The Journal of Canada’s Physician Assistants <p>The <em><strong>Journal of Canada's Physician Assistants (JCANPA)</strong> </em>is a peer-reviewed open-access journal. JCANPA is a forum to share and translate knowledge of Canada's Physician Assistants' practice, profession, and solutions. </p> <p><em><strong>Canadian Physician Assistants</strong></em> are academically and clinically educated medical generalists who practice medicine within a formalized and collaborative partnership with physicians. PA education prepares medical clinicians who can adapt to their clinical environments which may include primary health care, specialty practice, surgery, emergency or hospital-based roles. PAs over time develop an increased knowledge of a medical or surgical specialty. The PAs’ scope of practice mirrors that of the physicians, and practice within trust-centred relationships and formalized contracts of supervision.</p> <p>Visit your Physician Assistant, Nurse Practitioner, or Physician to discuss your health and medical concerns. This journal is not intended to provide directions for self-care and treatment. When it comes to health, direct communication with qualified and knowledgeable medical providers makes a difference.</p> <p><span class="st"><span class="Y0NH2b CLPzrc g9yevd">Respectfully used to symbolize our Journal's values, hopes, and purpose, a</span></span><span class="Y0NH2b CLPzrc g9yevd">n <strong>Inukshuk</strong> in the shape of a person signifies safety, hope and friendship. </span>Used as a directional marker in Canada's North, the Inukshuk is an Inuit symbol of communication. F<span class="st">rom the Inuktitut, ᐃᓄᒃᓱᒃ, plural ᐃᓄᒃᓱᐃᑦ; alternatively, inukshuk in Inuinnaqtun, iñuksuk in Iñupiaq, or <em>inukshuk</em> in English. </span></p> University of Manitoba en-US The Journal of Canada’s Physician Assistants 2562-6841 <p>Authors published in the Journal of Canada's Physician Assistants (JCanPA) retain copyright of their articles, including all drafts and final published version. By agreeing to publish in JCanPA, authors grant the journal the right of first publication and distribution rights of the articles. Authors are free to submit their work to other publications in addition to JCanPA, provided they acknowledge its initial publication in JCanPA.</p><p>JCanPA is published online in the public domain. JCanPA holds no legal responsibility as to how these materials are used by the public. Please ensure all authors, co-authors, and investigators have read and agree to these terms.</p> A Review of the Medical Ethics Surrounding COVID-19 Lockdowns in Personal Care Homes and the Impacts on Those Living with Dementia <p>The impacts of the COVID-19 pandemic on personal care homes has played out daily in the media headlines across the country. Although Manitoba seemed to avoid the worst of this early on in the pandemic, recently the province has seen a disturbing surge in overall case levels (Government of Manitoba, 2020). This rise in COVID-19 cases in Manitoba has forced personal care homes to once again lockdown and restrict not only all visitor access but also limit social interaction among the residents themselves. When looking at this situation broadly, locking down all personal care homes seems to be like the obvious decision to make. Residents in personal care homes represent one of our most vulnerable populations and the virus has been shown to spread quickly with serious medical impacts to this group. Significant virus spread in these personal care homes could easily overwhelm our healthcare system and lead to unnecessary deaths. Clearly the decision to lockdown the personal care homes can be readily justified as a means of protecting not only this vulnerable group but also supporting the larger community who either provide healthcare or are requiring healthcare for other non-COVID-19 related reasons. While the above is true, the decision to do this is far from being straight forward. The impacts of these lockdowns are far reaching and go way beyond just the containment of the virus. There is a fine balance between maintaining the emotional and mental well-being of an individual living with dementia and managing the physical health of the greater population.</p> Hannah Smith Copyright (c) 2021 Hannah Smith 2021-01-26 2021-01-26 2 6 The impact of adding a physician assistant to a rural community hospital intensive care unit <p>Physician Assistants (PAs) are being used to enhance service delivery in a variety of practice settings. This study investigated the impact of adding a physician assistant to an internist team covering a rural community hospital Intensive Care Unit (ICU) in North East Ontario.&nbsp; Retrospective chart reviews and CIHI data extraction was done on a cohort of ICU patients prior to the hiring of a PA (no PA) and compared to a cohort of ICU patients who had received care from a PA during their ICU stay. Inverse probability of treatment propensity scores were applied to match a no PA cohort (n=136) to a PA cohort (n=132).&nbsp; Cohorts were matched to gender, age, comorbidity, and diagnostic groups. &nbsp;The use of a PA was associated with a trend towards lower mortality (42% vs 27%, p&lt;0.07) and no difference in readmission rates or resource intensity.&nbsp; Post PA patients had greater lengths of CCU and hospital stay (19 hrs, p&lt;0.002; 2 days, p&lt;0.002) and more complete admission notes (p&lt;0.003).&nbsp; Adding a PA was associated with greater CCU and hospital length of stay, more complete admission notes and a trend towards improved mortality. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p>&nbsp;</p> Donald Fung, MD MSc. FRCPC Joseph Caswell, Ph.D. Tanya James Gavan Harman, MD, MSc, FRCPC Kerry Reed, MD PhD CCFP Michael Conlon, Ph.D Venessa Charette Copyright (c) 2020 Donald Fung, MD MSc. FRCPC, Joseph Caswell, Ph.D., Tanya James, Gavan Harman, MD, MSc, FRCPC , Kerry Reed, MD PhD CCFP, Michael Conlon, Ph.D 2021-01-25 2021-01-25 2 6 p1 11 Four Approaches to Canadian Physician Assistant Education: Does how we teach PAs make a difference? <p>Each of the four Canadian PA programs have a unique approach in educating and training their students where in the end, all students share the same competency and equivalence. The University of Toronto approaches its delivery of education through <em>distance learning</em>; McMaster University through <em>problem-based learning</em>; and the University of Manitoba and Canadian Armed Forces through <em>direct instruction.</em></p> <p>The purpose of this study was to determine how the delivery of PA education and different teaching designs influence the transfer-of-learning of Canadian PAs when transitioning from formal training to clinical practice. This descriptive study used an online survey to understand the gross patterns that emerged from each institute.</p> <p>The survey collected 90 responses in total. Majority respondents of all PA programs were employing the training designs emphasized by their institute; there was a correlation between the most common resource provided by their program and the most frequently used resource that PAs personally used to support their education. When transitioning from didactic year to clinical rotations, majority of PAs from the University of Manitoba, the University of Toronto and Canadian Armed Forces felt confident in practicing medicine. On average, it took McMaster University graduates nine months to feel comfortable in their role as PAs, eight months for the University of Manitoba graduates, seven months for the University of Toronto graduates and twelve months for Canadian Armed Forces graduates. Unique trends in the transfer-of-learning of PAs were not noted across the PA programs in Canada despite each program’s unique training design.</p> Malaika Qureshi Copyright (c) 2020 Malaika Qureshi 2021-01-25 2021-01-25 2 6 12 31 LTR: Developing an International PA Program Partnership: The Challenges and Benefits <p>Open Letter to the Editor and Canadian PA Educators</p> Virginia Valentin Copyright (c) 2021 Virginia Valentin 2021-01-25 2021-01-25 2 6 Are we providing ethical health care to new residents of Canada? <p>As mandated by the Canada Health Act, the intention of Canadian health care is to ensure the physical and mental well-being of residents of Canada by providing reasonable access to health services, without financial or other barriers.&nbsp; Is Canada meeting the objective of the Canada Health Act for those people who are new arrivals to the country? &nbsp;Health care is a universal, basic good and as such, it should be provided to all who reside within Canada, regardless of their immigration status.&nbsp; As this discussion highlights, Canada is falling short in the provision of health care to those residents who are not Canadian citizens.&nbsp; The current structure of care fails to meet the ethical principles of autonomy, beneficence, non-maleficence, and justice.&nbsp; &nbsp;&nbsp;</p> Camille Wagner Copyright (c) 2020 Camille Wagner 2021-01-25 2021-01-25 2 6 p50 59 A Cutaneous manifestation in a patient with Novel Coronavirus 2019 (COVID-19) <p>This case report describes a skin rash presented in a patient diagnosed with COVID-19. At the beginning of the COVID-19 pandemic in 2019, no skin involvement was initially observed, but more recent cases have been reported. (Marraha, 2020) Most of the cases were in Italy (eleven cases), Spain (nine cases), France (seven cases), and the United States (six cases). (Sameni, 2020) In a recent letter from Thailand, it was stated that almost all COVID‐19 patients had cutaneous signs. (Wollina, 2020)</p> Gisoo Bani-Adam Copyright (c) 2021 Gisoo Bani-Adam 2021-01-25 2021-01-25 2 6 Intra-thecal Baclofen pump for treatment of spasticity in Spine Cord Injury (SCI) patient with a multi-disciplinary approach <p>Case-Study approach to the treatment of a spinal cord injury patient's spasticity using an intrathecal baclofen pump and a multi-disciplinary team.</p> Jaime Teran W. Alsunbul Copyright (c) 2020 Jaime Teran, W. Alsunbul 2021-01-25 2021-01-25 2 6 38 40 Radiation Oncology Physician Assistant <p><strong>Purpose:</strong> Changes in our healthcare system and funding constraints create a pressing need to explore new ways to respond to the ever-increasing demands while maintaining high quality patient care in Radiation Oncology (RO). Physician Assistants (PA) undergo medical training at accredited programs in Canada or the U.S.A. Direct mentorship by supervising Radiation Oncologists (RO) is integral to obtain oncology-based knowledge in order to function in a sub-specialized role. Herein, we aimed to assess a pilot project incorporating a PA within a Department of RO at a tertiary care academic cancer center and to identify opportunities for role expansion.</p> <p><strong>Materials and Methods:</strong> From January 2015 to December 2019, data from ambulatory care clinical activities were prospectively collected for a PA practicing in a RO Department. Indicators relating to activities profile (clinical, educational and administrative), new consultations, follow-ups and on-treatment reviews were captured and analyzed. The PA role and schedule has an adaptable component in response to the clinical needs of the RO department, with emphasis to be assigned in clinics where absence of residents or fellows would negatively impact patient flow and wait times. For consistency, data was derived from sites of continuous involvement only, during the period of January – December 2019.</p> <p><strong>Results:</strong> Over the 5-year assessment interval, the PA provided at least one session (e.g. half a day) of care-related activities within twelve disease sites. Of these, participation was continuous in 4 sites in 2019: Breast, GU, Eye, and Endocrine. During 2019, the PA was involved (e.g. assessment, evaluation and/or patient education) in 3.2% (49 of 1516) of the Breast, 4.3% (56 of 1311) of the GU, 39.2% (104 of 256) of the Eye and 27% (85 of 314) of the Endocrine clinic new consultations. The total new consultations seen by the PA across all sites for 2019 was 4.16% (377 of 9054) in a department with 37 RO and 1 PA.</p> <p><strong>Conclusions:</strong> Within a tertiary care RO Department, a PA provides an additional model of care within a variety of tumor sites. The PA acquired RO related expertise, and the role can expand access to specialized RO care. It has the flexibility to evolve and adapt across disease sites. Incorporating PAs to the care delivery paradigm within busy tertiary centers can increase capacity for patient care, education and research activities. Future studies ascertaining PA impact on patient wait times, task delegation, role expansion, patient satisfaction and value assessment of this model are warranted.</p> Maitry Patel Copyright (c) 2021 Maitry Patel 2021-01-26 2021-01-26 2 6