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Deciding Between Repeat Cesarean Delivery and a Trial of Labor
No full textAttempting a vaginal birth after a previous caesarean has been a well contested topic of debate among the obstetrical medical community. The old phrase “once a caesarean section, always a caesarean section” drove many providers to refuse a trial a labor to their patients. Even in modern times, risks of uterine rupture and other complications from vaginal deliveries leave some providers hesitant in counseling pregnant patients with previous caesarean deliveries. Repeat caesarean deliveries come with their own challenges such as increased risk of adhesions and infections. This article outlines the various risks and benefits of attempting a vaginal birth after a caesarean section compared to a repeat caesarean, as well as discusses who should be counseled as a candidate for a trial of labor. Shared decision making and evidence-based practice are the ultimate cornerstones in providers and patients choosing the appropriate delivery method
Combatting America’s Gun Violence: Strategies for Primary Care Providers to Discuss Firearm Safety with Patients
No full textGun violence is a significant public health concern in the United States. Overall, rates of firearm homicide and suicide increased over the years, disproportionately impacting minority communities and younger Americans.1-2 Primary care providers (PCPs) have a unique opportunity to help combat firearm violence. Prior studies have shown that PCPs believe firearm safety is an important issue to discuss with patients, but many do not feel their knowledge on the topic is adequate to provide appropriate counseling.3-5 Therefore, more efforts must be made to educate PCPs regarding safe firearm practices and how to discuss these concepts with patients. This article aims to provide CME for primary care providers to understand proper home firearm safety measures, empower them to discuss key points with patients, and identify available supplemental resources
Addressing Mental Health in Gender Incongruence and Gender Dysphoria
No full textWith the current political climate increasing its focus on medicine, especially on the rights of transgender individuals and their parents, it is important to understand the challenges gender dysphoric and transgender patients face. Maintaining positive mental health is one of these many challenges. Gender dysphoric and transgender individuals have an increased risk of anxiety, depression, and suicide, and it is the provider’s duty to recognize and address these issues. In physician assistant school, students are taught about the standardized patient. They are told to respect the patient and their pronouns but rarely go more in depth about the healthcare associated with patients that do not fit the norm. There is limited time in the students’ didactic year, but with legislation constantly changing and targeting healthcare professions’ scope of practice, it is important to learn about all populations. Different populations have different medical needs, especially gender dysphoric and transgender populations. This article will focus on terminology that may be familiar to some providers, mental health challenges, and approaches to treatment for gender dysphoric and transgender patients
Otosclerosis and Hearing Loss: Diagnosis, Treatment, and Practice Considerations in the Juvenile Population
No full textOtosclerosis is an early adult-onset disease that can cause significant disability and morbidity due to hearing loss. It is currently considered the most common cause of middle ear hearing loss in young adults, but is less prevalent in juvenile patients and, therefore, not widely discussed in literature. This CME will discuss etiology and pathophysiology, clinical presentation, diagnosis, and management of otosclerosis in juvenile patients as compared to adults
EndeavorRX and the Treatment of Attention Deficit Hyperactivity Disorder during a Stimulant Shortage
No full textADHD, a prevalent neurological disorder that poses risks of educational and employment difficulties, criminality, and mortality1,2,3,4 . Despite its 5% prevalence and 20,000 PubMed publications, diagnosing and treating ADHD remains a challenge5. Diagnosis is complex as it relies on clinical judgment with assessments available to medical providers, teachers, and parents to help identify ADHD behaviors. Although a majority of diagnoses occur in childhood, distinguishing ADHD behaviors from typical childhood development is challenging. Treatment involves preferred first-line stimulants like Amphetamine and Methylphenidate, but managing their varied metabolism from patient to patient requires careful dosage control. Shortages are common due to overwhelming demand and as Schedule II medications, they carry significant risks. This CME addresses ADHD\u27s etiology, pathophysiology, the stimulant shortage, and introduces EndeavorRX – the first FDA-approved videogame for ADHD treatment. This innovative approach provides hope amidst challenges posed by traditional treatment methods and supply constraints
Evaluating the Pathogenesis and Treatment Algorithms for Patients with Irritable Bowel Syndrome
No full textIrritable Bowel Syndrome is a common gastrointestinal condition that is characterized by abdominal pain and discomfort and altered bowel habits. Irritable Bowel Syndrome is thought out to be a multifactorial disorder that involves GI dysmotility, symptomology, altered gut microbial environment and alteration of the CNS with mental health manifestations including depression and anxiety. Many theories of the pathophysiology of IBS have been put forward, however the exact etiology remains unclear to this day. IBS is diagnosed based on the Rome IV Criteria that represent one of the four subtypes; 1) IBS with constipation (IBS-C), 2) IBS with diarrhea (IBS-D) 3) mixed IBS (IBS-M) or 4) IBS with unclassified. Over the years, prevalence of IBS has increased in gastroenterology clinics leading to a significant economic burden in healthcare. Patients diagnosed with IBS are more prone to live a poor quality of life that limits work productivity and social activities along with developing symptoms of anxiety and depression, representing an increased utilization of the healthcare system resources. The diversity and individuality of a patient with IBS along with the absence of known pathophysiology to gear medical management towards makes treatment for IBS difficult. In this paper, we will explore the different theories of pathogenesis of Irritable Bowel Syndrome while also looking at current and emerging treatment options targeting those theories
A Thoughtful Approach to Weight Loss Management
No full textAs a student preparing to graduate PA school, one of the areas I hope to improve upon is my ability to educate patients in a comfortable, caring, encouraging, and effective manner. In my experience, the topic of weight-loss is often handled in ways that are insensitive, making patients feel shameful about their condition and less inspired to change. The goal of this article will be to address the current literature on how to medically manage obesity in patients and combine resources that offer more effective, encouraging, and subtle approaches that will help lead to a more effective, shame-free treatment of our patients. This paper will serve as a CME reference for providers looking for an informative and thoughtful guide to counseling patients who need help managing their weight
Whole-Food Plant-Based Diet Impact on Chronic Disease Reversal
Get PDFThis article delves into the prevalence and costs associated with various chronic diseases, elucidates how adopting a whole food plant-based (WFPB) diet can effectively combat these ailments, and offers resources and guidance for healthcare providers to engage in discussions about WFPB diets with their patients. A WFPB diet centers around unprocessed, natural foods like fruits, vegetables, whole grains, legumes, nuts, and seeds, while eschewing animal based products. This dietary regimen prioritizes nutrient-rich, plant-derived foods, favoring minimally processed options to enhance overall health and vitality. Its design is deliberate, offering a therapeutic approach to tackling chronic diseases and fostering recovery. By emphasizing plant-based sources and minimizing intake of detrimental nutrients like animal protein, saturated fat, trans-fats, cholesterol, simple sugars, and sodium, this dietary pattern serves as a shield against the development of disease. Scientific evidence has consistently linked these nutrients to a reduced risk of chronic diseases, including Heart Disease, Type 2 Diabetes, and certain cancers, owing to their potent disease-fighting properties. Moreover, the inclusion of dietary fiber in such foods plays a pivotal role in enhancing digestion, regulating blood sugar levels, and fostering satiety. This multifaceted benefit aids in weight management by curbing caloric intake and thwarting overeating tendencies. It\u27s imperative to acknowledge that many healthcare providers currently lack familiarity with WFPB diets or struggle to effectively integrate nutrition into holistic healthcare practices. Equipping providers with a comprehensive understanding of WFPB diets and their potential benefits can empower them to communicate nutrition-based prevention and management strategies for patients at risk of or grappling with chronic diseases, thus bridging the gap between the current and desired state of nutritional healthcare
Risk stratification, Treatment and Side Effect Management in Diffuse Large B Cell Lymphoma
No full textDiffuse Large B-cell Lymphoma is a malignant disorder of lymphocytes that appears with diffuse infiltration of lymphoid cells into lymph nodes or surrounding tissue such as the GI tract or central nervous system.1 It is the most common form of non-Hodgkin Lymphoma. Patients who are more likely to develop this lymphoma are individuals of ages 60 or older.2 .The standard first-line treatment involves combo chemotherapeutic regimen called R-CHOP. R-CHOP includes the following agents: rituximab, cyclophosphamide, doxorubicin HCl, vincristine and prednisone
What is Active Learning? Perspectives from Five STEM Professors’ Teaching Practices in Their Classrooms
Get PDFThis senior thesis investigated what ways, if any, STEM professors incorporated active learning pedagogy in their undergraduate classrooms at a small private university in the Northeast United States. STEM pedagogy was investigated because of the increasing popularity of active learning methods in the classroom compared to the didactic type of teaching that was prominent in the past.1 A qualitative case study of five STEM professors was conducted, involving the collection of data from biographical questions, an hourlong interview, and analysis of a document provided by a professor. This document could have been a lesson plan, an assignment, or an activity they created during the Fall 2022 and Spring 2023 semesters. From said document, four themes emerged from my analysis of data: (a) considering students’ prior knowledge, (b) scaffolding students’ learning experiences, (c) imagining and revising instructional sequences to guide student learning, and (d) supporting students’ learning through various resources. These are the four active learning strategies that were commonly found in answers from the interviewed professors. These findings may suggest that STEM professors implement active learning in their classrooms; however, my data also found that none of the professors in this study have completed any formal education in active learning frameworks. This study highlights the possibility of STEM professors applying active learning in their classrooms because of their experience as teachers rather than a formal education on active learning pedagogy