What Is New in Diabetes Technology?

The purpose of this article is to provide nurse practitioners with an update on the current state of diabetes technology. The update includes information about insulin pumps, also known as continuous subcutaneous insulin infusion and continuous glucose monitoring. In addition, emerging technologies such as mobile diabetes apps and telemedicine will be reviewed. Finally, a brief review of the current state of research and type 1 diabetes will be presented.     

What Next? The Next Transit from Biology to Diagnostics: Next Generation Sequencing for Immunogenetics

The human genome project triggered the introduction of next generation sequencing (NGS) systems. Although originally developed for total genome sequencing, metagenomics and plant genetics, the ultra-deep sequencing feature of NGS was utilized for diagnostic purposes in HIV resistance and tropism as well in detecting new mutations and tumor clones in oncology. Recent publications exploited the feature of clonal sequencing for immunogenetics to dissolve the growing number of ambiguities. This concept is quite reliable if all exons of interest are tested and the amplification region includes flanking introns. Challenging questions on quality control, cost effectiveness, workflow, and management of enormous loads of data remain if NGS is considered as routine method in the immunogenetics laboratory. If solved, NGS has big potential to have a major impact on immunogenetics by way of providing ambiguity-free HLA-typing results faster, but will also have a great influence on how immunogenetics testing and workflows are organized.     

Hypertension Clinical Practice Guidelines (ISH, 2020): What Is New?

ObjectiveIn May 2020, the International Society of Hypertension (ISH) published “Practice Guidelines for the Management of Hypertension.” The ISH 2020 guidelines were developed based on evidence criteria (i) to be used globally, (ii) to be fit for application in low-middle-income and high-income settings, and (iii) to be concise, simple, and easy to use by clinicians, nurses, and community health workers, as appropriate. The defined purpose was to adhere to the current evidence and develop a balanced proposal for global use in line with the ISH mission.MethodologyMultiple novel approaches have been included keeping in mind about lifestyle modification and flexibility in treatment options.Results and ConclusionsThe ISH 2020 guidelines are practical and physician friendly. It also proves immensely helpful for low-resource countries without national guidelines on the management of hypertension.     

Focused Cardiac Ultrasound Training: How Much Is Enough?

Background

Focused transthoracic echocardiography (F-TTE) is an important tool to assess hemodynamically unstable patients in the Emergency Department. Although its scope has been defined by the American College of Emergency Physicians, more research is needed to define an optimal F-TTE training program, including assessment of proficiency.

Objective

The goal of this study was to determine the effectiveness of current standards in post-residency training to reach proficiency in F-TTE.

Methods

Fourteen staff Emergency Physicians were enrolled in a standardized teaching curriculum specifically designed to meet the 2008 American College of Emergency Physicians’ guidelines for general ultrasound training applied to echocardiography. This training program consisted of 6 h of didactics and 6 h of scanning training, followed by independent scanning over a 5-month period. Acquisition of echocardiographic knowledge was assessed by an online pre- and post-test. At the conclusion of the study, a hands-on skills test assessed the trainees’ ability to perform and interpret F-TTE.

Results

Ninety percent of trainees passed the written post-test. Two views, the parasternal long and short axis, were easily obtainable, regardless of the level of training or the number of ultrasounds completed. Other views were more difficult to master, but strong trends toward increased competency were evident after 10 h of mixed didactic and scanning training and > 45 ultrasounds.

Conclusions

A short, 12-h didactic training in F-TTE provided proficiency in image interpretation and in obtaining adequate images from the parasternal window. More extensive training is needed to master the apical and subcostal windows in a timely manner.