DiversityNursing Blog

Dr. Edward Soffen

Source: www.livescience.com

Dr. Edward Soffen is a board-certified radiation oncologist and medical director of the Radiation Oncology Department at CentraState Medical Center's Statesir Cancer Center in Freehold, New Jersey. He contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

As a radiation oncologist, my goal is to use radiation as an extremely powerful and potent tool to eradicate cancer tumors in the body: These techniques save and extend patients' lives every day. 

Historically, radiation treatments have been challenged by the damage they cause healthy tissue surrounding a tumor, but new technologies are now slashing those risks.

How radiation therapies work

High-energy radiation kills cancer cells by damaging DNA so severely that the diseased cells die. Radiation treatments may come from a machine (x-ray or proton beam), radioactive material placed in the body near tumor cells, or from a fluid injected into the bloodstream. A patient may receive radiation therapy before or after surgery and/or chemotherapy, depending on the type, location and stage of the cancer. 

Today's treatment options target radiation more directly to a tumor — quickly, and less invasively — shortening overall radiation treatment times. And using new Internet-enabled tools, physicians across the country can collaborate by sharing millions of calculations and detailed algorithms for customizing the best treatment protocols for each patient. With just a few computer key strokes, complicated treatment plans can be anonymously shared with other physicians at remote sites who have expertise in a particular oncologic area. Through this collaboration, doctors offer their input and suggestions for optimizing treatment. In turn, the patient benefits from a wide community of physicians who share expertise based upon their research, clinical expertise and first-hand experience. 

The result is safer, more effective treatments. Here are five of the most exciting examples:

1. Turning breast cancer upside down

When the breast is treated while the patient is lying face down, with radiation away from the heart and lungs, a recent study found an 86 percent reduction in the amount of lung tissue irradiated in the right breast and a 91 percent reduction in the left breast. Additionally, administering prone-position radiation therapy in this fashion does not inhibit the effectiveness of the treatment in any way.

2. Spacer gel for prostate cancer

Prostate cancer treatment involves delivering a dose of radiation to the prostate that will destroy the tumor cells, but not adversely affect the patient. A new hydrogel, a semi-solid natural substance, will soon be used to decrease toxicity from radiation beams to the nearby rectum. The absorbable gel is injected by a syringe between the prostate and the rectum which pushes the rectum out of the way while treating the prostate. As a result, there is much less radiation inadvertently administered to the rectum through collateral damage. This can significantly improve a patient's daily quality of life — bowel function is much less likely to be affected by scar tissue or ulceration. [Facts About Prostate Cancer (Infographic )]

3. Continual imaging improves precision

Image-Guided Radiation Therapy (IGRT) uses specialized computer software to take continual images of a tumor before and during radiation treatment, which improves the precision and accuracy of the therapy. A tumor can move day by day or shrink during treatment. Tracking a tumor's position in the body each day allows for more accurate targeting and a narrower margin of error when focusing the beam. It is particularly beneficial in the treatment of tumors that are likely to move during treatment, such as those in the lung, and for breast, gastrointestinal, head and neck and prostate cancer. 

In fact, the prostate can move a few millimeters each day depending on the amount of fluid in the bladder and stool or gas in the rectum. Head and neck cancers can shrink significantly during treatment, allowing for the possibility of adaptive planning (changing the beams during treatment), again to minimize long term toxicity and side effects.

4. Lung, liver and spine cancers can now require fewer treatments 

Stereotactic Body Radiation Therapy (SBRT) offers a newer approach to difficult-to-treat cancers located in the lung, liver and spine. It is a concentrated, high-dose form of radiation that can be delivered very quickly with fewer sessions. Conventional treatment requires 30 radiation treatments daily for about six weeks, compared to SBRT which requires about three to five treatments over the course of only one week. The cancer is treated from a 3D perspective in multiple angles and planes, rather than a few points of contact, so the tumor receives a large dose of radiation, but normal tissue receives much less. By attacking the tumor from many different angles, the dose delivered to the normal tissue (in the path of any one beam) is quite minimal, but when added together from a multitude of beams coming from many different planes, all intersecting inside the tumor, the cancer can be annihilated. 

5. Better access to hard-to-reach tumors

Proton-beam therapy is a type of radiation treatment that uses protons rather than x-rays to treat cancer. Protons, however, can target the tumor with lower radiation doses to surrounding normal tissues, depending on the location of the tumor. It has been especially effective for replacing surgery in difficult-to-reach areas, treating tumors that don't respond to chemotherapy, or situations where photon-beam therapy will cause too much collateral damage to surrounding tissue. Simply put, the proton (unlike an x-ray) can stop right in the tumor target and give off all its energy without continuing through the rest of the body. One of the more common uses is to treat prostate cancer. Proton therapy is also a good choice for small tumors in areas which are difficult to pinpoint — like the base of the brain — without affecting critical nerves like those for vision or hearing. Perhaps the most exciting application for this treatment approach is with children. Since children are growing and their tissues are rapidly dividing, proton beam radiation has great potential to limit toxicity for those patients. Children who receive protons will be able to maintain more normal neurocognitive function, preserve lung function, cardiac function and fertility. 

While cancer will strike more than 1.6 million Americans in 2015, treatments like these are boosting survival rates. In January 2014, there were nearly 14.5 million American cancer survivors. By January 2024, that number is expected to increase to nearly 19 million. 

But make no mistake — radiation therapy, one of the most powerful resources used to defeat cancer, is not done yet. As we speak, treatment developments in molecular biology, imaging technology and newer delivery techniques are in the works, and will continue to provide cancer patients with even less invasive treatment down the road.

Source: www.livescience.com

  PAULA SPAN

What she wanted, the patient told the geriatricians evaluating her, was to be able to return to her condominium in Boston. She had long lived there on her own, lifting weights to keep fit and doing her own grocery shopping, until a heart condition worsened and she could barely manage the stairs.

So at 94, she consented to valve replacement surgery at a Boston medical center. “She never wanted to go to a nursing home,” said Dr. Perla Macip, one of the patient’s geriatricians. “That was her worst fear.”

Dr. Macip presented the case on Saturday to a meeting of the American Academy of Hospice and Palliative Medicine. The presentation’s dispiriting title: “The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?”

Like Dr. Macip, a growing number of physicians and researchers have grown critical of 30-day mortality as a measure of surgical success. That seemingly innocuous metric, they argue, may actually undermine appropriate care, especially for older adults.

The experience of Dr. Macip’s patient — whom she calls Ms. S. — shows why.

Ms. S. sustained cardiopulmonary arrest during the operation and needed resuscitation. A series of complications followed: irregular heartbeat, fluid in her lungs, kidney damage, pneumonia. She had a stroke and moved in and out of the intensive care unit, off and on a ventilator.

After two weeks, “she was depressed and stopped eating,” Dr. Macip said. The geriatricians recommended a “goals of care” discussion to clarify whether Ms. S., who remained mentally clear, wanted to continue such aggressive treatment.

But “the surgeons were optimistic that she would recover” and declined, Dr. Macip said.

So a discussion of palliative care options was deferred until Day 30 after her operation, by which time Ms. S. had developed sepsis and multiple-organ failure. She died on Day 31, after life support was discontinued.

The key number here, surgeons and other medical professionals will recognize, is 30.

Thirty-day mortality serves as a traditional yardstick for surgical quality. Several states, including Massachusetts, require public reporting of 30-day mortality after cardiac procedures. Medicare has also begun to use certain risk-adjusted 30-day mortality measures, like deaths after pneumonia and heart attacks, to penalize hospitals with poor performance and reward those with better outcomes.

However laudable the intent, reliance on 30-day mortality as a surgical report card has also generated growing controversy. Some experts believe pressures for superior 30-day statistics can cause unacknowledged harm, discouraging surgery for patients who could benefit and sentencing others to long stays in I.C.U.s and nursing homes.

“Thirty days is a game-able number,” said Dr. Gretchen Schwarze, a vascular surgeon at the University of Wisconsin-Madison and co-author of an editorial on the metric in JAMA Surgery. Last fall, she led a session about the ethics of 30-day mortality reporting at an American College of Surgeons conference.

“Surgeons in the audience stood up and said, ‘I can’t operate on some people because it’s going to hurt our 30-day mortality statistics,’” she recalled. The debate is particularly urgent for older adults, who are more likely to undergo surgery and to have complications.

Those questioning the 30-day metric point to potential dilemmas at both ends of the surgical spectrum. Surgeons may decline to operate on high-risk patients, even those who understand and accept the trade-offs, because of fears (conscious or not) that deaths could hurt their 30-day results.

At a hospital in Pennsylvania, for instance, a cardiothoracic surgeon declined to operate on a man who urgently needed a mitral valve replacement. He wasn’t elderly, at 53, but he was an alcoholic whose liver damage increased his risk of dying.

Dr. Douglas White, the director of ethics and decision-making in critical illness at the University of Pittsburgh School of Medicine, was asked to consult. According to Dr. White, the surgeon explained that “we have been told that our publicly reported numbers are bad, and we have to take fewer high-risk patients.”

Other surgeons at the hospital, under similar pressure, also refused. A helicopter flew the patient to another hospital for surgery.

An outlier case? A study in JAMA in 2012 compared three states that require public reporting of coronary stenting results to seven nearby states that didn’t report. Older-adult patients having acute heart attacks had substantially lower rates of the stenting in the reporting states. Doctors’ concerns about disclosure of poor outcomes might have led them to perform fewer procedures, the authors speculated; they might also have weeded out poorer candidates for surgery.

Perhaps as important for older people, when things go wrong, surgical teams concerned about their 30-day metrics may delay important conversations about palliative care or hospice, or even override advance directives.

“There are no good published studies on this, but it’s something we see,” Dr. White said. “Surgeons are reluctant to withdraw life support before 30 days, and less reluctant after 30 days.”

That may have been what happened to Ms. S. Or perhaps her aggressive treatment resulted from a surgical ethos that has little to do with mortality reports.

“We want to cure patients and help them live, and we consider it a failure if they don’t,” said Dr. Anne Mosenthal, who heads the American College of Surgeons committee on surgical palliative care.

With surgeons already prone to optimism and disinclined to withdraw life support, the effect of reporting failures, if there is one, is subtle. Surgeons tell themselves, “Maybe if we wait a little longer, he’ll improve; there’s always a chance,” Dr. Mosenthal said.

But many older patients, and their families, have different ideas about what makes life worth sustaining and might welcome a frank discussion before a month passes.

“The 30-day mortality statistic creates a conflict of interests,” said Dr. Lisa Lehmann, an associate professor of medical ethics at Harvard Medical School. “It can lead to the violation of a physician’s duty to put patients’ interests first.”

Leaders at the nonprofit National Quality Forum, which just endorsed 30-day mortality as a measure for coronary bypass surgery, find such fears overblown. The forum evaluates quality measures for Medicare and other insurers, and went ahead with its endorsement despite some physicians’ objections.

“There is some concern,” said Dr. Helen Burstin, the chief scientific officer of the forum, but “certainly no evidence” that the metric is unduly influencing patient care.

“Is it better not to measure and compare, just because we can’t get it perfect?” added Dr. Lee Fleisher, a co-chairman of the forum’s surgery standing committee.

But critics think other quality measures might serve better. Perhaps the benchmark should be 60- or 90-day mortality. Perhaps patients having palliative surgery to relieve symptoms should be tracked separately, because comfort is their goal, not survival.

Maybe quality should include days spent in an I.C.U. or on a ventilator, Dr. Schwarze said.

“Medicine isn’t just about keeping people alive,” she said. “Some of it is about relieving suffering. Some of it is about helping people die.”

Source: www.nytimes.com

By AVIANNE TAN

A Minneapolis mom who wanted a natural birth was more than 13 hours into labor when she felt she wasn't going to make it without something to take the edge off the pain. But rather than asking for an epidural or narcotics, she begged for laughing gas.

"It immediately took my fear away and helped calm me down, though I could still feel the pain," Megan Goodoien, who gave birth at the Minnesota Birthing Center this month, told ABC News today. "I didn't laugh because the labor was so intense, but I everything suddenly felt doable just when I thought I couldn't make it anymore. It's definitely a mental thing."

Though nitrous oxide has long been used in European countries and Canada, the gas is now making a resurgence in the U.S., according to medical experts.

The gas, once popular in the U.S., was sidelined after the advent of the epidural in the 1930's, midwife Kerry Dixon told ABC News, noting she believes epidurals took over because they were more profitable. Dixon did not treat Goodoien but works at the Minnesota Birthing Center.

"The average cost for a woman opting for nitrous oxide is less than a $100, while an epidural can run up to $3,000 because of extra anesthesia fees," Dixon said.

The U.S. Food and Drug Administration approved new nitrous oxide equipment for delivery room use in 2011, which could also explain the resurgence, Dixon told ABC News.

"Maybe 10 years ago, less than five or 10 hospitals used it [for women in labor]," Dr. William Camann, director of obstetric anesthetics at Brigham and Women's Hospital, told ABC News. "Now, probably several hundred. It’s really exploded. Many more hospitals are expressing interest."

He added the gas popular in dentists' offices has an "extraordinary safety record" in delivery rooms outside the U.S. But more studies are needed to confirm its safety, other doctors say.

Laughing gas works differently than an epidural or narcotic in that it targets pain more on a mental level than physical, experts said.

"It's a relatively mild pain reliever that causes immediate feelings of relaxation and helps relieve anxiety," Camman said. "It makes you better able to cope with whatever pain you’re having."

But gas can also change awareness, said Dr. Jennifer Ashton, a senior medical contributor for ABC News and practicing OB/GYN.

"In delivering over 1,500 babies, I had never used it nor has anyone asked for [nitrous oxide]," Ashton told ABC News. "[M]ost moms want to be totally aware when they are in labor."

Mothers who have opted for nitrous oxide like that it's self-administered by the patient, who has total control over if and when it's used.

A Nashville mother said she opted for the gas during labor only after she found herself too tense to push.

"I instantly felt relaxed," Shauna Zurawski told ABC News. "Before, I was so tense. I was fighting against the contractions, which definitely wasn't good. But after the laughing gas, my body was able to do what it was supposed to. It was so neat."

Both Goodoien and Zurawski said they put a nitrous oxide machine's mouthpiece over their mouth and nose and inhaled about 30 seconds before their next contraction to get the maximum effect.

Another advantage is that the chemical gets out of your system shortly after stopping inhalation.

"With my first child, I had an epidural, I was numb for so long after the delivery and it took a while to get back to normal," Zurawski said. "But with the nitrous oxide, I was walking around and taking pictures almost right after."

Both Goodoien and Zurawski said they didn't experience any adverse side effects.

Nitrous oxide's possible side effects are usually just minor nuisances such as nausea, dizziness or drowsiness, medical experts told ABC News.

Patients can also choose to stop or get an epidural at any time if they find they don't want the laughing gas.

It's still early to tell how popular this new option will get, but in countries like New Zealand, about 70 percent of women in labor choose to use laughing gas, Dixon said.

"When I was working in New Zealand, I told one of my patients, [laughing gas] wasn't really used in the U.S. and you know what she said?" Dixon asked. "'I thought they have everything in America!'"

Source: http://abcnews.go.com

By LIZ NEPORENT

Just like Luke Skywalker, 7-year-old Liam Porter of Augusta Georgia has been given a brand new arm.

Porter, who was born without the lower part of his left arm, was recently surprised with a prosthetic arm modeled after the Imperial Clone Troopers in Star Wars.

“Liam wants it made clear it is a Clone Trooper not a Storm Trooper arm,” said his mother Ryan Porter.

In the Star Wars movies, Clone Troopers are the good guys and Storm Troopers are evil.

Porter used to have a traditional prosthesis but it was boring and clunky, John Peterson, the limb’s designer said. The boy thinks the new arm is not only “extremely awesome,” it’s lighter and easier to move. It has a clamp on it and a rail system to slide different attachments on and off. As he grows, the arm can be adjusted.

Porter’s space-age appendage was a arranged by E-nable, a global network of volunteers who 3D print mechanical hands and arms for kids in need then give them away for free.

Jon Schull, E-nable’s founder, is also a research scientist at the Rochester Institute of Technology. He said the group pairs each child with a “maker” who takes a basic prosthetic design and customizes it.

Peterson went above and beyond, Schull noted.

“I believe this is the first Clone Trooper arm we’ve done,” Schull said.

The arm took about three months to make and cost about $300, according to Peterson. The price tag for a typical prosthetic arm is upwards of $9,000, Schull pointed out.

In its first year, E-nable has given away more than 700 arms and hands. Members of 501st Georgia Garrison, a group of people who dress up as Storm (and Clone) Troopers, presented Porter with his at a surprise ceremony held at a local movie theater.

“He was actually speechless, which for him is a rarity,” his mom said. “It’s amazing John donated his time and own money to make this happen, just to see the joy on my son’s face.”

Source: http://abcnews.go.com

Jenna Birch

While cancer can strike anyone — young or old, unhealthy and healthy — we do have some idea of what can affect risk. Genetics often play a role, for instance, as do lifestyle habits. But according to a new study from Johns Hopkins University researchers, much of cancer risk may actually be due to mere chance.

Cancer develops when stem cells of a given tissue make random mistakes, mutating unchecked after one chemical letter of DNA is incorrectly swapped for another — the equivalent of a cell “oops.” It happens without warning, like the body’s roll of the die. 

For the new study, published in the journal Science, researchers wanted to see how much of overall cancer risk was due to these unpreventable random mutations, independent of other factors like heredity and lifestyle. 

“There is this question that is fundamental in cancer research: How much of cancer is due to environmental factors, and how much is due to inherited factors?” Cristian Tomasetti, PhD, a biomathematician and assistant professor of oncology at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, tells Yahoo Health. “To answer that question, however, the idea came that it would be important to determine first how much of cancer was simply due to ‘replicative chance.’"

To measure this, the researchers plotted the number of stem cell divisions in 31 types of tissues over the course of a lifetime against the lifetime risk of developing cancer in the given tissue. From this chart, the scientists were able to see the correlation between number of divisions and cancer risk — and from that correlation, researchers were able to determine the incidence of cancer in a given tissue due to replicative chance.

Ultimately, researchers found that roughly two-thirds of the cancer incidence was due to this replicative chance, or simply “bad luck.” (However, it’s worth noting researchers did not examine some cancers, such as breast and prostate cancers, because of lack of reliable stem-cell turnover information.)

But don’t assume you’re simply doomed to the hand fate deals you. After additional analysis, researchers found that of the 31 cancers examined, 22 could be explained by “bad luck” — but for the other nine, there was another factor aside from simple chance that likely contributed to the cancer.

This is presumably because environmental and hereditary factors play a role in development. “There are many cancers where primary prevention has huge positive effects, such as vaccines against infectious agents, quitting smoking or other altered lifestyles,” says Tomasetti. 

Incidentally, the cancers where risk could be lowered by primary preventive practices were ones you may expect — diseases like skin cancer, where limiting sun exposure can lower your risk, as well as lung cancer, where avoiding smoking is key. 

Source: www.yahoo.com

By Melissa Wirkus

“HIT has been shown to help some patients, but it has also been shown to perhaps provide some complications in care, or less than adequate care, when messages are not received, when messages are interrupted or when messages are routed to the inappropriate person,” explained Milisa Manojlovich, PhD, RN, CCRN, associate professor at the University of Michigan School of Nursing (UMSN) and member of U-M’s Institute for Healthcare Policy and Innovation.

Manojlovich will serve as the primary investigator on a new $1.6 million grant from the federal Agency for Healthcare Research and Quality (AHRQ) that will focus on health IT’s effects on nurse–physician communication. Manojlovich and her co-investigators will look at how communication technologies make it easier or harder for doctors and nurses to communicate with each other. They hope their research will identify the optimal way to support effective communication while fostering improved and positive interdisciplinary team-based care.

Until the research is completed, Manojlovich offers some simple procedures clinicians can begin to adopt right now to help alleviate common problems with digital communication:

1.   Use multiple forms of technology  

Just like there is more than one way to treat a cold, there is more than one way to communicate electronically. Utilizing multiple forms of technology to communicate important information, or sometimes even reverting back to the “old-fashioned” ways of making a phone call or talking in person, can help ensure the receipt of a message in an environment that is often inundated.

“One of the things we are going to investigate is this idea of matching the message to the medium,” Manojlovich said. “So depending on the message that you want to send, you will identify what is the best medium to send that message.”

Using the current Ebola situation in Texas as an example, Manojlovich explained that using multiple forms of technology as a back-up to solely documenting the information in the EHR system could have mitigated the breakdown in communication that occurred. “Although the clinician did her job by entering the information into the EHR, she maybe should have texted or emailed the physician with the information or found someone to talk to in person about the situation. What we are trying to do with this study is see if there is another way that messages like this could have been transmitted better.”

2.   Include the whole message 

Reducing fragmented messages and increasing the aggregation of key data and information in communications may be one of the most critical pieces to improving communication between nurses and physicians. Manojlovich has been passionate about nurse–physician communication throughout her career and has conducted several previous studies on communication technologies.

“What we’ve noticed, for example, is that nurses will sometimes use the same form of communication over and over again. In one of the studies we actually watched a nurse page the same physician three times with the same question within an hour period.”

The physician did not answer any of the messages, and Manojlovich concluded it was because the pages were missing critical components of information related to the patient’s care plan. Increasing the frequency of communications can be beneficial, but only if the entire message and all important facets of information are relayed.

“If you do what you’ve always done, you’re going to get what you’ve always gotten. If you don’t alter or change the communication technology you are using, you are going to get the same results,” she added.

3.   Incorporate a team-based approach 

“At a really high level the problem is that a lot of these computer and electronic health record technologies are built with individuals in mind,” Manojlovich said. “When you talk about care process and team processes, that requires more interaction than the technologies are currently able to give us. The computer technologies are designed for individual use, but health care is based on the interaction of many different disciplines.”

Infusing this collaborative mindset into the “siloed” technology realm will undoubtedly help to improve the communication problems between providers and clinicians at all levels and all practice settings--which is especially important in today’s environment of co-morbidities and coordinating care.

Nurses play a critical role in improving communication as frontline care providers. “Nurses are the 24-hour surveillance system for hospitalized patients. It is our job to do that monitoring and surveillance and to let physicians know when something comes up.”

“I believe that for quality patient care, a patient needs input from all disciplines; from doctors, nurses, pharmacists, nutritionists--everyone,” Manojlovich said. “We are being trained separately and each discipline has a different knowledge base, and these differences make it difficult for us to understand each other. Developing mutual understanding is really important because when we have that mutual understanding I think outcomes are better and it can be argued that the quality of care is better when you have everyone providing input.”

Source: www.nursezone.com

The U.S. is currently seeing a physician shortage that will only continue to rise and affect medical practices all over the country. By 2020, the American Association of Medical Colleges (AAMC) estimates there will be a shortage of more than 90,000 physicians, and that number will grow to 130,000 by 2025.

To solve this problem, many healthcare providers are turning to Nurse Practitioners (NPs) and Physician Assistants (PAs). While many people believe NPs and PAs are unable care for patients as well as physicians, studies have found that to be untrue.  Victoria Garment, editor at SoftwareAdvice.com--a website that presents reviews and ratings of healthcare technology-- explains:

“Decades of studies have demonstrated that, when permitted to practice to the full extent of their training, NPs and PAs can perform a majority of the tasks that physicians do while providing the same quality of care.”

These tasks can include performing physical exams, diagnosing and treating conditions such as diabetes or high blood pressure, writing prescriptions, order diagnostic tests and more. Additionally, “while PAs cannot practice independently of physicians, there are approximately 250 practices across the U.S. that are run solely by NPs,” Garment said.

Another benefit of hiring NPs and PAs is the significant cost savings:

• Reduced salary expenses - The average base salary of a physician is more than double that of NPs and PAs.
• Lower overhead costs - Studies show PAs require lower overhead costs than physicians by department, patient demographics and medical care resource use, resulting in a $30,000 boost to the bottom line.
• Lower costs of care - The costs of NP-managed practices have been found to be 23 percent below physician-managed practices. This can lead to statewide savings of $4.2-$8.4 billion.
• Higher patient volumes - Another study found that adding an NP to a practice can double patient numbers and boost yearly revenue by $1.65 million per 100,000 enrollees.
• Reduced insurance and liability costs - Not only is a PA’s liability risk cost one-third of a physician’s, but NPs also have much lower rates of malpractice claims and lower costs per claim.

What’s more, patients often report having an equal or even better experience with an NP or PA compared to a physician. A survey by Medscape found that 80 percent of patients felt NPs “always” listened while carefully compared to 50 percent of physician patients. Similarly, the Kaiser Permanente Center for Health Research released a report that said PA patients ranked their satisfaction levels between 89 to 96 percent for the quality of care they received in the areas of interpersonal care, confidence in the provider and understanding of patient problems.

With all the benefits that NPs and PAs bring, they can be a great addition or alternative to any medical practice, especially those experiencing physician shortages.

To read the full report on The Profitable Practice blog, visit: “Nurse Practitioners and Physician Assistants: Why You Should Hire One (or the Other).”