The Exchange
Commentary and Observations from
the Medical Front Lines
Sign up to receive posts from The Exchange
CATEGORIES
The “HINTS” Examination in Vertigo
Posted By: 
Ben Taylor, PA-C, PhD, DFAAPA | October 15, 2019
Vertigo is a symptom, not a diagnosis. It presents a unique problem for many clinicians because it is symptomatic of a plethora of diagnoses, ranging from benign to immediately life threatening. The challenge of navigating vertigo becomes even more daunting when having to differentiate benign peripheral vertigo from potentially life-threatening central vertigo, which is frequently the result of a cerebellar stroke. CT scan is often the initial imaging modality when stroke is being considered but is notoriously insensitive—particularly when it comes to the posterior fossa—missing 60% to 90% of acute ischemic strokes in the brainstem or cerebellum. more >
Found in: Miscellaneous, Neurology
How Have Carcinogens Tainted Our Generic Drug Supply?
Posted By: 
Lawrence Herman, MPA, PA-C | October 11, 2019
In July 2018, the FDA announced that a known carcinogen, called N-Nitrosodiumdimethylamine, or NDMA, had been found in valsartan manufactured by Zhejiang more >
FDA Approves First Oral GLP-1 RA
Posted By: 
Lawrence Herman, PA-C, MPA | October 08, 2019
The US Food and Drug Administration has approved semaglutide (Rybelsus, Novo Nordisk) as the first oral glucagon-like peptide receptor agonist (GLP-1 RA)—for more >
The Real Risks of Vaping: All Clinicians Must Ask the Right Questions and Warn Patients
Posted By: 
Daniel Thibodeau, MHP, PA-C | October 04, 2019
Most of us have seen the recent news regarding the alarming rise of respiratory-related illnesses and deaths due to e-cigarettes, or vaping. For those not more >
New Statement Related to Hospitalized Heart Failure Patients
Posted By: Daniel Thibodeau, MHP, PA-C | October 01, 2019
The American College of Cardiology has issued a new Expert Consensus Decision Pathway for the management of patients with heart failure. This newly released more >
'Tis the Flu Season! 2020 Influenza Updates
Posted By: 
Susanne J. Phillips, DNP, APRN, FNP-BC | September 27, 2019
On August 23, 2019, the Centers for Disease Control and Prevention published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the more >
Beware: The “Ankle-biter” Mosquitoes
Posted By: 
Susan M. Tiso, DNP, APRN, FNP-BC | September 24, 2019
It’s the end of summer and the mosquitoes are biting. Two invasive (non-native) mosquito species have been identified in California and other parts of the more >
Update: State Regulatory Environment for Opioid Prescribing
Posted By: Susanne J. Phillips, DNP, APRN, FNP-BC | September 20, 2019
As prescribers for patients with acute and chronic pain in primary care, NPs and PAs are very much aware of the national opioid epidemic, including ways in more >
What’s the Best Way to Stay Hydrated?
Posted By: Susan M. Tiso, DNP, APRN, FNP-BC | September 17, 2019
I see patients with acute illnesses in urgent care every week, and many have fever and anorexia, and are a bit dehydrated. As part of the management plan, I more >
Managing Multiple Generations in Your Workplace
Posted By: 
Debra A. Danforth, DNP, APRN | September 13, 2019
Nowadays it’s common to see several generations working together in our clinical offices, with some people working into their late 60’s and 70’s. This more >
Disaster Preparedness
Posted By: Debra A. Danforth, DNP, APRN | September 10, 2019
Since we are in the heart of hurricane season on the East Coast, it is important to be ready. September is National Preparedness Month to promote family and more >
Thoracic Aortic Aneurysm (Part 2)
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | September 06, 2019
Thoracic aortic aneurysms often expand slowly over time and usually without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start more >
Thoracic Aortic Aneurysm (Part 1)
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | September 03, 2019
Thoracic aortic aneurysms (TAA) are located above the diaphragm, may involve one or more aortic segments (aortic root, ascending aorta, arch, or descending more >
The Dilemma of the Opioid Crisis and Cancer Pain
Posted By: 
Beth Eaby-Sandy, MSN, CRNP, OCN | August 30, 2019
The misuse of opioids and inappropriate prescribing patterns have led to addiction and overdose deaths in the United States that have risen sharply in the past more >
What the Heck is NTRK?
Posted By: Beth Eaby-Sandy, MSN, CRNP, OCN | August 27, 2019
Neurotrophic receptor tyrosine kinase (NTRK) is a gene, and when it fuses to an unrelated gene in some cancers it can become a driver for cancer growth. Two more >
Medical Marijuana, Fibromyalgia, and PTSD
Posted By: 
Richard S. Pope, PA-C, MPAS | August 23, 2019
Have you made up your mind about the use of medical marijuana in your practice? I haven’t yet, but writing this posting has improved my knowledge of its more >
Lyme Arthritis—From High Index of Suspicion to Diagnosis and Treatment
Posted By: Richard S. Pope, PA-C, MPAS | August 20, 2019
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 more >
Telehealth Policy Update—A National Resource for Advanced Practice Providers
Posted By: Susanne J. Phillips, DNP, APRN, FNP-BC | August 16, 2019
Telehealth is a method of enhancing delivery of health services, including diagnosis and monitoring of acute and chronic conditions, counseling, therapy, and more >
Nutrition Recommendations for Prevention or Delaying Onset of Dementia and Cognitive Decline
Posted By: Susanne J. Phillips, DNP, APRN, FNP-BC | August 13, 2019
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 >
Do Meal Times Affect Weight Control?
Posted By: Susan M. Tiso, DNP, APRN, FNP-BC | August 09, 2019
In 2009, researchers at Northwestern University conducted a study on mice and timed feeding, later publishing their research in Obesity. For 6 weeks more >
Are Chemicals Making Us Fat?
Posted By: Susan M. Tiso, DNP, APRN, FNP-BC | August 07, 2019
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 >
An Interesting Wrinkle in the Hahnemann University Hospital Bankruptcy
Posted By: Lawrence Herman, MPA, PA-C | August 02, 2019
Hahnemann University Hospital has been an institution in downtown Philadelphia, seemingly forever. The level I trauma center, medical training facility, and more >
A Glimpse of What Artificial Intelligence May Bring to Medicine
Posted By: Lawrence Herman, MPA, PA-C | July 30, 2019
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 >
Energy Drinks Tied to QTc Prolongation
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | July 26, 2019
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 >
Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | July 22, 2019
The American Geriatrics Society 2019 Updated Beers Criteria—updated from 2015—are designed to reduce older adults' drug-related problems including, but not more >
Palliative Care for Heart Failure: An Early Discussion Would Benefit Patients
Posted By: Daniel Thibodeau, MHP, PA-C | July 19, 2019
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 >
No Difference in Outcomes and Treatment No Matter the Etiology—Analysis from PARADIGM-HF Trial
Posted By: Daniel Thibodeau, MHP, PA-C | July 16, 2019
Heart failure (HF) is a complicated disease state with multiple, staged therapies. Over the last couple of years, addition of a sacubitril/valsartan more >
Team-Based Care: Latest Data on Family Physician, PA, and NP Practices
Posted By: Susanne J. Phillips, DNP, APRN, FNP-BC | July 12, 2019
A recent study published in Family Medicine demonstrates the positive impact on practice capacity and scope of practice of family physicians when more >
Preceptors and Tax Credits—Interprofessional Policy Change
Posted By: Susanne J. Phillips, DNP, APRN, FNP-BC | July 09, 2019
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 >
Beat the Heat
Posted By: Debra A. Danforth, DNP, APRN | July 05, 2019
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 >
Firework Safety Tips
Posted By: Debra A. Danforth, DNP, APRN | July 02, 2019
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 >
Metastatic Lung Cancer: Immunotherapy Gives Hope
Posted By: Beth Eaby-Sandy, MSN, CRNP, OCN | June 28, 2019
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 >
Breaking Down Racial Disparities in Cancer Care: The Affordable Care Act
Posted By: Beth Eaby-Sandy, MSN, CRNP, OCN | June 26, 2019
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 >
How Do Drug Pricing Systems Work? If There Is More Competition, Shouldn’t the List Price Go Down?
Posted By: Richard S. Pope, PA-C, MPAS | June 22, 2019
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 >
T2DM and Osteoporosis: Where Do We Stand in 2019?
Posted By: Richard S. Pope, PA-C, MPAS | June 18, 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 >
CHAMPS HF - We All Can do Better!
Posted By: Daniel Thibodeau, MHP, PA-C | June 14, 2019
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 >
Acute Renal Failure After Cancer Treatment
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | June 11, 2019
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 >
What Price to Save Your Child?
Posted By: Lawrence Herman, MPA, PA-C | June 07, 2019
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 >
Choose Wisely As To When You Schedule Your Medical Care
Posted By: Lawrence Herman, MPA, PA-C | June 05, 2019
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 >
Consider Deprescribing in Our Older Adults
Posted By: Daniel Thibodeau, MHP, PA-C | June 01, 2019
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 >
The Mediterranean Diet and Cardiovascular Disease
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | May 24, 2019
The Mediterranean diet represents the most notable overall dietary pattern in nutritional epidemiology that has been extensively studied over the last 2 more >
Advanced Practice Providers and Liability Risk
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | May 21, 2019
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 >
National Stop the Bleed Month
Posted By: Debra A. Danforth, DNP, APRN | May 17, 2019
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 >
Lower Cholesterol – The Natural Way
Posted By: Debra A. Danforth, DNP, APRN | May 14, 2019
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 >
Procalcitonin Levels in the Management of COPD Exacerbations
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | May 10, 2019
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 >
Hypertension in the Pediatric Population
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | May 07, 2019
The prevalence of systemic hypertension (HTN) in the pediatric population is now commonly observed to be increasing, especially in view of the growing more >
It’s a Digital World: Screen Time Recommendations for Children
Posted By: Susan M. Tiso, DNP, APRN, FNP-BC | May 03, 2019
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 >
Using Policy to Impact HPV Vaccine Rates
Posted By: Susan M. Tiso, DNP, APRN, FNP-BC | May 02, 2019
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 >
Measles Outbreak – A Public Health Concern
Posted By: Daniel Thibodeau, MHP, PA-C | April 26, 2019
The modern world was turned upside down in 1997 when researcher Andrew Wakefield suggested there was a direct correlation between the MMR more >
Cardiovascular Health Promotion—A Must Read for PAs and NPs
Posted By: Daniel Thibodeau, MHP, PA-C | April 23, 2019
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 >
What is the Best Treatment for Painful Osteoporotic Compression Fractures of the Spine?
Posted By: Richard S. Pope, PA-C, MPAS | April 19, 2019
Pop quiz: What is the best method of treatment for osteoporotic compression fractures of the spine? Nonsurgical treatment (NST) Balloon kyphoplasty more >
A View of Rheumatology From 31 Years And 30,000 Feet
Posted By: Richard S. Pope, PA-C, MPAS | April 16, 2019
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 >
Was the Apple Heart Study Virtually Useless?
Posted By: Lawrence Herman, MPA, PA-C | April 12, 2019
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 >
Universal Influenza Vaccine Begins Phase I Clinical Trials
Posted By: Lawrence Herman, MPA, PA-C | April 09, 2019
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 >
Fluoroquinolone Use and the Potential Risk for Aortic Aneurysm or Dissection
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | April 05, 2019
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 >
Aspirin Use for ASCVD Prevention
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | April 02, 2019
For decades aspirin has been a staple of primary prevention of atherosclerotic cardiovascular disease (ASCVD) in at-risk populations, based on recommendations more >
Use of Simulation in NP and PA Programs
Posted By: Debra A. Danforth, DNP, APRN | March 29, 2019
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 >
The History of Simulation
Posted By: Debra A. Danforth, DNP, APRN | March 26, 2019
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 >
Expanding JAK Inhibitor Market for RA on the Horizon in 2019: “Which One Is the Best?”
Posted By: Richard S. Pope, PA-C, MPAS | March 22, 2019
Rheumatoid arthritis (RA) treatments continue to improve outcomes in the latest clinical trials. At the 2018 American College of Rheumatology (ACR) meeting more >
CARES Study Prompts FDA Boxed Warning on Febuxostat
Posted By: Richard S. Pope, PA-C, MPAS | March 19, 2019
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 >
Caution: Population Is Having More Heart Attacks at a Younger Age
Posted By: Daniel Thibodeau, MHP, PA-C | March 15, 2019
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 >
Patient Autonomy: Keeping Our Patients’ Self-Determination Preserved
Posted By: Daniel Thibodeau, MHP, PA-C | March 12, 2019
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 >
Who Should Be Responsible? Social Media and Accurate Vaccine Information
Posted By: Lawrence Herman, MPA, PA-C | March 08, 2019
The World Health Organization recently listed what they call “vaccine hesitancy”—the reluctance or refusal to be vaccinated despite the availability of more >
How Much Revenue Do You—and Your Practice—Generate for Your Hospital?
Posted By: Lawrence Herman, MPA, PA-C | March 05, 2019
Merritt Hawkins, a large search firm specializing in physicians and advanced practice providers (APPs), has published their periodic survey report detailing more >
Vaping: What Parents Need to Know
Posted By: Debra A. Danforth, DNP, APRN | March 01, 2019
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 >
Substance Use Disorders in Youth
Posted By: Debra A. Danforth, DNP, APRN | February 26, 2019
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 >
How Do You Make a Diagnosis of Gout Without Seeing MSU Crystals Under a Microscope?
Posted By: Richard S. Pope, PA-C, MPAS | February 22, 2019
Primary care/urgent care/emergency rooms are all settings where acute monoarthritis is seen. The differential diagnosis includes acute crystal arthritis (gout, more >
Is Long-term Survival Associated With the Use of Nitrogen-containing Bisphosphonates?
Posted By: Richard S. Pope, PA-C, MPAS | February 20, 2019
In the January issue of Osteoporosis International, there was an article entitled, “Mortality Risk Reduction Differs According to Bisphosphonate more >
Treating the Hypertensive Patient With Chronic Kidney Disease
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | February 15, 2019
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 >
Anticoagulants and Recurrent Thrombosis
Posted By: Ben Taylor, PA-C, PhD, DFAAPA | February 11, 2019
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 >
Transcatheter Aortic Valve Replacement: What's In It for Your Patient?
Posted By: Daniel Thibodeau, MHP, PA-C | February 08, 2019
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 >
States' Involvement With Medicaid Expansion
Posted By: Daniel Thibodeau, MHP, PA-C | February 05, 2019
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 >
Super Bowl and Food Recovery
Posted By: Susan M. Tiso, DNP, APRN, FNP-BC | February 03, 2019
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 >
Here We Go Again: Measles in Seattle This Time
Posted By: Susan M. Tiso, DNP, APRN, FNP-BC | January 31, 2019
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 >
Leading the Charge Toward Maintenance of Certification Changes
Posted By: Lawrence Herman, MPA, PA-C | January 28, 2019
The rationale and justification behind certification examinations has always been explained to me as it must be guaranteed to patients that anyone practicing more >
Who Should Step Up to Help in an In-flight Medical Emergency?
Posted By: Lawrence Herman, MPA, PA-C | January 25, 2019
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 >