Rent-a-MEDEX: An early PA prototype Pedersen, Donald; Hooker, Roderick S
JAAPA (Montvale, N.J.),
2023-Apr-01, Volume:
36, Issue:
4
Journal Article
Peer reviewed
In the 1970s, busy physicians knew little about the capabilities of a new member of the healthcare team-the physician associate/assistant (PA). Internal studies by the University of Utah and ...University of Washington educational programs demonstrated that the MEDEX/PA could increase access to care by providing quality, cost-effective care in rural primary care practices. Marketing this concept was essential, and in the early 1970s, the Utah program devised an innovative plan, partially funded through a grant from the federal Bureau of Health Resources Development, called Rent-a-MEDEX. Physicians in the Intermountain West were introduced to graduate MEDEX/PAs in order to gain firsthand experience about how these new clinicians could benefit a busy primary care practice.
The DTS‐MEDEX‐2009 campaign was a field experiment in which extra observations were adaptively deployed to improve the short‐range forecast of Mediterranean high‐impact weather (HIW) during autumn ...2009. For the DTS‐MEDEX‐2009 cases, five different sensitivity analysis techniques were carried out to provide targeting guidance: singular vectors (SV) from the ECMWF; ensemble transform Kalman filter (ETKF) and Kalman filter sensitivity (KFS) from Météo France; and ensemble and adjoint sensitivities from the University of the Balearic Islands. However, the value of the targeting guidance provided by such a variety of sensitivity products has never been assessed for a Mediterranean HIW event. Since radiosonde and AMDAR profiles were the only observational means available during the DTS‐MEDEX targeting campaign, this study tests the ability of each sensitivity product in identifying the region where a plausible sounding leads to a greater impact on the forecast of a potential high‐impact cyclone over southern Italy on 5 December 2009. All targetable radio‐sounding sites are also tested and a severe‐weather meteorologist is used as a confronting reference. The verification testbed comprehends single sounding experiments and multiple sounding strategies by using the WRF Data Assimilation system. Single sounding tests reveal that sensitivity products fail to recognize the best location for a single observation since most of the soundings added over operational radio‐sounding stations have a larger influence on intense cyclone forecast than the points highlighted by the objective sensitivity calculation methods. Additionally, it is shown that human‐based decisions, after evaluating available sensitivity information, are not optimal, either in single or in multiple sounding strategies.
This study describes the MEDEX physician assistant (PA) program's experience with screening, educating, and graduating PA students who were international medical graduates (IMGs).
The study reviewed ...IMG-PA demographics including country of origin; prior primary care practice; and current practice location, specialty, and medically underserved designation. Descriptive statistics and chi-square analysis or Fisher exact test summarize outcomes.
Thirty-nine IMG-PAs were graduated from 1991 through 2013. IMGs came from central and eastern Europe (48.7%), Asia (33.3%), and other regions. Most (69.2%) are women. Almost all (91.7%) practice in urban settings, 55.6% are in primary care, and 30.6% work in medically underserved areas. IMG-PAs in primary care were more likely to practice in underserved areas (P=0.009).
MEDEX has graduated IMG-PAs who possess appropriate clinical and professional PA skills.
The introduction of physician assistants (PAs) into Alaska began in 1971 with seven MEDEX Northwest students, who were paired with physician preceptors for 12 months. Scores of PAs were recruited as ...health officers on the Trans-Alaska Pipeline System starting in 1974, and by 1977 the state had 200 PAs. In 1979, the Alaska Board of Medical Examiners ratified the first set of regulations and began issuing licenses the following year. Throughout the 1970s and following pipeline completion, more PAs were employed by private, state, and federal agencies to meet the needs of a growing population. Forty years later, Alaska has one of the richest legacies in PA deployment of any state. This article is based on the authors' memories, communications with those involved in the program, and historical documents archived at the MEDEX Northwest Physician Assistant Program at the University of Washington in Seattle, along with Alaskan archival sources.
Objectives.—Sleep at extreme altitudes is characterized by the repetitive occurrence of central apneas that in some cases may lead to a marked decrease in arterial oxygen saturation. During the ...Ludwig Maximilians University Expedition to Mt. Everest (MedEx 2006), nocturnal polygraphic recordings were made at different altitudes and included the first recordings ever made at 7500 m, which were completed on 8 separate occasions during the expedition. Methods.—The study was performed on the author (K.M., 58 years, 181 cm, 75 kg), who is an experienced high-altitude mountaineer. The standard polygraphic parameters, such as nasal and oral airflow, thoracic and abdominal effort, oxygen saturation, heart rate, body position, movement, and snoring, were collected with a portable sleep recording device (AlphaScreen, SensorMedics, Germany, Hochberg) at different altitudes between 5300 m and 7500 m, and were compared with baseline assessments made in Munich, Germany (altitude 508 m). The daytime value of oxygen saturation at rest was measured at South Col (8000 m) and at the South Summit (8763 m) without breathing supplemental oxygen for at least 10 minutes. Results.—The number of apneas and hypopneas of central origin increased up to a maximum of 148/h with a minimal blood oxygen saturation of 48% at 7500 m, compared with <5/h at Munich. After 11 days of acclimatization, data recorded at 5300 m showed a marked reduction of disturbed sleep. The Apnea-Hypopnea-Index dropped from 138/h to 51/h, and the minimal blood oxygen saturation rose from 57% to 67%. At South Col (8000 m), the daytime value of oxygen saturation at rest ranged between 53% and 55%, and on South Summit (8673 m) without breathing supplemental oxygen for at least 10 minutes, it fluctuated around 50%. Conclusions.—These data correlate well compared with those obtained in hypobaric chamber studies and show that regardless of physiologic adjustment to low oxygen conditions at Base Camp altitude, during the final summit attempt oxygen saturation drops further to 55% and even less. Thus recordings of nocturnal oxygen saturation at Camp 3 (7500 m) on Everest, where the night is spent before the summit attempt, may help to show the actual efficiency of hypoxic ventilatory response and to detect the individual hypoxic tolerance to altitudes above 8000 m.
Among complementary medicine approaches, diagnostic screening tools based on neuroreflexology have been recently developed. Such techniques are based on the rationale that measurement of electrical ...impedance of specific dermal zones might reflect the occurrence of pathological states in the corresponding internal organs or systems. Our objective was to evaluate the reliability of a neuroreflexology-based diagnostic test in diagnosing immune-mediated diseases in a blinded single centre study. Seventy-eight patients with immune-mediated diseases (38 patients with autoimmune diseases (AD), and 40 allergic patients) were included in the study. Thirty age and sex matched healthy subjects were also evaluated as a control group. All the patients and subjects underwent conventional medical history and physical examination. We evaluated a device manufactured by Medex Screen Ltd (Arad, Israel). The Medex Test analysis was carried out by a second physician who was blinded to the previous diagnosis. A high correlation between the formal clinical diagnosis and the results of the measurement of electrical skin impedance was reported, with a specificity of 93.3% and a sensitivity of 81.2%. Both sensitivity and specificity dropped when analysing the autoimmune and the allergic group separately, but remained significant for the autoimmune diseases. Degree of activity of the allergic disorders, or specific treatment, did not affect the diagnostic properties of the described device. The Medex Test neurophysiology based technique has the potential to serve as a diagnostic tool for immune based pathologies. Future studies will define this tool place in routine evaluation and potential screening ability.
In the United States there is a shortage and geographical maldistribution of physicians engaged in primary care: general practice, pediatrics, and internal medicine. Part of our nation's ...comprehensive health policy (U.S. Department of Health, Education, and Welfare, 1971), therefore, encourages an increased supply of primary care physicians and their redeployment. But even if there were far more of these physicians practicing in previously underserved localities, the improved capacity to deliver the appropriate level of care would still be limited by the performance of time-consuming functions that do not require full medical training. The reallocation of such functions to new "midlevel" medical positions and the training of new manpower types to staff them are thus desired innovations and are being supported by the federal government on a trial basis. One of the earliest examples of a midlevel training program is MEDEX (Smith, 1970), which trains former medical corpsmen and places them with rural and urban general practitioners in order to "medically extend" the services of these physicians. What can psychology contribute to these experiments in manpower restructuring of one of our most important human services industries? The purpose of this article is to describe the evaluative research methodology developed by psychologists at the National Center for Health Services Research and Development (NCHSRD) for assessing what happens when new midlevel workers are introduced into ambulatory, primary care practice units. We have assembled our methodology into what we refer to as the Uniform Manpower Evaluation Protocol (NCHSRD, 1971).
We evaluated 12 disposable pressure transducers from 11 manufacturers. All are rated Acceptable and are ranked in four groups. The first two groups have similar performance characteristics. Groups ...three and four are ranked primarily according to the effect of fluid spills and the ease of achieving accurate dynamic response. Although list prices are somewhat high, negotiated prices are usually lower. Users should weigh advantages and disadvantages against clinical preference and price.
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