JAAPA : official journal of the American Academy of Physician Assistants
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The US opioid epidemic is a complex problem that has resulted in legislative actions to make treatment more accessible to patients. Physician assistants (PAs) have taken an active role in expanding their scope of practice to keep up with treatment needs. This article describes opioid use disorder in the United States, treatment gaps, safe treatment with buprenorphine, and PA prescriptive authority.
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Case Reports
Hypothenar hammer syndrome: An uncommon cause of secondary syndrome and digital ischemia.
Hypothenar hammer syndrome affects less than 1% of the population, but if the diagnosis is delayed, digital gangrene and critical ischemia can ensue. The condition is caused by injury to the ulnar artery at the level of the hook of hamate when the palm of the hand is repetitively used as a hammer. ⋯ Patients with hypothenar hammer syndrome often present with symptoms of secondary Raynaud syndrome; if Raynaud is unilateral, a vascular origin should be suspected and ruled out. Treatment options for hypothenar hammer syndrome include conservative treatment measures, fibrinolysis, or surgical resection and repair, and depend on the specific injury and timing of diagnosis.
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This article describes a patient who presented with an ST-segment elevation myocardial infarction that quickly developed into acute cardiogenic shock refractory to conventional medical therapy. Extracorporeal membrane oxygenation was used to manage the patient's heart failure and bridge to a long-term left ventricular assist device.
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The ability for PAs to easily move from one specialty to another without additional formal training is a unique feature of the profession that is valued by PAs and their employers. Specialty certification has been viewed as a threat to this flexibility, yet 73% of PAs are in specialty practice. ⋯ In particular, specialty certification may be appropriate as a means for promotion within healthcare systems so long as it is not used as a requirement for entry into specialty practice, credentialing, or third-party reimbursement. A portfolio model may give stakeholders an alternative way to assess the experience and competencies of PAs in specialty practice areas.
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The FDA has approved sacubitril/valsartan, an angiotensin-receptor-neprilysin inhibitor, for the treatment of chronic symptomatic heart failure (stage C) in patients with a left ventricular ejection fraction of 35% or less. This article discusses results from a major clinical trial, PARADIGM-HF, and the role of this new drug in heart failure treatment.