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> en-US <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> (Ian Jones, MPAS, PA-C, CCPA) (Ian Jones) Sat, 19 Jun 2021 19:05:18 +0000 OJS 60 CANADIAN PHYSICIAN ASSISTANT COMPETENCY FRAMEWORK 2021 <p>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 "<strong>Canadian Physician Assistant Competency Framework 2021 (Canadian EPA-PA)</strong>". 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.&nbsp;</p> 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) Copyright (c) 2021 PA Ian W Jones (He/Him) MPAS, CCPA, PA-C, Leslie Nickell, MSW, MD, CCFP, Kristen Borrows, Ph.D. MSc, BHSc-PA, CCPA, Major Ashley Millham (he/him) Sat, 19 Jun 2021 00:00:00 +0000 Warfarin versus DOACs in the prevention of thromboembolic stroke in patients with Afib. <p>ABSTRACT</p> <p>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.</p> <p>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.</p> PA Allen Szabon CD, DMSc, MPAS, CCPA Copyright (c) 2021 Allen Szabon Sat, 19 Jun 2021 00:00:00 +0000 Dietary Interventions for the Reduction of Postoperative Ileus Following Abdominal Surgery: A Literature Review <p><strong>Introduction</strong>: 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.&nbsp;<strong>Objective</strong>: 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. <strong>Methods</strong>: 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.&nbsp;<strong>Results</strong>: 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.&nbsp;<strong>Conclusion</strong>: 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.</p> PA Chantale Bosc, Dr. Hebbard Copyright (c) 2021 PA Chantale Bosc, Dr. Hebbard Sat, 19 Jun 2021 00:00:00 +0000 Rheumatoid Arthritis Self-Management Toolkit for Physician Assistants <p><strong>Background:</strong> Self-management is a key component of treatment for rheumatoid arthritis (RA), a systemic inflammatory autoimmune disease. Primary care physician assistants (PA) are uniquely situated to provide chronic disease management, equipping patients with the education and skills needed to self-manage RA. <strong>Purpose: </strong>To create a self-management toolkit for primary care PAs to use with patients diagnosed with RA. <strong>Methods:</strong> Characteristics of effective patient self-management interventions for individuals with RA were identified through a literature search. Ovid MEDLINE, EMBASE, and CINHAL databases were systematically searched and a total of 8 articles met inclusion criteria. Thematic analysis identified common themes of effective RA self-management interventions. <strong>Results: </strong>Four patient characteristics were identified to influence self-management of RA including patient medication management and education, healthy lifestyle, symptom management with non-pharmacological interventions, and emotion management. Two primary healthcare provider characteristics were identified to impact patient self-management of RA including smooth transition of care between healthcare providers and knowledgeability and confidence of primary healthcare providers. <strong>Implications: </strong>Based on the identified characteristics of effective RA self-management, a toolkit for primary care PAs was proposed.</p> Hannah Keith Copyright (c) 2021 Hannah Keith Sat, 19 Jun 2021 00:00:00 +0000 Anthrax <p>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.</p> <p>&nbsp;</p> Cindy Gilmore Copyright (c) 2021 Cindy Gilmore Sat, 19 Jun 2021 00:00:00 +0000 Human Papilloma Virus <p>Abstract</p> <p>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.</p> <p>Method. Articles from PubMed, CDC, and FDA were reviewed.</p> <p>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.</p> <p>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.</p> Pat Stringfellow Copyright (c) 2021 Pat Stringfellow Sat, 19 Jun 2021 00:00:00 +0000