Advanced Practice Providers Recognized as Valuable Healthcare Resources: Increasing the Illinois PA’s Scope of Practice to Match Their NP Cohort

Abstract: Nurse practitioners (NPs) and physician assistants (PAs) represent a group of non-physician, advanced-practice providers (APPs) within our healthcare system. Non-physician providers are part of an inter-disciplinary team, working alongside physicians and a variety of allied healthcare providers. The purpose of this paper is to take a closer look at these two professions (NP and PA), with a focus on Illinois providers and the legislative strategies that guide their roles and abilities to practice. Illinois is a region where APP practices are inequitably regulated. Their Nurse Practice Act outlines a broad scope of practice for Advanced Practice Registered Nurses (APRNs). However, the Illinois PA Practice Act barely addresses the PA’s scope of practice, and also delineates certain restrictions, which limit practice in ways not paralleled for the NP. The goal of this paper was to construct an objective comparison between these two APP groups, in order to dispel the misconceptions that have led to these disparate Practice Acts. Specifically, the Master of Science in Nursing - Family Nurse Practitioner (MSN-FNP) training was compared to the Master of Science in Physician Assistant Studies (MSPA or MPAS) degree. Using these criteria, fifteen MSN-FNP programs were compared to nine MSPA programs among Illinois universities. Results revealed that NP and PA programs have similar educational objectives, all with demanding medical curricula, guided by strict accreditation standards. The data further revealed that Illinois PA educational training requires completion of more clinical practicum hours than does NP training: 704 (mean) hours for FNP students; compared to 2,108 (mean) hours for PA students. Furthermore, PA program accreditation requires that students complete practicum hours within seven medical fields, as well as elder care in long-term residential facilities, plus procedural skills training and proof of procedural skills competencies. Most NP programs are online and encourage concurrent nursing employment, thus supporting a part-time course load. NP programs are therefore designed to allow a flexible timeline for completion, some permitting five to six years. In comparison, all PA programs are full-time, in-person curricula, and discourage concurrent employment due to extensive course hours, and stringent requirements for advancement. The bottom line here is, NP and PA programs both have sound delivery methods and rigorous requirements, but longer chronological length should not be misinterpreted as greater in substance. Conclusion: This paper evaluated the highly advanced training programs of NPs and PAs in Illinois and found no data to support the differences in the Illinois Practice Acts governing these two groups. Despite the rigorous, highly advanced, and closely monitored training protocols of PA education, legislative bodies in Illinois do not fully recognize the PA provider’s significant potential. It is therefore, fair and reasonable to request these limitations be re-evaluated, in order to allow Illinois PAs to practice to the full potential of their professional training. In Illinois, NPs have achieved full provider status. Equal designation should be delegated to Illinois PAs

Use of topical imiquimod in the treatment of VIN: a case report and review of the literature

Vulvar intraepithelial neoplasia (VIN) is a premalignant disease of the vulvar squamous epithelium. Standard treatment for VIN lesions is surgical excision. Alternative therapeutic options for conservative treatment have been sought by patients to prevent disfigurement and to preserve sexual function. We present such a patient in whom topical imiquimod was used with a successful outcome. Imiquimod is effective in the treatment of VIN, as well as convenient, self-administered, and generally well tolerated. Keywords: vulvar intraepithelial neoplasia, Bowen’s disease, squamous cell carcinoma in situ, imiquimo

Safety and Efficacy of OnabotulinumtoxinA for Treatment of Crow’s Feet Lines in Chinese Subjects

Background:. This study evaluated the safety and efficacy of onabotulinumtoxinA for the treatment of crow’s feet lines (CFL) in Chinese subjects. Methods:. This 5-month, double-blind, randomized, parallel-group, placebo-controlled phase 3 study was conducted in China. Subjects with moderate-to-severe CFL at maximum smile received a single treatment of onabotulinumtoxinA 24 U (total; n = 316) or placebo (n = 101) on day 1. The primary efficacy measure was the proportion of investigator-assessed responders (achieved CFL severity of none or mild at maximum smile using the Facial Wrinkle Scale with Asian Photonumeric Guide at day 30). Additional endpoints included other response definitions (achieving at least 1-grade improvement at maximum smile and at rest using the Facial Wrinkle Scale with Asian Photonumeric Guide at day 30), duration of effect, subject-reported outcomes, and safety. Results:. All efficacy endpoints were met. At day 30, the proportion of subjects achieving none or mild severity at maximum smile was significantly greater (P < 0.001) in the onabotulinumtoxinA group (63.9%) versus the placebo group (5.0%). The proportion of subjects assessing the change in CFL appearance as much improved/very much improved was also significantly greater with onabotulinumtoxinA than placebo (P < 0.001). Subjects’ self-assessed outcomes were similar to investigator-assessed results. Median duration of effect with onabotulinumtoxinA was ≥5 months using all responder definitions. A low occurrence of treatment-related adverse events was reported, with no new safety findings. Conclusions:. OnabotulinumtoxinA 24 U was effective and well tolerated for the treatment of CFL in Chinese subjects, with responses maintained over 5 months