OBJECTIVE: This study aimed to measure the impact of adverse events (AEs) on advanced practice provider (APP) well-being and to describe symptoms of second victim syndrome (SVS) among this group of healthcare professiona...OBJECTIVE: This study aimed to measure the impact of adverse events (AEs) on advanced practice provider (APP) well-being and to describe symptoms of second victim syndrome (SVS) among this group of healthcare professionals. METHODS: A survey was designed to measure the incidence of AEs among APPs employed at a large healthcare system and AE impact on emotional, physical, and professional well-being. It also measured burnout, callousness, and the desire for peer support among APPs who had experienced AEs and those who had not. RESULTS: Of the 350 APPs who completed the survey, 55.4% had experienced an AE. APPs exposed to an AE had a higher rate of burnout ( p = .027) than those who had not. Following an AE, 97% of APPs experienced one or more symptoms of SVS; additionally, 87% sought peer support after an AE, with 96% finding it helpful. CONCLUSION: Findings demonstrate that AEs have a negative emotional impact on APP well-being and are associated with burnout and callousness. Peer support is desired by APPs after AEs and may enhance recovery.
Malaysia's healthcare system features a dual-tier structure with government and private sectors rooted in its colonial history. Assistant medical officers (AMOs) play a crucial role within this system, constituting the t...Malaysia's healthcare system features a dual-tier structure with government and private sectors rooted in its colonial history. Assistant medical officers (AMOs) play a crucial role within this system, constituting the third largest group of healthcare professionals. The profession has evolved over 230 years, originating with the introduction of medical assistants to Malaysia by the British East India Company in 1786. Initially known as apothecaries or dressers, the role's responsibilities have transformed over the years in response to the nation's healthcare demands, as have its associated titles, with professionals becoming known as hospital assistants, medical assistants, and, finally, AMOs. Engaged in clinical duties in emergency and prehospital care, primary healthcare, medical and surgical care, management, and administrative functions, AMOs are linchpins in ensuring comprehensive healthcare services. Their training has progressed from apprenticeships to certificate, diploma, and bachelor's degree programs, ensuring they are well-equipped for diverse healthcare challenges. The profession will continue to evolve through further educational development, strengthening organizational structures, AMO role reinforcement, career advancement, human resource development, and international collaboration. AMOs have emerged as indispensable contributors to Malaysia's healthcare landscape, embodying adaptability and dedication in the pursuit of enhanced health outcomes.
Global health emergencies such as the COVID-19 pandemic have revealed the fragility of medical infrastructure in the US and elsewhere. Specifically, the pandemic insidiously targeted the relationship between public healt...Global health emergencies such as the COVID-19 pandemic have revealed the fragility of medical infrastructure in the US and elsewhere. Specifically, the pandemic insidiously targeted the relationship between public health and medicine by affecting the screening for and prevention of communicable diseases, such as HIV. This case report focuses on a patient with a problematic and late HIV diagnosis amid the pandemic and discusses HIV history, pathogenesis, epidemiology, and current screening guidelines. Although the negative implications of the pandemic are yet to be fully unraveled, health professionals can combat its ill effects on disease screening and prevention by proactively educating their patients on best health practices, including safe sex and sexually transmitted infection (STI) screening, as well as on when to seek care.
Popliteal artery entrapment syndrome (PAES) is a form of vascular compromise that is characterized by compression of the popliteal artery by the muscular structures of the popliteal fossa. The underlying etiology of this...Popliteal artery entrapment syndrome (PAES) is a form of vascular compromise that is characterized by compression of the popliteal artery by the muscular structures of the popliteal fossa. The underlying etiology of this condition stems from both congenital and functional mechanisms. This case report describes a patient with an insidious onset of bilateral leg pain, who was initially diagnosed with chronic exertional compartment syndrome and later found to have PAES.
Hospital-acquired pressure injuries (HAPIs) constitute a major concern for acute care facilities. These injuries can negatively impact a patient's health and create significant financial burdens for hospitals. Early dete...Hospital-acquired pressure injuries (HAPIs) constitute a major concern for acute care facilities. These injuries can negatively impact a patient's health and create significant financial burdens for hospitals. Early detection of pressure injuries and implementation of prevention strategies are crucial to avoiding complications, extended hospital stays, and poor outcomes for the patient as well as added costs for the facility. This article explores the pathophysiology, risk factors, staging guidelines, prevention methods, financial implications, and impact of HAPIs in patients who are hospitalized, emphasizing the importance of early detection and preventive strategies.
OBJECTIVE: This project aimed to establish the Advanced Practice Provider Fellowship Program in Gastroenterology at the University of Colorado in order to enhance participating fellows' clinical skills and specialty trai...OBJECTIVE: This project aimed to establish the Advanced Practice Provider Fellowship Program in Gastroenterology at the University of Colorado in order to enhance participating fellows' clinical skills and specialty training while also increasing return on investment (ROI), advanced practice provider (APP) retention, and long-term profitability. METHODS: A structured fellowship program curriculum was developed with input from faculty leaders and financial advisors. The program's financial feasibility supported potential profitability by year 2. Recruitment strategies targeted new graduates and midcareer APPs. Program evaluation criteria included knowledge assessments, preceptor feedback, and self-evaluations. RESULTS: Thirteen candidates were interviewed, demonstrating the program's ability to attract external applicants. The curriculum utilized diverse didactic resources and assessment tools. Faculty buy-in and support were secured, facilitating program implementation. CONCLUSIONS: The Advanced Practice Provider Fellowship Program in Gastroenterology at the University of Colorado offers a promising approach to enhancing provider proficiency and achieving financial profitability. The curriculum includes focused learning objectives, current guidelines, didactic modules, knowledge assessment examinations, and evaluations.
The increasing use of antidepressants, escalating rates of unintended pregnancy, and disproportionately high rate of maternal suicide in the United States, as compared with other high-income countries, all highlight the...The increasing use of antidepressants, escalating rates of unintended pregnancy, and disproportionately high rate of maternal suicide in the United States, as compared with other high-income countries, all highlight the urgent need for more clarity on available treatment options for perinatal depression. Misrepresentative data obtained from animal experiments and observational human studies, many of which do not account for underlying mental illness as a confounder, largely overestimate the teratogenicity of antidepressants. These outdated data-coupled with a lack of clear guidance from leading agencies-have created a healthcare scenario rife with decisional conflict. As general practitioners frequently serve as patients' first point of contact within the US healthcare system, primary care is central to preconception and mental health management. This article educates primary care providers on the risks of untreated perinatal depression and the realities of antidepressant teratogenicity. Doubling as a narrative review, the article also synthesizes available evidence to provide a risk-based guide for treatment with antidepressants that emphasizes a shared decision-making approach.
Dental pain, infections, and abscesses are common concerns in primary care settings. Prompt diagnosis and targeted management are essential to prevent severe complications such as sepsis, bone or soft tissue loss, and ai...Dental pain, infections, and abscesses are common concerns in primary care settings. Prompt diagnosis and targeted management are essential to prevent severe complications such as sepsis, bone or soft tissue loss, and airway compromise. This article provides physician associates and other clinicians with practical, evidence-based strategies to identify and manage odontogenic infections, distinguish between infectious and noninfectious dental pain, and select appropriate antibiotic regimens, with special attention to antibiotic resistance trends. It also highlights circumstances under which collaboration with dental specialists becomes necessary and emphasizes patient education to prevent recurrence. By bridging knowledge gaps in dental health management, this article empowers clinicians to address these conditions confidently in outpatient settings, improving patient outcomes, reducing unnecessary ED visits, and lowering healthcare costs.
The healthcare industry is in the midst of unprecedented change as hospitals and health systems nationwide balance the need to increase patient access to services with managing costs. Nurse practitioners and physician as...The healthcare industry is in the midst of unprecedented change as hospitals and health systems nationwide balance the need to increase patient access to services with managing costs. Nurse practitioners and physician associates are well-positioned, and often overlooked, members of the healthcare team who can serve as resources for organizations to improve care access. Using an intentional and data-driven process, one academic medical center both improved patient access and increased revenue through a holistic care model redesign in three specialty areas, as described in this organizational case report.
In the US, approximately 40 million people, or 12% of the nation's population overall, suffer from migraine. Globally, the prevalence of migraine is estimated at 1.1 billion cases; the condition ranks as the second leadi...In the US, approximately 40 million people, or 12% of the nation's population overall, suffer from migraine. Globally, the prevalence of migraine is estimated at 1.1 billion cases; the condition ranks as the second leading cause of disability-adjusted life years behind chronic lower back pain and is the top cause of years lived with disability among women ages 15 to 49 years worldwide. Studies have shown that people with migraine lose an average of 3.51 ± 0.1 hours of productive time per week, thereby impacting their ability to work and achieve financial stability or success. The burden of disease extends to other key aspects of life, including personal relationships and overall well-being. Given migraine's prevalence and burden, it is prudent for clinicians to be aware of the variety of potentially effective strategies to relieve the condition. This article provides an update on clinical evidence for the use of cannabidiol in the prevention and treatment of migraine headaches as an adjunct or alternative to primary treatment modalities.
Hypothermia is characterized by an abnormally low body temperature, typically resulting from prolonged cold exposure. However, hypothermia has a broad differential diagnosis that may require thorough evaluation for vario...Hypothermia is characterized by an abnormally low body temperature, typically resulting from prolonged cold exposure. However, hypothermia has a broad differential diagnosis that may require thorough evaluation for various etiologies beyond cold exposure. This case report describes a 34-year-old man who presented to the ED with confusion and weakness, ultimately found to be due to hypothermia and hypoglycemia following an episode of binge drinking alcohol and dietary fasting. The pathophysiology and interplay among alcohol use, nutrition, hypoglycemia, and hypothermia is explored, emphasizing the importance of appropriate history collection in cases of hypothermia as well as consideration of conditions within the differential diagnosis beyond environmental exposure.
A 32-year-old man diagnosed with type 1 diabetes mellitus presented to the ED following loss of consciousness and was ultimately diagnosed with acute invasive fungal sinusitis (AIFS). AIFS is a disease that most commonly...A 32-year-old man diagnosed with type 1 diabetes mellitus presented to the ED following loss of consciousness and was ultimately diagnosed with acute invasive fungal sinusitis (AIFS). AIFS is a disease that most commonly affects people with immunocompromise such as those with a hematologic malignancy, diabetes, or HIV; those on immunosuppressant drugs posttransplant; and those on chemotherapy or long-term corticosteroids. In this case, the patient's diabetic ketoacidosis put him in a high-risk physiologic state. Following presentation, the patient was managed in the ICU to reverse his immunocompromise. He underwent six surgical debridements and received systemic broad-spectrum antifungal and antibacterial therapies. Ultimately, the patient developed intracranial arteritis, thromboses, and subsequent infarction, which were incompatible with meaningful life. This case highlights the variable presentation and mortality of AIFS, showing that an absence of sinonasal symptoms does not rule out the condition and that, though outcomes are generally thought to be more favorable in diabetes mellitus than other immunocompromised states, AIFS is a serious diagnosis for any individual with immunosuppression. The patient's clinical picture correlated well with radiologic progression of the disease; however, this is not always the case.