The Exchange

Commentary and Observations from
the Medical Frontlines

 
<a href='/the-exchange/lyme-arthritis-from-high-index-of-suspicion-to-diagnosis-and-treatment'>Lyme Arthritis—From High Index of Suspicion to Diagnosis and Treatment</a>

Lyme Arthritis—From High Index of Suspicion to Diagnosis and Treatment

An effusion of the knee(s) is the most common manifestation of Lyme arthritis, a late stage of infection with Borrelia burgdorferi, the tick involved in transmission. Geographically found in the East, Midwest, and now spreading into new areas, Lyme arthritis is often misdiagnosed as a nonspecific inflammatory arthritis of unknown cause. more >

Found in: Infectious Diseases, Rheumatology

<a href='/the-exchange/telehealth-policy-update-a-national-resource-for-advanced-practice-providers'>Telehealth Policy Update—A National Resource for Advanced Practice Providers</a>

Telehealth Policy Update—A National Resource for Advanced Practice Providers

Telehealth is a method of enhancing delivery of health services, including diagnosis and monitoring of acute and chronic conditions, counseling, therapy, and more >

<a href='/the-exchange/nutrition-recommendations-for-prevention-or-delaying-onset-of-dementia-and-cognitive-decline'>Nutrition Recommendations for Prevention or Delaying Onset of Dementia and Cognitive Decline</a>

Nutrition Recommendations for Prevention or Delaying Onset of Dementia and Cognitive Decline

In 2015, researchers at Rush University Medical Center in Chicago and Harvard School of Public Health in Boston published results of their prospective study of more >

<a href='/the-exchange/do-meal-times-affect-weight-control-'>Do Meal Times Affect Weight Control?</a>

Do Meal Times Affect Weight Control?

In 2009, researchers at Northwestern University conducted a study on mice and timed feeding, later publishing their research in Obesity. For 6 weeks more >

<a href='/the-exchange/are-chemicals-making-us-fat-'>Are Chemicals Making Us Fat?</a>

Are Chemicals Making Us Fat?

Holistic health proponents are advocating to get rid of our so-common use of plastics for environmental as well as health reasons. For example, did you ever more >

<a href='/the-exchange/an-interesting-wrinkle-in-the-hahnemann-university-hospital-bankruptcy'>An Interesting Wrinkle in the Hahnemann University Hospital Bankruptcy</a>

An Interesting Wrinkle in the Hahnemann University Hospital Bankruptcy

Hahnemann University Hospital has been an institution in downtown Philadelphia, seemingly forever. The level I trauma center, medical training facility, and more >

<a href='/the-exchange/a-glimpse-of-what-artificial-intelligence-may-bring-to-medicine'>A Glimpse of What Artificial Intelligence May Bring to Medicine</a>

A Glimpse of What Artificial Intelligence May Bring to Medicine

I’ve always been fascinated by what the intersection of big data, technology, and medicine will bring. While I am a firm believer that IBM’s Watson will more >

<a href='/the-exchange/energy-drinks-tied-to-qtc-prolongation'>Energy Drinks Tied to QTc Prolongation</a>

Energy Drinks Tied to QTc Prolongation

Consuming caffeinated energy drinks is associated with QTc interval prolongation, which is a risk factor for torsades de pointes, according to a small study in more >

<a href='/the-exchange/updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults'>Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults</a>

Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

The American Geriatrics Society 2019 Updated Beers Criteria—updated from 2015—are designed to reduce older adults' drug-related problems including, but not more >

<a href='/the-exchange/palliative-care-for-heart-failure-an-early-discussion-would-benefit-patients'>Palliative Care for Heart Failure: An Early Discussion Would Benefit Patients</a>

Palliative Care for Heart Failure: An Early Discussion Would Benefit Patients

As clinicians, we care for patients over the course of a lifetime and often face the reality of patients who are challenged with end-of-life (EOL) decision more >

<a href='/the-exchange/no-difference-in-outcomes-and-treatment-no-matter-the-etiology-analysis-from-paradigm-hf-trial'>No Difference in Outcomes and Treatment No Matter the Etiology—Analysis from PARADIGM-HF Trial</a>

No Difference in Outcomes and Treatment No Matter the Etiology—Analysis from PARADIGM-HF Trial

Heart failure (HF) is a complicated disease state with multiple, staged therapies. Over the last couple of years, addition of a sacubitril/valsartan more >

<a href='/the-exchange/team-based-care-latest-data-on-family-physician-pa-and-np-practices'>Team-Based Care: Latest Data on Family Physician, PA, and NP Practices</a>

Team-Based Care: Latest Data on Family Physician, PA, and NP Practices

A recent study published in Family Medicine demonstrates the positive impact on practice capacity and scope of practice of family physicians when more >

<a href='/the-exchange/preceptors-and-tax-credits-interprofessional-policy-change'>Preceptors and Tax Credits—Interprofessional Policy Change</a>

Preceptors and Tax Credits—Interprofessional Policy Change

This blog is information only and not to be construed for legal tax advice—you must consult your tax professional regarding personal tax advice. If more >

<a href='/the-exchange/beat-the-heat'>Beat the Heat</a>

Beat the Heat

Your body may be unable to cool itself in hot temperatures, which could lead to a heat stroke or heat exhaustion. This is very common in the summer months. more >

<a href='/the-exchange/firework-safety-tips'>Firework Safety Tips</a>

Firework Safety Tips

Happy Canada Day (July 1) and Happy 4th of July to all the NPs and PAs! According to the US Consumer Product Safety Commission, an estimated 12,900 more >

<a href='/the-exchange/metastatic-lung-cancer-immunotherapy-gives-hope'>Metastatic Lung Cancer: Immunotherapy Gives Hope</a>

Metastatic Lung Cancer: Immunotherapy Gives Hope

In 2005, the 5-year survival rate for patients with stage IV or metastatic non–small-cell lung cancer (NSCLC)—the most common type of lung cancer—was a more >

<a href='/the-exchange/breaking-down-racial-disparities-in-cancer-care-the-affordable-care-act'>Breaking Down Racial Disparities in Cancer Care: The Affordable Care Act</a>

Breaking Down Racial Disparities in Cancer Care: The Affordable Care Act

Racial disparities are well known to exist in cancer care and outcomes. Several barriers exist including access to care, cultural biases about healthcare and more >

<a href='/the-exchange/how-do-drug-pricing-systems-work-if-there-is-more-competition-shouldn-t-the-list-price-go-down-'>How Do Drug Pricing Systems Work? If There Is More Competition, Shouldn’t the List Price Go Down?</a>

How Do Drug Pricing Systems Work? If There Is More Competition, Shouldn’t the List Price Go Down?

Have you ever noticed how much more expensive drug prices become every year? I think we have all noticed this increase, so this week I decided to look in to more >

<a href='/the-exchange/t2dm-and-osteoporosis-where-do-we-stand-in-2019-'>T2DM and Osteoporosis: Where Do We Stand in 2019?</a>

T2DM and Osteoporosis: Where Do We Stand in 2019?

Bone mineral density (BMD) in type 2 diabetics is trending higher and higher, and BMI is associated with type 2 diabetes mellitus (T2DM). However, higher BMD more >

<a href='/the-exchange/champs-hf-we-all-can-do-better-'>CHAMPS HF - We All Can do Better!</a>

CHAMPS HF - We All Can do Better!

Many of us manage patients with heart failure with a reduced ejection fraction, or HFrEF. The management of this patient population is complex, and most more >

<a href='/the-exchange/acute-renal-failure-after-cancer-treatment'>Acute Renal Failure After Cancer Treatment</a>

Acute Renal Failure After Cancer Treatment

Acute renal failure (ARF) in cancer patients is a dreadful complication that causes substantial morbidity and mortality. ARF is defined as a sustained and more >

<a href='/the-exchange/what-price-to-save-your-child-'>What Price to Save Your Child?</a>

What Price to Save Your Child?

Let’s say you have your first child and are elated to bring him or her home from the hospital. A month later, you notice something isn’t right and soon more >

<a href='/the-exchange/choose-wisely-as-to-when-you-schedule-your-medical-care'>Choose Wisely As To When You Schedule Your Medical Care</a>

Choose Wisely As To When You Schedule Your Medical Care

Most of us tend to need a pick-me-up—perhaps a cup of coffee—around mid- to late-afternoon. But a new study published by JAMA on May 10, 2019 in more >

<a href='/the-exchange/consider-deprescribing-in-our-older-adults'>Consider Deprescribing in Our Older Adults</a>

Consider Deprescribing in Our Older Adults

We all have patients in our practices who are older and on numerous medications. They are stabilizing their problems but are faced with the reality of nearing more >

<a href='/the-exchange/the-mediterranean-diet-and-cardiovascular-disease'>The Mediterranean Diet and Cardiovascular Disease</a>

The Mediterranean Diet and Cardiovascular Disease

The Mediterranean diet represents the most notable overall dietary pattern in nutritional epidemiology that has been extensively studied over the last 2 more >

<a href='/the-exchange/advanced-practice-providers-and-liability-risk'>Advanced Practice Providers and Liability Risk</a>

Advanced Practice Providers and Liability Risk

It is a misconception that advanced practice providers can’t get sued because any errors are a physician’s responsibility. PAs and NPs can and do make more >

<a href='/the-exchange/national-stop-the-bleed-month'>National Stop the Bleed Month</a>

National Stop the Bleed Month

Did you know that May 2019 is the first ever National Stop the Bleed Month? Also, May 23 is the second annual Stop the Bleed® Day. So what is “stop the more >

<a href='/the-exchange/lower-cholesterol--the-natural-way'>Lower Cholesterol – The Natural Way </a>

Lower Cholesterol – The Natural Way

According to the Centers for Disease Control and Prevention, 95 million US adults aged 20 or older have total cholesterol levels higher than 200 mg/dL. Many more >

<a href='/the-exchange/procalcitonin-levels-in-the-management-of-copd-exacerbations'>Procalcitonin Levels in the Management of COPD Exacerbations</a>

Procalcitonin Levels in the Management of COPD Exacerbations

The use of procalcitonin-based protocols to guide the decision to administer antibiotics has been evaluated in infections of different origins and settings. A more >

<a href='/the-exchange/hypertension-in-the-pediatric-population'>Hypertension in the Pediatric Population</a>

Hypertension in the Pediatric Population

The prevalence of systemic hypertension (HTN) in the pediatric population is now commonly observed to be increasing, especially in view of the growing more >

<a href='/the-exchange/it-s-a-digital-world-screen-time-recommendations-for-children'>It’s a Digital World: Screen Time Recommendations for Children</a>

It’s a Digital World: Screen Time Recommendations for Children

We definitely live in a different day and age than when I was a child… As children, my siblings and I just opened the door and went outside to play all day more >

<a href='/the-exchange/using-policy-to-impact-hpv-vaccine-rates'>Using Policy to Impact HPV Vaccine Rates</a>

Using Policy to Impact HPV Vaccine Rates

For more than 10 years we have had a safe and effective vaccine that can prevent several types of cancer. I understand the reluctance to accept a vaccine when more >

<a href='/the-exchange/measles-outbreak--a-public-health-concern'>Measles Outbreak – A Public Health Concern</a>

Measles Outbreak – A Public Health Concern

The modern world was turned upside down in 1997 when researcher Andrew Wakefield suggested there was a direct correlation between the MMR more >

<a href='/the-exchange/cardiovascular-health-promotion-a-must-read-for-pas-and-nps'>Cardiovascular Health Promotion—A Must Read for PAs and NPs</a>

Cardiovascular Health Promotion—A Must Read for PAs and NPs

PAs and NPs are encouraged to read a recent issue of the Journal of the American College of Cardiology on cardiovascular health and promotion. This more >

<a href='/the-exchange/what-is-the-best-treatment-for-painful-osteoporotic-compression-fractures-of-the-spine-'>What is the Best Treatment for Painful Osteoporotic Compression Fractures of the Spine?</a>

What is the Best Treatment for Painful Osteoporotic Compression Fractures of the Spine?

Pop quiz: What is the best method of treatment for osteoporotic compression fractures of the spine? Nonsurgical treatment (NST) Balloon kyphoplasty more >

<a href='/the-exchange/a-view-of-rheumatology-from-31-years-and-30-000-feet'>A View of Rheumatology From 31 Years And 30,000 Feet</a>

A View of Rheumatology From 31 Years And 30,000 Feet

The last 31 years of my PA career has been in the subspecialty of rheumatology. As I reflect on the changes in the field, I have become aware of the incredible more >

<a href='/the-exchange/was-the-apple-heart-study-virtually-useless-'>Was the Apple Heart Study Virtually Useless?</a>

Was the Apple Heart Study Virtually Useless?

When Apple included in the Apple Watch the capability of providing public health apps in detecting things such as falls and irregular pulses, many began to more >

<a href='/the-exchange/universal-influenza-vaccine-begins-phase-i-clinical-trials'>Universal Influenza Vaccine Begins Phase I Clinical Trials </a>

Universal Influenza Vaccine Begins Phase I Clinical Trials

The National Institutes of Health have begun the first clinical trial of an innovative universal influenza vaccine candidate. A Phase I trial will examine the more >

<a href='/the-exchange/fluoroquinolone-use-and-the-potential-risk-for-aortic-aneurysm-or-dissection'>Fluoroquinolone Use and the Potential Risk for Aortic Aneurysm or Dissection</a>

Fluoroquinolone Use and the Potential Risk for Aortic Aneurysm or Dissection

Fluoroquinolones have long been a popular class of antibiotics for use in a myriad of infections. There are even newer fluoroquinolones that have been more >

<a href='/the-exchange/aspirin-use-for-ascvd-prevention'>Aspirin Use for ASCVD Prevention</a>

Aspirin Use for ASCVD Prevention

For decades aspirin has been a staple of primary prevention of atherosclerotic cardiovascular disease (ASCVD) in at-risk populations, based on recommendations more >

<a href='/the-exchange/use-of-simulation-in-np-and-pa-programs'>Use of Simulation in NP and PA Programs</a>

Use of Simulation in NP and PA Programs

In the last several years, both NPs and PAs have sent out surveys on the use of simulation in their programs, and articles have been published with the more >

<a href='/the-exchange/the-history-of-simulation'>The History of Simulation</a>

The History of Simulation

As director of a simulation center at an academic institution, it has been exciting to see the remarkable advances made in this field over more >

<a href='/the-exchange/expanding-jak-inhibitor-market-for-ra-on-the-horizon-in-2019--which-one-is-the-best-'>Expanding JAK Inhibitor Market for RA on the Horizon in 2019: “Which One Is the Best?”</a>

Expanding JAK Inhibitor Market for RA on the Horizon in 2019: “Which One Is the Best?”

Rheumatoid arthritis (RA) treatments continue to improve outcomes in the latest clinical trials. At the 2018 American College of Rheumatology (ACR) meeting more >

<a href='/the-exchange/cares-study-prompts-fda-boxed-warning-on-febuxostat'>CARES Study Prompts FDA Boxed Warning on Febuxostat</a>

CARES Study Prompts FDA Boxed Warning on Febuxostat

On February 21, 2019, the US Food and Drug Administration (FDA) issued a boxed warning on febuxostat. This was a result of the CARES study published in the more >

<a href='/the-exchange/caution-population-is-having-more-heart-attacks-at-a-younger-age'>Caution: Population Is Having More Heart Attacks at a Younger Age</a>

Caution: Population Is Having More Heart Attacks at a Younger Age

This March, the American College of Cardiology will meet in New Orleans for their annual scientific assembly, and one major discussion will be the growing more >

<a href='/the-exchange/patient-autonomy-keeping-our-patients-self-determination-preserved'>Patient Autonomy: Keeping Our Patients’ Self-Determination Preserved</a>

Patient Autonomy: Keeping Our Patients’ Self-Determination Preserved

If you’ve practiced in medicine for at least 20 years, you may remember the case of Terri Schiavo, a woman in her 20s who was in a coma for more than a more >

<a href='/the-exchange/who-should-be-responsible-social-media-and-accurate-vaccine-information'>Who Should Be Responsible? Social Media and Accurate Vaccine Information</a>

Who Should Be Responsible? Social Media and Accurate Vaccine Information

The World Health Organization recently listed what they call “vaccine hesitancy”—the reluctance or refusal to be vaccinated despite the availability of more >

<a href='/the-exchange/how-much-revenue-do-you-and-your-practice-generate-for-your-hospital-'>How Much Revenue Do You—and Your Practice—Generate for Your Hospital?</a>

How Much Revenue Do You—and Your Practice—Generate for Your Hospital?

Merritt Hawkins, a large search firm specializing in physicians and advanced practice providers (APPs), has published their periodic survey report detailing more >

<a href='/the-exchange/vaping-what-parents-need-to-know'>Vaping: What Parents Need to Know</a>

Vaping: What Parents Need to Know

So what is vaping? Vaping is the inhaling and exhaling of an aerosol produced by using a vaping device. Vaping is illegal for anyone under the age of 18, and more >

<a href='/the-exchange/substance-use-disorders-in-youth'>Substance Use Disorders in Youth</a>

Substance Use Disorders in Youth

In the United States, about 5% of youth aged 12 to 17 will develop a substance use disorder (SUD) each year, but fewer than 10% of the 1.3 million youth who more >

<a href='/the-exchange/how-do-you-make-a-diagnosis-of-gout-without-seeing-msu-crystals-under-a-microscope-'>How Do You Make a Diagnosis of Gout Without Seeing MSU Crystals Under a Microscope?</a>

How Do You Make a Diagnosis of Gout Without Seeing MSU Crystals Under a Microscope?

Primary care/urgent care/emergency rooms are all settings where acute monoarthritis is seen. The differential diagnosis includes acute crystal arthritis (gout, more >

<a href='/the-exchange/is-long-term-survival-associated-with-the-use-of-nitrogen-containing-bisphosphonates-'>Is Long-term Survival Associated With the Use of Nitrogen-containing Bisphosphonates?</a>

Is Long-term Survival Associated With the Use of Nitrogen-containing Bisphosphonates?

In the January issue of Osteoporosis International, there was an article entitled, “Mortality Risk Reduction Differs According to Bisphosphonate more >

<a href='/the-exchange/treating-the-hypertensive-patient-with-chronic-kidney-disease'>Treating the Hypertensive Patient With Chronic Kidney Disease</a>

Treating the Hypertensive Patient With Chronic Kidney Disease

Hypertension (HTN) is present in approximately 80% to 85% of patients with chronic kidney disease. Uncontrolled HTN is the second leading cause of kidney more >

<a href='/the-exchange/anticoagulants-and-recurrent-thrombosis'>Anticoagulants and Recurrent Thrombosis </a>

Anticoagulants and Recurrent Thrombosis

The other day a student asked me, “If a patient is taking a blood thinner for a previous venous thromboembolism (VTE), is it still possible for them to get a more >

<a href='/the-exchange/transcatheter-aortic-valve-replacement-what-s-in-it-for-your-patient-'>Transcatheter Aortic Valve Replacement: What's In It for Your Patient?</a>

Transcatheter Aortic Valve Replacement: What's In It for Your Patient?

Over the last few years more and more development and technology has been devoted to transcatheter aortic valve replacement, or TAVR. This procedure, developed more >

<a href='/the-exchange/states-involvement-with-medicaid-expansion'>States' Involvement With Medicaid Expansion</a>

States' Involvement With Medicaid Expansion

For a little over 50 years, Medicaid has provided health care as a stop gap to millions of people. With the passage of the Affordable Care Act (ACA), few more >

<a href='/the-exchange/super-bowl-and-food-recovery'>Super Bowl and Food Recovery</a>

Super Bowl and Food Recovery

Super Bowl Sunday is reportedly one of the biggest eating days of the year, behind Thanksgiving. There were lots of parties and celebrations this week, which more >

<a href='/the-exchange/here-we-go-again-measles-in-seattle-this-time'>Here We Go Again: Measles in Seattle This Time</a>

Here We Go Again: Measles in Seattle This Time

As of January 31, 2019, there were 42 confirmed cases of measles in the Pacific Northwest. This includes 41 cases in Clark County, the epicenter for the more >

<a href='/the-exchange/leading-the-charge-toward-maintenance-of-certification-changes'>Leading the Charge Toward Maintenance of Certification Changes</a>

Leading the Charge Toward Maintenance of Certification Changes

The rationale and justification behind certification examinations has always been explained to me as it must be guaranteed to patients that anyone practicing more >

<a href='/the-exchange/who-should-step-up-to-help-in-an-in-flight-medical-emergency-'>Who Should Step Up to Help in an In-flight Medical Emergency?</a>

Who Should Step Up to Help in an In-flight Medical Emergency?

Recently I got an email from Medscape that detailed three articles, and one piqued my curiosity: “Who Should Step Up to Help in an In-flight Medical more >

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