My long term care rotation at Gouverneur exceeded my expectations. Before the rotation, I didn’t have a great understanding of the daily operations of the clinical team in the long term setting. I was surprised to find the case variety that I saw and the clinical correlations that I made to be very educational and rewarding. As a result of this rotation, I feel much more comfortable detecting abnormal findings on physical exam and developing plans for large and complex problem lists. My preceptor allowed me a lot of independence to evaluate patients and develop plans on my own. She would then double check my findings and offer validation and/or constructive criticism of my plan. I initially found this to be challenging, but looking back now, I realize how important it was to my growth and confidence as a future PA.

My two site visits helped me to practice my ability to concisely present patients to clinicians who are otherwise unfamiliar with my patients’ cases, a skill that I know I will continue to develop and execute throughout the course of my career as a PA student and PA. I enjoyed getting to hear my classmates do the same, as listening to patient presentations and extracting the pertinent information is another skill that is of utmost importance. I appreciated how collaborative the dynamic of these site visits were, I engaged in many insightful and constructive conversations about assessments, differential diagnoses, and plans, which are areas where I specifically am looking to strengthen because sometimes I struggle to articulate my thought processes. I learn best when I am able to work with my peers instead of as an individual, so overall, I really enjoyed how my site evaluator facilitated our visits as they were particularly valuable learning experiences to me.

“Oral Simnotrelvir for Adult Patients with Mild-to-Moderate Covid-19“

Cao B, Wang Y, Lu H, et al. Oral Simnotrelvir for Adult Patients with Mild-to-Moderate Covid-19. N Engl J Med. 2024;390(3):230-241. doi:10.1056/NEJMoa2301425

Summary:

Nirmatrelvir-ritonavir, also known as Paxlovid, shows efficacy in reducing hospitalization and death from COVID-19 and is approved for such use in the United States. However, its numerous drug interactions pose challenges in certain patients, such as my geriatric patient recently diagnosed with COVID-19. This very recent double-blind, randomized, placebo-controlled trial sought to investigate the efficacy of Simnotrelvir-ritonavir, a protease inhibitor combination similar to Paxlovid with fewer drug interactions.

This study assigned patients who had mild-to-moderate COVID-19 with onset of symptoms within the past 3 days to receive 750 mg of simnotrelvir plus 100 mg of ritonavir or placebo twice daily for 5 days. The results indicate that a 5-day course of simnotrelvir-ritonavir led to a 1.5-day reduction in the time to symptom resolution, and none of the participants progressed to severe disease or died by day 29. This drug has received emergency approval in China and it will be interesting to see if it is approved in the U.S. given its apparent efficacy and preferred drug interaction profile.