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Objective: Assess the ability of computed tomography colonography (CTC) to perform at high levels of sensitivity and specificity for colorectal cancer screening in an asymptomatic population. Design: Systematic literature review. Methods: Searches were done in PubMed, Cochrane Library, TRIP Database, and UptoDate, utilizing the terms CT colonography, colonoscopy, virtual colonoscopy, screening, and colon cancer. In PubMed the following limits and terms were used: published in the last 5 years, humans, meta-analysis, randomized controlled trial, and English. Results: A meta-analysis by Mulhall et al revealed two studies meeting inclusion/exclusion criteria: Pickhardt et al and Macari et al. Searching Pickhardt et al through 'related articles' in PubMed yielded the Wessling et al study. Conclusion: CTC can achieve high accuracy, but only under specific conditions using multi-detector CT scanners, primary 3D data interpretation, well-prepared patients, collimation of < or = 1.25 mm, and data interpretation by an experienced radiologist. Cost-effectiveness and compliance in the general population, as well as radiation exposure and follow-up requirements with colonography for CRC screening, need further study. [ABSTRACT FROM AUTHOR]

Objective: Primary care workforce projections continue to predict significant physician shortages. An oversupply of primary care physician assistants (PAs) and NPs also is predicted. This paradox calls into question the assumptions that underlie workforce projection models, which likely underestimate the primary care contributions of PAs and NPs., Methods: Federally qualified health center data from the 2016-2019 Uniform Data System were used to calculate the number of clinic visits per full-time equivalent (FTE) physician, PA, and NP. Visits per FTE were compared across provider type to determine provider-specific productivity ratios., Results: The combined PA and NP productivity ratio increased relative to physicians in each year, ranging from 0.85 in 2016 to 0.88 in 2019. Clinic visits per FTE for PAs and family physicians were nearly equivalent., Conclusions: Primary care workforce projection models should be reexamined to more accurately capture the productivity of PAs and NPs., (Copyright © 2021 American Academy of Physician Assistants.)

Purpose: The Affordable Care Act (ACA), enacted in 2010, created the Expansion of Physician Assistant Training (EPAT) grant with the goal of increasing the number of physician assistants (PAs) entering primary care. There has been no analysis regarding the practice patterns of students graduating from EPAT-funded programs. This study aimed to describe the workforce impact of federal investment in PA education through the EPAT program., Methods: In 2018 the authors administered an anonymous electronic survey to all 27 EPAT PA programs funded from 2010 to 2015. The goal was to assess program and graduate characteristics, practice patterns, and intention to apply to similar future opportunities. The survey was IRB exempt., Results: There was a 59.30% response rate representing 366 total graduates, which reflected 62.46% of the 586 Health Resources and Services Administration (HRSA)-reported total EPAT-funded students. Of the respondents, 16.41% of EPAT recipients self-identified as non-White, 4.54% indicated Hispanic ethnicity, 53.65% identified as being of disadvantaged status, and 32.92% reported coming from rural backgrounds. Sixty-three percent entered primary care immediately following graduation, while 87.88% reported practicing primary care immediately after graduation or at the last point of contact. Fifty-two percent of EPAT graduates practiced in medically underserved areas (MUAs)., Conclusion: Recipients of HRSA EPAT funding practiced in primary care specialties immediately following graduation at a rate that was 2.5 times higher than the national PA average. This specialty choice was durable for several years post-graduation. The EPAT program funded over 140 PA graduates who immediately practiced in MUAs. This funding supported a more racially and ethnically diverse student population and higher number of students coming from rural areas than the national average for PA students., Competing Interests: David Keahey is a current employee of PAEA and was the PI on the University of Utah's 2010-2015 HRSA EPAT grant. Tyler Smith is a current employee of PAEA, and Donovan Lessard was employed by PAEA from May 2015 to October 2018. For the remaining author, no conflict of interest or source of funding was declared., (Copyright © 2021 Physician Assistant Education Association.)

The treatment of patients with acute and chronic pain not attributed to cancer or end-of-life conditions is a challenge for many clinicians. Although CDC guidelines that focus on the primary care setting have provided critical recommendations, evidence-based guidance is lacking on optimal duration of opioid treatment for postoperative and acute care in specialty settings. Over the last 2 decades, the liberal use of opioids has resulted in many unintended consequences, including dependence and abuse, illicit distribution of legally and illegally prescribed opioid medication, progression to IV heroin and an epidemic of overdoses, and most recently an increase in the incidence of HIV among patients sharing syringes, frequently in communities with historically low HIV rates. This article analyzes these complex issues and proposes strategies to help clinicians improve patient care through education and responsible prescribing.

Community health centers (CHCs), a principal source of primary care for over 24 million patients, provide high-quality affordable care for medically underserved and lower-income populations in urban and rural communities. The authors propose that CHCs can assume an important role in the quest for health care reform by serving substantially more Medicaid patients. Major expansion of CHCs, powered by mega teaching health centers (THCs) in partnership with regional academic medical centers (AMCs) or teaching hospitals, could increase Medicaid beneficiaries' access to cost-effective care. The authors propose that this CHC expansion could be instrumental in limiting the added cost of Medicaid expansion via the Affordable Care Act (ACA) or subsequent legislation. Nevertheless, expansion cannot succeed without developing this CHC-AMC partnership both (1) to fuel the currently deficient primary care provider workforce pipeline, which now greatly limits expansion of CHCs; and (2) to provide more CHC-affiliated community outreach sites to enhance access to care. The authors describe the current status of Medicaid and CHCs, plus the evolution and vulnerability of current THCs. They also explain multiple features of a mega THC demonstration project designed to test this new paradigm for Medicaid cost control. The authors contend that the demonstration's potential for success in controlling costs could provide help to preserve the viability of current and future expanded state Medicaid programs, despite a potential ultimate decrease in federal funding over time. Thus, the authors believe that the new AMC-CHC partnership paradigm they propose could potentially facilitate bipartisan support for repairing the ACA.

Purpose: The purpose of this study was to assess the number of Health Resources and Services Administration Expansion of Physician Assistant Training (EPAT)-funded physician assistant (PA) programs planning to maintain class size at expanded levels after grant funds expire and to report proposed financing methods. The 5-year EPAT grant expired in 2015, and the effect of this funding on creating a durable expansion of PA training seats has not yet been investigated., Methods: The study used an anonymous, 9-question, Web-based survey sent to the program directors at each of the PA programs that received EPAT funding. Data were analyzed in Excel and using SAS statistical analysis software for both simple percentages and for Fisher's exact test., Results: The survey response rate was 81.48%. Eighty-two percent of responding programs indicated that they planned to maintain all expanded positions. Fourteen percent will revert to their previous student class size, and 4% will maintain a portion of the expanded positions. A majority of the 18 programs (66%) maintaining all EPAT seats will be funded by tuition pass-through, and one program (6%) will increase tuition. There was no statistical association between the program type and the decision to maintain expanded positions (P = .820)., Conclusions: This study demonstrates that the one-time EPAT PA grant funding opportunity created a durable expansion in PA training seats. Future research should focus on the effectiveness of the program in increasing the number of graduates choosing to practice in primary care and the durability of expansion several years after funding expiration.

As American medicine continues to undergo significant transformation, the patient-centered medical home (PCMH) is emerging as an interprofessional primary care model designed to deliver the right care for patients, by the right professional, at the right time, in the right setting, for the right cost. A review of local, state, regional and national initiatives to train professionals in delivering care within the PCMH model reveals some successes, but substantial challenges. Workforce policy recommendations designed to improve PCMH effectiveness and efficiency include 1) adoption of an expanded definition of primary care, 2) fundamental redesign of health professions education, 3) payment reform, 4) responsiveness to local needs assessments, and 5) systems improvement to emphasize quality, population health, and health disparities.

Field trials were established to compare alum-treated poultry litter (ATPL), normal poultry litter (NPL), and triple superphosphate (TSP) as fertilizer sources for corn (Zea mays L.) when applied at rates based on current litter management strategies in Virginia. Trials were established in the Costal Plain and Piedmont physiographic regions near Painter and Orange, VA, respectively. Nitrogen-based applications of ATPL or NPL applied at rates estimated to supply 173 kg of plant-available nitrogen (PAN) ha(-1) resulted in significantly lower grain yields than treatments receiving commercial fertilizer at the same rate in 2000 and 2001 at Painter. These decreases in grain yield at the N-based application rates were attributed to inadequate N availability, resulting from overestimates of PAN as demonstrated by tissue N concentrations. However, at Orange no treatment effects on grain yield were observed. Applications of ATPL did not affect Al concentrations in corn ear-leaves at either location. Exchangeable soil Al concentrations were most elevated in treatments receiving only NH4NO3 as an N source. At N-based application rates, the ATPL resulted in lower Mehlich 1-extractable P (M1-P) and water-extractable soil phosphorus (H2O-P) concentrations compared to the application of NPL. A portion of this reduction could be attributed to lower rates of P applied in the N-based ATPL treatments. Runoff collected from treatments which received ATPL 2 d before conducting rainfall simulations contained 61 to 71% less dissolved reactive phosphorus (DRP) than treatments receiving NPL. These results show that ATPL may be used as a nutrient source for corn production without significant management alterations. Alum-treated poultry litter can also reduce the environmental impact of litter applications, primarily through minimizing the P status of soils receiving long-term applications of litter and reductions in runoff DRP losses shortly after application.