The 15th Annual Clinical and Professional Poster Session, coordinated by AAPA's Clinical and Scientific Affairs Council (CSAC), features abstracts in three categories: original research, case studies/clinical reports, and posters previously presented at medical or scientific conferences. The session consists of three galleries: one depicting posters presented by fellow members, another displaying posters created by PA students, and the third focused on PA education.
The poster session highlights the unique research that PAs, PA faculty, and PA students have accomplished during the past year and provides an excellent venue for extended informal discussion with meeting attendees.Posters listed alphabetically by title
CLINICAL AND PROFESSIONAL GALLERY
Original Research
No. Title and Authors
1 A Six Year Retrospective Study of MRSA Infections at a Rural Hospital. C. Lippitt
2 Comparison of Professional Benefits Provided to Physician Assistants in Cardiology Practices. M. Clark, O. Chen, T. Tak, and J. Flesher
3 Mortality among Boston's Rough Sleepers: A Six Year Observational Study. J. Roncarati, J. O’Connell, S. Swain, and C. Kane
4 Physician Assistants in Taiwan: A 2004 Survey. C. Kao Lo and P. Chang
5 School Breakfast Program as a Vehicle for Nutrition Education in Nigeria.F. Ogunfiditimi and O. Odegbami
6 The Effects of Early Patient Education on Immunization Rates of Infants in Galveston County. T. Bigler and K. Stephenson
7 The Role of Physician Assistants in Addressing Healthy People 2010’s Leading Health Indicators. R. McNellis and MM. Léger
8 What Contributes to Physician Assistant Retention in Rural Communities?R. Hooker and L. Henry
Case Studies/Clinical Reports
No. Title and Authors
9 An Unusual Case of Anemia in a 10-year-old Male. J. Van Rhee
10 Choosing Diabetes Education Materials for Patients with Limited Literacy Skills. K. Stephenson
11 Healthcare for Evacuees from Hurricanes Katrina and Rita: Operation Minnesota Lifeline. M. Zellmer
12 The “Seat Belt Sign” (SBS): A Marker for Associated Intra-Abdominal and Spine Injury. S. Nyberg and B. Thomas
Previously Presented
No. Title and Authors
13 Low-Dose Titration with Oxymorphone Extended Release to Achieve Effective Long-term Treatment of Moderate to Severe Pain in Opioid-Naive Patients. H. Ahdieh, R. Kerwin, and F. Yuen
14 Nutritional Assessment of Liver Transplant Patients: A Physiologic Approach. V.C. Zacharias, B.J. Borjas, T. Kaiser, K. Hess, and G. Neff
15 Occupational Daydreams of Physician Assistants Based Upon Holland Typologies. D. LaBarbera and L. Placeway
16 The Effect of Ethnicity on Immediate Reconstruction Rates after Mastectomy for Breast Cancer. J. Tseng, S. Kronowitz, C. Sun, A. Perry, G. Babicra, K. Hunt, H. Kuerer, L. Newman, G. Robb, and S. Singletary
17 Autologous Chondrocyte Implantation for Focal Chondral Defect of the Patella. S. Saddler and P. Porter
EDUCATION GALLERY
Original Research
No. Title and Authors
18 Analyzing Survey Research in Physician Assistant Education: 1992-2005. P.E. Jones and R. Hooker
19 Correlation of PANCE Performance with Transition Points during Physician Assistant (PA) Education.C. Blankenship and G. Boissonneault
20 What Happened in Basic Clinical Skills 2005? Teaching the Physical Exam. G. Landel, R. Cupp, D. Brock, and K. Wick
21 What Primary Care Procedural Skills are PA Schools Teaching and how are they Teaching them? J. Carlson, Stacy Laack, and Curt Stilp
Previously Presented
No. Title and Authors
22 PACKRAT, GPA and PANCE: A Comparison Analysis of Predictive Performance. C. Shallenberger, B. Fondy and R. Hutchinson
STUDENT GALLERY
Outstanding Student Research
No. Title and Authors
23 Evaluation of an Extended-Interval Gentamicin Dosing Protocol in Neonates £ 33 Weeks Gestational Age. J. Thomas
24 Retinal Degeneration: Effects of Elevated Plasma Homocysteine on Retinal Morphology of Diabetic Mice. T. Van Ells, B. Moister, L. Amarnath, S. Haddow Reffett, P. Roon, S. Smith, V. Ganapathy, and B. Mysona
25 The Public Awareness Regarding Male Breast Cancer. T. Sanderson, O. Chen, and L. Hill
Original Research
No. Title and Authors
26 A Patient's Guide to Common Laboratory Tests. J. Penn, J. Twietmeyer, J. Fenner, S. Lasher, K. Bennett, M. Tuffo, S. Hoffmann, E. Dobler, and M. Sobolewski
27 A Proposed Curriculum Design for a Postpartum Depression Workshop for Clinicians.L. Ireland, P. Pagels, O. Chen, and J. Shores
28 A Study of Frequent Horse Riders in South Central Kansas: Their Perceptions and Knowledge of Riding Safety.J. Allen and S. Nyberg
29 An Analysis of the Value Card Sort Responses of One Private University’s Physician Assistant Classes of 2003-2007.C. Lanier, R. Wilkerson, and Dawn LaBarbera
30 An Investigation of the Use of Barrier Protection During Oral Sex in College-Aged Students: Are Students Aware of the Dental Dam and Using It Correctly? A. Coble, M. Manzo, E. McKnight, and M. Natali
31 Attitudes and Practices of Physician Assistants in the State of Kansas with Regards to Opioid Management in Chronic Non-Malignant Pain Patients. A. Weaver and T. Quigley
32 Determining Attitudes of Kansas Chiropractors Regarding Immunization Practices. S. Holman and S. Nyberg
33 Diabetes Education with Homebound Elderly: Effects on Disease Progression. H. Misja, M. Benedict, and M. Bergseth
34 Effectiveness of an Educational Program on Prenatal and Postnatal Care Knowledge in Women Seeking Help from a Crisis Pregnancy Center. N. Thompson, L. Porter, R. Kancianic, and L. Travis
35 Factors Contributing to Tobacco use among Physician Assistants in Kansas. C. Koster and R. Muma
36 Health Care Providers' Knowledge of Advance Directives. R. Coulson, J.Kocian, E. Madden, A. Pinkerton
37 Health Literacy: An Evaluation of the Readability of Diabetes Mellitus Patient Education Materials across Different Patient Populations in a Community. L. Gerencir, A. Bosworth, and C. Evans
38 Healthy People Seton Hall.K. Wrigley, K. Simas, D. Ackerly-Kofod
39 Increasing the Overall Prevalence of Tuberculosis Screening among the Homeless Population through Education and Advertisement. J. Hodgson, L. Albanese, and H. Reynolds
40 Knowledge Assessment of Physician Assistants and Physician Assistant Students on Medical Insurance Plans and Coverage. A. Abebe, K. Graham, N. Moulton, and J. Parker
41 Physician Assistants- Progress in Practice. D. Bridge, C. Hart, J. Lavanture, and E. Roberts
42 Public Automated External Defibrillator Placement: Can We Find Them? An Assessment of a Local Public Access Defibrillator Program. R. DeRosa and K. Sweeney
43 The Effects of Stress on Personal Relationships among First Year Physician Assistant Students. K. Primrose, H. Collier, and L. Pete
44 The Impact of a Free Community Clinic on the Utilization of a Local Emergency Department. S. Bleything, M. Van Sickel, J. Spiegel, and D. LaBarbera
45 The Influence of Prior Education, Mentor and Employment Experience as Practice Setting Determinants of Physician Assistants. E. Sims, H. Lemke, and O. Chen
46 The Outcome of Facilitating Conflict Resolution in School Aged Children. N. Larkin, A. Yesenosky and T. Esty
47 The Truth about Exercise Prescriptions: Do They Motivate Patients to Change? A. Ziegeweid and R. Dehn
48 The Use of Herbal Medicine and the Incidence of Potential Drug-Herb Interactions. D. Beaty, B. Hutsko, and T. Dodd
49 The Use of Peak Flow Monitor in the Asthmatic Child. J. Chui, M. Gatta, and A. Albrigo
50 Use of Antipsychotic Therapy in Geriatric Nursing Home Patients – An Ongoing Performance Improvement Project. A. Dunaway, E. Macnamara, M. Phillips, and B. Taylor
51 Wellness Intervention in a Collegiate Community. A. Hopwood, K. Gray, and M. Wellings
Case Studies/Clinical Reports
No. Title and Authors
52 Os Trigonum Syndrome: A Case Report. M. Kelly and F. Feudale
Previously Presented
No. Title and Authors
53 A Comparison of Interviewed and Non-interviewed Student Cohorts for the PA Program of Study and National Physician Assistant Certification Exam Scores. L. Humphries and R. Muma
54 Epidemiology of Dyslipidemia, Fitness, and Exercise Intervention in a Male HIV-Infected Cohort. K. Schuer, J. Clasey, A. Thornton, B. Garvy, K. Adams, and F. Rownelli
55 High Blood Pressure Increases the Renal Medullary Transport Proteins UT-A1, AQP2, and NKCC2/BSC1 in Rats.B. Murrell, J. Sands, S. Reffett, and J. Klein
56 Potentials and Barriers of Physician Assistants Working in Hospice. R. Boyer, O. Chen, and L. Hill
CLINICAL AND PROFESSIONAL GALLERY
Original Research
1. A Six Year Retrospective Study of MRSA Infections at a Rural Hospital. C. Lippitt, Bassett Healthcare, Copperstown, New York
Statement: Methicillin-Resistant Staphylococcus Aureus (MRSA) is a growing concern within the medical community. These infections are much more difficult to treat due to antibiotic resistance and pose an increased risk in certain patient populations.
Purpose: A review of the data collected over the last six years regarding the incidence of MRSA infections at Bassett Healthcare, a 214-bed community based rural upstate New York hospital located in Cooperstown, N.Y.
Methods: A total of 517 charts were reviewed from the year 2000 to 2005. A total of 359 charts were found to have adequate data to use within the parameters of the study. Data recorded included age, sex, culture source, and whether a nosocomial or community-based etiology.
Results: During the 6-year period reviewed, there was a four-fold increase of reported incidence of MRSA infections (2000=39 cases and 2005=160 cases). Average age showed a fairly steady trend: 57, 65, 52, 63, 53, and 55 years for the time period. However, as the numbers of total cases increased, so did the incidence within each age group. The percentages of “skin” source versus “routine urine/sputum” source didn’t vary significantly: 50, 61, 59, 67, 53, and 48 percent for the years studied. Finally, in regards to the percent of community based sources, compared with nosocomial acquired, showed 45, 29, 32, 24, 54, and 33 percent respectively.
Discussion: I was surprised by the tremendous increase in case numbers in such a short period of time. My sense in working in the clinic was that I would find a trend toward a younger and younger population. The data did support this by showing as the total number of cases increased, the number of cases in each age group also rose. Overall, the largest risk factor seemed to be time spent in a hospital or “health” facility. Limitations of this review included missing complete data for the tracking of patients with MRSA infections. There was no definite “protocol” in dealing with or documenting information. Thus, various providers evaluated and treated in varying ways making precise tracking difficult. Transferred patients posed a unique situation in gathering information from the original institution.
Conclusion: According to the CDC, MRSA is increasingly a cause of nosocomial and community-onset infection with unknown national scope and magnitude. Our rural hospital shows a significant and steady increase in all age groups and total numbers of both nosocomial and community based MRSA infections.
2. Comparison of Professional Benefits Provided to Physician Assistants in Cardiology Practices. M. Clark, O. Chen, T. Tak, and J. Flesher, University of North Texas Health Science Center, Division of Physician Assistant Studies, Fort Worth, Texas
Purpose: The purpose of this study was to compare the professional benefits provided to Physician Assistants (PAs) in specific cardiology practice settings. Professional benefits considered in this study included salary, contract, licensure, CME funds, retirement, and health insurance.
Methods: A 2004 APAC survey was sent to 582 Physician Assistants identified by the 2003 AAPA census as listing cardiology as their primary practice discipline. A total of 283 completed surveys (49%) were returned and among those respondents 264 were identified as practicing in a non-invasive, an invasive, or a combined (non-invasive/invasive) cardiology practice setting. The data of this study was extracted from the survey and re-analyzed using SPSS (12.0 version) to perform descriptive and Chi-Square statistical test.
Results: The majority of the respondents 193 (73%) listed a combined practice setting as their primary practice setting, the non-invasive practice setting 48 (18%), and invasive practice setting 23 (9%). The majority of the respondents were in full time practice settings with 100% for the invasive group, 92% for the non-invasive group, and 89% for the combined group. The typical annual gross salary for all three practice groups was $60,000 – $99,000 with the combined practice group reporting a higher percentage of PAs with a salary over $80,000 (23%). When asked about a professional contract with the employer the non-invasive group were almost twice as likely not to have a contract with their employer (12%) compared to the other groups (x2 =17.352 p<.002). Even though the combined and invasive practices were statistically evenly split on having a contract, both groups reported slightly more not having a contract. All practice groups were most likely to have liability insurance provided by their employer (87%). The combined practice setting was most likely to provide CME funding over $1500.00 (52%). Of the three practice groups the invasive practice setting group has a higher percentage of PAs receiving less than $1500 CME funding (43%). Licensure funding was provided by the employer with 77% of the combined group, 64% of the non-invasive group, and 56% of the invasive group(x2=6.98, p<0.03). Professional dues were provided by the employer in 75% of the combined group, 64% of the non-invasive group, and 60% of the invasive group. Retirement benefits were provided to 83% of the invasive group, 82% of the combined group, and 75% of the non-invasive group. Health insurance was provided to 87% of the combined group, 87% of the invasive group, and 81% of the non-invasive group.
Conclusion: All practice settings were likely to provide professional and personal benefits. The majority of cardiology PAs practice in a combined (non-invasive/invasive) practice setting. The salary ranges for the three practice groups were comparable but the combined practice setting was most likely to offer a higher salary. PAs in non-invasive practice settings were more likely not to have a contract. The invasive practice group was less likely to receive employer funding for licensure and professional dues.
3. Mortality among Boston's Rough Sleepers: A Six Year Observational Study. J. Roncarati, J. O’Connell, S. Swain, and C. Kane, Boston Health Care for the Homeless Program, Boston, Massachusetts
Purpose: Rough sleepers are a subset of the homeless population who live on the streets and avoid shelters. Little is known of the health care needs of this elusive population. The multidisciplinary Street Team of the Boston Health Care for the Homeless Program (BHCHP) has provided direct care services to the urban street dwellers for over a decade and have attempted to decrease as well as describe the mortality of this at risk group.
Methods: A six-year prospective study of 119 high risk chronically homeless rough sleepers was undertaken in January 2000. Criteria for inclusion in this cohort include age over 18, living on the streets for at least six consecutive months, and one or more of seven identified risk factors. Data sources, including BHCHPs electronic medical record, medical records at two academic teaching hospitals, a supplemental Palm Pilot street database, and death certificates, provide the team with data about the cohort’s burden of illness, service utilization, housing disposition, and causes of death.
Results: After six years, the whereabouts of all but five individuals was known. 37 (31%) persons died: seven cirrhosis, four alcohol or drug overdose, seven cancer, and four AIDS. Another 15 (13%) are currently in health care facilities (hospitals, respite care, and nursing homes), while three are incarcerated. Over a third (34%) of this population transitioned to housing during these years of intensive care management.
Conclusion: Rough sleepers represent a vulnerable subset of the homeless population who suffer complex and chronic medical, psychiatric, and substance abuse problems and have extraordinarily high rates of morbidity and mortality. Improvement in the identification of those at risk and improved coordination of care may help reduce mortality and improve health status in this vulnerable population.
4. Physician Assistants in Taiwan: A 2004 Survey. C. Kao Lo and P. Chang, Fooyin University, Kaohsiung Hsien, Taiwan
Purpose: Taiwan, the Republic of China, is the only Asian nation with universal healthcare; but it is struggling with meeting the demand for more doctors. In the mid 1990s, a small cadre of nurses expanded their role and became physician assistants (PAs) or nurse specialist practitioners (NSPs). This was accomplished through special programs developed independently in medical centers and hospitals. In 2004, Fooyin University began a formal PA education program. However, the role and prevalence of existing PAs had not been assessed. A survey was undertaken to identify the areas where PAs were located, their role and function, and to report to the Ministry of Health the need for formal recognition.
Methods: In 2004, a mailed questionnaire was sent to all 504 accredited hospitals (23 urban medical centers, 81 rural hospitals, and 400 district hospitals). The survey was designed to identify where PAs were employed, their roles and responsibilities, and what their prevalence was. Telephone prompting was used to increase the rate of return. Validation of the survey results was undertaken by a visit to six of the hospitals that employ PAs.
Results: A total of 159 hospitals returned the survey (32% return rate). Most of the questionnaires were completed by administrators or senior nursing supervisors. A total of 1,419 PAs were employed at the 159 responding hospitals. The majority of PAs work in surgery (39%) or internal medicine (36%), with the remainder in obstetrics, pediatrics, and emergency medicine. Role delineation consisted of patient management and medical service (42%), consultation service (26%), academic research (12%) and other (20%). Nearly a quarter (23%) of the PAs had a bachelor’s or master’s degree. The remainder had an associate degree. Of those hospitals reporting, the majority (55%) conduct their own PA training.
Conclusion: The number and distribution of PAs in Taiwan, the Republic of China, is larger than had been assessed to date. If the responding hospitals are representative of other PA-employing hospitals, the prevalence of PAs in Taiwan may number 2,000 or more. Both the survey and personal visits by the consultants of this survey interviewed PAs in roles that were both inpatient and outpatient, with a great deal of support by the supervising physicians. The PAs interviewed expressed a desire for a higher education degree and a more formal education process. The results of this survey were presented to the Minister of Health and used as a framework for additional surveys to further delineate the role of PAs.
5. School Breakfast Program as a Vehicle for Nutrition Education in Nigeria. F. Ogunfiditimi and O. Odegbami, Public Health and Education in Nigeria, Inc., Ann Arbor, Michigan
Purpose : The purpose of the evaluation was to provide a comprehensive but rapid assessment of the main problems, weaknesses and strengths of the current school feeding policy, as well as its management and implementation.
Methods: This was a descriptive study based on a review of the literature, an analysis of prescribed meals, and an analysis of meals being served to children in a sampled school of 1300 students. Data on actual meals served was obtained from field visits to the school from March to June 2003. At the school, food was weighed using visual estimation. During the site visits, the preparation, serving and storage of the food was also observed and discussions were held with Head-teacher, teachers, and food vendors to obtain additional inputs. The Nutri-Kids program (School Lunch Computer Services, Inc, Princeton, NJ) was used to determine the nutrient content of each item and meal offered, served, and consumed. Specific nutrients analyzed included: energy, protein, carbohydrates, total fat, saturated fat, calcium, iron, vitamin A, vitamin C, cholesterol, sodium, and fiber. Mann-Whitney test was performed using Statistical Package for the Social Sciences (version 10, 1999, SPSS Inc, Chicago, Ill). In order to assess the various meals, a conceptual framework was developed. Meals were then evaluated according to these criteria.
Results:
- Malnutrition amongst primary school children of Expressway Primary School is common. On the basis of nutritional status alone, a comprehensive primary school nutrition program is appropriate.
- Primary school health and nutrition programs are increasingly seen as a priority area of child health in developing countries. Therefore, having a school nutrition program to improve the general health and learning capacity of primary school children is a worthy aim.
- Many of the problems with the implementation of the school breakfast program have resulted from inadequate management.
- Breakfast often happens at an inappropriate time of the day, the food may be of a substandard quality and quantity.
6. The Effects of Early Patient Education on Immunization Rates of Infants in Galveston County. T. Bigler and K. Stephenson, University of Texas Medical Branch, Galveston, Texas
Purpose: A longitudinal prospective cohort study at a university hospital to evaluate the efficacy of post-partum parental education to improve immunization compliance in Galveston County. In 1999, The Texas Retrospective Immunization Survey (TRIS) reviewed immunization records of five years old in Galveston County and found an immunization rate of 56.2% when they were two years of age.
Methods: Physician Assistant students (PA-S) on rotation in the newborn nursery performed the intervention, consisting of patient education regarding childhood vaccinations. Specific points included reviewing the immunization schedule, the importance of receiving immunizations at the recommended times, and the availability of reduced costs vaccination clinics. Subjects enrolled in the study received reminders in the mail about immunizations when their child was two, four, and six months old; those living in Galveston County received a list of community shot clinics. Using the statewide immunization registry, the child’s records were reviewed to establish whether the child obtained the recommended vaccines and a chi-square test was used to compare the rates of immunization between the groups.
Results: January 2006. A total of 1211 subjects are enrolled to date. Of the 505 infants at least 12 months of age, 131 (25.9%) resided in Galveston County at the time of birth, 291 (57.6%) of the parents prefer to speak Spanish, 259 (51.3%) are female. At 12 months of age, there was no difference in immunization rates between the cohort’s intervention (25.3%; n=261) and the control groups (28.7%; n=244; p=0.389). Of the factors used to predict immunization status (county of residence at birth, gender of the infant, parent’s preferred language and immunization status at two, four and six months of age), meeting immunization requirements at two, four, and six months of age predicted immunization status at 12 months of age (p=0.046, 0.014, and 0.000, respectively).
For Galveston County infants enrolled in the study at 12 months of age, the immunization rate is 35.1%. There was no difference in the immunization rates between the control and intervention groups (C=35.8%, I=34.4%, p=0.862). Meeting immunization requirements by six months of age predicted being up to date at 12 months (p=0.024). Families for which Spanish was the preferred language were also more likely to have obtained a complete immunization series for their child (p=0.041).
Conclusion: Patient education supporting the importance of immunizations prior to hospital discharge has yet to preferentially improve immunization compliance at 12 months of age in the intervention group. Meeting immunization requirements by six months of age did predict being up to date at 12 months for the entire cohort, verifying that the reminders at two, four and six months are reinforcing the need to complete the immunization series. Additional families are being enrolled and continuation of this research will determine the factors that make a significant difference in immunization rates at two, four, six, 12 and 35 months of age. Additional studies are needed to establish the accuracy of the immunization registry.
7. The Role of Physician Assistants in Addressing Healthy People 2010’s Leading Health Indicators. R. McNellis and MM. Léger, American Academy of Physician Assistant, Alexandria, Virginia
Objectives: To measure the baseline knowledge of Healthy People 2010 to PAs. To measure the knowledge and effectiveness of dissemination about Healthy People 2010 to PAs.
Background: Currently, there are over 55,000 physician assistants (PAs) in clinical practice in the U.S. Physician assistants work in every specialty and setting in healthcare. There is anecdotal evidence that PAs provide high levels of patient education and preventive services but little quantitative data exists. In 2002 the American Academy of Physician Assistants (AAPA) endorsed Healthy People (HP) 2010. At its annual conferences between 2003 and 2005 PAs attending the conference were surveyed about their knowledge, attitudes and behaviors related to the HP 2010’s leading health indicators.
Methods: During the annual meeting, attendees may complete a survey with nearly 160 questions on various aspects of PA practice, employment, experiences and opinions. Beginning in 2003, several questions were added to the survey asking PAs to identify which goals and objectives of HP 2010 they have integrated into their practice. In 2004, the questions were reformatted to identify the degree to which the goals and objectives were integrated into the respondent’s practice. In 2005 the questions was changed slightly to broaden the response to include other health promotion or disease prevention programs. Over 2000 attendees were surveyed during each of the three years.
Results: The results showed that 80% of PAs believe in the value of HP 2010. Three quarters of PAs encourage physical activity, two thirds counsel on tobacco cessation, over half address overweight and obesity but less than half of PAs address the other leading health indicators. The results were very specialty and setting dependent. PAs that work in family practice, pediatrics and obstetrics and gynecology had the highest rates of addressing leading health indicators.
Conclusion: PAs can have a significant impact on addressing leading health indicators but more dissemination is required especially for PAs in narrow specialties like dermatology.
8. What Contributes to Physician Assistant Retention in Rural Communities? R. Hooker and L. Henry, Department of Veterans Affairs, Dallas, Texas
Introduction: The raison d’être for developing, educating and deploying physician assistants (PAs) in the United States was to enable physicians to meet the medical needs of vulnerable populations. One such population consists of rural residents; PAs have historically been part of meeting their needs. However, for the past two decades PAs have been seeking employment opportunities in urban rather than rural areas. This dwindling medical workforce in remote locations has created a challenge for health policy makers and PA educators. However, in spite of the trend towards urban practice, a significant cadre of PAs continues to work in rural areas with needy populations.
We set out to understand what factors contribute towards retention of PAs in rural clinical practices. Our hypothesis is that there are common elements in the town or individuals that strongly contribute to their retention.
Method: We undertook a qualitative study on autonomous and isolated rural PAs in Texas.
Using the below criteria PA-town dyads were identified for inclusion in the study.
1. Work autonomously in a rural clinic
2. Average no more than eight hours per week of face-to-face interaction with the supervisory physician (who is at least 30 miles away)
3. Work as the sole medical provider in the community
4. Have worked in the community for more than 24 months prior to interview
5. The town is less than 5,000 population
A research team consisting of a medical workforce researcher, a medical anthropologist, and a research assistant visited each town or “census defined population” (some towns were unincorporated). Interviews were conducted with the PA, the clinic personnel, the postmaster, the mayor or city clerk and staff, and the supervising doctor. Following this a focus group session of 8-14 town residents was convened to probe for issues surrounding the role of a PA in a small town and what enablers and barriers existed for healthcare access.
Results: Eight Texas towns and PA practices were visited and they range in population from 450 to 4,500. All are geographically isolated from other towns and none are near interstate highways. Quantitatively the degree of “ruralality” ranged from 5-10 (Rural Urban Commuting Area Score: 1-10). The median age of those living within the census defined population is 41.6 years. In the aggregate 44% of all residents in the town surveyed are 65 years old or older (Medicare age). Most of the towns receive limited tax revenue with ranching and farming often a primary industry. Economically a school or a small industry such as a lumber company tends to be the largest employer in the town.
All of the PAs worked in the town for more than two years (range 2.5 to 10.5 years). The variety of diagnoses are typical for a family medicine oriented practice and caseloads ranged from 1600 to 3500 patient visits per year. All but one PA was salaried, but some receive additional remuneration for patient visits. The compensation of the PA was not identified as a factor in their retention.
Most of the PAs maintain a prominent role in the town through civic involvement outside the clinic (e.g., President of the Lion’s club, County Coroner, Civic Achievement Award, County Health Officer, etc.). The issue of a PA versus a physician was one of the questions; the prevailing town resident view was that a PA was better than no provider and the town was not large enough to sustain a doctor.
Half of the medical clinics were constructed within five years and most are owned by a hospital located in an urban area more than 30 miles away. Accounts are administered by the home institution and the lack of correct invoices was a contentious issue mentioned by many of the PAs and patients. Specifically the billing department did not always assign the correct diagnostic or procedure codes for a visit, which spilled over to patient complaints regarding the PA.
Assessment: The critical elements for retention of rural and autonomous PAs in this study is the desire to live in a remote area; the support of the town for a PA staffed clinic, and the confidence of the PA to work without direct supervision.
Discussion: We suggest that the role of a PA in a rural community is both an economic and a social stabilizing force for many rural residents. For example, the presence of a medical provider in the town was mentioned as a determinate for families with young children as to whether they will remain in the town or leave for locations where more medical care is available. Medicare age and Medicaid eligible residents are the least mobile of all town occupants, tend to rely on the PA for select needs more than comprehensive ones (minor injury, hypertension management, prescription refill, forms completed, etc.), and may benefit the most by a clinic nearby. For the rural health PA we observed that he or she ranks second or third in terms of social prominence in the town and postulate that this may contribute to their retention. Most (but not all) PAs have the option of moving elsewhere for employment but we hypothesize that the amenities of small town society may contribute to their retention. Deterrents to retention center on relationships with the employing hospital.
Conclusion: Rural towns that wish to attract PAs to staff small volume clinics may want to identify individuals who have the confidence to work alone, enjoy rural life and have an adequate clinic infrastructure in place for their employment.
Acknowledgement: The Association of Physician Assistant Programs and the American Academy of Physician Assistant provided partial support for this research through a special grant. Additional support by the co-investigators respective institutions enabled this study to reach its completion.
Case Studies/Clinical Reports
9. An Unusual Case of Anemia in a 10-year-old Male. J. Van Rhee, Western Michigan University, Grandville, Michigan
Introduction: Anemia in a child is a common finding and finding the cause is very important. Common causes include nutritional deficiencies; such as iron or vitamin B12, congenital hemolytic anemia, anemia of chronic disease, and hemoglobinopathies. In this case a 10-year-old with anemia noted, at the time of a routine sick visit, is discussed.
History: A 10-year-old male presents to the clinic with a three-day history of fever, non-productive cough, and myalgia. Family history is significant for a sibling with some sort of “blood trouble”. The patient is on no chronic medications, OTC medications use includes cough and cold medications, and his immunizations are up to date.
Physical Examination: Vitals are normal, except for a respiratory rate of 28/min and a temperature of 40.1°C. The patient appears ill and the physical examination is normal.
Laboratory testing reveals a WBC: 3,400/UL, Hgb: 10.2 g/dl, Hct: 30%, MCV: 66%, MCH: 22 pg, and Platelet count: 228,000/UL. RBC morphology includes moderate microcytosis and anisocytosis. Influenzae screen was positive for Influenzae A. All other tests are negative including Monospot, rapid strep screen, and chest x-ray.
Treatment and Follow-up: The patient was treated with fluids and antipyretics. A microcytic anemia was noted due to patient’s low hemoglobin and MCV. Further testing reveals a reticulocyte count 1.1%, iron studies normal, and hemoglobin electrophoresis on citrate agar at an acidic pH revealing Hgb A: 83.5%, Hgb A2: 1.2%, Hgb F: 3.3%, and Hgb Lepore: 12%.
Discussion: Hemoglobin Lepore has been noted in various ethnic groups, including Greek, Italian, American, Afro-American, Yugoslavian, Turkish Cypriots, and Asian Indians. Most patients with hemoglobin Lepore are asymptomatic or present with symptoms similar to those of beta-thalassemia. These signs and symptoms include growth failure, and jaundice. Physical examination findings may include hepatosplenomegaly. Laboratory findings include microcytic, hypochromic anemia with anisocytosis, poikilocytosis, and target cells. Diagnosis is based on the presence of Hgb Lepore (10-15%), elevated Hgb F, and decreased Hgb A2 on hemoglobin electrophoresis. Treatment consists of transfusion with packed RBCs as needed. Splenectomy is also useful in decreasing the degree of anemia. Hemoglobin Lepore should be considered in patients with findings consistent with beta-thalassemia and abnormal non-sickling hemoglobin.
10. Choosing Diabetes Education Materials for Patients with Limited Literacy Skills. K. Stephenson, University of Texas Medical Branch, Department of PA Studies, Galveston, Texas
Purpose: Develop methods for identifying appropriate diabetes education materials to meet the health literacy needs of patients.
Methods: Health literacy refers to the ability to read, comprehend and use information about health. The reading level of educational materials, in both English and Spanish, is an important component of the educational process that encourages patients and clients to adopt health care treatment options. The average reading level for Americans is at the eighth grade whereas Americans for whom English is their second language tend to read at the sixth grade level. Many Americans with diabetes have limited literacy skills which adversely impacts management of diabetes. Patients with diabetes and low literacy skills report difficulty comprehending complex management regimens and difficulty remembering management advice. Diabetics with low literacy skills are less likely to maintain tight glycemic control and are more likely to develop complications of diabetes. Health care costs for Americans with low literacy skills are four times that of those with more sophisticated reading skills. Additionally, health care professionals tend to underestimate the number of patients with low literacy skills and not recognize behaviors indicative of low literacy skills. Family members may accompany patients to help with written materials and patients may not risk revealing their limited skills by asking questions.
Rosal and others (2004) conducted focus group research among low-literate Hispanics seeking information about their preferences for diabetes patient education materials. The participants requested specific information about foods that they could eat rather than ones to be avoided and specific information on determining portion size. They preferred illustrations rather than information in text format. They were reluctant to try new foods and described a strong emotional response to the initial diagnosis of diabetes. Effective instructors were viewed as being both friendly as well as knowledgeable and committed to reinforcement of diabetes management information on a regular basis.
The Fry Readability Graph can be used to determine reading levels of materials in both English and Spanish by counting the number of sentences and syllables in three 100 word passages in patient education materials. The average number of syllables and sentences are then plotted against one another to determine the reading level. For Spanish passages, the same process is followed but the number 67 is subtracted from the number of syllables to account for differences in the word structure of the two languages.
Recommendations: Physician Assistants can use the Fry Readability Graph to evaluate the readability and suitability of diabetes education materials in both English and Spanish. Choose culturally sensitive materials that acknowledge the patient’s preferences in content, language and appearance of materials. Attend to nonverbal cues that may indicate low literacy skills. Choose materials that utilize pictures with succinct text. Demonstrate a commitment to patient education.
Conclusion: Choosing appropriate patient education materials can help facilitate management of diabetes by acknowledging the needs of patient to receive information that is culturally and linguistically appropriate to their health literacy needs.
11. Healthcare for Evacuees from Hurricanes Katrina and Rita: Operation Minnesota Lifeline. M. Zellmer, Mayo Clinic, Rochester, Minnesota
Purpose: Following mass disasters public health and health care system surge capacity is required to care for those displaced by the disaster. The purpose of this poster is to describe one innovative approach, Operation Minnesota Lifeline, for augmenting the surge capacity in Louisiana following Hurricanes Katrina and Rita.
Methods: The records of the partner institutions that made up Operation Minnesota Lifeline including the Louisiana Department of Health and Hospitals, American Refugee Committee International, Mayo Clinic, the University of Minnesota, and the College of St. Catherine are reviewed to provide a descriptive analysis of the health care response to this disaster provided from September into November 2005.
Results: Operation Minnesota Lifeline provided health services in the seven parishes in Region Four of the Louisiana Department of Health and Hospitals. This region received an estimated 40,000 evacuees from Hurricanes Katrina and Rita. Under the direction of the Region 4 Medical Director, and facilitated by the American Refugee Committee, a total of over 18,000 patients were vaccinated, 5,200 patients were examined, and 3,300 prescriptions were written by multi-disciplinary teams including a total of 257 volunteers from the Mayo Clinic, University of Minnesota and the College of St. Catherine. These services were provided in 64 different disaster shelters, over eight parish health units, in many churches, community centers, FEMA and Red Cross lines, and the Cajun Dome. An incident command organizational structure provided the mechanism of directing these services to identified areas of need, accessing the needed supplies and other resources necessary to provide this healthcare and integrating the efforts of the multi-disciplinary, multi-institutional volunteer teams.
Conclusions: The disaster following Hurricanes Katrina and Rita in August and September of 2005 displaced an estimated 40,000 people in Region 4 of the Louisiana Department of Health and Hospitals. Operation Minnesota Lifeline provided a coordinated multi-institutional response to the needs of those displaced and was the surge capacity needed by Region 4 to respond to the needs of this large number displaced people.
12. The “Seat Belt Sign” (SBS): A Marker for Associated Intra-Abdominal and Spine Injury. S. Nyberg and B. Thomas, Wichita State University, Department of Physician Assistant, Wichita, Kansas
Case Report: A 14 year-old female, restrained back-seat passenger was injured in a motor vehicle collision and was transported by EMS to a Level I trauma center. The back seat of this vehicle was equipped with a lap/shoulder belt but the patient had apparently disabled the shoulder harness and was wearing only the lap-belt. Her initial complaints were of upper abdominal pain and bilateral lower extremity paresis and loss of sensation. Physical examination of the abdomen revealed the presence of significant linear contusion and abrasion across her lower abdomen. A computed tomographic scan of the lumbar spine revealed a “Chance” fracture of the third lumbar vertebrae. Ultrasound FAST exam of the abdomen revealed free fluid in the abdomen. She was taken emergently to the OR for exploratory laparotomy and was found to have small bowel perforations and mesenteric avulsion as well as complete transaction of the right psoas and both rectus muscles.
Discussion: It is well-known that that the use of seat-belts has reduced the overall mortality associated with motor vehicle accidents. The use of a lap-belt alone has, however, been associated with an increased risk of intra-abdominal injury, predominantly to the small bowel. This pattern of injury has been termed "the seat-belt syndrome." In addition to intra-abdominal injury, there is an increased incidence of “Chance”, that is, flexion-distraction fractures of the vertebra, some of which result in spinal cord injury. One of the first indications of these potential injuries is the “seat-belt sign” (SBS), an area of contusion and/or abrasion to the lower abdomen, consistent with the position and imprint of a lap-belt. The presence of a SBS should alert the emergency care practitioner of the potential for serious intra-abdominal or vertebral spine injuries in a patient involved in a motor vehicle collision. This case presents the classic features of this injury.
Previously Presented
13. Low-Dose Titration with Oxymorphone Extended Release to Achieve Effective Long-term Treatment of Moderate to Severe Pain in Opioid-Naive Patients. H. Ahdieh, R. Kerwin, and F. Yuen, Endo Pharmaceuticals, Inc., Forest Hills, New York
Purpose: Many people with chronic moderate to severe pain caused by common conditions such as low back pain or osteoarthritis do not achieve satisfactory relief with nonopioid medications. Opioid medications may be indicated for these patients or patients at high risk of adverse events (AEs) associated with oral nonsteroidal anti-inflammatory drugs. The initial use of opioid medications in clinical practice is often limited by poor drug tolerability among opioid-naive patients. Tolerability may improve with a program of gradual dose titration. This study evaluated the safety and tolerability of oxymorphone extended release (ER), a new long-acting opioid formulation, during and after careful dose titration to a stabilized daily dose that provided adequate relief of moderate to severe pain.
Methods: Opioid-naive adults with chronic noncancer-related pain rated as moderate to severe on a categorical scale (0 = none to 3 = severe) and >40 on a 0–100-mm visual analog scale of increasing pain were enrolled. Patients received open-label oxymorphone ER 5 mg q12h for two days followed by titration to a stabilized dose that reduced their average daily pain score to ≤4 (on a 0–10 scale of increasing pain) for three out of five consecutive days. Stabilized patients entered the maintenance phase for an additional five months, with dose adjustments and oxymorphone immediate release (IR) 5 mg rescue medication as needed. Patients used diaries to record daily average pain, daily dose of oxymorphone ER, and use of oxymorphone IR.
Results: Ninety-four (74.6%) patients achieved a stabilized dose, with 20 (15.9%) discontinuing because of AEs. The median time to stabilization was 16 days (95% confidence interval, 14–20 d). 60 (63.8%) stabilized patients completed the maintenance phase, with 16 (17%) discontinuing because of AEs considered possibly or probably related to study medication. The most frequently reported AEs were constipation, somnolence, nausea, and dizziness; most were rated mild or moderate. There were seven serious AEs; six were considered unlikely related, and one (abdominal pain) was deemed probably related to study medication. The average daily dose changed little from the beginning of maintenance (27.7 mg) through the end of month five (30.8 mg). Use of oxymorphone IR averaged less than two tablets per day (range, 6.1–7.6 mg). The mean (± standard deviation) of the average daily pain score decreased from 6.2 (±1.3) at screening to 2.5 (±1.6) at one month of the maintenance phase (P<0.001). Thereafter, mean average pain remained <2.5 (P<0.001 for all months of the maintenance phase). Most patients and physicians assessed overall pain relief as good to excellent with a high level of satisfaction with oxymorphone compared with previous pain medication.
Conclusions: Oxymorphone ER q12h provided effective long-term relief in opioid-naive patients with moderate to severe chronic pain. By initiating treatment at a low dose and increasing slowly to minimize opioid-related AEs, the majority of patients achieved adequate relief of moderate to severe pain with good tolerability.
14. Nutritional Assessment of Liver Transplant Patients: A Physiologic Approach. V.C. Zacharias, B.J. Borjas, T. Kaiser, K. Hess, and G. Neff, University of Cincinnati, Internal Medicine, Digestive Diseases, Cincinnati, Ohio
Background: In the infancy of transplantation programs, the initial goal was to focus on patient survival. The emphasis has shifted to provide patients improved quality of life. This includes their nutritional well being, and ability to return to a previous healthy lifestyle. Liver transplant recipients suffer sarcopenia as a result of marked malnutrtion and deconditioning prior to liver transplantation. Patients suffering from end stage liver disease (ESLD) are in a state of flux due to muscle wasting and the accumulation of fluid in the form of ascites as the disease progresses. Each transplant patient poses a unique set of problems in terms of nutritional assessment, primarily due to a malfunctioning liver and the resultant decrease in metabolism and energy production. Nutritional status is difficult to evaluate in these patients and there is no present day standardized methodology to investigate and monitor these parameters.
Objective: We propose using a unique combination of physiologic parameters to determine this patient population's nutritional condition during the peri-transplant period. The test parameters will be distilled into a single numeric score called The Transplant Index of Nutritional Status (TINS) whose value will be used as an objective guide to assist in patient management.
Methods: Patient demographics collected include: gender, age, indication for transplant, and time to diagnosis of cirrhosis. Parameters to assess physiologic status include: subjective global assessment (SGA), bioelectric impedance analysis (BIA), skin fold measurement, body mass index (BMI), and handgrip strength. Anthropometric measures include weight, height, and mid-arm circumference. SGA was determined using an SGA rating form. BIA was measured at 50kHz, with total body water, fat mass, and fat free mass (FFM) determined using a bioimpedance analyzer with internal calculations. Right arm skin fold measurements, utilizing standard calipers, obtained by the same operator, calculations by the Durnin and Womersley equation provided FFM. BMI utilizing accepted norms was collected. Handgrip strength was measured using a standard dynamometer, on the non-dominant arm, with reported average force and coefficient of variation.
Results: In this pilot study, 10 ESLD patients met study criteria; females (n=3), males (n=7). Indication for transplant: Chronic HCV (n=4), Alcoholic Liver Disease (n=3), Cholestatic Liver Disease (n=3). The mean time from diagnosis of cirrhosis was 5.1 years. SGA information included: females; moderate (n=2), severe (n=1), males; moderate (n=3), normal (n=2), severe (n=2). Each parameter trended down in the six month period prior to liver transplantation while the post transplant period demonstrated a slow resolution of improvement during the study period.
Conclusion: Based on prior analyses, and with this preliminary data, using a weighted combination, it is possible to have a single predictive analysis of nutritional status (TINS). With the use of TINS, the transplant team will have an objective measure in order to determine which patients require nutritional and educational intervention for their continued improvement and survival prior to and after liver transplantation. We are planning a logistic regression model in the near future in order to facilitate and confirm these findings.
15. Occupational Daydreams of Physician Assistants Based Upon Holland Typologies. D. LaBarbera and L. Placeway, Rosalind Franklin University of Medicine and Science, PA Department, North Chicago, Illinois
Introduction: Occupational Daydreams have been studied since the mid-nineteen hundreds, looking for correlations and predictive validity of vocational choices. Many researchers including Holland strongly support the theory that occupational daydreams have predictive validity for vocational choice and thus can be a beneficial component of career counseling. Holland views occupational daydreams in terms of six RIASEC types: Realistic, Investigative, Artistic, Social, Enterprising, and Conventional. There are no large scale occupational daydream studies of any vocation.
The purpose of this study was to determine the Occupational Daydreams of Physician Assistants satisfied with their career choices.
Methods: This was a retrospective study that utilized nationally representative data gained from a survey solicitation of 2325 members of the AAPA’s mailing list. From a 50% survey response rate, 945 PAs who were satisfied with their career choices were mailed Holland’s Self Directed SearchForm R. Of these, 463 usable SDS booklets were returned. The Occupational Daydream section was completed by 389 participants (83.6%). Coding of Occupational Daydreams was conducted according to Holland’s typology.
Results: Statistical comparisons of the Occupational daydream respondents to the SDS respondents (who were representative of AAPA’s demographics) demonstrated that the Occupational daydream respondents were representative. The most frequent occupational daydreams in descending order were: physician, teacher, business owner, nurse, pilot, author/writer, veterinarian, counselor or research, biologist, and lawyer, photographer, or psychologist. From 378 participants (1337 codes), the overall PAs Occupational Daydream code was ISE, reflecting that of a general practice physician.
Discussion and Conclusions: Occupational Daydreams may be a quick and reliable index of an individual’s personality type and may be an accurate predictor of future career choices. This is the first large scale study of occupational daydreams for any profession. Understanding these Occupational Daydreams could be beneficial in career counseling for prospective PAs.
16. The Effect of Ethnicity on Immediate Reconstruction Rates after Mastectomy for Breast Cancer. J. Tseng, S. Kronowitz, C. Sun, A. Perry, G. Babicra, K. Hunt, H. Kuerer, L. Newman, G. Robb, and S. Singletary, University of Texas MD Anderson Cancer Center, Houston, Texas
Background: Multiple factors may influence whether patients undergo immediate breast reconstruction along with mastectomy for breast cancer. The authors investigated whether ethnicity was an independent predictor of immediate breast reconstruction.
Methods: The authors identified 1004 patients who underwent mastectomy for breast cancer during the period 2001-2002. The rates of immediate reconstruction among different ethnicities were evaluated using the chi-square test. Logistic regression was used to adjust for covariates, including age and disease stage. Medical records were analyzed to identify factors that influenced each patient's decision for or against immediate breast reconstruction.
Results: Three hundred seventy-six women (37.5%) underwent immediate breast reconstruction: This included 20.2% of African-American women, compared with 40.0% of white women, 42.0% of Hispanic women, 42.2% of Asian women, and 10.0% of Middle Eastern women (P < 0.001). The unadjusted odds ratio (OR) for immediate reconstruction for African-Americans versus whites was 0.38 (95% confidence interval [95% CI], 0.23-0.63; P < 0.001). After multivariate analysis, this disparity persisted, with an adjusted OR of 0.34 (95% CI, 0.18-0.62; P < 0.001). Asian women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.50; 95% CI, 0.24 -1.04; P = 0.06). Hispanic women did not have immediate reconstruction rates that differed significantly from white women. Middle Eastern women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.08; 95% CI, 0.02-0.38; P = 0.002), but they had a corresponding increase in the rate of delayed reconstruction. In a stepwise analysis of the decision pathway to immediate reconstruction, it was found that African-American women were less likely to be offered referrals for reconstruction, were less likely to accept offered referrals, were less likely to be offered reconstruction, and were less likely to elect reconstruction if it was offered.
Conclusions: African-American women underwent immediate breast reconstruction at significantly lower rates compared with white women, Hispanic women, and Asian women. After adjusting for covariates, including age and disease stage, African-American women and Asian women had lower rates of reconstruction compared with white women. The factors that contribute to these differences warrant further study.
17. Autologous Chondrocyte Implantation for Focal Chondral Defect of the Patella. S. Saddler and P. Porter, INOVA Mount Vernon Hospital, Alexandria, Virginia
Introduction: A focal chondral defect is a common source of knee pain. Optimal treatment for this common problem, however, poses a challenge for the clinician. Failures have resulted from conservative management and those that create fibrocartilage. Autologous chondrocyte implantation (ACI) has shown to produce favorable results in the replacement of articular cartilage with hyaline-like tissue. We present a case of ACI of the patella without realignment with positive results.
Case Study: A 32 year-old female with knee pain, slight varus alignment, and a 30 degree Q angle underwent arthroscopy, loose body excision, Genzyme biopsy, drilling of the lateral femoral condyle and chondroplasty of the medial femoral condyle and patella. Findings included an osteochondral defect of the medial femoral condyle (20 x 10 mm), lateral femoral condyle (3x 10mm), and an osteochondral lesion of the patella (30 x 20 mm). Due to pain six months post arthroscopy, she underwent an Autologous Chondrocyte Implantation for the medial femoral condyle and patella. Follow-up at six months and one year revealed modified Cincinnati knee ratings of excellent (86 pts) compared to her initial score of fair (68 pts).
Conclusion: ACI has shown to generate a durable hyaline-type replacement of an osteochondral defect. Although it is recommended that patients undergo patella realignment with ACI to improve results, our patient achieved an excellent result after ACI of both the patella and medial femoral condyle without patella realignment. We present this case to demonstrate that successful outcomes may be possible without realignment.
EDUCATION GALLERY
Original Research
18. Analyzing Survey Research in Physician Assistant Education: 1992-2005. P.E. Jones and R. Hooker, University of Texas Southwestern Medical Center, Dallas, Texas
Purpose: To identify trends in survey research conducted by physician assistant educational researchers and variables associated with differing response rates.
Methods: A retrospective review of all survey research reported in Perspective on Physician Assistant Education between 1992 and 2005 was conducted. Exclusion criteria were limited to surveys reporting data on currently enrolled students of individual programs, due to the falsely elevated response percentage obtained when faculty require participation.
Results: A total of 55 published survey research reports met the inclusion criteria. Of these, 33 (60%) were conducted by mail, seven were Internet-based, three were telephone only, two were mixed mail/E-mail/fax/telephone, and ten (18%) did not report the survey methodology. The most frequently surveyed cohorts were clinical physician assistants (N=13), physician assistant program directors (N=10), and physicians (N=8). Response rates for all surveys ranged from 16.9 to 100%, with an aggregate mean response rate of 60.8%. The highest mean response rate (100%) was obtained via telephone surveys, and the lowest was obtained via the Internet (54.3%). The mean mail-based survey response rate was 59%. Mean cohort response rates were as follows: PA program directors = 65.7%, clinical PAs = 52.5%, and physicians = 39.8%.
Conclusions: These data identify the cohorts most frequently surveyed by physician assistant educational researchers, the cohorts with the highest response rates, the evolving trend of Internet-based survey research, and the mean response rates between cohorts. The results identify trends to assist educational researchers as they design research methodologies to result in greater return rates when conducting survey research. Additionally, the results identified important cohorts that have received sparse attention in physician assistant educational research, such as post-graduate program directors and residents (one study each) and administrators and graduates of international PA programs (no studies). Deficiencies in the methodology and reporting of survey research were noted in the manuscript reviews. The N of subjects was missing in three studies, the subjects were mixed responders of faculty and students in one survey and physician assistants and nurse practitioners in another. When added to the relatively high number of reports that failed to identify survey methodology (18%) or target subjects (10.9%) these findings suggest a need for improved peer review of manuscripts prior to publication. Additional research is needed to clarify anecdotal mismatches of survey administration perception and reality. For example, physician assistant program directors report concerns over the frequency of surveys they receive, but only ten reached publication in this venue over a 13 year period. According to this study, very little is known about post-graduate physician assistant training programs and residents, and no survey data have been published in this journal on international programs or graduates. Given the recent increase in the interest in international PA training programs and the substantial increase in the number of U.S. post-graduate programs and enrolled residents, these areas call for further inquiry.
19. Correlation of PANCE Performance with Transition Points during Physician Assistant (PA) Education. C. Blankenship and G. Boissonneault, University of Kentucky, Lexington, Kentucky
Purpose: Of the many criteria by which a PA program may be evaluated, PANCE performance is among the most objective and meaningful. The purpose of the study was to evaluate performance indicators from specific didactic and clinical transition points in the University of Kentucky Physician Assistant Studies Program (PAS) as predictors of first-attempt Physician Assistant National Certifying Exam (f-PANCE) performance.
Methods: Grade point averages (GPA; at the end of the didactic [D-GPA] and clinical [C-GPA] phases) and Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACK-RAT) were compared to the f-PANCE scores for students in the graduating classes of 2003, 2004, and 2005 at the University of Kentucky Physician Assistant Masters Program. The study population included 129 students, with 46 (35.5%) from the class of 2003, 37 (29%) from the class of 2004, and 46 (35.5%) from the class of 2005. Linear regression analysis was utilized to compare PANCE score performance to the indicated program performance surrogates.
Results: All three surrogates were found to significantly correlate with f-PANCE performance. Of the three, C-GPA was least predictive with R 2=0.05 and P≤0.01. In contrast, D-GPA correlated with f-PANCE with R 2=0.39 and P≤10 -14 while PACK-RAT correlated with R 2=0.63 and P≤10 -28.
Discussion: Others have examined predictive relationships between various performance surrogates and f-PANCE performance including didactic and clinical performance, length of curriculum, and PACK-RAT scores. Like this study, these reports suggest PACKRAT scores to correlate best with f-PANCE performance. While useful, it may be more useful to identify earlier success indicators in order to improve curriculum, streamline remediation efforts, and ultimately improve success in PA education.
20. What Happened in Basic Clinical Skills 2005? Teaching the Physical Exam. G. Landel, R. Cupp, D. Brock, and K. Wick, MEDEX Northwest, Seattle, Washington
Introduction: Our physician assistant program has taught the Basic Clinical Skills (BCS) portion of its PA program in the same format for several years. In this course, students learn how to perform history-taking and physical examinations for a broad range of systems. Instructors for physical exams include practicing specialists who provide instruction on a part-time basis as well as core faculty. Each year there are only a handful of students who fail to meet the minimum requirements for a particular physical examination. These students must then pass a re-test in order to achieve a minimum passing grade in BCS. In 2005, more students required re-testing than in previous years.
Methods: In order to understand this shift, we interviewed students who were required to re-test as well as students who had met our program’s criteria for success. Interviews were conducted after re-testing of the physical examinations had been completed (re-testing occurs immediately following final exam week). We then examined evaluations and test scores of all students and explored possible factors that might impact student performance. Information from student evaluations and interviews was correlated with examination scores. Paired t-tests were used to compare scores received from specialist non–full-time instructors with scores received from full-time faculty, and chi-square tests compared binary outcomes (e.g., pass/fail) across these same two groups.
Results: Interviews revealed student beliefs that training was inconsistent among the various coaches during the quarter. Students reported that non-faculty specialists taught at a higher level than core faculty and at a level that was beyond their understanding. Analysis shows that students who were taught by non–full-time faculty earned statistically significant but roughly equivalent mean scores on their physical examination testing (non–full-time = 94, full-time = 96, P = .001). However, the variability of their scores was markedly wider than the other students (non–full-time variance = 44, full-time variance = 27). Students’ performance on musculoskeletal examinations was lower than on other organ system examinations. Physical exam instruction by specialist PAs was particularly troublesome for the students.
Conclusion: Mean performance on physical exam testing is roughly equivalent regardless of whether physical examination coaches are full-time faculty or part-time specialists, though variability in student performance and reported satisfaction is not equivalent. For example, students report more difficulty learning musculoskeletal physical examination procedures when specialists in orthopedic medicine deliver the initial presentations. This suggests that more extensive training is warranted for non–full-time faculty who are acting as physical examination coaches. Alternatively, class size could be reduced (thus reducing the number of small groups) so that full-time faculty can provide instruction for all student physical exam groups. Further study should address the possibility of combining student groups as they learn basic clinical skills or rotating faculty to different groups as the students are learning the various examinations. Our findings suggest that teaching physical examinations should be the responsibility of full-time faculty or that additional training should be provided to non–full-time faculty in order to ensure an equivalent student experience.
21. What Primary Care Procedural Skills are PA Schools Teaching and how are they Teaching them? J. Carlson, Stacy Laack, and C. Stilp, Rosalind Franklin University, Physician Assistant Department, North Chicago, Illinois
Purpose: To identify primary care technical procedural skills commonly taught by PA programs and to what extent they are taught.
Methods: Based on a review of the literature, primary care procedural skills and several emergency procedures were identified as to their importance and current use in practice. A survey was developed and sent to all APAP programs to identify if PA programs are teaching these skills, how they are being taught, and if PA programs feel they are able to verify direct experience in these procedures as part of their clinical training. University IRB approval and APAP approval was attained. Surveys were conducted online and results reviewed as part of a student thesis research project.
Results: The majority of PA programs (> 80%) have a formal clinical procedures course and report that they review the procedural skills taught in their curriculum annually for relevance in current clinical practice. Out of 50 procedures surveyed, all were addressed by a majority of PA curricula and nine (complex suturing, simple suturing, bladder catheterization, casting, splinting, endotracheal intubation, ACLS, IV catheter insertion, and venipucture) were identified as being taught during didactic training as important enough to warrant a laboratory or simulated exercise to ensure student competence in >75% of responding programs. Simple suturing/ laceration repair was the only procedure identified where >75% of programs could report that all students received experience during clinical training. There were no procedures surveyed that >50% of programs reported as not being addressed in their curriculum.
Conclusions: Generally, PA programs appear to be teaching a variety clinical procedural skills with several skills common across most curricula. There is variation with how and to what degree they are being taught from curricula to curricula, but an emphasis on simulation/ laboratory exercise in several indicates that PA faculty are going to lengths to ensure student competence in a select few. Further study needs to be done to correlate what procedural training PA programs are emphasizing as compared with what practicing PAs are expected to perform in primary care settings.
Previously Presented
22. PACKRAT, GPA and PANCE: A Comparison Analysis of Predictive Performance. C. Shallenberger, B. Fondy and R. Hutchinson, Seaton Hill University Physician Assistant Program, Greensburg, Pennsylvania
Purpose: The purpose of this study is to determine the relationship between individual student scores on the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) at multiple administration points in their physician assistant education, cumulative grade point averages (GPA’s) in the didactic and clinical curriculums and individual student scores on the PANCE.
Methods: The PACKRAT examination was administered to physician assistant students at three data points: before beginning the PA program, near the end of the didactic curriculum and near the end of the curriculum. Cumulative GPA’s were calculated for students for the didactic curriculum and for the clinical curriculum. The PACKRAT scores and GPA’s were then compared to PANCE scores for the same students.
Results: Analysis of the data reveals a positive correlation between the PACKRAT and PANCE scores at all data points. The correlation becomes progressively stronger from the baseline administration at the beginning the program through clinical year administration, which had the strongest correlation (r = 0.611). The didactic and clinical grade point averages also demonstrated a positive correlation with PANCE scores with ‘r’ values of 0.689 and 0.622 respectively. The highest ‘r’ value overall was between the didactic year GPA and the PANCE score.
Conclusion: Performance on the PACKRAT examination does demonstrate a positive relationship with PANCE performance. Although our sample size is small, our results do confirm the findings of positive correlation noted in previous studies (Cody, 2004 and Bruce, 2004). The data indicates that the strongest correlation in PACKRAT administration is near the end of the clinical year. The cumulative GPA at the close of the didactic curriculum has the most positive correlation of all variables analyzed with an ‘r’ value of 0.689.
It is difficult to generalize this information with a small sample size and limited numbers of students who performed poorly on the PANCE. A multi-center analysis involving (at the current time) six physician assistant programs is underway. The group is planning to study similar data sets and also to attempt to determine benchmark PACKRAT scores in relationship to PANCE performance.
STUDENT GALLERY
Outstanding Student Research
23. Evaluation of an Extended-Interval Gentamicin Dosing Protocol in Neonates £ 33 Weeks Gestational Age. J. Thomas, Wichita State University, Wichita, Kansas
Problem: Gentamicin is a commonly used antibiotic in the neonatal intensive care unit (NICU). Extended-interval dosing (EID) is the standard of care in adults nationwide due to ample evidence demonstrating that achieving appropriate antibiotic levels early in treatment improves effectiveness and reduces risk of gentamicin-induced nephrotoxicity and reduces treatment and monitoring costs. Unfortunately, only a limited number of studies have been conducted in neonates and these have included only small numbers of very premature neonates (GA ≤ 33 weeks). Because gentamicin has variable effects in different populations, data cannot simply be extrapolated to all neonate populations.
Purpose: This study evaluated the adoption of a simplified, weight-based, EID gentamicin protocol in neonates with a gestational age ≤ 33 weeks, and its impact on sub-therapeutic peaks, elevated troughs, and simplification of dosing and monitoring as compared to a traditional, gestational-age based, weight-based, multiple daily dose (MDD) protocol.
Methods: The MDD group consisted of all infants with a gestational age ≤ 33 weeks receiving gentamicin from Jan 2001 to Dec 2001 using a traditional MDD protocol. These patients received 2.5mg/kg every 8, 12, 18, or 24 hours based on three weight groupings and two age groupings. The new EID protocol was implemented throughout the NICU in Jan 2002. The EID group consisted of all infants with gestational age of ≤ 33 weeks receiving gentamicin from Mar 2002 to Feb 2003 using the newly adopted EID protocol of 3mg/kg q24h if weight < 1500gm and 4mg/kg q24h if weight ≥ 1500gm. The desired trough for these protocols was ≤ 2.0 mcg/ml and the desired peak was 5 – 12 mcg/ml.
Results: Data was collected on 123 patients in the MDD group, and 98 patients in the EID group. Average gestational age, gender, average birth weight, and length of stay were similar for both groups. The percentage of infants with at least one sub-therapeutic peak during therapy was significantly lower for the EID group (7% vs. 20%, p < 0.001); however the percentage of babies with at least 1 elevated trough was similar between the two groups (15% vs. 19%, p = 0.219). The average number of peaks obtained per patient was significantly lower in the EID group (1.36 ± 0.69 vs. 1.76 ± 1.38, p = 0.006) as was the average number of troughs obtained per patient (1.4. ± 0.77 vs. 1.91 ± 1.45, p = 0.001). As expected, the average number of doses administered per day was also significantly lower in the EID group (1.23 ± 0.70 vs. 1.47 ± 1.20, p = 0.016).
Conclusions: In this very premature neonate population, gestational age ≤ 33 weeks, this simplified, weight-based, EID gentamicin protocol appeared to provide optimal therapeutic levels requiring fewer serum measurements and fewer doses administered per day as compared to a traditional gestational-age and weight-based, MDD protocol.
24. Retinal Degeneration: Effects of Elevated Plasma Homocysteine on Retinal Morphology of Diabetic Mice. T. Van Ells, B. Moister, L. Amarnath, S. Haddow Reffett, P. Roon, S. Smith, V. Ganapathy, and B. Mysona, Medical College of Georgia, Physician Assistant Program, Augusta, Georgia
Purpose: Modest elevation of homocysteine (Hcy), a sulfur-containing amino acid that enhances the vulnerability of neuronal cells to excitotoxic injury, is a risk factor in hypertension and neurodegenerative diseases. Clinical studies implicate elevation of plasma Hcy in the pathogenesis of diabetic retinopathy, which is characterized by neuronal loss and vasculopathy. The present study addresses whether moderate elevation of plasma Hcy in the presence of diabetes accelerates neuronal cell loss in diabetic retinopathy.
Methods: Founder mice, heterozygous for a mutation of the cystathionine beta synthase (CBS) gene, were used to establish our colony. CBS +/- mice have seven fold increase in plasma Hcy levels when maintained on a high methionine diet (HMD, 0.5% methionine drinking water). Mice were fed the HMD from the time of weaning. Diabetes (DB) was induced in three week old mice using three injections of streptozotocin (75 mg/Kg). Two groups of mice were studied: DB/high Hcy mice and non-DB/normal Hcy (controls). At 10 and 15 weeks post onset of diabetes, eyes were obtained, embedded in OCT and 10 m m thick cryosections prepared. Sections were evaluated morphologically.
Results: Significant differences in retinas of DB/high Hcy mice (n=5) versus controls (n=5) were obtained 15 weeks post-onset of diabetes. Total retinal thickness was significantly decreased in the DB/high Hcy mice compared to controls (188.0μm ± 7.0 versus 243.2μm ± 12.9, respectively, p<0.005). Measurements of the inner nuclear layer and inner plexiform layer revealed a marked decrease in DB/high Hcy mice compared to controls (27.1μm ± 1.1 versus 36.2μm ± 1.7, p<0.005; 34.1μm ± 1.3 versus 43.5μm ± 2.1, p<0.005, respectively). In addition, DB/high Hcy mice had significantly fewer retinal ganglion cells than controls (9.3 cells/100μm ± 0.1 versus 14.1 cells/100μm ± 0.4, respectively, p<0.005).
Conclusions: There is a significant decrease in the thickness of the total retina in DB/high Hcy mice. Specifically, the thickness of the inner nuclear layer and inner plexiform layer is significantly reduced. In addition, the number of retinal ganglion cells is reduced in DB/high Hcy mice compared to controls. When compared to previous studies from this laboratory, moderate increases in plasma Hcy coupled with diabetes cause a more dramatic alteration of retinal phenotype than elevated Hcy or the presence of diabetes alone. Substantial decreases in the numbers of retinal ganglion cells and reduced numbers of cells in the inner nuclear layer lead us to predict that retinal function will be severely compromised in these mice. Future studies will determine the effects of Hcy on retinal function. Since folate levels are inextricably linked to Hcy levels, future studies will also analyze the effects of folate supplementation on mice exposed to high levels of endogenous Hcy.
25. The Public Awareness Regarding Male Breast Cancer. T. Sanderson, O. Chen, and L. Hill, University of North Texas Health Science Center, Fort Worth, Texas
Purpose: The purpose of this research was to investigate the level of public awareness regarding male breast cancer.
Method: This study used survey and convenience sampling methods to collect data. The included participants were English speaking individuals 18 years of age and older. The survey consists of 10 questions which assessed awareness of: (1) male breast cancer, (2) the diagnostic testing utilized, and 3) the disease clinical presentation. The survey was distributed during June, July and August 2004 at three different locations in Texas. On completion of the survey, participants were given an educational pamphlet containing statistics, risk factors, signs/symptoms, detection and prevention of male breast cancer. SPSS version 11.5 was utilized to perform Chi-square for the statistical analysis.
Results: A total of 355 surveys were distributed and completed. The results showed that 316 (89.0%) participants expressed an awareness of male breast cancer. Nearly half of the participants, 164 (46.3%), reported awareness of mammography’s diagnostic role in male breast cancer. Less than a quarter of the participants (23.2%) acknowledged an awareness of the associated signs and symptoms of male breast cancer. These three key questions were also compared by gender, age, ethnicity and educational level. Female participants had a better understanding compared to the male participants regarding male breast cancer awareness and diagnostic testing used (x2=4.63, x2=10.64; p<0.05). Participants 46 years of age and older were more knowledgeable than participants 18-45 years of age about male breast cancer awareness, diagnostic testing and clinical signs/symptoms specific to the disease (x2=15.69, x2=17.32, x2=6.039; all p<0.001). There were no statistical significance noted among the different ethnicities regarding male mammography as well as the disease signs and symptoms (all p>0.05). There were no statistical significant differences noted among the different educational levels on all three key questions (all p>0.05). The participants reported that the most common informational source of male breast cancer was media (56.3%).
Conclusion: The study results showed that the public has a general awareness of male breast cancer; however, the results seemed to indicate a superficial understanding. This indicates a need for male breast cancer public education, specifically focused on the recognitions of the clinical signs and symptoms of the disease. Media was reported to have the most significant role in the educational process of this disease; therefore, it would be ideal to use multiple media sources to complete this task.
The biases of this research were using convenience samples and health promotion centers as sampling sites, which would likely attracted individuals who had more interests in health maintenance. Regarding future research recommendations, it would be advantageous to select sample locations outside of health promoting environments to expand the diversity of the participating population.
Original Research
26. A Patient's Guide to Common Laboratory Tests. J. Penn, J. Twietmeyer, J. Fenner, S. Lasher, K. Bennett, M. Tuffo, S. Hoffmann, E. Dobler, and M. Sobolewski, Drexel University, Philadelphia, Pennsylvania
Purpose: The purpose of this study is (1) to design and implement education brochure on common laboratory tests and (2) to assess participant’s knowledge of common laboratory tests.
Methods: As a component of the Leadership and Stewardship Course, the authors were required to develop a patient education brochure. Reflecting upon the authors past experiences in the medical profession, the authors realized there was a need to better educate patients about common laboratory tests. As PAs and public educators, it is our role to take initiative in increasing patient knowledge. We believe that if patients are given the opportunity to learn, they will be more informed.
This was a mix-methodology research study. Respondents in this study included 100 participants from Pennsylvania, New Jersey, California, Ohio, Connecticut, Michigan, Texas, and New York. A five question pre-test and post-test was administered to the research participants to assess their knowledge of common laboratory tests. The pre and post test consisted of the same five closed-end questions. The test questions addressed purpose of laboratory tests, procedure for laboratory tests, and anticipated results for laboratory tests. Research study participants were administered the pre-test prior to reading the patient education brochure. After reading the patient education brochure research study participants were administered the post-test and asked to respond to 1 open-ended question. The open-ended question addressed the strengths and weakness of the patient education brochure. The study incorporated quantitative and qualitative paradigms. The process of triangulation was used to control for any inherent bias of the closed-ended and opened-end question. The qualitative data obtained from the closed-ended questions was analyzed using SPSS (Statistical Package for the Social Sciences). The methods used to analyze the qualitative data from the open-end question involved the following format: open coding (initial categories of information formed about the phenomenon being studies) and axial coding (data is assembled in new ways after open coding identifies a central category about phenomenon).
Results: It is anticipated that research study participants will be better informed of the common laboratory tests as a result of reading a cultural sensitive patient education brochure and this may translate into increased compliance when laboratory tests that are order for patients.
Conclusion: Patient education studies are important and offer valuable insight into the results of introducing medical knowledge to everyday people. This study has helped us recognize that patients may be more motivated to act on their own behalf when given the information to do so. Patients who are more informed about their health are better able to play an active role in their health care. A patient with hypercholesterolemia who is not going to the lab for their routine lipid panel test, may be unknowingly putting their health in jeopardy by not realizing that part of the lipid panel test is measuring their cholesterol levels. With knowledge and understanding comes empowerment to make positive changes toward better health.
27. A Proposed Curriculum Design for a Postpartum Depression Workshop for Clinicians. L. Ireland, P. Pagels, O. Chen, and J. Shores, University of North Texas Health Science Center, Fort Worth, Texas
Purpose: Early recognition and treatment for patients with postpartum depression is of great importance. The purpose of this project was to design a workshop that would: (1) provide knowledge and tools to help clinicians determine risk factors, recognize signs and symptoms, and to be able to screen patients for postpartum depression and psychosis; and (2) provide clinicians information about current treatment options and interventions.
Methods: This proposed workshop is designed to be a Continuing Medical Education ( CME) activity consisting of two one-hour interactive lectures and a one-hour case study workshop. The target audience in this workshop is clinicians who have contact with women who may be pregnant or plan to become pregnant, have contact with women of childbearing age, or women with children under the age of two years. The effectiveness of this workshop will be assessed by using pre and post workshop surveys and a follow-up survey six months after the workshop.
Results: There are three hours of curriculum included in this workshop. The first hour contains a motivational briefing by providing the prevalence, statistics, and the importance of recognizing postpartum depression. The main lecture consists of (1) Defining postpartum blues, depression, and psychosis; (2) Recognizing risk factors; (3) Recognizing major signs and symptoms; and (4) Developing a differential diagnosis; followed by: (1) Interviewing techniques and communication skills; (2) Screening tools; and (3) Treatment options for the second hour. The goal for the third hour is to apply learned knowledge to two case studies. This section includes practice in: (1) Developing a case-specific list of risk factors and interview questions by using two designed cases; (2) Analyzing results of screening tools for each case; and (3) Formulating an assessment and plan of action for each case.
Conclusion: It is anticipated that upon completion of the workshop, the participating clinicians will significantly increase their ability and confidence in assessing postpartum women for depression. Implementation of this workshop would be required to determine whether attending this workshop would result in improved recognition of postpartum women with depression.
28. A Study of Frequent Horse Riders in South Central Kansas: Their Perceptions and Knowledge of Riding Safety. J. Allen and S. Nyberg, Wichita State University, Wichita, Kansas
Purpose: Injuries sustained while riding a horse are common and can be devastating. Horse riding is a dangerous pastime with more accidents occurring per hour than during motor-cycling. Head injuries are the most common cause of hospitalization following injury. The purpose of this study is to survey a population of frequent horse riders in south central Kansas about their attitudes toward safety when riding horses and to determine the percentage of horse riders who own and utilize safety equipment while riding. It is anticipated that the information gained from this study will be incorporated into a horse-riding safety awareness program being developed by mid-level providers at a Level I trauma center.
Methods: A convenience sample of frequent horse riders in four, rural Kansas counties was selected for participation in this study. Researchers attended meetings of county saddle clubs and attendees age 13 and older were asked to complete a short survey. Parental consent for participation was obtained for all minor children. A nine-item survey was designed to investigate the demographics and characteristics of the rider’s safety. Data points included: age, gender, frequency of horse riding, ownership of a riding helmet, use of a helmet while riding, education regarding riding safety, type of individual providing safety education (health care professional, parent, 4-H leader, etc.) and injuries sustained while horse riding. Data were analyzed using standard statistical methods.
Results: A total of 127 riders completed the survey tool. The majority of the subjects (62%) rode their horses eight or more times a month. While horse riding, 60% of the subjects have sustained injuries. Of the riders surveyed, only 26% of the riders owned a riding helmet. For those who do own helmets, they were worn less than 25% of the time when riding. The majority (82%) of the riders know of the importance of wearing a riding helmet. Only 3% of the riders were educated about riding safety by a healthcare professional.
Conclusion: Data revealed that the majority of horse riders know the benefits of wearing safety equipment, yet they still chose not to wear head protection. Of the riders who have been educated on wearing head protection, very seldom has the advice been given by a healthcare professional. This information highlights an area in which health care professionals can play a role in providing vital health and safety education to their patients who are frequent horse riders.
29. An Analysis of the Value Card Sort Responses of One Private University’s Physician Assistant Classes of 2003-2007. C. Lanier, R. Wilkerson, and Dawn LaBarbera, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
Background: There are many factors that determine job satisfaction including values, personalities, attitudes, and work environments. In theory, attention to these variables can aid vocational decision-making and thereby impact satisfaction. There is no research specific to the vocational values of any profession. Understanding the values important to Physician Assistants would add to the knowledge of the PA profession’s traits thereby aiding vocational counseling.
Purpose of the Study: To investigate the vocational values of one private university’s PA students (classes 2003-2007).
Methods:
Subject Selection -A convenience sample of 264 PA students from one private university volunteered their results from a required value card sort assignment conducted during the P.A. Professional Issues and Ethics course (HPAS500). Identifiers were removed for research use.
Card Sort Assignment -PA students are each given a card sort exercise consisting of 100 pre-printed value cards, a yes card, and a no card. Users are asked to quickly sort through the value cards into yes (important) and no (not important) stacks with consideration of personal life values and of a career as a physician assistant. The yes stack is re-sorted to leave only ten of which the top three are rank ordered. Results of the rank order and top ten are recorded onto a personal profile summary sheet.
Data Processing -Variables collected included class year, gender, top 10 career values and the rank-ordered top three. Values were categorized and frequency analyses were performed. Chi-square analysis was used to test for significant differences between values.
Results: There was a 96.7% participation rate of 273 PAS (n=264); 82.6% (n=218) female and 17.4% (n=46) male students, reflecting the gender distribution of the PA class. The three most frequently cited values were “doing what I enjoy,” “developing a work/life balance,” and “being a good parent.” Within the top ten vocational values, female students differed significantly from the male students in choosing the value “being in a supportive community or family” more frequently. (p<0.05)
Conclusions: This is the first study of career values on the Physician Assistant profession. While this study is limited to PA students of one program, there appear to be certain themes emerging for career values. Male and female students are showing some differences in the values they deem important when making vocational decisions. This study could be furthered by expanding it to the PA profession at large.
30. An Investigation of the Use of Barrier Protection During Oral Sex in College-Aged Students: Are Students Aware of the Dental Dam and Using It Correctly? A. Coble, M. Manzo, E. McKnight, and M. Natali, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: With ten to twenty million new sexually transmitted diseases cases being diagnosed each year, associated costs amount to approximately 17 billion dollars annually. One-quarter of these cases occur in adolescents. Although many adolescents are aware of the risks of unprotected intercourse, few seem to understand the risks of unprotected oral sex, rating it as a safe alternative to sexual intercourse in previous studies. Skin to skin transmission of diseases such as syphilis, Human Papilloma Virus, herpes, and chancroid can occur during oral sex. In addition, bodily fluids may be transferred resulting in transmission of Human Immunodeficiency Virus. As potential Primary Care Physician Assistants, we may have the unique opportunity to educate young adults about safe oral sex practices prior to disease transmission. We, therefore, seek to determine whether or not a population consisting of college-aged students is utilizing available barrier protection while participating in oral sex in order to better understand the education level and practices of this age group regarding oral sex. Specifically, we will investigate student knowledge about, and use of, dental dams. We hypothesize that the dental dam will be an underused resource despite student's being aware of risky behavior.
Methods: The study population will consist of individuals 18 to 29 years old enrolled in local colleges and universities. Participating individuals will be asked to fill out a 21-question survey regarding the individual’s current sexual practices, knowledge of disease transmission during sexual activity and their use of protection during sexual activities including but not limited to oral sex. Questions will be a combination of Yes/No questions and Likert-type questions, designed to identify discrepancies between opinions of, and the practice of, safe sexual practices during intercourse compared to oral sex. Questions will also determine where students have obtained most of their knowledge regarding safe sexual practices. Data will be analyzed using analysis of variance and chi-square analysis with level of significance set at a P <0.05.
Results: The results of this study are currently pending completion of survey collection and data analysis. We anticipate that our analysis will reveal a discrepancy between level of sexual activity, perceived risk of behavior and the application of knowledge regarding risk in terms of use safety precautions. In addition, we predict that the dental dam will be an underused resource. Regarding source of knowledge obtained, it is our expectation that more information will be from the Internet and friends than from the patient's health care provider.
Conclusions: The primary care office offers a setting in which the risks of unprotected oral sex may be conveyed to young adults. With the wide range of resources available to this age group, including primarily friends and the internet, information given pertaining to this topic may be conflicting or even inaccurate. It is therefore the responsibility of physician assistants working in this setting to educate patients and to provide information that may potentially lead these individuals to safer sexual practices, thereby reducing the incidence of sexually transmitted diseases, particularly during oral sex.
31. Attitudes and Practices of Physician Assistants in the State of Kansas with Regards to Opioid Management in Chronic Non-Malignant Pain Patients. A. Weaver and T. Quigley, Wichita State University Physician Assistant Program, Wichita, Kansas
Introduction: Acute and chronic pain is common conditions practitioners continually face in diagnosing and treating patients. The use of prescribing opioids in chronic non-malignant pain (CNMP) patients is controversial due to fear of legal issues and a lack of awareness of state guidelines for treatment. The purpose of this research was to investigate the attitudes and practices of Physician Assistants (PAs) in Kansas in the treatment of CNMP and their awareness of state guidelines for controlled substances.
Methods: A cross sectional, non-randomized survey study was administered to all licensed PAs (N=577) in the state of Kansas in 2005. The survey consisted of specific questions regarding attitudes toward opioid management, prescribing habits, and familiarity with the recommended guidelines of the state of Kansas.
Results: Slightly less than half of the PA’s in this study were aware of state guidelines for the use of controlled substances in CNMP and actively follow three of the five clinical documentation recommended. Among the177 PAs responding in study, only nine percent stated they would never prescribe an opioid for the use of CNMP. There was a significant relationship between awareness of state guidelines and clinical documentation of a history and physical, treatment, and informed consent.
Conclusion: Practitioners continue to be hesitant in prescribing opioids for CNMP due to concern for legal issues and fear of potential substance abuse in patients. This pilot study highlights the need for larger studies of primary clinicians and the potential of patient under- treatment of CNMP.
32. Determining Attitudes of Kansas Chiropractors Regarding Immunization Practices. S. Holman and S. Nyberg, Wichita State University, Wichita, Kansas
Introduction: The number of practicing chiropractors is expected to reach 100,000 in the United States by 2010 and approximately 25% of US citizens visit chiropractors for treatment of health conditions each year. Chiropractors are generally accepted and respected as providers of primary health care services and are in a position to provide the health care consumer with advice regarding health promotion and prevention of disease. Vaccinations are considered by the traditional medical community to be safe and effective to prevent a number of infectious diseases. It is unknown however, whether chiropractors have similar beliefs regarding the safety and efficacy of vaccines.
Methods: The purpose of this descriptive, cross-sectional study was to investigate the attitudes of Kansas chiropractors regarding immunizations. A survey was distributed to all chiropractors in the state of Kansas. The survey collected demographic information including personal and family immunization status, prior medical school education on immunization practice and year of graduation. In addition, chiropractors were asked about their attitudes toward safety of immunizations and whether they recommend immunization to their patients.
Results: Standard statistical analysis revealed that the majority (52%) of Kansas chiropractors believe that immunizations are unsafe and do not encourage patients to be immunized. In addition, 40% believe that immunizations are ineffective in the prevention of disease.
Conclusion: A significant portion of chiropractors in the state of Kansas believe that immunizations are unsafe and ineffective in the prevention of diseases; thereby discouraging their use. The results of this study have significant potential public health implications in the campaign to increase rates of vaccinations among children, thereby reducing the morbidity and mortality associated with vaccine preventable disease.
33. Diabetes Education with Homebound Elderly: Effects on Disease Progression. H. Misja, M. Benedict, and M. Bergseth, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: In the United States, 16 million individuals currently live with diabetes mellitus; approximately 20% of individuals over the age of 65 in North America have this condition. Age related physiological changes increase the risk for this disease, and because of the growth of the aging population in the United States, the prevalence of diabetes mellitus is on the rise. Patients with uncontrolled hyperglycemia have increased risk for many acute and chronic complications. Elderly patients, due to various socioeconomic factors as well as limited understanding of their condition, tend to have difficulty with blood glucose regulation, which is increased by lack of access to health care, resulting from family situations, geographic location, health insurance, family situation, physical ability or personal attitudes. The purpose of this study is to assess the effect of an individual diabetes education program on the understanding and management of diabetes mellitus in the homebound elderly population.
Methods: The population for this study will consist of patients over the age of 65 with diabetes mellitus who are enrolled in the homecare program at one urban health care center. The participants will be divided by the staff of the homecare program into a control and study group. Both groups will receive the standard of care for their diabetic management and other medical conditions, and the study population will be involved in an individual diabetes education course in their home, consisting of education on topics such as disease pathology, medications, foot care, diet, exercise and complications. A standard curriculum will be used, but the education will also address topics about which each patient has questions or concerns. The course will involve five sessions of about one to two hours in length over a period of five weeks; education is administered by second-year physician assistant students. Impact of the education will be assessed by measuring changes in hemoglobin A1C, BMI, waist-hip ratio, systolic blood pressure and weight, as well noting changes in knowledge by comparing results on a brief quiz about diabetes taken both pre- and post-education.
Results: Results of this study are currently pending due to ongoing education and enrollment in the study. It is anticipated that there will be improvement in the patients’ knowledge about their disease state as well as trends toward improvement in clinical measurements.
Conclusions: Studies are not available regarding the effectiveness of diabetes education in the management of diabetes mellitus in the homebound elderly population. However, with the increasing life expectancy and prevalence of this disease state, it is imperative the effective ways to reach this population with educational material are developed in order to help these individuals to remain healthy and as independent as possible.
34. Effectiveness of an Educational Program on Prenatal and Postnatal Care Knowledge in Women Seeking Help from a Crisis Pregnancy Center. N. Thompson, L. Porter, R. Kancianic, and L. Travis, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: Although adolescent pregnancy rates are decreasing in the United States, the rate is still the highest in the fully industrialized nations. Nearly one in three young women before age twenty become pregnant for the first time, finding themselves in need of education and support. In general, this population is at a higher risk for health problems during pregnancy and later in life. It is known that many pregnant adolescents are open to educational programs geared toward increasing their knowledge in nutrition, prenatal and postnatal care. Nutrition education has been shown to improve pregnancy outcomes in studies performed in other countries by reducing incidence of birth defects, low birth weight, and pregnancy complications. These difficulties occur at a greater percentage of pregnancies in adolescents than in adult women, making education beneficial for this population. Due to the fact that nutrition education has been shown to be beneficial, it is likely that education in other areas regarding pregnancy and childcare would be beneficial as well. The proposed program would include education regarding stress management, safety, healthcare, and nutrition with the goal to help reduce the prevalence of these unfortunate outcomes of adolescent motherhood.
Methods: The population in our study will include pregnant women aged 13 to 24 years of age. It is necessary to use this vulnerable population because the purpose of this study is to evaluate a class geared towards improving the knowledge of young pregnant women. The study will be 8 sessions. The eight sessions will be divided by topics including nutrition, safety, fetal and infant growth, and standard prenatal and postnatal medical care. Those participating will be given a packet with the information to be discussed in the course at the start of the study. Data will be collected through anonymous written pre-testing and post-testing on topics covered in the program and will be analyzed utilizing paired t tests.
Results: The results of this study are currently pending completion of the sessions. It is anticipated that the pregnancy course will improve the knowledge of the pregnant women participating, evidenced by an increase in mean score from pretest to posttest.
Conclusion: There are few studies that have been conducted over the years to determine the acceptance and effectiveness of a prenatal and postnatal educational program for young mothers. It is therefore important to assess the benefit of such classes in order to best prepare adolescent mothers for pregnancy and motherhood and decrease the number of complications that frequently present in this age group.
35. Factors Contributing to Tobacco use among Physician Assistants in Kansas. C. Koster and R. Muma, Wichita State University, Wichita, Kansas
Introduction: Research has been conducted on the prevalence of tobacco use among physicians and nurses and whether or not these providers who use tobacco are more or less effective in promoting cessation counseling to their patients. Similar research has not been conducted on PAs.
Methods: The purpose of this cross-sectional study was to explore the prevalence of tobacco use among a convenience sample of physician assistants (PAs) in Kansas, factors contributing to their tobacco use, and whether or not their tobacco use affects their beliefs concerning tobacco cessation counseling. A survey was sent to Kansas PAs regarding these questions and results were analyzed using descriptive statistics and Chi-Square analysis.
Results: The survey response rate was 46% (n=577). The number of PAs that smoked and used other forms of tobacco was 4.3 percent and 2.7 percent respectively. Beliefs concerning the health dangers of tobacco and the importance of tobacco cessation counseling, among others, were statistically different among the tobacco users versus the non-tobacco users. Physician Assistants that were smokers believed that tobacco cessation counseling was less important than non-smokers. Also, PAs that smoked, believed counseling was less difficult than the non-smokers. Finally, PAs that use other forms of tobacco believed the health dangers of tobacco were less than those of non-tobacco users.
Conclusion: This preliminary study represents the first evaluation of PAs smoking habits and their perceptions about tobacco cessation counseling. Findings were similar to other health care providers, in particular physicians. A large nationwide study is recommended before conclusions can be generalized to PAs.
36. Health Care Providers' Knowledge of Advance Directives. R. Coulson, J.Kocian, E. Madden, and A. Pinkerton, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: Recently widely publicized cases involving end of life care have brought the topic of advance directives to the forefront of the general population. Advance directives are usually used to avoid prolonging an inevitable dying process. However, despite the publicity given to the ethical dilemmas, it is estimated that 80% of the public does not have advance directives in place. Studies have been conducted to probe patients’ knowledge of advance directives, but not the awareness of healthcare providers. Other studies have focus on the attitudes of healthcare providers towards advance directives. However, studies have not been conducted to directly examine health care providers’ understanding of advance directives or how this affects the likelihood of discussing the subject with patients. This combination of facts puts forth the question, are most health care professionals knowledgeable enough on the subject of advance directives to address these matters with their patients? This study was conducted to both assess health care providers knowledge of advance directive as well examine attitudes regarding the subject.
Methods: The population of this study consisted of healthcare providers and healthcare students from both a 2005 state physician assistance conference and local private practices. A two-part survey was distributed to subjects, the first part examining the subject’s knowledge of advance directives, the second part examining personal attitudes on advance directives. Associations between the type of profession (physician, midlevel practitioner, nurse, student) and answers will be analyzed using ANOVA, general linear model and logistic regression.
Results: Results of this study are currently pending, as survey collection and data analysis are ongoing. It is anticipated that practicing clinicians and students will generally be knowledgeable about the purpose of advance directives, but will score lower on more specific questions such as those about conditions in which advance directives are put into motion and when such requests are not honored. It is anticipated that the second part of the survey will show that subjects believe healthcare professionals are responsible for aiding their patients in creating directives, but that the subject does not regularly discuss such directives with his/her own patients.
Conclusions: Studies have not been published analyzing healthcare providers’ knowledge of advance directives, or their attitudes toward responsibility and personal practices regarding advance directives. Past studies have shown that patient satisfaction is increased when advance directives were discussed at routine health maintenance visits. It is important that healthcare providers are aware of advance directives and feel comfortable discussing the subject with their patients. Patients may not know what an advance directive is or where to start if they do. Because advance directives are meant to be guidelines for medical care, it is important that healthcare providers are well-informed on the subject and not only able to educate and provide resources for patients, but are capable of initiating conversation on the subject.
37. Health Literacy: An Evaluation of the Readability of Diabetes Mellitus Patient Education Materials across Different Patient Populations in a Community. L. Gerencir, A. Bosworth, and C. Evans, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: Health literacy is defined as the ability to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions. Patient education materials are an effective means to provide information to patients about illnesses and can lead to improved outcome when they are designed properly. However, most materials are not at a reading comprehension level appropriate for patients. The purpose of this study is to determine if the health literacy guidelines set by the National Center for the Study of Adult Learning and Literacy and the goals of Healthy People 2010 are being met in the study community. This study focuses on the readability of Diabetes Mellitus (DM) patient education materials since it is a chronic debilitating illness requiring strict patient adherence to treatment. A previous study examining DM materials found the readability ranged from a grade level of 5.3 to 14.1. Current demographics reveal the prevalence of DM is significantly higher in areas of lower economic status. The hypothesis is that patient education materials provided at facilities with patients of low socioeconomic status are equal in readability to those found at facilities with patients of higher socioeconomic status. Therefore, health care facilities serving patients of low socioeconomic status are not tailoring the patient education materials to an appropriate reading level.
Methods and Statistics: Patient education pamphlets on DM will be collected from multiple healthcare facilities serving different patient populations. The data collected will represent two economically depressed communities and two communities of higher socioeconomic status within one county. Four readability algorithms, the Simplified Measure of Gobbledygoop, Flesch-Kincaid Readability Index, the Flesch Reading Ease, and the Gunning-FOG index will be used to analyze the approximate level of education needed to comprehend the samples. The frequencies and mean grade level/readability score from each of the four readability algorithms will be analyzed using a common software application. The student t-test will be used to compare the average readability of the patient education materials from each of the four sites listed.
Results: Results for this study are currently pending and data collection is continuing. Preliminary analysis of a sample of patient education pamphlets reveals equal readability independent of the demographics of the patient population.
Conclusion: The average reading level of the United States is eighth grade, yet twenty percent of adults have a fifth grade reading level. In order to address this critical issue, initiatives have been established to create appropriate written material for patients of all literacy levels. Two of the facilities where data is being collected have a greater proportion of minorities, elderly, people living in poverty, and lower rates of educational attainment as compared to the demographics of the other two facilities in the study. Data analysis has shown that readability of the patient education pamphlets is not appropriately tailored to the patient population by the healthcare facilities. Therefore, there is a need for healthcare providers to assess their patient population’s functional health literacy to supplement patient care with patient education materials.
38. Healthy People Seton Hall. K. Wrigley, K. Simas, D. Ackerly-Kofod, Seton Hall University, South Orange, New Jersey
Purpose: The purpose of this study is to investigate whether there is an association between smoking and other negative behaviors within the Seton Hall University student community.
Methods: Participants will complete an online survey that will ask lifestyle questions about smoking (independent variable) and other behaviors such as exercise, seatbelt and helmet use, and access to firearms (dependent variables). Using an alpha level of 0.05, effect size of 0.2, and a power of 0.8, a sample size of 788 will be sufficient. Correlation of the continuous variables with the binary independent variable will be made by logistic regression. Two-by-two contingency tables will be used to cross-tabulate the binary categorical dependent variable with the independent variable (smokers/nonsmokers). Analysis will be performed using SPSS.
Results: Null Hypothesis: There will be no difference in smokers and nonsmokers in performing healthy behaviors. Alternate Hypothesis: There is a difference between smokers and nonsmokers in performing exercise, seatbelt and helmet use, and access to firearms.
Conclusion: Healthcare professionals routinely screen for tobacco use. By identifying the relationship between tobacco use and other behaviors that negatively impact health in a young adult population, we hope to provide clinicians with additional motivation to screen the 18-34 year old population for factors that contribute to the leading causes of morbidity and mortality for this age.
39. Increasing the Overall Prevalence of Tuberculosis Screening among the Homeless Population through Education and Advertisement. J. Hodgson, L. Albanese, and H. Reynolds, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: The homeless population is among the main groups considered to be at high risk for tuberculosis infection. Among the homeless living in urban areas, 53% of the newly-reported cases of TB have been attributed to new primary infections, compared to only 10% of the reported cases in the general population. Close living quarters of the homeless and non-compliance with recommended treatment has resulted in treatment failure, further spread of preventable illness, and the development of drug-resistant strains. The purpose of the proposed research is to increase tuberculosis screening of the street homeless population in an urban medically underserved area through education and advertisement. The objectives include: increasing awareness of the availability of free tuberculosis screening x-rays offered by a local health department, educating these individuals about the signs and symptoms of tuberculosis, and thus increasing the overall incidence of screening.
Methods: The subject population for our research included the chronic street homeless of an urban area along with some adjective low socioeconomic areas affiliated with a non-profit community organization called Operation Safety Net (OSN). This research project consisted of educating the homeless on tuberculosis, in order to promote tuberculosis screening at a mobile van, staffed and operated by the local health department. There are two phases of this project, the first was flier distribution and the second was data collection and analysis to compare screening rates. The fliers were constructed at a fifth grade reading level to advertise for each screening and included information regarding the free chest x-ray screening for Tuberculosis by the local health department, including the date, time, and location (general area and specific site). Also, common symptoms of tuberculosis listed on the flier included; deep cough, weight loss, coughing up blood or yellow stuff, night sweats, fever, chest pain, can’t eat, and muscle pain. Fliers were distributed one to two days before, or the day of the local health department chest x-ray screening van performed a designated screening session.We are currently waiting for the data from the local health department in order to complete phase two of our project.
Results: Although the results and discussion are pending at this time, preliminary results indicated that increased penetrance via advertisement along with education have increased TB screening among the homeless population in this area. Therefore, it is hypothesized that there will be at least a 20% overall increase in TB screening of homeless people affiliated with OSN when comparing 2004 and 2005 data.
Conclusions: There have been no attempts in the past to advertise tuberculosis screening to the homeless population in this area through education and flier distribution. However, research has shown that tuberculosis has had resurgence nationally, especially among the homeless population. Increased knowledge of both tuberculosis and available screening is the key to intervention in preventing spread of disease or even death in this population.
40. Knowledge Assessment of Physician Assistants and Physician Assistant Students on Medical Insurance Plans and Coverage. A. Abebe, K. Graham, N. Moulton, and J. Parker, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: With the increasing cost of healthcare, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans availability is essential for patients. Those without insurance are less likely to seek medical attention and preventive medicine services. Lack of healthcare insurance can cause fewer annual physicals, mental health evaluations, mammograms, and influenza vaccinations.
It is important for clinicians to understand various insurance coverages. This study assesses the knowledge of physician assistants (PA) and PA students regarding various managed care health insurance plans. We hypothesize that most surveyed will lack some knowledge regarding their patients’ insurance plans. We also hypothesize that certified PA’s will be more knowledgeable than the PA students about health care plans.
Methods: This cross-sectional study assessed the knowledge that PAs and PA students have regarding HMOs, PPOs, and POS. A two page survey including demographic information (gender, ethnicity, status, occupation, years working as a PA, field of medicine currently working in, and if and what type of job was held before entering the PA profession) and questions about HMOs, PPOs, and POS’s was utilized . The survey was distributed to certified PAs and PA students at the state physician assistant conference in October 2005 . After collection, one point was given per correct answer; total possible points = 16. A general linear model was fit with the participant’s score and factors/covariates: age, gender, ethnicity, status, and whether or not they worked before the beginning the PA program. An ANOVA model with the status predicting the score was used. Post-hoc tests, such as pairwise comparisons, were then used to detect significant differences. An overall error rate of a = 0.05 was used.
Results: There were 24 first-year students (25%), 22 second-year students (22.9%), and 50 certified PAs (52.1%), with a mean age of 32.17 (standard deviation of 11.51) and mean score 47.46% (standard deviation of 0.1548). The mean number of years working for certified PAs was 11.26 years (standard deviation of 10.00). Status was the only significant factor, and there was no significant difference between the mean scores of second-year students and certified PAs (p=0.469). There was a significant difference between first-year students and second-year students (p=0.036). The mean score for first-year students was 0.3672 (standard deviation of 0.1489). The mean score for second-year students was 0.4744 (standard deviation of 0.1102). The mean score for certified PAs was 0.5263 (standard deviation of 0.1500).
Conclusion: No previous studies address the PA profession’s knowledge of insurance plans. This is disconcerting because different plans may alter treatment plans of patients. Thus, educating PA students and certified PAs about different types of insurance coverage is requisite in providing quality health care.
41. Physician Assistants-Progress in Practice. D. Bridge, C. Hart, J. Lavanture, and E. Roberts, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: Over the past 30 years, physician assistants (PAs) have demonstrated that they are an integral component of today’s modern delivery of health care. However, there still is some uncertainty within the public as to what exactly a PA is, what they can or cannot do, and how they are educated. Since there have not been definitive studies performed to evaluate the public’s perception of PAs since the early 1970s, we wanted to determine how people view PAs today now that there are over 50,000 physician assistants in practice. This study aims to determine what the general population knows about PA education and credentialing, and how comfortable they would be with PAs performing specific procedures.
Methods: The population of this study consisted of volunteers, age 18 years or older, recruited from around the country. All participants received a survey either online or via hardcopy. The first part of the survey included questions regarding the participant’s age, gender, race, education, and current state of residence. It also included questions on prior healthcare experience, prior contact with PAs, and questions regarding their knowledge of PA education and credentialing. The second part consisted of statements regarding how willing and comfortable the participants would be having PAs perform specific tasks. The participants were asked to respond on a 5-point scale survey, from very willing/ comfortable to very unwilling/ uncomfortable and including undecided. Associations between willingness to see a PA, and gender, age, area of residence, race, and education will be analyzed using analysis of variance, t-tests, and correlation coefficients. The level of significance will be set at P < 0.05.
Results: Results for this study are pending and data collection is ongoing. Currently, over 550 surveys have been completed. Preliminary results show that less than 20% of respondents (n= 557) knew what type of education a PA needs and that PAs are certified after passing the boards. The majority (>50%) of respondents answered that they were very willing or willing to have a PA perform tasks ranging from taking a medical history to assisting in surgery. Between 45%-55% (n=465) of those surveyed felt comfortable or very comfortable with a PA performing a procedure on himself or herself, child, spouse or parent. At this time the data has not been analyzed to determine if there is any difference between gender, age, area of residence, race, or education.
Conclusions: There have been no definitive studies performed to evaluate the public’s perception of PAs since the early 1970s. Since then physician assistants have become an integral component of the health care system. However, there are still patients who are reluctant to see a PA or do not understand what a PA is. Now that PAs are being used more often, in ever increasing roles, it is important to determine how people view PAs today and how that has evolved. This will allow PAs the opportunity to see where misinformation has occurred and to be able to better focus education and awareness in these areas.
42. Public Automated External Defibrillator Placement: Can We Find Them? An Assessment of a Local Public Access Defibrillator Program. R. DeRosa and K. Sweeney, Philadelphia University, Philadelphia, Pennsylvania
Purpose: In the early 1990’s a smaller, lighter and more portable defibrillator known today as the automated external defibrillator (AED) was created. Over the past ten years, public access defibrillator (PAD) programs have been implemented to increase availability of AEDs in the public setting. Despite efforts to educate the community while placing automated external defibrillators in the public arena, the authors suspect that a great percentage of the general public is largely unaware that these devices are available for use or how to find them. The purpose of this study is to assess the public’s ability to locate an AED and to determine if this suburban community is willing to use them on a fellow citizen.
Methods: Surveys will be distributed randomly to shoppers at a local suburban Philadelphia mall and also to parishioners of a large church congregation in the same community. Approximately 150 surveys will be distributed at each location. Subjects must be age 18 or older to participate in this study. After gaining informed consent, subjects will complete a survey consisting of twenty questions pertaining to knowledge of location of publicly placed AEDs, previous CPR/AED education, recognition of universal signs for AEDs and willingness to use the device on another citizen. Each subject will receive a keychain for participating in the study.
Results: We believe that the results of this study will show the majority of people surveyed in this community are not aware that AEDs are available for use. We feel this study will also show that the public does not know how to locate one in the event of a sudden cardiac arrest. We can anticipate that most people in this community would be willing to use an AED on a fellow citizen. We also anticipate that most healthcare providers would be more inclined than the lay public to assist a victim of sudden cardiac arrest.
Conclusion: This study is important in that it will show whether or not the lay public in this suburban community has knowledge of publicly placed AEDs, whether or not they can find them and assess their willingness to use these devices on another citizen. Subsequently, this will help us to develop and implement more effective community education and public access defibrillator programs.
43. The Effects of Stress on Personal Relationships among First Year Physician Assistant Students. K. Primrose, H. Collier, and L. Pete, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: The purpose of this study was to evaluate the effects of stress on the relationships of first year physician assistant students. Many studies have already been done to examine the amount of stress present in graduate students studying medicine, law, and clinical psychology. While the information obtained by these studies has been beneficial to the groups they addressed, both the physician assistant program and the impact that stress has on the personal relationships of physician assistant students have been neglected. The purpose of this study was to determine each student’s perceived stress level and how it correlated to their personal relationship satisfaction at the beginning of the program and how it changed over time in the didactic year.
Methods: A correlation/exploratory study design was implemented to determine the relationship between perceived stress and relationship satisfaction of first year physician assistant students. Subjects were recruited from a list of first year students provided by Master of Physician Assistant Studies Program. A total of 48 subjects, both male and female, participated in the study. The subjects were asked to complete a 21 question survey on three separate occasions assessing demographics, perceived stress, and relationship satisfaction, during the first year of PA school. The Perceived Stress Scale and the Perceived Relationship Quality Component Inventory were used consisting of 16 Likert-type items. A simple t-test will be used to determine the level of stress amongst first year physician assistant students at various points during the didactic year. Then, a two- tailed t-test will be used to determine the impact of this stress upon the personal relationships of the students. A p-value of <0.05 will be used for the level of significance.
Results: Results of this study are pending as data is still being collected. It is predicted that the students will have increasing levels of stress as the didactic year progresses, and that the increasing stress will negatively impact their perceived relationship satisfaction score.
Conclusions: It is important to note that stress, whether accompanied by depression or anxiety disorders or not, can have a serious impact on the personal relationships of all people. Physician assistant students should not be overlooked when it comes to the presence of stress in their daily lives and the impact that it has on their personal relationships. The first year of any physician assistant program can be very intense and time consuming, leaving little time for the student’s personal life. This time deficiency places a lot of strain on the student. Students are likely to have a different perception of stress and cope differently. The benefits of this study will be to identify the amount of stress present, determine how it affects the student’s personal relationships, and offer suggestions for coping with the stress and increasing personal relationship satisfaction.
44. The Impact of a Free Community Clinic on the Utilization of a Local Emergency Department. S. Bleything, M. Van Sickel, J. Spiegel, and D. LaBarbera, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
Introduction: Over 45 million Americans currently lack health insurance coverage. Without primary care access, the uninsured often turn to the emergency department (ED). As a result, EDs provide care for both emergent and non-emergent patients and bear the subsequent financial burden. Medical assistance from charity organizations, community clinics, and free clinics attempts to provide more appropriate primary care avenues. Few studies have been conducted to assess the impact of free clinics and their contributions to the health care safety net for the uninsured.
Purpose: To investigate the impact of a large metropolitan area free clinic on the utilization of the local ED.
Methods: Clinic: The volunteer-based primary care clinic (Bread of Healing, Milwaukee) is funded from churches and individuals. Some small grants pay volunteer salaries. The clinic is staffed by physicians, residents, medical students, a parish nurse and a clinical manager. Patients are referred to the clinic at hospital or ED discharge, or via parish nurse network, churches, and the local medical school. Many of the clinic’s1500 patients live in the surrounding neighborhood. The clinic is located thirteen blocks from the local ED ( Aurora Sinai Medical Center).
This retrospective study included 152 patients aged 19-64 years who enrolled in the clinic between 2002 and 2003. Patients who had visited the clinic at least once in the year prior to data collection were identified for possible inclusion. Patients were cross referenced into the local medical center’s electronic medical records system for number of ED visits. Clinic patients were excluded if they were not identified in the medical center’s system. Demographics were tabulated. The number of visits made to the local ED 18 months prior to clinic enrollment was compared to the number of ED visits over 18 months post-enrollment using a paired t-test (α = 0.05).
Results: The mean patient age was 48.3 + 10.32 years with 55.3% male and 44.7% female. Ethnic distribution was 77.6% African American, 13.8% Caucasian, 2% Hispanic, 2% Asian, 2% other, and 3.3% not specifying race.
The total number of pre-enrollment visits to the ED was 252 and post-enrollment were 180. The mean number of pre-enrollment visits to the ED was 1.66 + 2.9; post-enrollment, 1.18 + 2.1. Paired t-testing was significant, t= 2.247, p= 0.026; the assumption of a normal distribution was violated, however. Thus a Wilcoxon signed rank test was performed which was significant, z= -3.329, p= 0.001.
Conclusions: The free clinic statistically impacted local ED usage; 72 fewer visits were made in the 18 month period following enrollment, likely translating into a considerable reduction in ED costs. By using the model of this pilot study, other community clinics may conduct similar impact evaluations to provide evidence of the efficacy of their programs in the hopes of continuing to lower hospital costs and improving funding opportunities for community clinics.
45. The Influence of Prior Education, Mentor and Employment Experience as Practice Setting Determinants of Physician Assistants. E. Sims, H. Lemke, and O. Chen, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
Purpose: This study intended to identify how education, mentor, and employment experiences prior to entry into PA school would predict a PA’s choice of practice setting after graduation.
Method: A total of 1,288 practicing PAs who were members of the Texas Academy of Physician Assistants (TAPA) were solicited via email to participate in an online survey. The survey consisted of 21 questions, 15 items reflecting the potential influences of education, mentors, and/or employment experience prior to entry into PA school on choice of practice setting after graduation. Others were demographic questions. SPSS (11.5) was used to perform descriptive statistics and discriminant analysis. Data was collected from late August to mid-September 2004.
Results: A total of 255 PAs responded to the survey for an overall response rate of 21%. Among the three potential influences (education, mentor, and employment experience prior to PA school), prior employment experience can best predict PAs’ practice setting choice after graduated from PA school (Wilks’ Λ=0.890, p<0.001). Prior experience in working with patients was a better predictor for choosing primary care practice settings (Wilks’ Λ=0.709, p<0.001), and prior experience in working with technology was a better predictor for choosing non-primary care practice settings (Wilks’ Λ=0.822, p<0.001).
Conclusion: The results of this survey indicated that employment experience prior to PA school seems to be able to better predict what practice setting a PA will choose after graduation. Questions could be added to PA schools’ supplemental applications that focus on applicants’ prior employment experience. These prior employment questions could help PA schools whose primary intent is to recruit students interested in primary care practice settings. The other two factors (prior education or prior mentor experience) did not show predictive value on PAs’ choice of practice setting, most likely due to the timing of the influences and the fact that experiences prior to PA school are overshadowed by those taking place during PA school. Further studies are required to determine the influences of these factors.
46. The Outcome of Facilitating Conflict Resolution in School Aged Children. N. Larkin, A. Yesenosky and T. Esty, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: Behavioral problems among school-aged children and adolescents in the school setting have been on the rise since the 1980’s. An estimated 11% to 20% of children who present in primary care settings have significant behavioral and psychosocial problems. Research has shown that pediatricians identify behavior based problems as the most commonly reported issues in their practice. The scientific rationale of this study is to teach children aged seven to thirteen about various emotions and how to handle the different emotions. In particular, they will learn how to deal with angry feelings and ways to cope when they are feeling angry or upset. The optimistic end result would be to provide long-term benefits to these children so they can function better as individuals in society.
Methods: The particular program that our research team is utilizing is an eight week interventional program designed by the researchers on learning about emotions. These sessions will be done in a group of no more than twelve children with eight forty-five minute sessions. All children seven to thirteen years of age that are currently residing in a foster program were included in the research study. Children not residing at the foster program, or who do not wish to participate were excluded. During the first session, a pre-test will be given that will identify how often children currently think about their actions and deal with their anger and emotions in a positive way. After the eight week program, a post-test will be administered to see if these behaviors have changed. The statistical analysis will be performed by the paired t test to compare the pre and post test score.
Results: Currently, the results of this study are pending because data collection and analysis of the surveys are continuing. It is anticipated that those in the interventional program would show improvement in controlling their anger and making positive decisions.
Conclusion: There is a subset of youth who exhibit behavioral problems early in development and continue throughout their course of life. Children can lack positive figures in their lives, and they may not have the necessary skills to make positive choices. If the home environment does not facilitate positive decision making, many feel that the school should provide the proper surroundings. But in reality, some schools do not provide the arena for growth and development. It is here where the negative cycle can occur. These children are punished for their incorrect behaviors which could cause them to withdraw and act out. This can progress to psychosocial, health, and developmental issues or deficiencies . This project will allow children to develop positive ways to manage their anger and emotional issues.
47. The Truth about Exercise Prescriptions: Do They Motivate Patients to Change? A. Ziegeweid and R. Dehn, University of Iowa Physician Assistant Program, Iowa City, Iowa
Purpose: This investigation is being conducted to determine whether exercise prescriptions, based on the transtheoretical “stages of change” model (TTM), exclusively promote exercise behavior change in adult patients.
Methods: Pretest-posttest survey design. Adult participants were recruited while attending scheduled provider visits at a family practice outpatient clinic in rural Southeastern Iowa. After obtaining informed consent, all participants were asked to complete a baseline survey regarding exercise and were given a standard exercise information sheet. Every other participant was then assigned to receive a standardized TTM-based exercise prescription. Posttest surveys were administered to all participants four weeks after baseline and changes in physical activity level, stage of exercise change, and self-efficacy were measured using descriptive analysis techniques. Exclusion criteria included subjects under age 18, those with preexisting chronic health conditions prohibiting regular exercise, and subjects unable to take part in the study immediately following their clinic visit.
Results: Data is to be collected from February to March 2006 and analyzed from April to May 2006. Anticipate that subjects receiving the exercise prescription intervention will have an increase in total activity level, increased self-efficacy, and will be in the “active stages” of behavior change versus control. Estimated sample size n=25.
Conclusion: Results will be analyzed with the goal of determining whether exercise prescriptions are independently effective in motivating individuals to change activity level and can be used effectively to promote exercise to patients in a busy clinic setting.
48. The Use of Herbal Medicine and the Incidence of Potential Drug-Herb Interactions. D. Beaty, B. Hutsko, and T. Dodd, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: The purpose of the study is to identify the incidence of potential drug-herb interactions in a sample of patients managed in the family practice and internal medicine settings.
Methods: Approximately 500 subjects between the ages of 21 and 75 years of ago taking at least one herbal supplement will be conveniently sampled from family practice and internal medicine clinics and surveyed about their use of herbal supplements, their prescription medications, their knowledge of interactions between the two, and there primary care physician’s awareness of their use of herbal supplements. Statistical analyses will be performed on the data obtained from the survey to determine the incidence of potential adverse drug-herb interactions.
Results: Data collection is ongoing; however, we project that the percent of patients surveyed who use at least one herbal supplement will be approximately 50 to 55%. Approximately 75% of those patients will have experienced potential adverse interactions between their prescription medications and an herbal supplements. Of this 75%, approximately10% will be aware of these potential interactions. Of the 55% of patients taking herbal supplements, only about 30% will have informed their primary care physician of their use of herbal supplements. Of those, approximately 60% will have potentially harmful drug-herb interactions.
Conclusion: Based on the results of this study, the majority of patients taking herbal supplements will be unaware of the potentially harmful interactions between their prescription medications their herbal supplements. This is partly due to the lack of communication about the use of herbals between patient and healthcare provider well as the lack of patient and practitioner knowledge of these interactions. Interventions to reduce the risk of serious complications from the use of herbal medications with various prescription medications may include programs encouraging healthcare providers to inquire about the use of herbal supplements in every patient and to become more aware of common interactions.
49. The Use of Peak Flow Monitor in the Asthmatic Child. J. Chui, M. Gatta, and A. Albrigo, Seton Hall University, South Orange, New Jersey
The most common pediatric emergency is asthma exacerbation with 700,000-1,000,000 emergency room visits reported yearly among children ages 5-17. The peak flow meter is designed to gauge self-awareness of asthmatic status and can alert the patient of the need for medical attention before an exacerbation develops. It is our hypothesis that the daily use of home peak flow meter will decrease the number of emergency department visits by the pediatric patient with moderate or severe asthma, when compared to the asthmatic pediatric patient who does not use a home peak flow meter. The subjects used in our study are pediatric patients, ages 7-17, diagnosed with moderate to severe asthma. Case report forms will be randomly distributed to the parents of patients at participating pediatrician’s offices concerning his or her child’s use of peak flow monitor and number of emergency room visits due to asthma exacerbations. We will compare the number of emergency room visits and length of hospital stay (LOS) for children who use peak flow meters with children who do not. We will use binary logistic regression to compare the continuous outcome variables (LOS) and number of emergency room visits for the two groups. Statistical significance will be based on alpha = 0.05 (two-tailed). An indication of the efficacy of peak flow monitoring is the reduction in emergency room visits and LOS. We expect to see substantial a difference between the two groups.
50. Use of Antipsychotic Therapy in Geriatric Nursing Home Patients – An Ongoing Performance Improvement Project. A. Dunaway, E. Macnamara, M. Phillips, and B. Taylor, Medical College of Georgia Physician Assistant Program, Augusta, Georgia
Purpose: The purpose of this study is to evaluate the compliance to safety guidelines for use of antipsychotic therapy in a geriatric nursing home population.
Methods: A chart review will be conducted to identify all patients receiving antipsychotic therapy in the nursing home. Each patient receiving antipsychotic therapy will be included in the study. The charts will be further reviewed for the following information: indication for therapy, dose reduction attempts, presence and use of monthly behavioral monitoring sheets (which serve as documentation of psychotic symptoms), and yearly abnormal involuntary movement testing (AIMS). These results will be compared to previous antipsychotic medication use evaluations.
Results: The results are expected to show continued improved performance based on previous data collected in February 2003 (n=51), January 2004 (n=54), and July 2005 (n=53). Appropriately documented indication for antipsychotic therapy increased each year (76% in 2003, 85% in 2004, 89% in 2005); appropriate dose reduction attempts increased each year (43% in 2003, 81% in 2004, 94% in 2005); monthly behavioral monitoring sheets with accurate reflection of psychotic symptoms increased each year (57% in 2003, 94% in 2004, 96% in 2005); yearly AIMs tests increased in the second year (71% in 2003 to 80% in 2004) followed by a significant decrease the third year (70% in 2005).
Conclusions: Based on previous chart reviews, the safety guidelines continue to be met with increasing compliance. Dose reduction attempts significantly improved in previous reviews and are expected to remain high in the 2006 chart review. Each category being evaluated has room for improvement, especially yearly AIMs testing. Ongoing quality assurance through chart reviews will help compliance with safety guidelines of antipsychotic therapy in geriatrics. The results will be used to identify opportunities to improve documentation practices and standard of care.
51. Wellness Intervention in a Collegiate Community. A. Hopwood, K. Gray, and M. Wellings, Chatham College Physician Assistant Program, Pittsburgh, Pennsylvania
Purpose: Obesity is an epidemic in the United States and contributes to approximately 300,000 mortalities yearly. In the US there has been a drastic increase in obesity among college students. This dramatic weight increase can lead to obesity and associated health problems such as hypertension. Other issues affecting this population include tobacco use, binge drinking and unhealthy eating habits. In this study, we reviewed recent trends regarding health and wellness perspectives, incorporated educational lectures and attempted to educate this population health and wellness.
Methods: As part of an ongoing health and wellness program in a local college, the population studied consisted of adult participants. All subjects received a survey consisting of 11 modified Likert type questions regarding various health topics, physical status, emotional well-being and alcohol practices. The participants’ weight, blood pressure, and BMI were obtained. All subjects were tested on upper and lower body strength and flexibility. All data was recorded on the fitness pre- test and filed until the post-testing date. Participants were encouraged to exercise three or more times weekly and attend at least three educational lectures in order to remain in the study. At the end of the eight week session, participants underwent post-testing. All data were collected and entered into the Statistical Packages for the Social Sciences computer program. Chi square and paired t-tests will be performed to evaluate the statistical significance. An ANOVA will then be performed to compare this year’s statistical data with the statistics from the previous year. The significance level will be set at P < 0.05.
Results: The results from this study are currently pending since data collection is ongoing. We anticipate a combination of educational lectures and increased physical activity will decrease the overall systolic blood pressure, percentage of body fat, and weight, while increasing the upper and lower body strength, flexibility, and emotional well-being of all participants. This study is also expected to raise the awareness of risky behaviors including binge drinking and overeating. In addition, we plan to evaluate the participants’ knowledge of various aspects of health by administering the fit for the future survey at the beginning and end of the eight week fitness program.
Conclusion: There currently have not been any published studies evaluating the wellness of collegiate students and faculty and the impact on physical and perceived emotional well-being. Other studies were conducted reviewing the complications of obesity, and have shown that an increase in exercise has a positive impact on overall physical and emotional health. Because of the morbidity and mortality associated with obesity and the increase in obesity in adolescents and young adults, it is important to examine whether these participants would benefit from this type of fitness program.
Case Studies/Clinical Reports
52. Os Trigonum Syndrome: A Case Report. M. Kelly and F. Feudale, King’s College, Wilkes-Barre, Pennsylvania
Introduction: The Os Trigonum is an accessory bone located posterior to the talus in the ankle and is found in 2.5 – 14 percent of the normal population1. When the ossification center remains separate from the talus and causes pain with plantar flexion it is termed Os Trigonum Syndrome2. The pain is produced by impingement of structures between the posterior articular portion of the tibia and the dorsum of the calcaneus 3. Those most susceptible to this condition are athletes, particularly ballet dancers, soccer players, gymnasts, and martial artists. This is a case of a 21 year-old female gymnast who suffered from posterior ankle pain prior to her diagnosis of Os Trigonum Syndrome.
Case report: A 21 year-old female gymnast experienced recurrent right ankle pain before being diagnosed with Os Trigonum Syndrome. She complained of posterior ankle pain with radiation to the anterior portion of her ankle. Conservative treatment was tried, but failed, which prompted her to see an orthopedic specialist. It was recommended that surgery was the only way to correct her ankle pain. She elected to have the surgery and has fully recovered to compete after six months of intense physical therapy.
Discussion: Os Trigonum Syndrome is fairly rare and is often misdiagnosed as tendonitis or retrocalcaneal bursitis. Clinicians must consider Os Trigonum Syndrome in the differential for all patients with posterior ankle pain. It can be easily ruled out by plain radiographs of the ankle, which demonstrate the absence of the Os Trigonum accessory bone. However, if the bone is present, it does not confirm the diagnosis but is suggestive enough to warrant further investigations which might include an MRI and possibly a bone scan. Treatment options consist of rest, restriction of plantar flexion, analgesics, and possible surgery. This paper will discuss how to diagnose Os Trigonum Syndrome and the advantages versus disadvantages of controversial surgical approaches.
Previously Presented
53. A Comparison of Interviewed and Non-interviewed Student Cohorts for the PA Program of Study and National Physician Assistant Certification Exam Scores. L. Humphries and R. Muma, Wichita State University, Wichita, Kansas
Introduction: Certain student attributes (e.g., GPAs, personal interview scores) have been used by professional college programs to help differentiate candidates during the admissions process in an effort to select candidates that are likely to be successful. Though certain attributes have been evaluated over the years (e.g., GPA), information is lacking regarding the importance of interviewing candidates for admission. Physician assistant programs have routinely interviewed prospective candidates without knowing if the interview makes a difference specifically on the PA national certifying exam score (NCCPA).
Methods: A retrospective study was done comparing NCCPA aggregate exam scores of WSU PA students. Study subjects included graduates from 1991-1996 who served as the interviewed cohort and graduates from 1997-2002 who served as the non-interviewed cohort. Each study group was subject to descriptive and parametric statistics with the alpha level set at 0.5. An independent sample t-test was used to see if there was a significant difference in NCCPA aggregate exam scores between the cohort groups.
Results: The mean of each cohort group was similar. The mean for the interviewed graduates was 496.67 (SD +/- 28.54) and the mean for the non-interviewed graduates was 474.33 (SD +/- 15.28), which were not statistically different.
Discussion: In this small study, which only evaluated interviewed and non-interviewed cohort’s aggregate NCCPA exam scores, no difference was found. A large scale study evaluating the same variables is suggested before generalizations can be made.
54. Epidemiology of Dyslipidemia, Fitness, and Exercise Intervention in a Male HIV-Infected Cohort. K. Schuer, J. Clasey, A. Thornton, B. Garvy, K. Adams, and F. Rownelli, University of Kentucky, College of Health Sciences, Physician Assistant Studies, Lexington, Kentucky
Purpose: This pilot study has been designed to evaluate the epidemiology of dyslipidemia in a male HIV-positive cohort at the University of Kentucky Blue Grass Care Clinic, Lexington, KY. This study will assess metabolic abnormalities including hypercholesterolemia, dyslipidemia, insulin resistance, as well as bone density, body composition, and overall fitness of a random group of HIV infected men. The study also will measure pro-inflammatory cytokines as well as pro-atherosclerotic markers thought to be involved in the progression of cardiovascular disease. Exercise intervention and recruitment/retention issues in the study also are discussed.
Methods: Participants were recruited based on inclusion criteria including males <45 years of age, CD4+ cells >200/ml, undetectable viral load, abnormal blood lipids, as well as HIV medication regimen. Patients were excluded from participation based on criteria including abnormal ECG, abnormally low bone density, on lipid-lowering medication with normal blood lipids or already participating in regular exercise. To evaluate fitness, as well as the effects of exercise intervention, pre and post (before and after training) testing procedures included Oral Glucose Tolerance Test (OGTT) to measure insulin sensitivity, nutrition and mental health evaluation, measurement of body composition, bone density, percent body fat measured by bioimpedence, inflammatory cytokine and C-Reactive protein (CRP) analysis. Finally, submaximal graded exercise tests we also performed in order to predict maximal oxygen consumption (VO 2max), an indicator of aerobic fitness in study subjects.
Results: The study shows that most of the subjects enrolled had at least one abnormality in their blood lipid profiles, which classifies these patients, as recommended by the NCEP ATPIII, as people in need for changing lifestyle in order to address the lipid abnormality. Furthermore, we have found that the proportion of patients followed at the University of Kentucky Blue Grass Care Clinic with dyslipidemia, either total cholesterol >200 mg/dl, Triglycerides (TG) >200mg/dl, or HDL <40 mg/dl, is 49%. Most of those have low levels of HDL with or without elevated total cholesterol and/or TG. The pilot study shows that abnormalities in fasting glucose, OGTT, bone density, fitness (as measured by VO 2 max), CRP, and inflammatory cytokines were all noted, in various combinations, in study participants.
Conclusions: These data indicate that dyslipidemia occurs in a significant proportion of HIV-infected patients seen at the University of Kentucky outpatient clinics. The participants in the study and the data that was collected from them indicate that these young men living with HIV infection have one or more significant metabolic abnormality and are in relatively poor physical condition in terms of aerobic fitness which puts them at significant risk of developing cardiovascular disease. Moreover, cytokine and CRP analysis may indicate an alternative method at evaluating risk of metabolic and cardiovascular disease.
55. High Blood Pressure Increases the Renal Medullary Transport Proteins UT-A1, AQP2, and NKCC2/BSC1 in Rats. B. Murrell, J. Sands, S. Reffett, and J. Klein, Medical College of Georgia, Augusta, Georgia
Background: The kidney responds to sustained increases in blood pressure (BP) by increasing water and sodium excretion. Angiotensin II (Ang II) is a potent hypertensive agent that modulates this pressure natriuresis response. We investigated whether the protein abundances of the UT-A1 urea transporter, aquaporin 2 (AQP2), or the Na-K-2Cl cotransporter (NKCC2/BSC1) changed following increases in systolic BP.
Methods: Sprague-Dawley rats (300-400 g) were infused with Ang II (500ng/min/kg) by osmotic minipump.
Results: Systolic BP was significantly increased within three days and remained elevated for the duration of the experiment (200 vs. 130 mmHg in pair-fed control rats). Urine osmolality decreased in the Ang II-treated rats to 45% of control rats. Next, kidneys were dissected into inner medullary (IM) tip and base, and outer medulla ( OM), and analyzed by western blot. There were significant decreases in: UT-A1 (to 55% of control rats in IM tip and 60% in IM base), AQP2 (to 25% of control in IM tip and 45% in IM base), and NKCC2/BSC1 (to 50% of control in OM). Immunohistochemistry also showed a decrease in UT-A1 in the IM following treatment. Aldosterone, whose production is stimulated by Ang II, was previously shown to decrease UT-A1 protein abundance but does not affect AQP2 or NKCC2/BSC1 (Gertner et al., JASN 2004). Therefore, to determine if the decrease in protein abundances was the result of hypertension, Ang II, or Ang II stimulation of aldosterone, rats were given either norepinephrine (NE) (1944 ng/min/kg) or Ang II plus spironolactone (30 mg/day; to block the mineralocorticoid receptor). NE-treated rats had elevated systolic BP (170 vs. 125 mmHg in control rats) and decreased urine osmolality (to 45% of control) and medullary transporter abundances, similar to Ang II. Compared to Ang II alone, Ang II and spironolactone yielded similar increases in BP and urine volume and decreases in urine osmolality and UT-A1 and AQP2 proteins in the IM, but reduced the decrease in UT-A1 in the IM base.
Conclusions: We conclude that decreases in UT-A1, AQP2, and NKCC2/BSC1 proteins: (1) may contribute to the diuresis and natriuresis that occurs following Ang II or NE-induced hypertension; and (2) does not involve aldosterone.
56. Potentials and Barriers of Physician Assistants Working in Hospice. R. Boyer, O. Chen, and L. Hill, University of Texas Health Science Center, Fort Worth, Texas
Purpose: This study intended to identify potentials for Physician Assistants (PAs) to work in hospice and to identify the barriers that may be preventing PAs from working in hospice.
Method: A total of 7,449 practicing PAs from 16 state chapter PA societies were invited to participate in this cross sectional study. A modified cluster sampling method was used to collect the data. The investigators developed a 17 question survey to collect the data. A cover letter was e-mailed to the above prospective participants inviting them to respond to the survey. The prospective participants could access the survey by selecting a URL link within the cover letter. Once the data collection was complete, Chi-Square and ANOVA statistical analysis was performed using SPSS (11.5) software.
Results: A total of 6,721 PAs received the e-mail and 1,036 practicing PAs responded (15% response rate). The respondents who had referred a patient to hospice at least six times had more interest in working for a hospice than those who had referred a patient only one to five times (F=18.577, p <0.001). The respondents who felt that they had received adequate training had a higher interest in working for a hospice than those who felt they had not been adequately trained (t = -3.710, p < 0.001). Almost all (98.8%) of the respondents felt that they did not clearly understand the regulations for Medicare reimbursement of PA hospice services.
Conclusion: Potentials for PAs to work with terminally ill patients were identified: over 97% of the respondents felt that hospice is a beneficial program and PAs could be a beneficial addition to a hospice team. Some barriers identified for PAs to practice in hospice were: PAs lack formal education in working with terminally ill patients in a hospice setting, dissatisfaction exists with the education received in PA school in working with this patient population, and respondents did not understand the current regulations involving Medicare reimbursement for hospice services. With a few changes in PA school curricula and changes in the reimbursement regulations, there will be a great potential for PAs to work in a hospice setting.
