The Exchange

Commentary and Observations from
the Medical Front Lines

Latest Miscellaneous Articles on PCE's The Exchange

Toxic Culture and Driving Meaningful Change

Toxic Culture and Driving Meaningful Change

I have recently taken an increased interest in podcasts. One of my favorites is Brené Brown's Dare to Lead series. In an April 2022 episode, Brown (who is a research professor, leadership expert, and author) and her Chief of Staff, Barrett Guillen, reflect upon a recent paper in the MIT Sloan Management Review, "Why Every Leader Needs to Worry About Toxic Culture" by Sull et al. In addition, Brown and Guillen infuse the podcast with their own experiences working with differ... Continue Reading

Filed under: Miscellaneous, Practice Management/Career

May Is Older Americans Month

May Is Older Americans Month

In the month of May, we celebrate Older Americans Month, led by the Administration for Community Living (ACL). To honor this month, on April 29, 2022, Presid... Continue Reading

Filed under: Miscellaneous

Pesticide Poisoning: What APPs Should Know

Pesticide Poisoning: What APPs Should Know

Pesticides—which can be found in insecticides, herbicides, fungicides, rodenticides, molluscicides, and nematicides—can pose health risks to humans by im... Continue Reading

Filed under: Curbside Consultations, Miscellaneous

Diversity in Research and the <em>All of Us</em> Research Program

Diversity in Research and the All of Us Research Program

I have been working in the PA field for well over 18 years and have always thrived on knowing that I am treating my patients with evidence-based medicine. Ho... Continue Reading

Filed under: Health Policy and Trends, Miscellaneous, Women's Health

True Confessions of a Former Sugar-Substitute Lover

True Confessions of a Former Sugar-Substitute Lover

For years I drank beverages sweetened with non-nutritive sweeteners and thought they were the greatest invention—I could enjoy a sweet treat without th... Continue Reading

Filed under: Miscellaneous

Women Making a Difference and Paving the Way: Part 2 – Nurse Practitioners

Women Making a Difference and Paving the Way: Part 2 – Nurse Practitioners

In this second post for Women's History Month, I will be focusing on the contributions of female NPs who have gone above and beyond in the field to exemplify... Continue Reading

Filed under: Miscellaneous, NPs & PAs

Women Making a Difference and Paving the Way: Part 1 – Physician Associates/Assistants

Women Making a Difference and Paving the Way: Part 1 – Physician Associates/Assistants

In New York City, the 1-year anniversary of the garment workers' strike—where the International Ladies' Garment Workers' Union led 15,000 women in a march... Continue Reading

Filed under: Miscellaneous, NPs & PAs

Barriers in Healthcare: A Focus on Language

Barriers in Healthcare: A Focus on Language

We live in a society filled with a diverse set of cultures and languages. The US especially has been known to have one of the largest immigrant populations.... Continue Reading

Filed under: Miscellaneous, Practice Management/Career

Facilitating Behavior Changes

Facilitating Behavior Changes

I recently listened to a very good speaker on helping patients with behavior change. Dr Judson Brewer is an addiction psychiatrist who has researched mindful... Continue Reading

Filed under: Curbside Consultations, Miscellaneous

The Health Risk of Consuming Sugar-Sweetened Beverages

The Health Risk of Consuming Sugar-Sweetened Beverages

When I inquire about dietary intake during a new patient history, I am always surprised to hear how many people drink sugar-sweetened beverages. Although con... Continue Reading

Filed under: Miscellaneous, Preventive Medicine

Attitude: Reframing a Bad Diagnosis

Attitude: Reframing a Bad Diagnosis

As medical practitioners it can be our job to inform patients of serious illness. Any diagnosis that is new to the patient and implies changing one's li... Continue Reading

Filed under: Miscellaneous

Wearable Technology Is Helpful, But Not Perfect

Wearable Technology Is Helpful, But Not Perfect

We have all seen this scenario before: A patient comes in and tells you that they've seen a concerning reading on their smartphone or smartwatch regarding so... Continue Reading

Filed under: Miscellaneous

IV Tocilizumab Shortage for Rheumatology Patients: A Result of the COVID-19 Pandemic

IV Tocilizumab Shortage for Rheumatology Patients: A Result of the COVID-19 Pandemic

The COVID-19 pandemic has brought many challenges to our daily rheumatology practices: From the initial switch to mostly telemedicine appointments in early 2... Continue Reading

Filed under: Miscellaneous, Rheumatology

Moving Forward

Moving Forward

With so many stories circulating about our collective struggle to "return to normal" after the last year and a half, I have been thinking a lot about how we... Continue Reading

Filed under: Miscellaneous

Focus on the Task

Focus on the Task

Effective leaders, in any space, have the ability to successfully modulate their emotions as part of self-regulation. This allows for the selective filtering... Continue Reading

Filed under: Miscellaneous, Practice Management/Career

How to Withdraw Life Support

How to Withdraw Life Support

This is a follow-up to my previous blog... Continue Reading

Filed under: Curbside Consultations, Miscellaneous

Palliative Care Starts Sooner Than You Think!

Palliative Care Starts Sooner Than You Think!

Last year, I transitioned from being an ER PA to a critical care PA, now working in our hospital's ICU. It was not the hardest job change I have ever made: I... Continue Reading

Filed under: Curbside Consultations, Miscellaneous

Innovation in a Post-Pandemic World: What We Have Taught Ourselves

Innovation in a Post-Pandemic World: What We Have Taught Ourselves

So much has changed since January of this year. By now, most states are working to get back to some sense of normalcy while hospitals and healthcare systems... Continue Reading

Filed under: Health Policy and Trends, Miscellaneous, Practice Management/Career

An Exciting Prospect for an Old SSRI in the COVID-19 Pandemic

An Exciting Prospect for an Old SSRI in the COVID-19 Pandemic

Can an old selective serotonin reuptake inhibitor (SSRI), fluvoxamine, prevent individuals infected with COVID-19 from severe clinical decompensation? This 4... Continue Reading

Filed under: Infectious Diseases, Miscellaneous

Should We Be Screening all Patients Over 50 for Age-Related Macular Degeneration?

Should We Be Screening all Patients Over 50 for Age-Related Macular Degeneration?

A growing public health issue for older adults is impaired sight. In fact, in 2011, 12% of US adults aged 65 to 74 years reported trouble with their vision,... Continue Reading

Filed under: Miscellaneous, Preventive Medicine

The Sky Isn’t the Limit for This PA

The Sky Isn’t the Limit for This PA

Hayley Arceneaux, PA-C, is anything but ordinary. At the age of 10, she already had her black belt in Taekwondo. Then she was diagnosed with osteosarcoma of... Continue Reading

Filed under: Miscellaneous, NPs & PAs

Bringing Awareness to Body Dysmorphic Disorder (BDD)

Bringing Awareness to Body Dysmorphic Disorder (BDD)

Social media has revolutionized the way that humans see themselves. Thanks to filters and Photoshop, we can create and post the perfect image of ourselves, c... Continue Reading

Filed under: Miscellaneous, Psychiatry

Climate Change and Health: Let’s Take a Stand to Save Lives!

Climate Change and Health: Let’s Take a Stand to Save Lives!

Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) agree that climate change has a significant negative effect... Continue Reading

Filed under: Miscellaneous, Public Health

Sunscreen Updates

Sunscreen Updates

Everyone knows they should protect their skin from the harmful effects of UVA and UVB exposure. The proper way to do so, however, has been the subject of muc... Continue Reading

Filed under: Dermatology, Miscellaneous

Acute Versus Chronic Mesenteric Ischemia

Acute Versus Chronic Mesenteric Ischemia

Acute mesenteric ischemia (AMI), also commonly called bowel or intestinal ischemia, refers to inadequate blood flow to the small intestine (arterial or venou... Continue Reading

Filed under: Gastroenterology, Miscellaneous

National Nurses Week May 6-12: Let’s Not Forget Where It Started

National Nurses Week May 6-12: Let’s Not Forget Where It Started

Two hundred years ago, on May 12th, Florence Nightingale was born—it is now a day when we celebrate nurses around the world. Did you know that... Continue Reading

Filed under: Miscellaneous, NPs & PAs

Throat Abscess Differentiation

Throat Abscess Differentiation

Deep neck space infections are frequently seen in medical clinics and EDs despite the advent of antibiotics. They most commonly arise from a septic focus of... Continue Reading

Filed under: Miscellaneous

Silver Linings

Silver Linings

In the wake of the fear, confusion, and devastation propagated by the COVID-19 pandemic, we are realizing the world as we have known it will forever be a cha... Continue Reading

Filed under: Miscellaneous

Global Commitment and Pandemic Prevention

Global Commitment and Pandemic Prevention

Several years ago, I was fortunate to hike in the Zambia bush where I was accompanied by a naturalist who spoke of the many issues related to wildlife trade... Continue Reading

Filed under: Infectious Diseases, Miscellaneous, Public Health

Intermittent Fasting: Is it Hype or Is There Science Behind It?

Intermittent Fasting: Is it Hype or Is There Science Behind It?

Intermittent fasting (IF) is a form of time-restricted fasting that involves consuming foods during a specific time window and fasting for the remaining hour... Continue Reading

Filed under: Health Policy and Trends, Miscellaneous

Consent for Invasive Exams While Under Anesthesia?

Consent for Invasive Exams While Under Anesthesia?

There was an interesting article in the New York Times called "She Didn't Want a Pelvic Exam. She Received One Anyway. Continue Reading

Filed under: Health Policy and Trends, Miscellaneous

Loretta C. Ford Turns 99

Loretta C. Ford Turns 99

On December 28, 2019, Dr Loretta C. Ford, co-founder of the first nurse practitioner program, turned 99. Loretta is known to her friends as "Lee,... Continue Reading

Filed under: Miscellaneous, NPs & PAs

Raynaud’s Phenomenon: A Common Sense Approach to Diagnosis and Management

Raynaud’s Phenomenon: A Common Sense Approach to Diagnosis and Management

Raynaud's phenomenon (RP) is all too common in New England during the colder months of the year. In October, we often see patients return who ha... Continue Reading

Filed under: Miscellaneous, Rheumatology

Can High-dose Vitamin D Prevent Functional Decline in Our Older Population?

Can High-dose Vitamin D Prevent Functional Decline in Our Older Population?

Lower extremity functional decline in our elderly population is a major risk factor for falls, hip fracture, frailty, and loss of autonomy. As the baby boome... Continue Reading

Filed under: Miscellaneous, Orthopedics, Preventive Medicine

Intermittent Fasting

Intermittent Fasting

If you think about how humans have been eating for centuries, it has likely included some "natural" intermittent fasting. For examp... Continue Reading

Filed under: Cardiometabolic, Miscellaneous, Preventive Medicine, Public Health

circadian rhythm clock

Circadian Rhythms and Metabolic Syndrome

As researchers explore the complex relationship of circadian rhythm and metabolic syndrome, they are searching for root causes and best treatment approaches Continue Reading

Filed under: Cardiometabolic, Miscellaneous, Preventive Medicine, Public Health

The Continued Study of an Old Drug: Aspirin

The Continued Study of an Old Drug: Aspirin

It started out by taking extract from the willow tree and using it as a medicinal agent well over 150 years ago. Today, this extract, now transformed into ac... Continue Reading

Filed under: Cardiometabolic, Miscellaneous

Older Driver Safety Awareness Week

Older Driver Safety Awareness Week

December 2-6, 2019 is Older Driver Safety Awareness Week. This week aims to promote public understanding of the importance of mobility and transportation in... Continue Reading

Filed under: Miscellaneous

Can Robots Read Your CT Scan?

Can Robots Read Your CT Scan?

At a plenary session of the World Conference on Lung Cancer in September, 2019, in Barcelona, Spain, Hugo Aerts, PhD presented fascinating data on the use of... Continue Reading

Filed under: Miscellaneous, Oncology/Hematology

An Updated Cochrane Review: Can Exercise Reduce Falls in Our Elderly Population? Which Exercises Show Proof?

An Updated Cochrane Review: Can Exercise Reduce Falls in Our Elderly Population? Which Exercises Show Proof?

We all know how devastating falls can be in our older patients. I send many to physical therapy specifically for fall prevention. Most have osteoporosis, an... Continue Reading

Filed under: Miscellaneous, Orthopedics

The “HINTS” Examination in Vertigo

The “HINTS” Examination in Vertigo

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 be... Continue Reading

Filed under: Miscellaneous, Neurology

FDA Approves First Oral GLP-1 RA

FDA Approves First Oral GLP-1 RA

The US Food and Drug Administration has approved semaglutide (Rybelsus, Novo Nordisk) as the first oral glucagon-like peptide receptor agonist (GLP-1 RA)&mda... Continue Reading

Filed under: Miscellaneous

What’s the Best Way to Stay Hydrated?

What’s the Best Way to Stay Hydrated?

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... Continue Reading

Filed under: Miscellaneous, Public Health

Managing Multiple Generations in Your Workplace

Managing Multiple Generations in Your Workplace

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Filed under: Miscellaneous

An Interesting Wrinkle in the Hahnemann University Hospital Bankruptcy

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... Continue Reading

Filed under: Miscellaneous

Beat the Heat

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. H... Continue Reading

Filed under: Miscellaneous

Firework Safety Tips

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... Continue Reading

Filed under: Miscellaneous

National Stop the Bleed Month

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 “... Continue Reading

Filed under: Health Policy and Trends, Miscellaneous, Preventive Medicine, Public Health

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

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... Continue Reading

Filed under: Miscellaneous, Preventive Medicine, Public Health

The History of Simulation

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 time. The u... Continue Reading

Filed under: Miscellaneous

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

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 Emerge... Continue Reading

Filed under: Miscellaneous

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