A Review of Procedural Skills Performed by Advanced Practice Providers in Emergency Department and Critical Care Settings

Advanced practice providers (physician assistants and nurse practitioners) are part of the interdisciplinary teams integral to successful care and improved outcomes for acutely ill patients in intensive care units and emergency departments. Between physician shortage and increased complexity of patients with often rapidly deteriorating conditions, the addition of advanced practice providers and expansion of acute care provider roles result in positive outcomes including decreased hospital length of stay, improved continuity of care, decreased hospital costs and increase inpatient, physician and staff nurses job satisfaction. This article attempts to examine the role that advanced practice providers (APPs) play in performing diagnostic and therapeutic procedures in acute care settings, education provided in physician assistant (PA) and nurse practitioner (NP) programs, and post-graduate training required to achieve competency and comfort in performing procedures. PA and NP training and credentialing often vary at the state level and by practice site. This article aims to collect information on how these roles compare as well as which procedures are actually being performed by advanced practice providers in the emergency department and critical care settings. Considering the healthcare system move towards team-based care, procedures performed by APPs align with the needs of the patient population served and correspond to the procedures done within the teams by physician providers. Independently billing under national provider identifier is cost effective but can be influenced by the current physician reimbursement system or lack of understanding of APP billing process by health care systems. Though there is limited research in this area, this article serves as a starting point to examining the current utilization and utility of APPs performing procedures in the emergency department and critical care settings.     

G protein-coupled receptors: Key molecules in metabolic associated fatty liver disease development

Metabolic associated fatty liver disease (MAFLD) is a range of hepatic disorders with progression to steatohepatitis with risk of development of fibrosis, cirrhosis, and hepatocellular carcinoma. MAFLD is strongly related to metabolic disorders of active fatty acids, which seem to be selective according to their specific ligand of G protein-coupled receptors (GPRs) located in immune response cells. An approach to study the pathophysiological mechanisms of MAFLD could be through the expression of active fatty acids ligands. The expression of GPRs is associated with obesity, microbiota environment, and dietary characteristics in patients with MAFLD. More specifically, GPR41, GPR43, GPR20, and GPR120 have been associated with alteration of lipid metabolism in hepatic and intestinal cells, and consequently they have a key role in metabolic diseases. We observed that GPR120 is not expressed in nonoverweight/obese patients, regardless of the presence of MAFLD; meanwhile the expression of GPR41 is increased in patients with lean MAFLD. GPRs role in liver disease is intriguing and a field of research opportunity. More studies are necessary to define the role of active fatty acids in the development of metabolic diseases.     

Social support is linked to mental health,quality of life,and motor function in multiple sclerosis

Journal of Neurology - To investigate associations of social support to psychological well-being, cognition, and motor functioning in patients with multiple sclerosis (MS). Secondarily, we were...     

Esophageal Surveillance Practices in Esophageal Atresia Patients: A Survey by the Eastern Pediatric Surgery Network

IntroductionEndoscopic surveillance guidelines for patients with repaired esophageal atresia (EA) rely primarily on expert opinion. Prior to embarking on a prospective EA surveillance registry, we sought to understand EA surveillance practices within the Eastern Pediatric Surgery Network (EPSN).MethodsAn anonymous, 23-question Qualtrics survey was emailed to 181 physicians (surgeons and gastroenterologists) at 19 member institutions. Likert scale questions gauged agreement with international EA surveillance guideline-derived statements. Multiple-choice questions assessed individual and institutional practices.ResultsThe response rate was 77%. Most respondents (80%) strongly agree or agree that EA surveillance endoscopy should follow a set schedule, while only 36% claimed to perform routine upper GI endoscopy regardless of symptoms. Many institutions (77%) have an aerodigestive clinic, even if some lack a multi-disciplinary EA team. Most physicians (72%) expressed strong interest in helping develop evidence-based guidelines.ConclusionsOur survey reveals physician agreement with current guidelines but weak adherence. Surveillance methods vary greatly, underscoring the lack of evidence-based data to guide EA care. Aerodigestive clinics may help implement surveillance schedules. Respondents support evidence-based protocols, which bodes well for care standardization. Results will inform the first multi-institutional EA databases in the United States (US), which will be essential for evidence-based care.Level of EvidenceThis is a prognosis study with level 4 evidence.     

Infusion-related side-effects during convection enhanced delivery for brainstem-diffuse midline glioma/diffuse intrinsic pontine glioma

Journal of Neuro-Oncology - Side-effects during convection enhanced delivery (CED) are poorly understood. We intended to determine the frequency of side-effects during brain stem infusion and...