Determining volume status at the bedside is an essential skill clinicians must possess. Unfortunately, traditional bedside assessments, including measuring vital signs, obtaining a history, and performing a physical exam...Determining volume status at the bedside is an essential skill clinicians must possess. Unfortunately, traditional bedside assessments, including measuring vital signs, obtaining a history, and performing a physical examination, are often unreliable and limited by patient body habitus. Point-of-care ultrasound (POCUS) is a valuable and accurate adjunct to aid in determination of a patient's volume status. POCUS of the lungs, heart, inferior vena cava, and internal jugular vein can add valuable data for clinicians when determining volume status. Specifically, lung ultrasound is more accurate than physical examination and chest radiography in detecting pulmonary edema and pleural effusions; cardiac POCUS allows for qualitative estimations of left ventricle and right ventricle function and can confirm the presence or absence of clinically significant pericardial effusions; and POCUS of the inferior vena cava and internal jugular vein can estimate right atrial pressure, and in the appropriate clinical context, help to determine intravascular volume status.
Cytomegalovirus (CMV) is the most common congenital infection in the United States and a leading cause of nongenetic sensorineural hearing loss (SNHL). This article reviews the epidemiology and diagnosis of CMV infection...Cytomegalovirus (CMV) is the most common congenital infection in the United States and a leading cause of nongenetic sensorineural hearing loss (SNHL). This article reviews the epidemiology and diagnosis of CMV infection, with an emphasis on the effects of congenital infection on fetal and neonatal health. Recognition of early signs of infection and prompt testing in the neonate are imperative to prevent or decrease the severity of long-term sequelae, including SNHL. This article also highlights the importance of congenital CMV screening and audiology follow-up in infants, and it provides an overview of specialty interventions, possible treatment, related education, and prevention in women of reproductive age.
Fifth metatarsal base (FMB) fractures are among the most common fractures of the foot. Time to healing and time to return to activity depend on the location of the fracture, the presence of certain features or complicati...Fifth metatarsal base (FMB) fractures are among the most common fractures of the foot. Time to healing and time to return to activity depend on the location of the fracture, the presence of certain features or complications, and use of conservative or surgical management. This article provides a comprehensive overview of FMB fractures, including their classification by location or zone, diagnosis, and management based on fracture characteristics and complications. It emphasizes the role of advanced practice providers in recognizing cases requiring surgical intervention, and it provides management recommendations based on the current evidence base and the authors' practice experience to ensure optimal patient healing.
Syncope is a common clinical syndrome that is typified by loss of consciousness and has several etiologies ranging from benign to potentially life-threatening. To differentiate syncope from other conditions, a detailed h...Syncope is a common clinical syndrome that is typified by loss of consciousness and has several etiologies ranging from benign to potentially life-threatening. To differentiate syncope from other conditions, a detailed history is crucial. Several key historical components that aid in establishing the etiology of syncope include frequency, identifiable triggers, and prodromal symptoms. The differential diagnosis of syncope includes mechanical fall, seizure, narcolepsy, intoxication, and psychiatric conditions. Meticulous review of a patient's past medical conditions and medication list must be completed when evaluating syncope etiologies, as this information may aid in the elucidation of a cause or contributing factor. This case report illustrates the importance of history collection, as the underlying cause of syncope is not always easily identified.
Rotator cuff impingement was suspected when a 23-year-old male police officer presented to the orthopedic clinic with gradual-onset left shoulder pain and weakness; however, conservative management did not improve the pa...Rotator cuff impingement was suspected when a 23-year-old male police officer presented to the orthopedic clinic with gradual-onset left shoulder pain and weakness; however, conservative management did not improve the patient's symptoms. Subsequent imaging revealed a lytic lesion in the left humeral head, with CT-guided biopsy findings consistent with Rosai-Dorfman disease, an extremely rare histiocytic disorder. Typically self-limiting and benign, Rosai-Dorfman disease is characterized by overproduction and accumulation of rare non-Langerhans cell histiocytes, a type of immune cell, in various tissues. These histiocytes most commonly proliferate in the lymph nodes, causing hallmark lymph node enlargement. In cases that do not spontaneously resolve, individualized treatment may be required. The patient in this case report returned to normal activity following improvement without intervention.
Emerging evidence confirms that menopausal hormone therapy (MHT) remains the most effective treatment for managing vasomotor and genitourinary symptoms of menopause, with a favorable risk-benefit profile in specific pati...Emerging evidence confirms that menopausal hormone therapy (MHT) remains the most effective treatment for managing vasomotor and genitourinary symptoms of menopause, with a favorable risk-benefit profile in specific patient populations. Recent studies also indicate that initiating MHT in appropriate candidates is associated with reduced cardiovascular disease risk and lower all-cause mortality. This article provides a comprehensive overview of current guidelines for primary care providers, advocating for an evidence-based, patient-centered approach to enhancing menopausal care across diverse patient populations.
OBJECTIVE: The purpose of this study was to explore the association between physician associates' (PAs') personal characteristics and the likelihood of their experiencing violence and bias from patients in the clinical s...OBJECTIVE: The purpose of this study was to explore the association between physician associates' (PAs') personal characteristics and the likelihood of their experiencing violence and bias from patients in the clinical setting. METHODS: As part of a national survey conducted in 2022, 2,246 PAs agreed to participate in an optional module on their experiences with biased patient behavior and workplace violence. RESULTS: The results of this study illustrate the significance of certain demographic characteristics as predictors of the likelihood a PA will experience biased patient behaviors. Overall, 89.8% of PAs experienced some form of bias from patients, with female PAs reporting having experienced bias across all but one assessed area. Nearly one-third (31.9%) of PAs had been threatened with physical harm by patients, and 6.1% had been physically harmed by patients. CONCLUSIONS: Although this work demonstrates an interaction between a PA's social identity and their experiences of bias in patient encounters, purposeful samples may be needed to better understand the correlation of a PA's personal characteristics with rates of patient violence.
Worldwide, gastric cancer is the fifth most diagnosed malignancy, with more than 1 million diagnoses annually, and it also represents the fourth leading cause of cancer death, with approximately 770,000 deaths each year....Worldwide, gastric cancer is the fifth most diagnosed malignancy, with more than 1 million diagnoses annually, and it also represents the fourth leading cause of cancer death, with approximately 770,000 deaths each year. Relative 5-year survival rates are as high as 95% to 99% when the disease is diagnosed early in its course, but that rate drops to less than 30% when diagnosed in advanced stages. South Korea and Japan, two countries where gastric cancer is endemic, have implemented screening programs that successfully support earlier detection. No routine gastric cancer screening guidelines exist for practice in the United States. This article examines current evidence in support of gastric cancer prevention and screening measures. Two measures are buoyed by the literature: first, prevention of the disease by targeting modifiable risk factors, namely the eradication of Helicobacter pylori , and second, early detection among high-risk groups through endoscopic screening.
Alcohol use disorder (AUD) has devastating effects, and its prevalence in the US is growing. It is therefore important to examine multiple avenues for successful cessation and continued abstinence. Disulfiram, oral naltr...Alcohol use disorder (AUD) has devastating effects, and its prevalence in the US is growing. It is therefore important to examine multiple avenues for successful cessation and continued abstinence. Disulfiram, oral naltrexone, naltrexone IM, and acamprosate are currently the only four medications approved for the treatment of AUD by the FDA. This review aims to examine the efficacy of the approved medications as well as explore the use of off-label pharmacologic treatments used for AUD treatment (including gabapentin, baclofen, oxytocin, N-acetylcysteine, calcium carbonate, and psilocybin). Through this exploration, the most effective treatment for individuals with AUD can be determined to enable providers in ameliorating the prevalence of this disease.
Granting medical staff membership to advanced practice registered nurses (APRNs) and physician associates (PAs) is a national trend endorsed by The Joint Commission in 1983 and by the Centers for Medicare & Medicaid Serv...Granting medical staff membership to advanced practice registered nurses (APRNs) and physician associates (PAs) is a national trend endorsed by The Joint Commission in 1983 and by the Centers for Medicare & Medicaid Services in 2012. APRNs and PAs must participate in the system in which medical care policies are made and communicated. Medical staff privileges enable these clinicians to help develop and implement hospital and medical staff policies that improve the quality and appropriateness of patient care. Medical staff membership also encourages a culture that promotes interprofessional and collaborative practice, enhancing and strengthening clinician relationships. Through education and by updating bylaws, rules, and regulations, APRNs and PAs at our facility can now admit patients, and they have a voice and vote in medical staff governance committees that affect their practice.