The Journal of Canada’s Physician Assistants
The Journal of Canada's Physician Assistants (JCANPA) is a peer-reviewed forum dedicated to advancing scholarship, education, and clinical excellence within the physician assistant profession in Canada and globally. It publishes original research, clinical cases, reviews, and perspectives to serve as an important platform for knowledge exchange and strengthen the evolving role of PAs in the healthcare sector.
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. 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.
Registration for CAPA 2023 Now Open! The CAPA Annual Conference is the only national conference designed for Canadian physician assistants by physician assistants. The conference attracts Canadian and international PAs looking for high-calibre continuing professional development opportunities, learning from national and international experts, and networking and sharing expertise. With over 19 hours of high-calibre CPD, highlights will include: Workshops throughout Exhibit hall with networking breaks Welcome Reception Thursday, October 19 from 6:30pm to 8:30pm Awards Ceremony and President’s Dinner on Saturday, October 21 at 7:30 pm We hope to see you there! Call for E-Posters Submit your abstract by September 11 Have you conducted a research project? Do you have valuable data to share? Submitting a poster abstract is an important way to showcase your knowledge and expertise amongst your peers. Please consult the selection criteria before making your submission. Poster abstracts will be accepted in the following categories: original research case report educational resources and interventions All poster abstracts are automatically entered into the competition for Poster Awards, which are presented at the annual Awards Ceremony and President’s Dinner on Saturday, October 21, 2023. All posters will be displayed electronically for the duration of the conference. For Further Information: 877 744 2272 │admin@capa-acam.ca │capa-acam.ca
Copyright (c) 2023 Ian Jones; CAPA-ACAM Administration https://creativecommons.org/licenses/by-nc-nd/4.0
The Differences Between Canadian Armed Forces and Civillian Physician Assistants: An Interview Series
The number of Physician Assistants (PA) in Canadian healthcare will grow as the population increases and ages. The closure of the Canadian Armed Forces Physician Assistant Education Program will increase the direct entry of civilian-educated PAs into military service. Knowing the factors related to military or civilian education and practice is essential in understanding this human resource. Information for this qualitative study was gathered through structured interviews to develop and explore the themes occurring during the Canadian Armed Forces Physician Assistant’s journey through their career, education deployment, and transition to civilian employment. Civilian PAs joining the military must understand that the military is a controlled environment that requires flexibility and adaptability, but a high level of comradery is among the benefits. Role differences were noted in military and civilian practice and explored the experiences, practice environments, teamwork, resiliency, flexibility, limited range of patient ages, and medical conditions limited clinical experiences. The transitions into civilian practice by military PAs resulted in a steep learning curve related to the health concerns more common to civilian populations. Still, they were backed by the confidence and attributes those individuals developed in the military. Regarding work environments, the military requires and offers unique experiences and posting to remote locations, naval ships, and overseas, which can result in autonomous practice only found in specific rural civilian areas.
Canadian Armed Forces Physician Assistants
Copyright (c) 2023 Ms. Sophie Kennedy https://creativecommons.org/licenses/by-nc-nd/4.0
Exploring Physician Assistant Entrustable Professional Activities, Integration, and Role Satisfaction Within Academic Hospitals in Hamilton, Ontario, Canada.
Physician Assistants (PAs) have been integrated across academic teaching hospitals in Hamilton since 2010. A survey was administered to practicing PAs at Hamilton Health Sciences Centre (HHSC) or St. Joseph’s Healthcare (SJH) to explore PA role integration and PA satisfaction in working at an academic hospital. The 22 PA respondents reported a considerable amount of autonomy of 76% (with 100% being full autonomy). The PAs felt their respective training programs prepared them for the workforce. It is evident that PAs integrate well into the healthcare system; many are mentoring medical students, and all have excellent relationships with their supervising physician(s) and co-workers. However, many PAs expressed feelings of burnout, lack of compensation, and paucity of PA mentorship. Areas of improvement include increasing PA mentorship, recruiting more PAs, and integrating more specialized clinical experience into PA programs.
Entrustable Professional Activites (EPA)
Copyright (c) 2023 Juliana Wadie, Kristen Burrows, PhD MSc BSc BHSc(PA) CCPA https://creativecommons.org/licenses/by-nc-nd/4.0
How will you be part of the team? Lessons from the first PAs on a UK hospital service
The Physician Associate (PA) profession is relatively new to the British National Health Service. PAs have been educated in the United Kingdom since the mid-2000’s, but only recently have universities begun training large numbers of PAs. More than 70% of all UK PAs work in hospitals, but there is little published literature about the experiences of these PAs. This brief report is a sub-study of a larger grounded theory study on the barriers and facilitators to the integration of PAs into the NHS . PAs who had been the first PA on a secondary care service in the NHS were recruited. The PAs in this study were asked what advice they would share with those who are initiating the PA role on a specific hospital service. PAs advised their colleagues to: 1) Be able to explain the Physician associate role succinctly and clearly, 2) Manage expectations for the PA role, 3) Be honest and trustworthy. Know the limits of your knowledge and training, 4) Take initiative in all areas of your professional life, 5) Be a good team member, 6) Be patient and have perseverance, and 7) Get involved to solve administrative issues. This study has limited generalizability as a qualitative study, but the themes raised by these PAs may help newly graduated PAs achieve a successful transition. These data may also guide PA educators around the world as they prepare their students to enter hospital practice.
Copyright (c) 2023 Tamara Ritsema, Lillian https://creativecommons.org/licenses/by-nc-nd/4.0
Investigating Physician Assistant Burnout Amidst the COVID-19 Global Pandemic: A Qualitative Survey Response From Practicing PAs in Canada
The purpose of this study was to determine if there is an underlying element of burnout among practicing Physician Assistants (PAs) across Canada during the global COVID-19 pandemic and uncover any potential solutions for this arduous problem. A survey encompassing the Maslach Burnout Inventory (MBI)and qualitative questions were emailed to practicing Canadian PAs. A total of 118 practicings PAs fully completed the survey; the majority reported high levels of burnout, specifically on depersonalization and emotional exhaustion subscales, while all maintained a high level of personal accomplishment simultaneously. The majority of respondent PAs listed increased staffing, increased time off/consistent scheduling, and pandemic pay among others as major solutions to alleviate burnout in the future. In conclusion, Canadian PAs working during the global pandemic are indeed experiencing burnout, all while displaying a high level of resilience in certain MBI subscales. The individual responses provided by these frontline workers may highlight critical solutions that may be generalized to other healthcare jobs in order to prevent future occupational burnout.
Mental Health among Health Professionals
COVID and Burnout among Health Professionals
Copyright (c) 2021 Evan Nanni, MPAS, PA https://creativecommons.org/licenses/by-nc-nd/4.0
Cricothyrotomy Following Airway Hemorrhage from a Hypopharyngeal Cancer: A Clinical Case Study
This clinical study describes an emergency cricothyrotomy on a hospital inpatient awaiting major head and neck surgery for a hypopharyngeal cancer. The clinical presentation of this patient highlights the emergent interventions for a bleeding upper airway, that can quickly lead to complete airway obstruction. Early recognition of an unstable airway is critical for patient outcomes in the head and neck cancer population.
Copyright (c) 2021 Natalie Dies, CCPA, Jin Soo Andy Song, MD https://creativecommons.org/licenses/by-nc-nd/4.0
Nutrition in the Neoadjuvant Gastric Cancer Patient, is early administration appropriate?
ABSTRACT Purpose: Gastric cancer is one of the world's leading cancers. Despite the availability of testing, patients often present with advanced (stage III or stage IV) gastric cancer. These patients are always in a state of malnutrition and will be sarcopenic secondary to pain, loss of appetite, nausea, vomiting and dysphagia. Treatment for this cancer includes radical surgery, sometimes chemotherapy and rarely radiotherapy. It is already well documented that nutrition is critical to patient outcomes during chemotherapy, surgery and healing; because of this, many measures are already in place to improve nutrition in these patients. This literature review will look directly at the use of enteral feeding (EN) of gastric cancer patients prior to or in conjunction with neoadjuvant chemotherapy (NACT). Methods: Research was focused on the keywords: nutrition, gastric cancer, enteral feeding and neoadjuvant nutrition. Several electronic journals were reviewed, National Center for Biotechnology Information (NCBI), PubMed, QxMD Read, Science Direct, as well, a search was conducted through Alberta Health Services Knowledge Resource Service (KRS). Results: The combined information within each of the articles reviewed all recognized that early nutrition supplementation had positive impacts on maintaining albumin levels, an increase in the patient's immunity, improved healing and shortened length of hospital stay. Conclusion: All patients receive nutrition throughout their hospital stay; research indicates that the earlier nutrition is given to a patient, the better the overall outcomes of chemotherapy, surgery, shortened length of stay, and quality of life. Keywords: nutrition, gastric cancer, enteral feeding and neoadjuvant nutrition.
Copyright (c) 2021 Patrick Stringfellow, DMSc CCPA CD https://creativecommons.org/licenses/by-nc-nd/4.0
CANADIAN PHYSICIAN ASSISTANT COMPETENCY FRAMEWORK 2021
This document identifies the competencies and outcome-based goals for Physician Assistant education in Canada. Competency-based education allows for an outcome-based approach to curriculum delivery that directly addresses and assesses student preparation for clinical practice, patient navigation, and resource application. With the experience and feedback gathered from PA-program leadership, previous accreditation cycles, and practicing PAs, Canadian PA educators are proposing an updated competency framework reflecting competency-based medical education titled "Canadian Physician Assistant Competency Framework 2021 (Canadian EPA-PA)". The purpose of this document is to identify the competency-based goals and entrustable professional activities for Canadian PA education programs. Competency-based education allows for an outcomes-based approach to curriculum delivery that directly assesses learner preparation for clinical practice, patient navigation, and resource application.
Copyright (c) 2021 PA Ian W Jones (He/Him) MPAS, CCPA, PA-C, Kristen Burrows, Ph.D. MSc, BHSc-PA, CCPA, Leslie Nickell, MSW, MD, CCFP, Major Ashley Millham (he/him) https://creativecommons.org/licenses/by-nc-nd/4.0
Abstract Purpose. A review of the history and discovery of the human papiloma virus, was conducted along with the development and difficulities of distribution of the vaccine. Method. Articles from PubMed, CDC, and FDA were reviewed. Results. Reading from the journals show a long duration of time from when the disease was initially introduced, to recognition and finally development of a vaccine. Conclusion. Despite acknowledgement that the vaccine has the pontial to reduce or even rid the disease and so reduce the number of cancers originating from the virus, there are still groups who feel the vaccine has no place in their society.
Copyright (c) 2021 Pat Stringfellow https://creativecommons.org/licenses/by-nc-nd/4.0
Introduction: Anthrax is a highly contagious infectious disease that can lay dormant for many years. We present cases of anthrax linked to contaminated low-cost shaving brushes.
Copyright (c) 2021 Cindy Gilmore https://creativecommons.org/licenses/by-nc-nd/4.0
Dietary Interventions for the Reduction of Postoperative Ileus Following Abdominal Surgery: A Literature Review
Introduction: A postoperative ileus (POI) is a common complication in patients following abdominal surgery which slows patient recovery and increases postoperative morbidity, length of hospital stay, resource use and healthcare costs. Although many interventions have been hypothesized to play a role in the prevention and management of POI, including chewing gum, coffee, and early enteral feeding, current guidelines regarding best clinical practice are lacking. Objective: The efficacy and safety of various dietary interventions used in the reduction of POI, to aid in providing evidence-based recommendations for future Canadian guidelines on this topic. Chewing gum, coffee, and early enteral feeding was examined. Methods: This literature review used the PubMed database. The primary outcomes measured were the effectiveness of each intervention in lowering the incidence of an ileus as well as their overall safety. Results: Four of eight studies identified positive benefits from the addition of chewing gum on bowel recovery. Three primary studies identified that coffee is beneficial in reducing time to first bowel movement. Three of four studies showed that early enteral feeding significantly improves gastrointestinal motility. All studies reviewed agreed that their respective interventional measures are safe and are not associated with an increase in postoperative complications. Conclusion: Although none of the interventions reviewed show complete consensus regarding their ability to reduce POI, there is an agreement that these measures are safe, well-tolerated, and not related to any major adverse effects. Therefore, chewing gum, coffee, and early enteral feeding are all postoperative measures that patients can be encouraged to adopt. The exact combination of these methods which should be included in the guidelines is unknown and requires further studies to examine the additional benefits provided by using more than one intervention.
Copyright (c) 2021 PA Chantale Bosc, Dr. Hebbard https://creativecommons.org/licenses/by-nc-nd/4.0
Warfarin versus DOACs in the prevention of thromboembolic stroke in patients with Afib.
ABSTRACT Preventing thromboembolic (TE) events “such as stroke” is an important part of managing patients with non-valvular atrial fibrillation (Afib). Over the last 50 years, oral anticoagulant treatment with the Vitamin K Antagonist (VKA) warfarin has played a crucial role in the secondary prevention of stroke for patients with Afib. Direct oral anticoagulant (DOACs), and their dominance over warfarin has arrived for treatment of Afib in the context of stroke prevention and research indicates DOACs are, for the most part, superior to warfarin in the secondary prevention of stroke in patients with non-valvular Afib. But what does the evidence tell us about risk versus benefits? The purpose of this review of literature is to conduct a systematic review of the advantages and disadvantages of DOACs, namely dabigatran, rivaroxaban, apixaban and edoxaban compared with warfarin in patients with (non-valvular) Afib. In general, this review demonstrates the advantages of DOACs compared with warfarin including, DOACs are associated with lower rates of life-threatening and intracranial bleeding, DOACs have a rapid onset with peak effect within a few hours, they have predictable dose responses, thus eliminating the need for routine monitoring; and they have few, if any, important food or drug interactions, thus simplifying management. The findings of this systematic literature review suggest that in the secondary prevention of stroke in patients with non-valvular Afib, DOACs, demonstrate a significant advantage and enhanced safety profile over warfarin in reducing the risk of thromboembolic stroke compared with warfarin. As such, DOACs should be considered first-line therapy in the secondary prevention of stroke in patients with non-valvular Afib.
A search was conducted with search terms of “Oral Anticoagulants”, “Anticoagulants”, “Direct Oral Anticoagulants”, “New Oral Anticoagulants”, “Warfarin”, and “secondary prevention of non-valvular Afib”, “Afib”, “Stroke prevention” and “Stroke”.
Copyright (c) 2021 PA Allen Szabon CD, DMSc, MPAS, CCPA https://creativecommons.org/licenses/by-nc-nd/4.0
A Cutaneous manifestation in a 59-year-old patient with Novel Coronavirus 2019 (COVID-19) seen in a primary care clinic in Alberta, Canada: a case report
This case report describes a skin rash presented in a patient diagnosed with COVID-19 in Urmia, Iran. The patient was virtually connected to our clinic in Calgary, Alberta. The clinical manifestation in this case is an example of cutaneous lesions in patients with COVID-19 and can be used for an educational purpose. All data has been collected with the patient’s written consent. This clinical case study advocates for more data collection on the skin lesions in patients with COVID-19.
Exanthema; Coronavirus; Covid-19; Skin; Patients; Pandemics; Primary Health Care; Alberta; Canada
Copyright (c) 2021 Gisoo Bani-Adam https://creativecommons.org/licenses/by-nc-nd/4.0
A Cutaneous manifestation in a patient with Novel Coronavirus 2019 (COVID-19)
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)
The impact of adding a physician assistant to a rural community hospital intensive care unit
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. 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). Cohorts were matched to gender, age, comorbidity, and diagnostic groups. The use of a PA was associated with a trend towards lower mortality (42% vs 27%, p<0.07) and no difference in readmission rates or resource intensity. Post PA patients had greater lengths of CCU and hospital stay (19 hrs, p<0.002; 2 days, p<0.002) and more complete admission notes (p<0.003). Adding a PA was associated with greater CCU and hospital length of stay, more complete admission notes and a trend towards improved mortality.
Copyright (c) 2021 Donald Fung, MD, Joseph Caswell, Ph.D., Tanya James, Gavan Harmen, MD, Kerry Reed, MD, Michael Conlon, Ph.D, Venessa Charette https://creativecommons.org/licenses/by-nc-nd/4.0
Four Approaches to Canadian Physician Assistant Education: Does how we teach PAs make a difference?
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 distance learning; McMaster University through problem-based learning; and the University of Manitoba and Canadian Armed Forces through direct instruction. 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. 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.
Copyright (c) 2021 Malaika Qureshi https://creativecommons.org/licenses/by-nc-nd/4.0
Are we providing ethical health care to new residents of Canada?
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. Is Canada meeting the objective of the Canada Health Act for those people who are new arrivals to the country? 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. As this discussion highlights, Canada is falling short in the provision of health care to those residents who are not Canadian citizens. The current structure of care fails to meet the ethical principles of autonomy, beneficence, non-maleficence, and justice.
Copyright (c) 2021 Camille Wagner https://creativecommons.org/licenses/by-nc-nd/4.0
Intra-thecal Baclofen pump for treatment of spasticity in Spine Cord Injury (SCI) patient with a multi-disciplinary approach
Case-Study approach to the treatment of a spinal cord injury patient's spasticity using an intrathecal baclofen pump and a multi-disciplinary team.
Copyright (c) 2021 Jaime Teran, W. Alsunbul https://creativecommons.org/licenses/by-nc-nd/4.0
Combining Motivational interviewing with Cognitive Behavioural Therapy in Primary Care: A Literature Review
Over the decades, numerous psychological concepts have enhanced our understanding of human behaviours. Specifically, psychotherapies have assisted and improved overall well being for individuals with problematic behaviour. This literature review will compare the history, theory, principles, and core skills of motivational interviewing (MI) and cognitive behavioural therapy (CBT). This review will illustrate why a combined approach of MI and CBT is more beneficial than using either technique on its own. The evidence available on MI-CBT effectiveness in clinical practice and ways to implement it in primary care will be discussed.
Copyright (c) 2020 Sanjeef Thampinathan https://creativecommons.org/licenses/by-nc-nd/4.0
INTRAUTERINE CONTRACEPTION: A LITERATURE REVIEW INVESTIGATING THE BARRIERS LIMITING USE BY CANADIAN WOMEN.
Abstract Intrauterine contraceptive devices (IUCDs) are highly effective and recommended as first-line contraceptives for women. Very few Canadian women use these forms of contraception, and even fewer youths use these methods. Multiple research search engines allowed a literature review of papers about IUCDs, healthcare systems, patient and provider barriers, published between 2000 and 2020. Using a preference for Canadian studies identified and allowed investigating the barriers preventing the more widespread use of IUCDs by Canadian women with an emphasis placed on at-risk groups, in order to make recommendations for decreasing unintended pregnancies. Barriers broadly fit into the three categories of the healthcare system, the patients', and practitioner-based. Evidence suggests that there is an overall lack of awareness and limited knowledge regarding IUCDs among the public, provider misconceptions and lack of confidence in insertion capabilities, high upfront cost, and the systemic issues of limited access to contraceptive providers. Studies have shown that evidence-based education and removal of cost and access related barriers increase patient acceptance of and adherence to IUCDs. To increase the use of IUCDs by Canadian women, large scale subsidy and policies to create programmes targeted at improving public and provider education and awareness are required. Additionally, increased hands-on training and task sharing with allied providers is necessary to increase patient access and timely availability of these highly effective contraceptives.
Health Care Barriers, Contraception, Contraception Devices, Systemic Limitations to Health Care.
Copyright (c) 2020 PA Michelle Houston https://creativecommons.org/licenses/by-nc-nd/4.0
Factors that Influence Canadian Physician Assistants to Practice Rurally: A Survey Response
A shortage of healthcare professionals is considered to be a driving force behind access barriers in rural Canada. The use of Physician assistants (PAs) as healthcare providers in remote areas can help mitigate this shortage. There is currently no research available on rural Canadian PAs to assess factors that influence the choice to practice rurally. This study examined specific factors influencing currently practicing rural Canadian PAs to choose their rural practice. This study also assessed whether a rural upbringing or participating in a rural rotation positively related to choosing to practice medicine rurally. This is a cross-sectional descriptive study conducted through an electronic survey. The primary outcomes of this study included examining the significance of 12 factors on the choice to practice rurally as well as whether completing a rural rotation or having a rural upbringing significantly correlated to rural practice. The top three factors most significantly influencing a PA's decision to practice rurally were (1) increased level of autonomy, (2) type of practice, (3) scope of practice. There was a positive relationship between having a rural upbringing and practicing rurally (X2 (1, N = 61) = 30.47, p <.001). There was no relationship between completing a rural rotation and practicing rurally. It concluded individuals are more likely to choose rural practice if they had a rural upbringing. Canadian PA schools wishing to increase recruitment and recruitment to rural services can use the above results. Prospective employers can also use the above results to help attract more PAs to rural opportunities.
Copyright (c) 2020 PA Elise Mac Lean https://creativecommons.org/licenses/by-nc-nd/4.0
How Manitoba Physicians see the Value of Physician Assistants
This research investigates the value of physician assistants (PA), presenting the opinions of twenty supervising physicians on how PAs contribute to patient care, the health system, and the physician’s wellness. In May 2019, 72 supervising physicians of Manitoba’s 116 clinical PAs were sent a twenty-question electronic survey asking their perspectives of PA’s Value. A Literature review used PubMed, and Google Scholar search engines for the terms Value, physician assistant, and combinations of phrases related to PA benefit, PA values, Physician Value, and Canadian physician concerns with PAs, to guide the question development. Twenty physicians responded from the list of the seventy-two physician supervisors contacted, representing a response rate of 27.7%. Three of the physician respondents have employed a PA for less than a year, 85% or 16 MD for more than two years, with 36.84% of the total for longer than five years. Eighty-five percent (n=18/20) of the responding physicians rated the value of having a PA as very valuable or extremely valuable. At the same time, 95% (n=19) were likely or extremely likely to recommend hiring a PA to a friend or colleague. One physician did not find value in the PA they hired. The phrases used by physicians in describing the Value PAs brought to Manitoba Healthcare included Honesty and Respect (78.95%), Improved Access (73%), Excellence In Care (63.1%), A Better Workplace (78.95%), Better Patient Safety (73.68%), Better Teamwork (84.21%), Accountability (73.68%), Efficiency (73.68%), Decreased Stress 42.11%, and Better Communication with Patients (57.89%) Ultimately, the determination of PA’s Value is through the lenses of those looking and asking what is needed. Manitoba physicians represented in this survey indicate extreme satisfaction with the quality and Value PAs contribute to their practice environment and personal lives.
Copyright (c) 2020 Ian W Jones https://creativecommons.org/licenses/by-nc-nd/4.0
The Physician Assistant response to the COVID-19 Pandemic in Ontario
The COVID-19 pandemic has fundamentally changed our society and also had a profound impact on the way we practice medicine as Physician Assistants (PA). PAs have played an integral role in caring for patients and adapting to the rapidly changing landscape over the last few months. As the Ontario leadership team of the Canadian Association of Physician Assistants (CAPA), we’ve had the privilege of hearing first-hand accounts of how frontline Ontario PAs have been battling this pandemic and the critical role(s) they play on the teams they work in. In this commentary, we reflect on our experiences and discuss some of the key challenges we faced during the initial stages of our COVID-19 response in Ontario.
Copyright (c) 2020 Sahand Ensafi https://creativecommons.org/licenses/by-nc-nd/4.0
Initial employment patterns for the University of Manitoba’s Master of Physician Assistant Studies (MPAS); 2010-2016
This study examines the initial employment patterns for graduates from the Master of Physician Assistant Studies (MPAS) program in Manitoba, Canada. We conducted interviews with graduates of the MPAS program from 2010-2016 to provide insight into the number of graduates who found successful employment as Physician Assistants (PAs), the length of time to find employment as a PA, location of employment, and clinical setting of employment. Our results indicate high rates of employment for graduates from the MPAS program within three months of graduating, a concentration of employed graduates in urban areas, and graduate employment in a variety of clinical settings. Successful employment for MPAS graduates is argued to be linked to four key factors: the need for PAs in Manitoba, the importance of PA contributions to the practice setting, the employability of graduates from the MPAS program, and support for the PA role from the Manitoba Government. This study emphasizes and advocates for more research focused on PAs within the Canadian health care contexts.
Copyright (c) 2020 Ian Jones, Benjamin Collins, Joanne Hamilton, Helen Mawdsley https://creativecommons.org/licenses/by-nc-nd/4.0
Is There an Increase of Anastomotic Leaks with NSAID Use in Colorectal Surgery?
ABSTRACT Purpose: The purpose of this article is to review the current guidelines for Enhanced Recovery After Surgery (ERAS) following colorectal surgery with nonsteroidal anti-inflammatory drugs (NSAID) use and its association with anastomotic leaks. Method: A Medline literature search was conducted with search terms colorectal surgery, nonsteroidal anti-inflammatory drugs, and anastomotic leaks. Seventeen relevant articles served as the basis for this clinical review. This group was further refined to analyze selective vs non-selective NSAIDs to assess the overall risk of anastomotic leaks. Results: The use of NSAIDs postoperatively was associated with an overall increased risk of anastomotic leaks. This risk varied with the type of NSAID taken for pain control: selective vs non-selective. Non-selective NSAIDs had an increased risk while selective NSAIDs appeared safe. Conclusion: NSAIDs are an important aspect of the ERAS guidelines to improve patient outcomes after surgery. They provide an alternative option for pain control for opioid medications and their known side effects. Recent literature varies in the risk profiles and safety of different classes of NSAIDs. Postoperative use of NSAIDs, particularly diclofenac, is associated with increased risk for anastomotic leak following colorectal surgery. Keywords: Colorectal surgery, nonsteroidal anti-inflammatory drugs, anastomotic leaks.
Colorectal surgery, nonsteroidal anti-inflammatory drugs, anastomotic leaks
Copyright (c) 2020 PA Cindy Gilmore, DMSc, CCPA https://creativecommons.org/licenses/by-nc-nd/4.0
Professional, Practical and Political Opportunities: Optimizing the Role of Ontario Physician Assistants in Family Medicine
Objective: To identify that facilitators and barriers that influence Physician Assistant (PA) role optimization and success in family practice settings. Setting: Rural and urban family practice settings in Ontario that had employed a PA for a minimum of two consecutive years. Participants: Six family medicine clinics in Ontario represented by seven family medicine Physician Assistants, eight Family Physicians (seven supervising physicians, one physician/administrator), and one clinic manager. Method: To identify the factors that influence role success and barriers which prevent PA role optimization, we conducted an exploratory single case study with embedded subunits of analysis. Data consisted of semi-structured interviews with 15 participants and analysis of documents (medical directives, job announcements, and communications). Main findings: Barriers and facilitators to PA integration and role success can be categorized into professional, practice-based, and political factors. Professional factors that facilitate role optimization include the professional relationship between the PA and physician, level of comfort with autonomy, trust, rapport and PA competencies. Practice factors that optimize the role include appropriate administrative support/organization, investment in PA training and patient satisfaction. Barriers include employer knowledge of medical-legal risks, communication around the PA role and accessibility of funding. Political factors that limit role optimization and success include billing practices, absence of consistent funding models and lack of regulatory oversight. Conclusion: Most of the barriers identified relate to enduring policy legacies, which continue to limit the sustainability and stability of PAs in Ontario. Successful Family Physician-PA teams have created individualized solutions to these barriers, and describe their partnership as increasing patient access to care, improving work-life balance, expanding comprehensiveness of services, and advancing team-based collaborative care.
Professional, Practical and Political Opportunities
Kristen Burrows PHD, MSC, BHSC(PA) BSC CCPA
Mitchell Levine, MD MSC FRCPC FACP FISPE
Copyright (c) 2020 Kristen Burrows PHD, CCPA, Julia Abelson PHD, MSC, Patricia Miller PHD, MSC, PT, Mitchell Levine, MD MSC FRCPC FACP FISPE, Meredith Vanstone, PHD https://creativecommons.org/licenses/by-nc-nd/4.0
The Role, Contribution and Utilization of Physician Assistants in Primary Care
Objective: To understand the role, contribution, and utilization of physician assistants in the primary care setting. This systematic review aims to provide an accurate depiction of the growth and impact of the physician assistant profession in this field of medicine. Methods: Using electronic databases MEDLINE and EMBASE, a review was undertaken using specified search terms of articles between the years of 2010 - 2019. In this review, the eligibility criteria were English language studies conducted in North America or the United Kingdom, PAs working in primary care with recognized PA qualifications and research findings relevant to PAs that are presented separately. Results: At least 1029 publications were identified, of which 15 articles met the inclusion criteria. Ten of these studies were based in the United States, while five were based in the United Kingdom. PAs in primary care were found to see less complicated patients, required supervision, and improved the patient caseload for physicians. The patients’ acceptance of PAs is on the rise as more knowledge about the skills and roles become prominent. Conclusions: This review highlights the role of PAs in the primary care field, though more research is needed in areas such as patient outcomes to clearly understand the contribution and utilization of PAs in primary care.
Research is an important platform whereby leaders in any profession share their knowledge and expertise. Just like any growing profession, conducting and publishing research work is essential for Physician Assistants (PAs). Through research, PAs can highlight their vital roles in the Canadian Healthcare system in various clinical settings. PA research is important and very much needed yet challenging. It's often difficult to carryout meaningul studies especially when one lacks research background. This infographic aims to guide PAs interested in conducting research, in a stepwise fashion, from an idea to publication.Â
Copyright (c) 2019 Saira Rashid, Anne Dang https://creativecommons.org/licenses/by-nc-nd/4.0
Management of acute appendicitis: The antibiotics debate
Appendicitis is one of the most frequent causes for an acute abdomen requiring emergent abdominal surgery worldwide. It has a lifetime risk of 8.6 percent in males and 6.9 percent in females (1). Traditionally, operative management has been the dominant strategy for managing acute appendicitis. However, in recent times, there is much debate about implementing conservative medical management with antibiotics first to treat uncomplicated appendicitis. This article reviews the treatment strategies for acute uncomplicated appendicitis in light of contemporary research to determine if non-operative management is a feasible alternative.
Copyright (c) 2019 Alifiya Goriawala https://creativecommons.org/licenses/by-nc-nd/4.0
This case study describes an incidence of DRESS secondary to Phenytoin. DRESS is characterized by pyrexia, diffuse maculopapular rash, eosinophilia with reactive lymphocytes, hepatitis and renal dysfunction. Similar cases are commonly seen in some variation in many clinical settings where Physician Assistants are employed, and carries a high degree of mortality. Â It is hoped that through the publication of this case, that Physician Assistants will become more familiar with the signs, symptoms, diagnosis and treatment of DRESS, as well as the significant associated mortality and common offending medications.Â
Copyright (c) 2019 Steven Hall https://creativecommons.org/licenses/by-nc-nd/4.0