BACKGROUND

Of the 36 cases of human rabies that have occurred in the United States since 1980, 12 (33%) were presumed to have been acquired abroad. In the United States, it is recommended that international travelers likely to come in contact with animals in canine rabies-enzootic areas that lack immediate access to appropriate medical care, including vaccine and rabies immune globulin, should be considered for preexposure prophylaxis. In 1992, the death of an American missionary who had contracted rabies while stationed in Bangladesh highlighted this high-risk group.

METHODS

To assess their knowledge of rabies risk, rabies exposures, and compliance with preventive recommendations, we asked 695 missionaries and their family members to complete questionnaires about their time stationed abroad.

RESULTS

Of the 293 respondents stationed in countries where rabies is endemic, 37% reported prior knowledge of the presence of rabies in their country of service. Only 28% of the personnel stationed in rabies-endemic countries received preexposure prophylaxis. Having preexposure prophylaxis specifically recommended increased the likelihood of actually receiving it (O.R. 15.6, 95%CI 7.4 - 34.9). There were 38 reported exposures (dogs = 66%, another human = 20%), proven or presumed to be rabid. Three of the people exposed received rabies immune globulin and vaccine; 11 received vaccine alone; 8 received only basic first aid, and 16 received no treatment.

CONCLUSIONS

Although American missionaries stationed abroad are at an increased risk for exposure to rabies, compliance with established preventive measures was low. Prior to being stationed abroad, an educational rabies-prevention briefing, including encouragement to receive preexposure prophylaxis, could be an effective intervention for missionaries to decrease their risk of rabies.

Rotary Ni-Ti profile systems for preparing curved canals in resin blocks: influence of operator on instrument breakage

AIM

The aim of this study was to determine the incidence of fracture of ProFile 0.4 and 0.6 taper Series 29 nickel-titanium instruments with respect to operator experience.

METHODOLOGY

A total of 125 simulated root canals in resin blocks with the same geometrical shape in terms of angle and radius of curvature and coronal and apical orifice diameter were used. Five operators prepared all the specimens using an identical step-down instrument sequence, each one preparing 25 canals. The operators included two endodontists and three general practitioners. Statistical data concerning the incidence of instrument failure was compiled using Statlab and Fisher's partial least square difference analysis of variance.

RESULTS

A total of 21 (16.8%) instruments fractured, all had 0.04 tapers. Nine size 25 instruments failed, 9 size 20 instruments failed and 3 size 15. During the study, the Binary Tree analysis of instrument failure revealed two operator populations belonging to two different study periods. The first period, which represented the first 13 root canal preparations, was called the 'learning period', and the second period, which represented the next 12 sample preparations, was called the 'application period'. A greater number of instruments failed during the first period than during the second. In the 'learning period', both groups of operators learned the same way. In the 'application period', two groups could be distinguished; the first group consisted of a general practitioner who produced worse results, and the second group consisted of the other four operators.

CONCLUSIONS

The results indicate the necessity of mastering this rotary canal preparation technique, and the importance of improving competence through learning and experience.

Community structure and prevalence of hantavirus infection in rodents: a geographic division of the enzootic area in far eastern Russia

The results of an extensive rodent trapping effort throughout the southern part of far eastern Russia and hantavirus antigen screening of tissues were used to develop a multifaceted approach for the geographic division of the enzootic territory of hantavirus. Four species of rodents (Apodemus agrarius, Apodemus peninsulae, Microtus fortis, and Clethrionomys rufocanus) comprised 88.5 percent of 10,595 captured rodents and 94.1 percent of 996 antigen-positive animals. Rodent fauna and the prevalence and distribution of hantavirus antigen-positive animals were compared among major biotic communities in the region. The species composition of the rodent communities and the predominant hantavirus reservoir species were used as criteria to define zones with similar enzootic characteristics.

Endodontic retreatment: a rational approach to non-surgical root canal therapy of immature teeth

The specificity of retreating immature teeth involves generally a broadly wide open apex and/or an inverted root canal conicity (apical opening wider than the root canal orifice), a periapical pathology leading often to a continuous canal exudation and thin and fragile dentinal walls. Nonsurgical endodontic retreatment of immature teeth consists at first in removing coronal and root canal iatrogenic obstructions in order to regain total canal patency. Apexification is then the treatment of choice, preceding a final gutta-percha obturation. The present article outlines a step-by-step rational approach to the root canal retreatment of immature teeth, pertaining to their biomechanical and pathological specificity.

Clinical diagnosis and treatment of endodontic and periodontal lesions

Because of the intimate relationship of the root canal system and the periodontium, developing endodontic and periodontal lesions may mimic each other in clinical and radiographic appearance. The etiology, diagnosis, treatment, and prognosis of endodontic and periodontal lesions will be discussed.

Endodontic retreatment: a rational approach to root canal reinstrumentation

During nonsurgical endodontic retreatment, endodontic instruments are forced apically to remove the root canal filling material and regain canal patency. Undiscriminating burrowing down the canal in the apical direction may be fruitless and harmful. To avoid complications, the dentin overhanging the canal orifice must be removed and an unobstructed access established to the root filling material, so as to facilitate its removal. Reinstrumentation of the filled canal must take into consideration the nature of the filling material and the physical properties of endodontic instruments, as well as the dynamic aspects of canal preparation. This article discusses the mechanical considerations pertaining to root canal retreatment and outlines a step by step rationale approach to retreatment.

Scanning electron microscope observation of canal cleanliness

The aim of this study was to evaluate the cleansing efficiency of three root canal preparation techniques. The distal root canals of mandibular molars, divided into three groups of four teeth each, were prepared according to the following techniques: manual (serial), ultrasonic (Cavi-Endo), and automated (Canal Finder). The canal wall surfaces were examined under a scanning electron microscope at three levels. No preparation technique was found to result in any characteristic microscopic features that distinguished it from the other techniques. The lack of such differences makes it impossible to establish objective criteria for comparing these techniques in terms of root canal cleanliness. It was established that even canals that appeared to be clean included areas coated with smear layer and having uninstrumented areas and even pulpal tissue debris.

Importance of heterosexual activity in the transmission of hepatitis B and non-A, non-B hepatitis

To identify previously unrecognized sources for acquiring acute hepatitis B and non-A, non-B (NANB) hepatitis, we interviewed patients with these types of hepatitis who were reported to two county health departments in the United States and matched control subjects for known and potential risk factors for acquiring hepatitis. Of 218 patients with hepatitis B and 140 patients with NANB hepatitis, 46% and 53%, respectively, had no commonly recognized source for infection. When these patients were compared with control subjects, significantly more patients with hepatitis B had multiple heterosexual partners, accounting for 14% of all hepatitis B infections; more patients with NANB hepatitis either had sexual or household contact with a person who had hepatitis in the past or had multiple heterosexual partners, accounting for 11% of all NANB infections. This is the first study to suggest that heterosexual transmission may play an important role in the spread of NANB hepatitis.

The effect of hyaluronidase on akinesia during cataract surgery

The ability of hyaluronidase to improve akinesis in retrobulbar anesthesia was evaluated in a double-masked study. Forty consecutive patients undergoing cataract surgery were anesthetized with 3 ml of a 1:1 mixture of 4.0% lidocaine and 0.75% bupivacaine solution. In a predetermined randomized fashion, 2 ml of hyaluronidase (300 USP units) were added to half of the syringes, and 2 ml of saline to the remaining half. The level of akinesia was graded in six different positions of gaze. Seventy percent of the hyaluronidase group exhibited complete akinesis, while only 40% of the control group did. The mean scores for four out of six positions of gaze were significantly higher in the hyaluronidase patients than in the control group. Similarly, the hyaluronidase subjects showed a significantly higher sum score for the six sectors than did the control subjects (p = .0001). These results show that hyaluronidase significantly enhances akinesia. It is therefore recommended that it be included in the anesthetic regimen for such surgeries.

Epidermoid cyst of testicle. Ultrasonographic characteristics

Epidermoid cyst is a benign lesion of the testis which represents approximately 1 per cent of all testicular tumors. We describe a case in which preoperative ultrasound of the testis suggested a benign testicular lesion, thus permitting testis-sparing surgery. The proper management of this lesion remains a source of urologic controversy, and we review the rationales for both radical orchiectomy and simple excision.

Papillary cystadenocarcinoma of the prostate

We report an unusual case of papillary cystadenocarcinoma of the prostate causing symptoms of prostatism.