College of Medicine - Master of Physician Assistant Studies Capstone Projects

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    Understanding the Mental Health of Canadian Physician Assistant Students
    (2024-05-15) Berrington, Lauren
    The mental health of medical students has been well studied, revealing significant rates of anxiety, depression, and burnout. Despite the similarities in training, limited research has been done to understand the mental health of Physician Assistant (PA) students. This study investigates the mental health of first- and second-year PA students across Canadian training programs. Eligible students at the three Canadian PA programs received a recruitment email providing a link to a confidential survey hosted on REDCap. Participants provided non-identifying demographic information and completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screener (GAD-7), and the Maslach Burnout Inventory General Student version (MBI-GS(S)). Additional questions covered previous mental health history and coping styles. Seventy-three students completed the survey (response rate of 43.4%). One-third had seen a health professional in the past 12 months for mental health. Depression, anxiety, and burnout symptoms were prevalent. GAD-7 varied significantly between schools (higher at University of Manitoba vs McMaster University), and marginally between academic year (higher in first years). Positive correlations were found among PHQ-9, GAD-7, and burnout subscales. Maladaptive coping mechanisms were associated with higher anxiety, depression, and burnout, while adaptive coping positively correlated with PE burnout subscale. No significant differences in PHQ-9 or MBI-GS(S) were found between academic years or programs. As the PA profession continues to expand in Canada, understanding the prevalence of anxiety, depression and burnout is crucial. Improving PA student mental health should be a priority for education programs to promote a healthy workforce and develop a foundation for further research.
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    PERCEPTION, EFFICACY, AND TREATMENT OUTCOMES OF POINT-OF-CARE SYPHILIS TESTING IN CANADA AND THE UNITED STATES: A LITERATURE REVIEW
    (2024-05-15) Guenther, Sarah
    Introduction: Syphilis is a preventable sexually transmitted infection that causes systemic manifestations in the absence of appropriate treatment. The rise in infectious syphilis cases across Canada over the past several years has brought forth accessibility concerns for traditional serological laboratory testing. Despite the recent approval of rapid syphilis testing for use in professional settings by Health Canada, point-of-care syphilis testing remains underutilized. Objectives: This study investigates current literature on rapid point-of-care testing as an initial screening measure for infectious syphilis. The aim of this review is to explore the perception, field performance, and treatment outcomes of rapid syphilis testing in Canada and the United States to determine the utility of shifting toward point-of-care screening in Canada. Methods: A literature search using Google Scholar and PubMed databases identified articles examining the field performance of rapid syphilis testing in Canada and the United States in the last 24 years (2000-2024). Five primary research articles satisfied the inclusion criteria and were included in this review. Results: Five observational studies found rapid syphilis testing was generally well-accepted, highly specific with few false positives and negatives, and significantly reduced time to treatment compared to serological laboratory standards. Sensitivity and predictive value were variable; however, sensitivity improved with rising RPR titers. Conclusion: This review suggests that point-of-care testing is adequate as an initial screening measure for infectious syphilis but should be supplemented by traditional serological laboratory testing. The inability of treponemal tests to discern infectious syphilis from a previously treated infection is a key limitation of currently available rapid tests. Given the ease of test administration and the low burden of overtreatment with benzathine penicillin G, future studies should investigate the utility of point-of-care syphilis screening in resource-limited communities in rural and northern Canada.
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    The Effect of Physical Activity during Pregnancy on the Development of Postpartum Depression (PPD): A Literature Review
    (2024-05-15) Hunt, Katherine
    Introduction: Postpartum depression (PPD) is a condition characterized by major depressive mood disorder following childbirth. The onset of depressive symptoms is most often within four weeks after childbirth, but the diagnosis is often made up until a year postpartum. Current prevention and treatment strategies focus on the use of psychotherapy and anti-depressant medications. The research on alternative interventions such as the effect of exercise on the prevention of PPD is limited and inconclusive. Objective: The purpose of this study is to further understand how efficacious exercise is in the prevention of PPD. There are currently very few recommendations for preventing PPD, thus there are knowledge gaps to fill in this area of research. This study will look at the current literature and determine if there is enough evidence to recommend physical activity during pregnancy for the prevention of PPD. Methods: A literature search was done using PubMed and PsycINFO databases. The search was performed using key terms about physical activity during pregnancy and its relation to the prevention of PPD. Six articles were found that best met the inclusion criteria and were therefore used in the literature review. Results: Four studies selected were randomized controlled trials (RCTs) which used an intervention to investigate how physical activity would impact depression screening in the postpartum period. The other two articles used prospective and retrospective cohorts to analyze if activity levels would influence EPDS scores in the postpartum period. Discussion/Conclusion: The studies selected for review differed in study design and therefore the results of each study had some variation. Two of the RCTs showed no significant impact from exercise during pregnancy on PPD. However, these studies both faced issues with adherence, among other limiting factors. The other two RCTs selected followed similar protocols and both found exercise during pregnancy resulted in less prevalence of depressive symptoms in the postpartum period. Furthermore, both observational studies drew similar conclusions regarding the association between individuals reporting higher levels of activity in pregnancy and lower EPDS scores. No studies reviewed reported adverse effects from exercise during pregnancy on maternal mental health. Nonetheless, more research should be completed to validate the effect of prenatal exercise on the prevention of depression in the postpartum period.
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    The Use of Lidocaine Spray and Paracervical Nerve Block in Pain Management During Intrauterine Device Insertion: A Literature Review
    (2024-05-15) Plowman, Raelynn
    Introduction: An intrauterine device (IUD) is an extremely reliable form of contraception with one of the highest satisfaction rates among users. Yet, in Canada the use of IUDs as primary contraception remains low. Women report that pain during IUD insertion dissuades them from selecting this form of contraception. Despite evidence that women experience discomfort during IUD insertions, standard pain control options remain unavailable. Objective: This literature review aims to evaluate the evidence for lidocaine spray and lidocaine paracervical nerve block in the management of pain during IUD insertion. A second objective is to assess if these techniques are suitable for outpatient visits. Methods: A search on PubMed was performed with key words and inclusion criteria to obtain articles pertaining to the use of both topical and injected lidocaine as pain management techniques during IUD insertion. Results: Three studies explored the benefits of lidocaine spray during IUD insertion and two studies assessed the effects of a lidocaine paracervical nerve block. Not only were both topical and injected forms of lidocaine effective in reducing pain during IUD insertion, these techniques were also effective in reducing pain during other procedural steps. Additionally, all participants in the studies tolerated the procedure well on an outpatient basis. Conclusion: Two effective pain management techniques have been identified in the literature. Lidocaine spray was found to be effective in reducing pain in parous women during multiple steps of IUD insertion. While a paracervical block was effective in reducing pain during IUD insertion in nulliparous women. Further, these interventions were tolerated well and suitable for outpatient clinics.
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    Physician Assistants in Rural Emergency Medicine: A Literature Review
    (2024-05-15) Gessner, Olivia
    Introduction: Physician assistants (PAs) work as extensions of the supervising physician(s) to make decisions regarding the designation of tasks and encounters. They commonly see the same patient acuity mixture as the physician and work across different medical disciplines, notably the emergency department. No current review explores the collection of research on PAs working in rural emergency departments (EDs) within North America. Objective: This review will examine the role of PAs in rural EDs within North America. With this, decisions surrounding the expansion of the PA profession can be evidence-based and consistent with best practices. This paper will determine the areas of research surrounding the role of PAs in rural EDs that have been concentrated on and identify gaps in the research, as well as identify outcomes resulting from PA practice in this setting. Methods: A literature search using Embase and Ovid-MEDLINE databases was performed using key terms pertaining to physician assistants working in rural emergency departments. Nine articles were found to meet the inclusion criteria and were analyzed for this review. Results: Nine studies explored different aspects of PA roles and practice in rural EDs across North America. Three themes around PA roles, level of autonomy and outcomes are used to describe the nature of PA practice in rural EDs. The findings suggest that rural ED PAs provide care to a wide variety of patient presentations with varying levels of autonomy. Although the PA role appears to largely be accepted and commonly has positive effects on the ED, more research needs to be done in this area. Conclusions: These findings suggest key factors that require future research in both Canada and the United States. For this relatively novel profession in Canada to grow into a staple in the current health system, primary research on PAs working in settings such as rural emergency departments should be prioritized.