BOOK
Physician Assistant: A Guide to Clinical Practice E-Book
Ruth Ballweg | Darwin Brown | Daniel Vetrosky | Tamara S Ritsema
(2017)
Additional Information
Book Details
Abstract
Entering its 6th edition, Physician Assistant: A Guide to Clinical Practice is the only text that covers all aspects of the physician assistant profession, the PA curriculum, and the PA’s role in clinical practice. It is designed as a highly visual and practical resource to be used across the spectrum of lifelong learning, enabling students and practicing PAs to thrive in a rapidly changing health care system.
- Teaches how to prepare for each core clinical rotation and common electives, as well as how to work with atypical patient populations such as homeless patients and patients with disabilities.
- A succinct, bulleted writing style; convenient tables; practical case studies; and clinical application questions throughout enable you to master key concepts and clinical applications.
- Helps you master all the core competencies needed for certification or recertification.
- Addresses all six Physician Assistant Competencies, as well as providing guidance for the newly graduated PA entering practice.
- Includes quick-use resources, such as objectives and key points sections for each chapter, tip boxes with useful advice, abundant tables and images, and 134 updated case studies.
- Features chapters for the 7 core clinical rotations and 5 common electives, with key guidance on how to prepare effectively and what to expect.
- Provides updated health policy information, expanded information about international programs, cultural competencies, and pearls and pitfalls on working internationally as a PA.
- Outlines the basic principles of Interprofessional Education – an important new trend in medical education nationally.
- New chapters cover: Maximizing Your Education, Future of the Profession, Principles of PA Education, Managing Stress and Burnout, and many other topics.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| PHYSICIAN ASSISTANT: A Guide to Clinical Practice | i | ||
| PHYSICIAN ASSISTANT: A Guide to Clinical Practice | iii | ||
| Copyright | iv | ||
| Contributors | v | ||
| Foreword | xi | ||
| Preface | xiii | ||
| Acknowledgments | xv | ||
| Contents | xvii | ||
| I - OVERVIEW | 1 | ||
| 1 - Maximizing Your Physician Assistant Education | 3 | ||
| OVERVIEW AND INTRODUCTION | 3 | ||
| 2 - History of the Profession and Current Trends | 6 | ||
| FELDSHERS IN RUSSIA | 6 | ||
| CHINA’S BAREFOOT DOCTORS | 7 | ||
| DEVELOPMENTS IN THE UNITED STATES | 7 | ||
| DEVELOPMENTS AT DUKE UNIVERSITY | 8 | ||
| CONCEPTS OF EDUCATION AND PRACTICE | 8 | ||
| MILITARY CORPSMEN | 9 | ||
| OTHER MODELS | 10 | ||
| CONTROVERSY ABOUT A NAME | 10 | ||
| PROGRAM EXPANSION | 11 | ||
| FUNDING FOR PROGRAMS | 12 | ||
| ACCREDITATION | 13 | ||
| CERTIFICATION | 14 | ||
| ORGANIZATIONS | 15 | ||
| American Academy of Physician Assistants | 15 | ||
| Association of Physician AssistantProgramsto Physician AssistantEducationAssociation | 18 | ||
| TRENDS | 21 | ||
| NATIONAL HEALTH POLICY REPORTS | 22 | ||
| CURRENT ISSUES AND CONTROVERSIES | 22 | ||
| CONCLUSION | 23 | ||
| CLINICAL APPLICATIONS | 23 | ||
| 3 - International Development of the Physician Assistant Profession | 25 | ||
| CANADA | 26 | ||
| UNITED KINGDOM | 27 | ||
| THE NETHERLANDS | 28 | ||
| LIBERIA | 29 | ||
| INDIA | 29 | ||
| GHANA | 30 | ||
| SOUTH AFRICA | 30 | ||
| AUSTRALIA | 31 | ||
| KINGDOM OF SAUDI ARABIA | 33 | ||
| FEDERAL REPUBLIC OF GERMANY | 33 | ||
| NEW ZEALAND | 33 | ||
| AFGHANISTAN | 34 | ||
| ISRAEL | 34 | ||
| BULGARIA | 34 | ||
| REPUBLIC OF IRELAND | 34 | ||
| WHERE NEXT? | 35 | ||
| References | 35 | ||
| 4 - Physician Assistant Education: Past, Present, and Future Challenges | 37 | ||
| OVERVIEW OF PHYSICIAN ASSISTANT EDUCATION | 37 | ||
| BRIEF HISTORY OF PHYSICIAN ASSISTANT EDUCATION | 38 | ||
| Overview | 38 | ||
| 1960s | 38 | ||
| Historical Context | 38 | ||
| Physician Assistant Education Events | 38 | ||
| 1970s | 39 | ||
| II - MEDICALKNOWLEDGE | 117 | ||
| 11 - Evidence-Based Medicine | 119 | ||
| HISTORY OF EVIDENCE-BASED MEDICINE | 119 | ||
| EVIDENCE-BASED MEDICINE PROCESS | 120 | ||
| Task 1: Asking a Clinical Question | 120 | ||
| Task 2: Searching for Evidence | 120 | ||
| Evidence Essentials | 121 | ||
| Research Study Design. After the primary literature has been searched and sources of evidence identified, it is important to ass... | 121 | ||
| Evidence Pyramid. Proponents of EBM have developed an evidence pyramid to help users understand the relative rigor of the variou... | 123 | ||
| Important Concepts in Outcome Measurement | 123 | ||
| Evidence: Translating the Greek | 123 | ||
| Task 3: Evaluating the Evidence | 124 | ||
| Etiology or Harm Article | 125 | ||
| Commonly Used Outcome Measures. In a cohort study, relative risk is often used to describe the outcome of the study. Relative ri... | 125 | ||
| Potential Threats to Validity. Potential threats to both external and internal validity must be considered when evaluating these... | 125 | ||
| Diagnosis Articles | 126 | ||
| Usual Study Design. Studies that examine the diagnostic accuracy of new tests tend to use a design similar to the cohort design.... | 126 | ||
| Commonly Used Outcome Measures. In a study evaluating a new screening or diagnostic test the commonly used measures include sens... | 126 | ||
| Potential Threats to Validity. When evaluating a study of a new diagnostic or screening test, begin with assessing whether the n... | 128 | ||
| Prognosis Articles | 128 | ||
| Usual Study Design. Studies of prognosis examine the effects of interventions on the overall prognosis of disease. Mortality is ... | 128 | ||
| Commonly Used Outcome Measures. Prognosis studies may employ a number of outcome measures, including measures of mortality as we... | 128 | ||
| Potential Threats to Validity. A number of potential biases are important specifically to studies of prognosis. The potential th... | 129 | ||
| Treatment Articles | 129 | ||
| Usual Study Design. The RCT is the design of choice for the treatment study. In some situations, randomization of a participant ... | 129 | ||
| Commonly Used Outcome Measures. Outcome measures in RCTs depend largely on the type of dependent or outcome variable. If the out... | 129 | ||
| Potential Threats to Validity. There are a number of important characteristics of RCTs that need to be evaluated when assessing ... | 129 | ||
| Review Articles | 130 | ||
| Usual Study Design. Review articles are either systematic review articles or meta-analyses. The initial steps for these reviews ... | 130 | ||
| Commonly Used Outcome Measures. The outcome measures in a review article are usually reflective of those in the individual artic... | 130 | ||
| Potential Threats to Validity. Publication bias in a systematic review article or meta-analysis affects the validity of the stud... | 131 | ||
| Task 4: Applying the Evidence | 132 | ||
| Task 5: Evaluating the Process | 132 | ||
| References | 133 | ||
| 12 - Research and the Physician Assistant | 134 | ||
| WHAT IS RESEARCH? | 134 | ||
| TYPES OF RESEARCH | 134 | ||
| Basic Science Biomedical Research | 134 | ||
| Clinical Research | 135 | ||
| Health Services Research | 138 | ||
| Workforce Research | 138 | ||
| Educational Research | 140 | ||
| WHY SHOULD PHYSICIAN ASSISTANTS BE INVOLVED IN RESEARCH? | 140 | ||
| PHYSICIAN ASSISTANT STUDENTS AND RESEARCH | 141 | ||
| CONCLUSION | 142 | ||
| References | 143 | ||
| 13 - Keeping People Healthy | 144 | ||
| PRIMARY, SECONDARY, AND TERTIARY PREVENTION | 145 | ||
| IMMUNIZATION STRATEGIES | 147 | ||
| HEALTH DETERMINANTS | 149 | ||
| HEALTHY PEOPLE 2020 | 149 | ||
| UNITED STATES PREVENTIVE SERVICES TASK FORCE | 149 | ||
| INFLUENCING HEALTH BEHAVIOR CHANGES | 150 | ||
| CONCLUSION | 152 | ||
| References | 152 | ||
| 14 - Clinical Procedures | 154 | ||
| WOUNDS AND THEIR TREATMENT | 155 | ||
| Definitions | 155 | ||
| Wound Healing | 155 | ||
| Inflammatory Phase | 156 | ||
| Hemostatic Factors | 156 | ||
| Fibroblastic or Proliferative Phase | 156 | ||
| Maturation Phase | 156 | ||
| Factors That Affect Wound Healing | 157 | ||
| Wound Anesthesia | 157 | ||
| Sutures | 158 | ||
| Suture Types | 159 | ||
| Suture Sizes | 159 | ||
| Choice of Suture | 159 | ||
| Suture Needles | 160 | ||
| Wound Closure | 160 | ||
| Primary Closure | 160 | ||
| Delayed Primary Closure | 160 | ||
| Healing by Secondary Intention | 161 | ||
| Wound Suture | 162 | ||
| First Principle | 162 | ||
| Second Principle | 163 | ||
| Third Principle | 163 | ||
| Wound Tension | 163 | ||
| Debridement | 164 | ||
| Dead Space | 164 | ||
| Poor Technique | 164 | ||
| Special Considerations and Problems in Wound Closure | 165 | ||
| Triangular Flaps | 165 | ||
| Poor Skin Quality | 165 | ||
| Contaminated Wounds | 167 | ||
| Skin Glue | 167 | ||
| Dressings | 168 | ||
| Universal Precautions | 168 | ||
| COMMONLY PERFORMED CLINICAL PROCEDURES | 169 | ||
| Injections | 169 | ||
| Intramuscular Injections | 169 | ||
| Contraindications. Intramuscular injections should not be given at any site where a dermatitis or cellulitis exists | 169 | ||
| Equipment. The following equipment should be assembled | 169 | ||
| Gluteal Muscle. The gluteal muscle is the most common and preferred site of injection in adults and in children older than 2 yea... | 170 | ||
| Vastus Lateralis Muscle (Lateral Thigh). The vastus lateralis is the preferred injection site in infants. Although it may be use... | 170 | ||
| Possible Complications. The following complications may occur with IM injections | 170 | ||
| Follow-up. No special follow-up is required | 170 | ||
| Subcutaneous Injections | 170 | ||
| Contraindications. Subcutaneous injections should not be given at any site where a severe dermatitis or cellulitis exists | 170 | ||
| Equipment. The following equipment should be assembled | 170 | ||
| Possible Complications. Local reactions can occur with repeated injections over the same site | 170 | ||
| Follow-up. No specific follow-up is required | 170 | ||
| Intradermal Injections | 170 | ||
| Contraindications. Intradermal injection should not be given at any site where dermatitis or infection exists. Patients with a p... | 171 | ||
| Equipment. The following equipment should be assembled | 171 | ||
| Injection Sites. The ventral forearm is the most common site used. The back may be used for extensive allergen testing | 171 | ||
| Possible Complications. Severe local skin reactions may develop in hypersensitive patients | 171 | ||
| Follow-up. Patients should be instructed about when to return to have the skin reaction read, usually in 48 to 72 hours. If the ... | 171 | ||
| Venipuncture | 171 | ||
| Phlebotomy | 171 | ||
| Contraindications. Phlebotomy should not be performed if there is evidence of phlebitis, cellulitis, lymphangitis, scarring, rec... | 172 | ||
| Equipment. The following equipment should be assembled | 172 | ||
| Site Selection. The arm is the best site for phlebotomy, especially in the antecubital fossa (Fig. 14.22). The superficial veins... | 172 | ||
| Patient Preparation. The procedure should be explained to the patient to help reduce anxiety and elicit cooperation. The patient... | 172 | ||
| Peripheral Intravenous Catheterization | 173 | ||
| Contraindications. Catheters should never be placed where there is cellulitis, phlebitis, lymphedema, or pitting edema of the ex... | 173 | ||
| Equipment. The following equipment should be assembled | 173 | ||
| Catheter Selection. Considerations in selecting the correct catheter include the size and condition of the vein and the viscosit... | 173 | ||
| Site Selection. The veins most suitable for IV therapy are found at the dorsum of the hand, the volar aspect of the proximal uln... | 174 | ||
| Patient Preparation. Explain the procedure fully to the patient to minimize anxiety and elicit cooperation. The patient should b... | 174 | ||
| Possible Complications. Hematoma formation, extravasation, phlebitis, cellulitis, bacteremia, and sepsis may occur. Daily inspec... | 174 | ||
| Arterial Blood Gas Sampling | 174 | ||
| Radial Artery Puncture | 174 | ||
| Contraindications. Poor collateral circulation in the hand, as determined by the Allen test, or no palpable pulse in the radial ... | 174 | ||
| Equipment. A prepackaged blood gas sampling kit may be used, or assemble the following | 175 | ||
| Preparation of the Syringe. To heparinize one 5-mL glass (or plastic) syringe and 25-gauge needle, withdraw 0.5 mL of heparin in... | 176 | ||
| Patient Preparation. Explain the procedure to the patient to facilitate patient cooperation and reduce anxiety. Tell the patient... | 176 | ||
| Possible Complications. Hemorrhage or hematoma may occur at the puncture site, causing vascular compromise. Hematoma formation c... | 176 | ||
| Possible Complications. The possible complications in femoral artery puncture are essentially the same as for radial artery punc... | 176 | ||
| Lumbar Puncture | 176 | ||
| Indications | 177 | ||
| Contraindications | 177 | ||
| Equipment | 177 | ||
| Patient Preparation | 177 | ||
| Patient Positioning | 178 | ||
| Lateral Decubitus Position | 178 | ||
| Sitting Position | 178 | ||
| Site Selection | 178 | ||
| Possible Complications | 178 | ||
| Cerebral Herniation. A mass lesion, cerebral abscess, or increased intracranial pressure could result in cerebellar herniation t... | 178 | ||
| Bloody Cerebrospinal Fluid. Bloody CSF may occur from a traumatic tap or a subarachnoid hemorrhage. A traumatic tap occurs when ... | 178 | ||
| Spinal Headache. Spinal headaches are the most common complication associated with lumbar punctures and can be seen in approxima... | 178 | ||
| Follow-up | 178 | ||
| Urethral Catheterization | 179 | ||
| Indications | 179 | ||
| Contraindications | 179 | ||
| Equipment | 179 | ||
| Coudé Catheters. This type of catheter is bent at the distalmost end to allow smoother insertion in patients who have false pass... | 180 | ||
| Foley Catheters. This type of catheter has an inflatable balloon at the end to keep the catheter in place in the bladder | 180 | ||
| Patient Preparation | 180 | ||
| Possible Complications | 180 | ||
| Follow-up | 180 | ||
| Nasogastric Intubation | 180 | ||
| Indications | 180 | ||
| Contraindications | 180 | ||
| Equipment | 180 | ||
| Patient Preparation | 181 | ||
| Possible Complications | 181 | ||
| Follow-up | 181 | ||
| References | 181 | ||
| 15 - Genetic and Genomic Applications in Clinical Practice | 182 | ||
| FROM THE GENETIC AGE INTO THE GENOMIC AGE | 182 | ||
| Genetics and Genomics: The Language of Modern Medicine | 183 | ||
| A Genetic and Genomic View of Human Disease | 184 | ||
| Molecular Genetic Characterization of Human Disease | 184 | ||
| THE DIAGNOSTIC UTILITY OF FAMILY HISTORY DATA | 184 | ||
| Collecting Family History Data andCreatinga Pedigree | 185 | ||
| Pedigree Analysis | 186 | ||
| The Value of a “Negative” Family History | 187 | ||
| GENETIC AND GENOMIC TESTING | 187 | ||
| Definition of a Genetic or Genomic Test | 188 | ||
| Ethical Considerations of Genetic Testing | 189 | ||
| TYPES OF GENETIC AND GENOMIC TESTS | 189 | ||
| Carrier Screening | 189 | ||
| Carrier Screening May Reveal Asymptomatic and Symptomatic Individuals | 189 | ||
| Newborn Screening | 190 | ||
| Susceptibility and Presymptomatic Testing | 190 | ||
| Diagnostic Genetic Testing | 190 | ||
| Prenatal Genetic Testing | 190 | ||
| Pharmacogenetic and Pharmacogenomic Testing | 191 | ||
| Direct-to-Consumer Testing | 191 | ||
| CLINICAL DECISION-MAKING FRAMEWORK FOR GENETIC TESTING | 191 | ||
| COLLABORATING WITH GENETIC HEALTH PROFESSIONALS AND LIFELONG LEARNING IN GENETICS AND GENOMICS | 192 | ||
| THE PHYSICIAN ASSISTANT’S ROLE IN THE GENOMIC AGE: PUTTING IT ALL TOGETHER | 192 | ||
| 16 - Chronic Care Perspectives | 197 | ||
| A NEED FOR COORDINATED,PATIENT-CENTERED CARE | 197 | ||
| PATIENT–CLINICIAN PARTNERSHIPS AND TEAM-BASED CARE: A PARADIGM SHIFT IN CHRONIC DISEASE MANAGEMENT | 198 | ||
| ELEMENTS OF THE CHRONIC CARE MODEL | 198 | ||
| Self-Management and Self-Management Support | 200 | ||
| MOTIVATIONAL INTERVIEWING AND ACTION PLANNING | 201 | ||
| POPULATION-BASED CHRONIC DISEASE MANAGEMENT | 204 | ||
| NEW REIMBURSEMENT MODELS | 208 | ||
| USE OF TECHNOLOGY IN CHRONICDISEASEMANAGEMENT:NEW FRONTIERS | 208 | ||
| SUMMARY | 210 | ||
| CLINICAL APPLICATIONS | 210 | ||
| References | 211 | ||
| 17 - Considerations for a Logical Approach to Medication Prescribing | 214 | ||
| HISTORY OF PRESCRIPTION WRITING | 214 | ||
| CONTROLLED SUBSTANCES | 215 | ||
| EFFECTIVE PRESCRIBING | 215 | ||
| CONTENT OF A PRESCRIPTION2 | 215 | ||
| EVIDENCE-BASED APPROACH TO MEDICAL DECISION MAKING | 216 | ||
| PHARMACOLOGY AND THERAPEUTICS | 217 | ||
| Pharmacodynamics | 217 | ||
| Pharmacokinetics | 217 | ||
| Special Patient Populations | 219 | ||
| Pediatrics | 219 | ||
| Geriatrics | 219 | ||
| Obesity | 220 | ||
| Pregnancy and Lactation | 220 | ||
| PERSONALIZED MEDICINE AND PHARMACOGENOMICS | 221 | ||
| BARRIERS TO PATIENT COMPLIANCE | 221 | ||
| INTERPROFESSIONAL COLLABORATION WITH A PHARMACIST | 222 | ||
| ETHICAL QUANDARIES | 222 | ||
| CONCLUSION | 223 | ||
| References | 223 | ||
| 18 - Complementary and Integrative Health | 224 | ||
| NATURAL PRODUCTS | 226 | ||
| MIND–BODY PRACTICES | 228 | ||
| ADDRESSING COMPLEMENTARY AND INTEGRATIVE HEALTH IN CLINICAL PRACTICE | 229 | ||
| CLINICAL APPLICATIONS | 230 | ||
| References | 230 | ||
| 19 - Geriatric Medicine | 231 | ||
| GERIATRIC CARE | 232 | ||
| Chronic Conditions | 232 | ||
| Functional Status | 232 | ||
| Time and Perspective | 234 | ||
| NORMAL AGE-RELATED CHANGES | 234 | ||
| Sensory Changes | 234 | ||
| Cardiovascular Changes | 234 | ||
| Endocrine Changes | 235 | ||
| Immunologic Changes | 236 | ||
| Renal Function | 236 | ||
| GERIATRIC SYNDROMES | 236 | ||
| Dementia | 236 | ||
| Dementia Workup | 237 | ||
| Management of Dementia | 238 | ||
| Delirium | 238 | ||
| Urinary Incontinence | 239 | ||
| Stress Incontinence | 239 | ||
| Urge Incontinence and Overactive Bladder | 239 | ||
| Overflow Incontinence | 239 | ||
| Functional Incontinence | 239 | ||
| Instability and Falls | 240 | ||
| COMMON PROBLEMS IN GERIATRIC CARE | 241 | ||
| Screening and Health Promotion | 241 | ||
| Complications of Pharmacotherapy | 243 | ||
| Dizziness and Syncope | 243 | ||
| Sleep Problems | 244 | ||
| Screening Older Patients for Sleep Problems | 244 | ||
| Depression | 244 | ||
| Older Women’s Health | 246 | ||
| SEXUALITY AND AGING | 246 | ||
| Prostate Disease | 247 | ||
| UNIQUE ISSUES IN GERIATRIC CARE | 247 | ||
| Elder Abuse | 247 | ||
| Medicare and Medicaid | 248 | ||
| Ethnogeriatrics | 248 | ||
| Social Support and Caregiver Support | 249 | ||
| End of Life | 249 | ||
| COMMUNITY RESOURCES AND SERVICES | 250 | ||
| Information and Referral Services | 250 | ||
| Case Management or Care Coordination | 250 | ||
| Multipurpose Senior Centers | 250 | ||
| Day Care and Day Health Care Programs | 251 | ||
| In-Home Care | 251 | ||
| Senior Housing | 252 | ||
| CONCLUSION | 252 | ||
| CLINICAL APPLICATIONS | 252 | ||
| References | 253 | ||
| 20 - End-of-Life Issues | 255 | ||
| TRUTH TELLING | 255 | ||
| HELPING PATIENTS MAKE INFORMED DECISIONS | 256 | ||
| PLANNING FOR DEATH | 256 | ||
| ADVANCE DIRECTIVES | 257 | ||
| Physician Orders for Life-Sustaining Treatment | 258 | ||
| Out-of-Hospital Do Not Resuscitate Orders | 258 | ||
| HOSPICE | 259 | ||
| HAVING THE CONVERSATION | 259 | ||
| STAGES OF DYING | 261 | ||
| STAGES OF GRIEF | 261 | ||
| EMERGING ISSUES | 262 | ||
| CLINICAL APPLICATIONS | 262 | ||
| GLOSSARY | 263 | ||
| References | 263 | ||
| III - INTERPERSONAL AND COMMUNICATION SKILLS | 265 | ||
| 21 - Communication Issues | 267 | ||
| PATIENT-CENTERED COMMUNICATION | 267 | ||
| Communication Breakdowns | 268 | ||
| Barriers of Communication | 268 | ||
| HEALTH LITERACY AND CULTURAL COMPETENCY | 269 | ||
| INTERPROFESSIONAL COMMUNICATION | 269 | ||
| HEALTH INFORMATION TECHNOLOGY | 270 | ||
| PROFESSIONALISM AND CONDUCT | 271 | ||
| CONCLUSION | 271 | ||
| References | 272 | ||
| 22 - Electronic Health Record | 274 | ||
| DEVELOPMENT | 274 | ||
| MEANINGFUL USE | 275 | ||
| IMPLEMENTATION | 275 | ||
| BENEFITS AND BARRIERS TO IMPLEMENTING ELECTRONIC HEALTH RECORDS | 277 | ||
| SECURITY | 277 | ||
| SAFETY | 277 | ||
| CLINICAL APPLICATIONS | 278 | ||
| References | 278 | ||
| 23 - Patient Education | 280 | ||
| BARRIERS TO PATIENT EDUCATION | 280 | ||
| Patient Barriers | 281 | ||
| Provider Barriers | 283 | ||
| Health Literacy9,10 | 283 | ||
| PROVIDING STRUCTURE FOR EFFECTIVE PATIENT EDUCATION | 284 | ||
| References | 288 | ||
| 24 - Providing Culturally Competent Health Care | 289 | ||
| CULTURAL COMPETENCE | 289 | ||
| INTRODUCTION TO CULTURALLY COMPETENT PRACTICE | 289 | ||
| RATIONALE | 290 | ||
| BIAS AND STEREOTYPING | 291 | ||
| COGNITIVE ERRORS IN DECISION MAKING | 291 | ||
| KNOWLEDGE, SKILLS, AND ATTITUDES | 292 | ||
| LANGUAGE BARRIERS | 292 | ||
| SPECIAL POPULATIONS | 293 | ||
| CONCLUSION | 294 | ||
| References | 294 | ||
| IV - PATIENT CARE: CLINICAL ROTATIONS | 297 | ||
| 25 - Family Medicine | 299 | ||
| PHYSICIAN ASSISTANTS IN FAMILY MEDICINE: A BRIEF HISTORY | 299 | ||
| HISTORY REPEATS ITSELF | 299 | ||
| THE SPECIALTY OF FAMILY MEDICINE | 300 | ||
| THE FAMILY MEDICINE CLINICAL ROTATION | 302 | ||
| COMMON MEDICAL PROCEDURES IN FAMILY MEDICINE PRACTICES | 303 | ||
| THE BENEFITS OF PRACTICING FAMILY MEDICINE | 305 | ||
| CONCLUSION | 306 | ||
| References | 307 | ||
| 26 - Internal Medicine | 309 | ||
| PHYSICIAN ASSISTANTS IN INTERNAL MEDICINE | 309 | ||
| Physician Assistants in Internal Medicine Subspecialties | 310 | ||
| Internal Medicine Rotation | 310 | ||
| What to Expect and Know | 310 | ||
| Clinical Environment | 310 | ||
| OTHER HEALTH PROFESSIONALS | 311 | ||
| PATIENTS AND SPECIAL POPULATIONS | 311 | ||
| CHALLENGES AND REWARDS | 311 | ||
| References | 311 | ||
| 27 - Women’s Health | 312 | ||
| APPROACH TO THE PATIENT | 312 | ||
| WHAT TO EXPECT ON CLINICAL ROTATIONS | 312 | ||
| Surgery Service | 312 | ||
| Inpatient Service | 313 | ||
| Outpatient Service | 313 | ||
| Labor and Delivery and Postpartum | 314 | ||
| EXPECTATIONS FOR A SUCCESSFUL ROTATION | 314 | ||
| Interprofessionalism on Obstetrics and Gynecology | 315 | ||
| CLINICAL INFORMATION | 316 | ||
| PROMOTION OF WELLNESS | 316 | ||
| HOW TO APPROACH THE DIVERSE PATIENT | 318 | ||
| STUDENT AND FACULTY RESOURCES | 318 | ||
| STUDENT TIPS | 319 | ||
| STUDENT COMMENTS | 320 | ||
| WHEN TO REFER | 320 | ||
| SPECIAL CHALLENGES | 320 | ||
| REWARDS OF WORKING IN OBSTETRICS AND GYNECOLOGY | 321 | ||
| CONCLUSION | 321 | ||
| References | 322 | ||
| 28 - Pediatrics | 323 | ||
| HISTORY | 323 | ||
| PEDIATRIC ROTATIONS | 324 | ||
| WELL CHILD VISITS AND IMMUNIZATIONS | 324 | ||
| AMBULATORY PEDIATRICS | 326 | ||
| HOSPITAL PEDIATRICS | 328 | ||
| FOSTER AND ADOPTED CHILDREN | 328 | ||
| NEWBORNS | 328 | ||
| FAILURE TO THRIVE | 329 | ||
| ORAL HEALTH | 329 | ||
| DEVELOPMENTAL DISABILITIES | 329 | ||
| BEHAVIORAL AND MENTAL HEALTH DISORDERS | 329 | ||
| CHRONIC DISEASE | 330 | ||
| References | 330 | ||
| 29 - Behavioral Science and Medicine: Essentials in Practice | 331 | ||
| HISTORY OF MENTAL ILLNESS | 332 | ||
| MYTHS AND STIGMAS ATTACHED TO PSYCHIATRIC ILLNESS | 332 | ||
| AWARENESS OF YOUR OWN BIASES | 332 | ||
| EMPATHY AND RAPPORT | 332 | ||
| THE PHYSICIAN ASSISTANT–PATIENT ENCOUNTER | 332 | ||
| The Approach to the Patient | 332 | ||
| Identifying Information | 332 | ||
| Chief Complaint and History of Present Illness | 333 | ||
| Past Psychiatric History | 333 | ||
| Social History | 333 | ||
| Family History | 333 | ||
| Past Medical History | 333 | ||
| Psychiatric Review of Systems | 333 | ||
| Mental Status Examination | 334 | ||
| Physical Examination | 334 | ||
| Assessment and Impression | 334 | ||
| Plan and Treatment | 334 | ||
| Crisis Management | 336 | ||
| DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 5TH EDITION | 336 | ||
| EXPECTATIONS OF PHYSICIAN ASSISTANT STUDENTS ON PSYCHIATRIC CLINICAL ROTATIONS | 337 | ||
| Patient Populations Seen on a Psychiatric Rotation | 338 | ||
| Special Considerations During This Rotation | 338 | ||
| Other Members of the Team for This Discipline | 338 | ||
| MOTIVATIONAL INTERVIEWING | 338 | ||
| THE ROLE AND FUTURE PHYSICIAN ASSISTANTS IN PSYCHIATRY | 339 | ||
| CLINICAL APPLICATIONS | 340 | ||
| References | 340 | ||
| 30 - Surgery | 341 | ||
| HOW DO PRACTITIONERS IN A SURGICAL PRACTICE APPROACH THE PATIENT? | 342 | ||
| Will this Patient Benefit from Surgery? | 342 | ||
| Is Surgery the Most Appropriate Next Step? | 342 | ||
| Is this Patient a Surgical Candidate? | 342 | ||
| WHAT DO PHYSICIAN ASSISTANTS IN SURGERY TYPICALLY DO ON A DAILY BASIS? | 342 | ||
| Hospital Operations | 342 | ||
| Clinic Operations | 344 | ||
| WHAT WILL I BE EXPECTED TO DO DURING THE SURGERY ROTATION? | 344 | ||
| Hospital Operations | 344 | ||
| Clinic Operations | 346 | ||
| WHICH CLINICAL ENVIRONMENTS MAY I WORK IN DURING THE SURGERY ROTATION? | 346 | ||
| WHICH OTHER TYPES OF HEALTH PROFESSIONALS WILL I WORK WITH DURING THE SURGERY ROTATION, AND WHAT CAN I LEARN FROM THEM? | 347 | ||
| Attending Surgeon | 347 | ||
| Fellow | 347 | ||
| Fifth-Year (Chief) Resident | 347 | ||
| Junior Resident | 347 | ||
| Intern | 347 | ||
| Student | 347 | ||
| Anesthesia Team | 347 | ||
| Anesthesiologist | 347 | ||
| Certified Registered Nurse Anesthetists | 348 | ||
| Anesthesiology Assistants | 348 | ||
| Operating Room and Recovery Team | 348 | ||
| Postanesthesia Care Unit or Recovery Room Nurse | 348 | ||
| Operating Room Director | 348 | ||
| Operating Room Supervisor | 348 | ||
| Circulating Nurse (Circulator) | 348 | ||
| Scrub Nurse or Registered Nurse First Assist | 348 | ||
| Certified Surgical Technologist or Scrub Tech | 349 | ||
| WHICH CLINICAL INFORMATION DO THE PHYSICIAN ASSISTANTS AND PHYSICIANS ON THE SURGERY ROTATION ALWAYS WANT TO KNOW ABOUT THEIR PA... | 349 | ||
| WHICH SPECIAL POPULATIONS OF PATIENTS MAY I SEE ON THE SURGERY ROTATION? | 349 | ||
| WHAT ARE THE SPECIAL CHALLENGES OF SURGERY? | 349 | ||
| WHAT ARE THE SPECIAL REWARDS OF SURGERY? | 349 | ||
| SCRUBBING AND GOWNING AND GLOVING | 350 | ||
| Five-Minute Scrub | 350 | ||
| Alcohol-Based Handrubs | 350 | ||
| Assisted Gowning and Gloving | 350 | ||
| Self-Gowning and -Gloving | 350 | ||
| References | 352 | ||
| 31 - Emergency Medicine | 353 | ||
| HOW DO PRACTITIONERS IN EMERGENCY MEDICINE APPROACH THE PATIENT? | 353 | ||
| WHAT DO PHYSICIAN ASSISTANTS IN EMERGENCY MEDICINE TYPICALLY DO ON A DAILY BASIS? | 354 | ||
| WHAT WILL I BE EXPECTED TO DO ON THIS ROTATION? | 354 | ||
| WHICH CLINICAL ENVIRONMENTS MAY I WORK IN DURING THIS ROTATION? | 355 | ||
| WHICH OTHER TYPES OF HEALTH PROFESSIONALS WILL I WORK WITH ON THIS ROTATION, AND WHAT CAN I LEARN FROM THEM? | 355 | ||
| WHICH SPECIAL POPULATIONS OF PATIENTS MAY I SEE ON THIS ROTATION? | 355 | ||
| WHAT ARE THE SPECIAL CHALLENGES OF EMERGENCY MEDICINE? | 356 | ||
| WHAT ARE THE SPECIAL REWARDS OF EMERGENCY MEDICINE? | 356 | ||
| WHAT RESOURCES MIGHT BE HELPFUL TO ME ON THIS ROTATION? | 356 | ||
| 32 - Elective Rotations | 357 | ||
| CARDIOLOGY AND APPROACH TO THE PATIENT | 357 | ||
| PHYSICIAN ASSISTANTS IN CARDIOLOGY | 357 | ||
| PHYSICIAN ASSISTANTS IN CARDIOLOGY SUBSPECIALTIES | 358 | ||
| THE CARDIOLOGY ROTATION | 358 | ||
| What to Expect and Know | 358 | ||
| Clinical Environment | 359 | ||
| Other Health Professionals | 359 | ||
| Patients and Special Populations | 359 | ||
| CHALLENGES AND REWARDS IN CARDIOLOGY | 361 | ||
| HELPFUL RESOURCES | 361 | ||
| SUMMARY | 361 | ||
| APPROACH TO THE PATIENT | 362 | ||
| TYPICAL DAY | 363 | ||
| EXPECTATIONS OF THE STUDENT | 366 | ||
| CLINICAL SETTINGS | 366 | ||
| TEAM MEDICINE | 367 | ||
| ESSENTIAL CLINICAL INFORMATION TO BE OBTAINED FROM EACH PATIENT | 367 | ||
| WHAT ARE THE SPECIAL REWARDS OF DERMATOLOGY? | 368 | ||
| WHAT ARE THE SPECIAL CHALLENGES OF DERMATOLOGY? | 368 | ||
| APPROACH TO THE ORTHOPEDIC PATIENT | 370 | ||
| PHYSICIAN ASSISTANTS’ DAILY TASKS IN ORTHOPEDICS | 370 | ||
| EXPECTATIONS OF THE STUDENT | 371 | ||
| CLINICAL SETTINGS | 371 | ||
| TEAM LEARNING FROM HEALTH PROFESSIONALS ON THE ORTHOPEDIC TEAM | 371 | ||
| CLINICAL INFORMATION PHYSICIANS AND PHYSICIAN ASSISTANTS ALWAYS WANT TO KNOW ON THIS ROTATION | 376 | ||
| SPECIAL PATIENT POPULATIONS | 376 | ||
| WHAT ARE THE SPECIAL CHALLENGES OF ORTHOPEDICS? | 376 | ||
| WHAT ARE THE SPECIAL REWARDS OF ORTHOPEDICS? | 379 | ||
| FOR THE STUDENT | 383 | ||
| DEMOGRAPHICS | 385 | ||
| CANCER DISPARITIES | 386 | ||
| CANCER PREVENTION | 386 | ||
| PATIENT CARE | 387 | ||
| CANCER CARE | 388 | ||
| CANCER CARE IN THE TWENTY-FIRST CENTURY | 389 | ||
| GOALS OF TREATMENT | 390 | ||
| CLINICAL APPLICATIONS | 391 | ||
| HOW DO PRACTITIONERS IN MEDICAL SUBSPECIALTIES APPROACH THE PATIENT? | 393 | ||
| PRIMARY CARE PROVIDER–SPECIALIST RELATIONSHIP | 394 | ||
| WHAT DO PHYSICIAN ASSISTANTS IN MEDICAL SUBSPECIALTIES TYPICALLY DO ON A DAILY BASIS? | 394 | ||
| WHAT WILL I BE EXPECTED TO DO IN THIS ROTATION? | 394 | ||
| WHICH CLINICAL ENVIRONMENTS MAY I WORK IN DURING THIS ROTATION? | 395 | ||
| SUBSPECIALTIES | 395 | ||
| Neurology | 395 | ||
| Rheumatology | 396 | ||
| Infectious Diseases | 397 | ||
| Endocrinology | 398 | ||
| Pulmonology | 399 | ||
| Nephrology | 400 | ||
| Gastroenterology | 401 | ||
| WHICH SPECIAL POPULATIONS OF PATIENTS MAY I SEE MEDICAL SUBSPECIALTY ROTATIONS? | 402 | ||
| Endocrinology | 402 | ||
| Neurology | 402 | ||
| Pulmonology | 402 | ||
| Nephrology | 402 | ||
| Gastroenterology | 402 | ||
| Infectious Diseases | 403 | ||
| WHAT ARE THE SPECIAL CHALLENGES OF MEDICAL SUBSPECIALTIES? | 403 | ||
| WHAT ARE THE SPECIAL REWARDS OF MEDICAL SUBSPECIALTIES? | 403 | ||
| WHAT RESOURCES MIGHT BE HELPFUL TO ME ON THIS ROTATION? | 403 | ||
| HOW DO PRACTITIONERS IN SURGICAL SUBSPECIALTIES APPROACH THE PATIENT? | 404 | ||
| PRIMARY CARE–SURGICAL SPECIALIST RELATIONSHIP | 405 | ||
| WHAT DO SURGICAL SUBSPECIALTY PHYSICIAN ASSISTANTS DO ON A DAILY BASIS? | 405 | ||
| WHAT WILL I BE EXPECTED TO DO ON THIS ROTATION? | 405 | ||
| SURGICAL SUBSPECIALTIES | 406 | ||
| Cardiovascular and Thoracic Surgery | 406 | ||
| Neurosurgery | 407 | ||
| Ear, Nose, and Throat Surgery | 408 | ||
| Urologic Surgery | 408 | ||
| Plastic and Reconstructive Surgery | 409 | ||
| Trauma Surgery | 409 | ||
| Burn Surgery | 410 | ||
| WHAT ARE THE SPECIAL CHALLENGES OF SURGICAL SUBSPECIALTIES? | 411 | ||
| WHAT ARE THE SPECIAL REWARDS OF SURGICAL SUBSPECIALTIES? | 411 | ||
| WHAT RESOURCES MIGHT BE HELPFUL TO ME ON THESE ROTATIONS? | 411 | ||
| References | 411 | ||
| V - PROFESSIONALISM | 413 | ||
| 33 - Professionalism | 415 | ||
| UNDERSTANDING THE IMPORTANCE OF PROFESSIONALISM | 416 | ||
| ELEMENTS OF THE PHYSICIAN ASSISTANT COMPETENCY OF PROFESSIONALISM | 416 | ||
| BEHAVIOR TOWARD THE PATIENT | 417 | ||
| Values: Respect, Compassion, and Integrity | 417 | ||
| Primacy of Patient Welfare | 418 | ||
| Ethical Principles and Practice | 418 | ||
| Sensitivity and Responsiveness to a Diverse Population | 418 | ||
| BEHAVIOR TOWARD OTHER PROFESSIONALS | 419 | ||
| Professional Relationships With Physicians and Other Health Care Providers | 419 | ||
| BEHAVIOR TOWARD THE PUBLIC | 419 | ||
| Responsiveness to Patient Needs and the Needs of Society | 419 | ||
| Accountability to Patients, Society, and the Profession | 419 | ||
| Adherence to Legal and Regulatory Requirements | 420 | ||
| BEHAVIOR TOWARD ONESELF | 420 | ||
| Commitment to Excellence and Professional Development | 420 | ||
| Demonstrate Self-Reflection, Critical Curiosity, and Initiative | 420 | ||
| Know Professional and Personal Limitations | 420 | ||
| Practice Without Impairment | 421 | ||
| FOSTERING PROFESSIONALISM | 421 | ||
| CONCLUSION | 421 | ||
| CLINICAL APPLICATIONS | 422 | ||
| References | 423 | ||
| 34 - Clinical Ethics | 425 | ||
| CHAPTER ORGANIZATION | 425 | ||
| WHAT IS ETHICS? | 426 | ||
| THEORIES AND PRINCIPLES | 426 | ||
| METHODOLOGY | 426 | ||
| AMERICAN BIOETHICS HISTORY | 427 | ||
| “God Squad”: An Early Ethics Committee | 427 | ||
| Tuskegee Study | 428 | ||
| Beecher Papers | 429 | ||
| Belmont Report | 429 | ||
| Quinlan Case | 429 | ||
| CASES | 430 | ||
| ETHICS CONSULTATION AND RESOURCES | 442 | ||
| References | 443 | ||
| 35 - Medical Malpractice and Risk Management | 444 | ||
| WHAT IS MEDICAL NEGLIGENCE? | 444 | ||
| Duty | 445 | ||
| Breach of Duty | 445 | ||
| Causation | 445 | ||
| Injury and Damages | 446 | ||
| OTHER THEORIES OF RECOVERY | 446 | ||
| Abandonment | 446 | ||
| Informed Consent | 446 | ||
| ELEMENTS OF A LAWSUIT | 447 | ||
| Initial Filings | 447 | ||
| Discovery Stage | 448 | ||
| Settlement Talks and Mediation | 448 | ||
| Trial | 448 | ||
| RISK MANAGEMENT TECHNIQUES | 452 | ||
| CLINICAL APPLICATIONS | 453 | ||
| References | 453 | ||
| 36 - Postgraduate Clinical Training Programs for Physician Assistants | 454 | ||
| HISTORY OF POSTGRADUATE RESIDENCY EDUCATION | 454 | ||
| Program Development | 455 | ||
| Currently Available Programs | 455 | ||
| GENERAL CHARACTERISTICS OF EXISTING PROGRAMS | 456 | ||
| Application Process | 456 | ||
| Admission Requirements | 457 | ||
| Clinical Settings | 457 | ||
| Curriculum | 457 | ||
| Credential Awarded | 457 | ||
| Stipends and Fringe Benefits | 458 | ||
| RESIDENCY PROGRAM ACCREDITATION | 458 | ||
| ASSOCIATION OF POSTGRADUATE PROGRAMS | 459 | ||
| Resident Perceptions of Training | 459 | ||
| RESIDENCY GRADUATE EMPLOYMENT OPPORTUNITIES | 459 | ||
| SELECTING A RESIDENCY PROGRAM | 460 | ||
| CONCLUSION | 465 | ||
| CLINICAL APPLICATIONS | 466 | ||
| References | 466 | ||
| 37 - Dealing With Stress and Burnout | 467 | ||
| THE DECISION TO BECOME A PHYSICIAN ASSISTANT | 467 | ||
| EXPERIENCE OF STRESS IN TRAINING | 467 | ||
| Stress in Choosing the First Job | 469 | ||
| Educating Patients and Their Families | 469 | ||
| Relationships With Preceptors | 470 | ||
| Relationships With Administrators | 470 | ||
| STRESS ON THE JOB | 470 | ||
| Patient Care Issues | 470 | ||
| Formal Professional Issues | 471 | ||
| Role Ambiguity Issues | 472 | ||
| BURNOUT | 472 | ||
| Personal Characteristics | 472 | ||
| Identifying Burnout | 472 | ||
| Assessment and Treatment | 472 | ||
| CONCLUSION | 474 | ||
| CLINICAL APPLICATIONS | 475 | ||
| References | 475 | ||
| VI - PRACTICE-BASED LEARNING AND IMPROVEMENT | 477 | ||
| 38 - Health Disparities | 479 | ||
| WHAT ARE HEALTH DISPARITIES? | 479 | ||
| HEALTH DISPARITIES: SCOPE OF THE PROBLEM | 481 | ||
| Sexual Orientation | 481 | ||
| Age | 482 | ||
| Insurance Coverage | 482 | ||
| Geographic Location | 482 | ||
| Health Literacy | 483 | ||
| CLINICAL APPLICATIONS | 483 | ||
| References | 484 | ||
| 39 - Patient Safety and Quality of Care | 485 | ||
| QUALITY CARE MOVEMENT IN AMERICA | 485 | ||
| Determining the Magnitude of the Problem | 486 | ||
| Why Errors Occur | 486 | ||
| Human Mistakes | 487 | ||
| TYPES OF MEDICAL ERRORS | 487 | ||
| Diagnosis Errors | 487 | ||
| Medication Errors (Fig. 39.2) | 488 | ||
| Surgical Errors (Fig. 39.3) | 489 | ||
| Transition and Communication Errors | 491 | ||
| Introduction | 491 | ||
| Situation | 491 | ||
| Background | 491 | ||
| Assessment | 491 | ||
| Recommendation | 491 | ||
| Health Care–Associated Conditions | 492 | ||
| PATIENT SAFETY STRATEGIES | 492 | ||
| Role of the Patient | 493 | ||
| At the Appointment | 494 | ||
| VII - SYSTEMS-BASED PRACTICE | 499 | ||
| 40 - Health and Health Care Delivery Systems | 501 | ||
| HEALTH SYSTEMS | 501 | ||
| What Is a Health System? | 502 | ||
| Describing National Health Systems: United Kingdom, Canada, and the United States | 502 | ||
| How Is Care Financed? | 503 | ||
| Who Delivers Care? | 504 | ||
| Population Served? | 504 | ||
| THE U.S. HEALTH CARE SYSTEM: CHALLENGES AND INNOVATIONS | 504 | ||
| Horizontally Integrated Systems | 504 | ||
| Vertically Integrated Systems | 506 | ||
| Virtually Integrated Systems | 506 | ||
| The Challenges | 506 | ||
| Quality | 506 | ||
| Access | 506 | ||
| Cost | 506 | ||
| Equity | 508 | ||
| Innovations | 508 | ||
| The Affordable Care Act and the Triple Aim | 508 | ||
| Population Health | 508 | ||
| Patient-Centered Medical Homes | 509 | ||
| Accountable Care Organizations | 512 | ||
| Accountable Care Communities | 512 | ||
| “Considering state and regional variation in the Affordable Care Act” | 514.e1 | ||
| “Drawing the Health Care System” | 514.e1 | ||
| Stages of Health Reform | 514.e1 | ||
| “ACA Successes and Concerns” | 514.e1 | ||
| “The Terminology of Health Reform” | 514.e1 | ||
| 41 - Rehabilitative and Long-Term Care Systems | 515 | ||
| HOME CARE: INFORMAL CAREGIVERS | 516 | ||
| HOME CARE: HOME CARE ORGANIZATIONS | 517 | ||
| HOSPICE | 518 | ||
| MEDICAL HOUSE CALLS | 519 | ||
| ASSISTED LIVING FACILITIES | 520 | ||
| NURSING HOMES | 520 | ||
| References | 521 | ||
| 42 - Health Care for the Homeless | 522 | ||
| SOCIAL DETERMINANTS OF HEALTH | 522 | ||
| HEALTH DETERMINANTS | 522 | ||
| CATEGORIES OF HOMELESS PEOPLE | 522 | ||
| Children and Adolescents | 522 | ||
| Adults | 522 | ||
| Families | 523 | ||
| PATIENT AND FAMILY ASSESSMENT | 523 | ||
| HEALTH HISTORY | 523 | ||
| References | 524 | ||
| 43 - Correctional Medicine | 526 | ||
| WORKING IN A CORRECTIONAL ENVIRONMENT | 527 | ||
| PROVIDING HEALTH CARE IN CORRECTIONAL INSTITUTIONS | 527 | ||
| Access to Care | 527 | ||
| Clinical Autonomy | 528 | ||
| Quality of Care | 529 | ||
| Patient Satisfaction | 529 | ||
| STAFFING IN CORRECTIONAL MEDICINE | 529 | ||
| Staffing Issues | 529 | ||
| Clinical Performance Enhancement | 530 | ||
| Staff and Inmate Safety | 530 | ||
| COMMUNICABLE DISEASES IN CORRECTIONAL INSTITUTIONS | 531 | ||
| Infection Control | 531 | ||
| Community-Acquired Methicillin-Resistant Staphylococcus aureus | 531 | ||
| Tuberculosis | 532 | ||
| Human Immunodeficiency Virus | 533 | ||
| Sexually Transmitted Diseases | 533 | ||
| Syphilis | 534 | ||
| Gonorrhea and Chlamydia | 534 | ||
| Genital Herpes | 534 | ||
| Hepatitis | 534 | ||
| CHRONIC DISEASE IN CORRECTIONAL INSTITUTIONS | 534 | ||
| Asthma | 534 | ||
| Diabetes | 535 | ||
| Hypertension | 536 | ||
| MANAGING MENTAL HEALTH IN CORRECTIONAL INSTITUTIONS | 536 | ||
| Mental Health Screening | 536 | ||
| Suicide | 536 | ||
| Gender Dysphoria | 537 | ||
| Co-occurring Disorders | 537 | ||
| SPECIAL ISSUES IN CORRECTIONS | 537 | ||
| Pain Management | 537 | ||
| End of Life | 538 | ||
| MANAGING ETHICAL CONFLICTS IN CORRECTIONAL INSTITUTIONS | 538 | ||
| Autonomy | 538 | ||
| Justice | 539 | ||
| Beneficence | 539 | ||
| Confidentiality | 539 | ||
| FUTURE DIRECTIONS | 540 | ||
| CONCLUSION | 540 | ||
| CLINICAL APPLICATIONS | 541 | ||
| AUTHOR DISCLOSURE STATEMENT | 542 | ||
| References | 542 | ||
| 44 - Military Medicine | 544 | ||
| HISTORY OF MILITARY PHYSICIAN ASSISTANTS | 544 | ||
| THE INTERSERVICE PHYSICIAN ASSISTANT PROGRAM | 545 | ||
| RECRUITING CHALLENGES | 546 | ||
| SCOPE OF PRACTICE | 547 | ||
| ROLE OF PHYSICIAN ASSISTANTS IN THE MILITARY HEALTH SYSTEM | 547 | ||
| Peacetime | 548 | ||
| Wartime | 548 | ||
| SERVICE IMPACT | 549 | ||
| CONCLUSION | 550 | ||
| DISCLAIMER | 551 | ||
| References | 551 | ||
| 45 - Inner-City Health Care | 552 | ||
| HISTORY | 553 | ||
| THE GROWTH OF THE URBAN ENVIRONMENT AND THE INNER CITY | 553 | ||
| WHY INNER-CITY HEALTH CARE IS UNIQUE | 555 | ||
| DIVERSITY IN THE INNER CITY | 555 | ||
| HEALTH CARE IN THE INNER CITY | 557 | ||
| EFFECTS OF SOCIAL ISOLATION IN THE INNER CITY | 559 | ||
| RECENT TRENDS IN THE INNER CITY | 560 | ||
| ROLE OF PUBLIC TEACHING HOSPITALS | 560 | ||
| ROLE OF PUBLIC HEALTH DEPARTMENTS | 560 | ||
| ROLE OF COMMUNITY HEALTH CENTERS | 561 | ||
| INCREASING NEED FOR LANGUAGE LITERACY | 561 | ||
| HOMELESS HEALTH CARE IN THE INNER CITY | 561 | ||
| References | 563 | ||
| 46 - Rural Health Care | 564 | ||
| WHY YOU SHOULD READ THIS CHAPTER | 564 | ||
| WHAT IS RURAL, AND WHY DOES IT MATTER? | 564 | ||
| Definitions of Rural | 565 | ||
| RURAL DEMOGRAPHICS | 566 | ||
| Aging Populations | 566 | ||
| Minority Population Trends | 567 | ||
| ACCESS TO HEALTH CARE | 567 | ||
| RURAL HEALTH CARE SYSTEMS: HOSPITALS, CLINICS, AND THE SAFETY NET | 568 | ||
| Early Models | 569 | ||
| Critical Access Hospitals | 570 | ||
| Criteria for Critical Access Hospital Certification | 570 | ||
| Critical Access Hospitals—Physician Practice Mergers and Acquisitions | 571 | ||
| RURAL CLINICS: FRONTLINE ACCESS | 571 | ||
| Community and Migrant Health Centers | 571 | ||
| Rural Health Clinics | 572 | ||
| New Models for Frontier Communities | 573 | ||
| FUNDING AND REIMBURSEMENT FOR RURAL HEALTH SERVICES | 573 | ||
| Rural Incentives for Providers | 574 | ||
| RURAL HEALTH WORKFORCE ISSUES | 574 | ||
| PHYSICIAN ASSISTANTS AND RURAL MEDICINE | 575 | ||
| FEDERAL AND STATE POLICY IMPLICATIONS FOR RURAL HEALTH CARE | 576 | ||
| REQUISITES FOR RURAL PHYSICIAN ASSISTANTS | 577 | ||
| CHALLENGES AND REWARDS OF RURAL PRACTICE | 578 | ||
| References | 579 | ||
| 47 - International Health Care | 581 | ||
| PRACTICAL CONSIDERATIONS | 582 | ||
| General Issues | 582 | ||
| Licensure and Registration | 583 | ||
| Physician–Physician Assistant Relationship | 583 | ||
| Malpractice | 583 | ||
| Continuing Education | 584 | ||
| Salaries | 584 | ||
| QUALIFICATIONS | 584 | ||
| Medical Skills | 584 | ||
| Tropical Medicine | 584 | ||
| Public Health and Epidemiology | 584 | ||
| Human Resource Management and Teaching Expertise | 585 | ||
| Language Skills | 585 | ||
| OTHER CONSIDERATIONS | 585 | ||
| Stress | 585 | ||
| Medications and Standards of Treatment | 585 | ||
| Traditional Health Care | 585 | ||
| Personal Health and Safety | 586 | ||
| Land Mines and Unexploded Ordinance | 586 | ||
| Security | 586 | ||
| Reentry | 586 | ||
| Topics for Preparation | 586 | ||
| CLINICAL APPLICATIONS | 589 | ||
| 48 - Patients with Disabilities | 591 | ||
| PROVIDING APPROPRIATE CARE FOR PATIENTS WHO ARE DEAF AND HARD OF HEARING | 592 | ||
| Terms and Definitions | 592 | ||
| Best Practices | 593 | ||
| Challenges | 594 | ||
| Methods to Ensure Access | 594 | ||
| PROVIDING APPROPRIATE CARE FOR PATIENTS WITH MOBILITY DISABILITIES | 595 | ||
| Terms and Definitions | 595 | ||
| Best Practices | 596 | ||
| Challenges | 597 | ||
| Methods to Ensure Access | 597 | ||
| PROVIDING APPROPRIATE CARE FOR PATIENTS WITH VISUAL IMPAIRMENTS | 598 | ||
| Terms and Definitions | 598 | ||
| Best Practices | 598 | ||
| Challenges | 599 | ||
| Methods to Ensure Access | 599 | ||
| PROVIDING APPROPRIATE CARE FOR PATIENTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES | 599 | ||
| Terms and Definitions | 600 | ||
| Best Practices | 600 | ||
| Challenges | 601 | ||
| Methods to Ensure Access | 601 | ||
| CLINICAL APPLICATIONS | 601 | ||
| References | 602 | ||
| 49 - Mass Casualty Natural Disaster | 604 | ||
| PRINCIPLES OF TRIAGE | 605 | ||
| CHEMICAL, BIOLOGICAL, RADIOLOGIC, NUCLEAR, EXPLOSIVES, AND ENVIRONMENTAL INCIDENTS | 606 | ||
| Chemical Disasters | 606 | ||
| Biological Disasters | 607 | ||
| Nuclear and Radiologic Disasters | 608 | ||
| Improvised Nuclear Devices | 608 | ||
| Radiologic Dispersal Devices (Dirty Bombs) | 608 | ||
| Occupational Accidents and Radiologic Exposure Devices | 609 | ||
| Natural Disasters | 609 | ||
| Hurricanes | 609 | ||
| Tornadoes | 609 | ||
| Earthquakes | 610 | ||
| Tsunamis | 610 | ||
| Terrorism | 610 | ||
| PREPARING BEFORE DISASTER STRIKES | 610 | ||
| AFTER A CRISIS | 613 | ||
| Posttraumatic Stress Disorder | 613 | ||
| Special Populations | 614 | ||
| SUMMARY | 617 | ||
| CLINICAL APPLICATIONS | 617 | ||
| PERSONAL STORIES | 617 | ||
| Haitian Earthquake, 2010: International Disaster Relief | 619 | ||
| Henry Curran, PA-C | 619 | ||
| References | 620 | ||
| VIII - YOUR PHYSICIAN ASSISTANT CAREER | 623 | ||
| 50 - Leadership Skills for Physician Assistants | 625 | ||
| SELECTING AND ADMITTING LEADERS | 625 | ||
| LEADERSHIP FOR CLINICIANS | 625 | ||
| PHYSICIAN ASSISTANTS IN LEADERSHIP | 625 | ||
| A LEADERSHIP SKILL SET FOR PHYSICIAN ASSISTANTS | 626 | ||
| ENTRY INTO LEADERSHIP | 626 | ||
| BENEFITS FROM LEADERSHIP ROLES | 626 | ||
| CONCLUSION | 627 | ||
| 51 - Be a Physician Assistant Educator | 628 | ||
| ACADEMIC DIRECTOR | 629 | ||
| CLINICAL DIRECTOR | 630 | ||
| DIRECTOR OF ADMISSIONS | 631 | ||
| RESEARCH DIRECTOR AND DATA ANALYST | 632 | ||
| PROGRAM DIRECTOR | 632 | ||
| 52 - Professional Service | 635 | ||
| WHAT IS PROFESSIONAL SERVICE? | 635 | ||
| WHY SHOULD I GET INVOLVED INPROFESSIONALSERVICE? | 638 | ||
| HOW CAN I GET INVOLVED INPROFESSIONALSERVICE? | 639 | ||
| References | 639 | ||
| 53 - The Future of the Physician Assistant Profession | 640 | ||
| 54 - A Primer on Learning Objectives | 642.e1 | ||
| WHAT IS A LEARNING OBJECTIVE? | 642.e1 | ||
| WHY SHOULD WE HAVE LEARNING OBJECTIVES? | 642.e1 | ||
| WHAT ARE THE CHARACTERISTICS OF LEARNING OBJECTIVES? | 642.e1 | ||
| HOW TO WRITE LEARNING OBJECTIVES | 642.e2 | ||
| Format | 642.e2 | ||
| Common Errors and Pitfalls | 642.e2 | ||
| GIVE IT A TRY! | 642.e3 | ||
| ANSWERS | 642.e3 | ||
| 55 - A Primer on Item Writing | 642.e4 | ||
| COMPONENTS OF A CLASSIC MULTIPLE-CHOICE ITEM | 642.e4 | ||
| Writing the Vignette | 642.e4 | ||
| Writing the Lead-in Question | 642.e5 | ||
| Writing the Options | 642.e6 | ||
| AVOIDING TESTWISE CLUES | 642.e6 | ||
| PEER REVIEW OF ITEMS | 642.e7 | ||
| POSTTEST REVIEW OF ITEMS | 642.e7 | ||
| CONCLUSION | 642.e7 | ||
| EXAMPLES | 642.e7 | ||
| Example 1 | 642.e7 | ||
| Example 2 | 642.e8 | ||
| Example 3 | 642.e8 | ||
| Example 4 | 642.e8 | ||
| Example 5 | 642.e8 | ||
| Example 6 | 642.e8 | ||
| Example 7 | 642.e8 | ||
| 56 - Primer on Team-Based Learning | 642.e10 | ||
| TEAM-BASED LEARNING DEFINED | 642.e10 | ||
| WHY TEAM-BASED LEARNING? CLUES THAT LECTURES MAY NOT BE WORKING | 642.e11 | ||
| THE RATIONALE FOR TEAM-BASED LEARNING | 642.e12 | ||
| OVERVIEW OF THE TEAM-BASED LEARNING PROCESS | 642.e12 | ||
| Phase I: Preclass Preparation | 642.e13 | ||
| Selecting Readings for Pre–Team-Based Learning Preparation (Individual Study) | 642.e13 | ||
| Designing Application Exercises | 642.e14 | ||
| Phase II: The Readiness Assurance Process | 642.e14 | ||
| Scoring the Readiness Assurance Tests | 642.e15 | ||
| The “Answer Until Correct” Scoring Rubric | 642.e15 | ||
| Phase III: Application of Session Concepts | 642.e15 | ||
| The Role of the Instructor(s) in Team-Based Learning | 642.e15 | ||
| IMPLEMENTATION CONSIDERATIONS | 642.e16 | ||
| Team-Based Learning Timing and Student | 642.e16 | ||
| Team–Instructor Ratios | 642.e16 | ||
| Obtaining and Nurturing Faculty Buy-In | 642.e16 | ||
| Instructor Training | 642.e16 | ||
| Student Orientation to Team-Based Learning | 642.e16 | ||
| Foundational Team-Based Learning Readings | 642.e16 | ||
| SUMMARY | 642.e17 | ||
| References | 642.e17 | ||
| APPENDIX | 643 | ||
| Index | 645 | ||
| A | 645 | ||
| B | 647 | ||
| C | 648 | ||
| D | 651 | ||
| E | 653 | ||
| F | 655 | ||
| G | 655 | ||
| H | 656 | ||
| I | 658 | ||
| J | 660 | ||
| K | 660 | ||
| L | 660 | ||
| M | 660 | ||
| N | 662 | ||
| O | 664 | ||
| P | 664 | ||
| Q | 669 | ||
| R | 669 | ||
| S | 670 | ||
| T | 672 | ||
| U | 673 | ||
| V | 674 | ||
| W | 674 | ||
| Y | 675 | ||
| Z | 675 |