Continuing Medical Education for Nurse Practitioners, Physician Assistants & Physicians

Continuing Medical Education for Nurse Practitioners, Physician Assistants, Registered Nurses & Physicians

Continuing Medical Education for Nurse Practitioners, Physician Assistants, Registered Nurses & Physicians

Continuing Medical Education for Nurse Practitioners, Physician Assistants, Registered Nurses & Physicians

Continuing Medical Education for Nurse Practitioners, Physician Assistants, Registered Nurses & Physicians

Continuing Medical Education for Nurse Practitioners, Physician Assistants, Registered Nurses & Physicians

Alsco and Richard Childress Racing celebrate 10-year partnership

Action Packed Weekend of Racing Planned

Statement Highlights: A new scientific statement outlines the role of primary care professionals in helping their patients achieve Life's Essential 8, the key measures for improving and maintaining cardiovascular health defined by the American Heart ...

Per the DOE’s second annual “National Energy Employment Analysis,” a total of 6.4 million Americans now work in the traditional energy and energy-efficiency industries. More than 300,000 net new jobs were added in 2016, which accounted for 14 percent of the nation’s job growth.

Book for our free primary school screenings taking place at Showcase sites this June and July

BERLIN/WARSAW, 8 April 2016 – Political leaders must play a primary role in in countering discrimination and prejudice against Roma and Sinti and improving their situation, Frank-Walter Steinmeier, OSCE Chairperson-in-Office and Germany’s Federal Foreign Minister, and Michael Georg Link, Director of the OSCE Office for Democratic Institutions and Human Rights (ODIHR), said today, on the occasion of International Roma Day.

“Political leaders at all levels must be at the forefront of efforts to end the systematic discrimination and racism that have long afflicted Roma and Sinti communities and individuals in many countries in the OSCE region,” OSCE  Chairperson-in-Office Steinmeier said. “They have to lead both by word, in delivering positive messages and not resorting to negative stereotypes and scapegoating, and by example, in ensuring the implementation of policies at all levels of government to promote the integration and full political, economic and social participation of Roma and Sinti in their societies.”

In particular, they condemned the use by some politicians of racist language and messages aimed either at promoting hatred towards Roma and Sinti or reinforcing negative stereotypes.

“Alarmingly, we still see instances where politicians resort to the politics of fear and hatred for their own perceived gain, thus stoking unfair and dangerous prejudice against Roma and Sinti. This contributes to an atmosphere in which members of Europe’s largest minority are in danger of being targeted with hate crimes, including violent assaults, and even murder,” Director Link said. “Leaders must not only refrain from such statements, but take a step further – they must publicly condemn racist speech and acts against Roma and Sinti, and counter racism and discrimination in a systematic way.”

The subject of racist, anti-Roma rhetoric used by politicians was addressed at a side event organized by ODIHR and the Central Council for German Sinti and Roma, during the Human Dimension Implementation Meeting in Warsaw, on 30 September 2015, at which participants highlighted the important role of state institutions in overcoming racism.

The Organization’s work in this area is guided by the Action Plan on Improving the Situation of Roma and Sinti in the OSCE Area, adopted in 2003, which includes measures to combat racism and discrimination, to promote greater public and economic participation, and to ensure equal access and opportunities in the areas of education, employment, housing and health services.

“The blueprint for addressing racism and discrimination against Roma and Sinti and for improving their situation already exists, in the form of the Action Plan,” said Mirjam Karoly, Chief of ODIHR’s Contact Point for Roma and Sinti Issues. “Greater political will and leadership are vital to making this a reality.”

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Potential for primary energy savings in TLC/ICT centres through free cooling

TP-GSTR-GNSS - Considerations on the use of GNSS as a primary time reference in telecommunications
This report, initially posted on 1 July, was reposted on 12 October 2020 with a correct date of approval

Gov. Kathy Hochul of New York will face Representative Lee Zeldin this fall. Two Trump-endorsed candidates won key primaries in Illinois. Here’s what else happened.

Former President Donald J. Trump’s endorsement has helped propel some candidates to victory, but he’s also had some notable defeats.

Warwick Academy were crowned the Bermuda School Sports Federation’s Primary School Division One Netball champions at the Bernard Park Netball courts. Warwick Academy edged past Northlands Primary 5 – 4 in a very close encounter. Quin Burgess scored four goals to lead Warwick with Francesca Cressall-Haycock scoring the other. Sofia Odouri led Northlands with three […]

Somerset Primary School students recently hosted an International Dinner for students and parents, where the students highlighted the culture and cuisine of countries, including Japan, Mexico, India, and Bermuda. The event offered a variety of dishes for attendees to sample, celebrating the diversity within the school community. In honor of Diwali, the PTA also organized […]

Somerset Primary School is set to host its International Day Dinner today [November 5], offering students and their families a rich experience of global cuisine and culture. The event will take place in the school’s Assembly Hall from 4 pm to 6 pm. Each class will represent a different country such as Bermuda, Mexico, Japan, […]

Alison M. Kurimchak
Dec 1, 2020; 19:2068-2089
Research

Endometrial carcinoma (EC) is the most common gynecologic malignancy in the United States, with limited effective targeted therapies. Endometrial tumors exhibit frequent alterations in protein kinases, yet only a small fraction of the kinome has been therapeutically explored. To identify kinase therapeutic avenues for EC, we profiled the kinome of endometrial tumors and normal endometrial tissues using Multiplexed Inhibitor Beads and Mass Spectrometry (MIB-MS). Our proteomics analysis identified a network of kinases overexpressed in tumors, including Serine/Arginine-Rich Splicing Factor Kinase 1 (SRPK1). Immunohistochemical (IHC) analysis of endometrial tumors confirmed MIB-MS findings and showed SRPK1 protein levels were highly expressed in endometrioid and uterine serous cancer (USC) histological subtypes. Moreover, querying large-scale genomics studies of EC tumors revealed high expression of SRPK1 correlated with poor survival. Loss-of-function studies targeting SRPK1 in an established USC cell line demonstrated SRPK1 was integral for RNA splicing, as well as cell cycle progression and survival under nutrient deficient conditions. Profiling of USC cells identified a compensatory response to SRPK1 inhibition that involved EGFR and the up-regulation of IGF1R and downstream AKT signaling. Co-targeting SRPK1 and EGFR or IGF1R synergistically enhanced growth inhibition in serous and endometrioid cell lines, representing a promising combination therapy for EC.

At a recent clinical meeting, I heard that GPs local to me are about to lose the ability to request magnetic resonance imaging (MRI) scans for patients presenting with musculoskeletal symptoms. We’re instead advised to refer our patients to a musculoskeletal clinical assessment and triage service (CATS)—staffed largely by musculoskeletal advanced practitioners, who will assess our patients and determine whether imaging is warranted.The hope is that fewer patients will have unnecessary imaging and that this will reduce the potential harms of overdiagnosis. Radiologists rarely report musculoskeletal MRI scans as entirely normal, and it can be hard to know what to do with abnormal findings on an MRI. More often than not, patients with abnormal scans are referred to orthopaedic teams, even though there may not necessarily be a surgical target.At a population level, this is problematic on two fronts. Firstly, MRI scans are expensive and need to be used judiciously....

C-X-C motif chemokine receptor 4 (CXCR4)–directed imaging has gained clinical interest in aiding clinical diagnostics in primary aldosteronism (PA). We retrospectively evaluated the feasibility of CXCR4-directed scintigraphy using the novel CXCR-4 ligand [^99mTc]Tc-pentixatec in patients with PA. Methods: Six patients (mean age ± SD, 49 ± 15 y) underwent CXCR4-directed scintigraphy (including planar imaging and SPECT/CT) 30, 120, and 240 min after injection of 435 ± 50 MBq of [^99mTc]Tc-pentixatec. Adrenal CXCR4 expression was analyzed by calculating lesion-to-contralateral ratios (LCRs). Imaging results were correlated to clinical information. Histopathology and clinical follow-up served as the standard of reference. Results: Three subjects showed lateralization of adrenal tracer accumulation, with a mean maximum lesion-to-contralateral ratio of 1.65 (range, 1.52–1.70), which correlated with morphologic findings on CT. One individual underwent adrenalectomy and presented with complete biochemical and clinical remission at follow-up. Histopathologic workup confirmed unilateral aldosterone-producing adenoma. Conclusion: [^99mTc]Tc-pentixatec scintigraphy with SPECT in patients with PA is feasible and might offer a valuable alternative to CXCR4-directed imaging with [⁶⁸Ga]Ga-pentixafor PET.

Cancer of unknown primary (CUP) represents a heterogeneous group of metastatic tumors for which standardized diagnostic work-up fails to identify the primary site. We aimed to describe the Peter MacCallum Cancer Centre experience with ¹⁸F-FDG PET/CT in extracervical CUP with respect to detection of a primary site and its impact on management. A secondary aim was to compare overall survival (OS) in patients with and without a detected primary site. Methods: CUP patients treated between 2014 and 2020 were identified from medical oncology clinics and ¹⁸F-FDG PET/CT records. Information collated from electronic medical records included the suspected primary site and treatment details before and after ¹⁸F-FDG PET/CT. Clinicopathologic details and genomic analysis were used to determine the clinically suspected primary site and compared against 2 independent masked reads of ¹⁸F-FDG PET/CT images by nuclear medicine specialists to determine sensitivity, specificity, accuracy, and the rate of detection of the primary site. Results: We identified 147 patients, 65% of whom had undergone molecular profiling. The median age at diagnosis was 61 y (range, 20–84 y), and the median follow-up time was 74 mo (range, 26–83 mo). Eighty-two percent were classified as having an unfavorable CUP subtype as per international guidelines.¹⁸F-FDG PET/CT demonstrated a primary site detection rate of 41%, resulted in a change in management in 22%, and identified previously occult disease sites in 37%. Median OS was 16.8 mo for all patients and 104.7 and 12.1 mo for favorable and unfavorable CUP subtypes, respectively (P < 0.0001). Median OS in CUP patients when using ¹⁸F-FDG PET/CT, clinicopathologic, and genomic information was 19.8 and 8.5 mo when a primary site was detected and not detected, respectively (P = 0.016). Multivariable analysis of survival adjusted for age and sex remained significant for identification of a potential primary site (P < 0.001), a favorable CUP (P < 0.001), and an Eastern Cooperative Oncology Group status of 1 or less (P < 0.001). Conclusion: ¹⁸F-FDG PET/CT plays a complementary role in CUP diagnostic work-up and was able to determine the likely primary site in 41% of cases. OS is improved with primary site identification, demonstrating the value of access to diagnostic ¹⁸F-FDG PET/CT for CUP patients.

After a couple years of clashes with teachers in the state, West Virginia Senate President Mitch Carmichael was ousted in Tuesday's Republican primary election by a teacher.

Charter schools are playing a notable role in remarks about education from candidates like Joe Biden and Bernie Sanders. Yet it's not clear what if any role they'll have in important states like Iowa and New Hampshire.

After a couple years of clashes with teachers in the state, West Virginia Senate President Mitch Carmichael was ousted in Tuesday's Republican primary election by a teacher.

Nebraska Gov. Pete Ricketts signed a bill into law Wednesday that expands the state's anti-hazing regulations to elementary, middle, and high schools rather than just post-secondary institutions.

While the number of principals running for office has been dwarfed by teachers, school leaders are hoping to change policies in statehouses and in Washington that they say impact their students and families.

After a couple years of clashes with teachers in the state, West Virginia Senate President Mitch Carmichael was ousted in Tuesday's Republican primary election by a teacher.

WILMINGTON – The Delaware Children’s Department has launched a program that links pediatric primary care providers with free psychiatry consultations and assistance to streamline behavioral health care for children and youth. Implemented in 2019, the Delaware Child Psychiatry Access Program (DCPAP) is a beneficial resource for primary care providers serving young people with behavioral health needs. […]

Provisional Affordability Standards aim to strengthen primary care in Delaware through increased investment Insurance Commissioner Trinidad Navarro announced the release of the Office of Value-Based Health Care Delivery’s initial provisional Affordability Standards as part of a new report, Delaware Health Care Affordability Standards: An Integrated Approach to Improve Access, Quality and Value, which includes plans […]

General Assembly sent key bill to the Governor The Delaware General Assembly passed legislation to increase Delawareans’ access to high quality, affordable health care through a series of reforms that will refocus Delaware’s healthcare system on primary care and improvements in value. Senate Substitute 1 for Senate Bill 120 requires commercial health insurance companies to […]

The Delaware Department of Elections is informing voters that automatically registered voters may declare their party at the State Primary Election, September 10, 2024. Delaware is a Closed Primary State, meaning that only voters affiliated with the Democratic or Republican parties may vote in their party’s Primary Election. Eligible Voters must vote at their assigned Polling Place, and Polling Places are open from 7 a.m. – 8 p.m. on Primary Election Day.

Check here each week to keep up with the latest from John MacArthur's pulpit at Grace Community Church.

We propose a paper that provides education on commonly used long-acting injectable antipsychotics (LAIs) to improve primary care based mental health interventions in patients with severe mental illnesses (SMIs) such as schizophrenia, schizoaffective disorder, and bipolar disorders. With the expanding interface of primary care and psychiatry across all healthcare settings, it has become increasingly important for primary care clinicians to have a broader understanding of common psychiatric treatments, including LAIs. Long-acting injectable antipsychotics have been shown to be helpful in significantly improving treatment adherence, preventing disease progression, improving treatment response, decreasing readmission rates, and reducing social impairment. We discuss evidence-based indications and guidelines for use of long-acting injectable antipsychotics. We provide an overview of the treatment of SMI with LAIs, mainly focusing on the most commonly used long-acting injectable antipsychotics, advantages and disadvantages of each, along with outlining important clinical pearls for ease of practical application. Equipped with increased familiarity and understanding of these essential therapies, primary care clinicians can better facilitate early engagement with psychiatric care, promote more widespread use, and thus significantly improve the wellbeing and quality of life of patients with severe mental illness.

Purpose:

Providing medication abortion in the primary care setting is a promising way to increase access to abortion, a threatened service in many States. This study aimed to characterize primary care clinicians’ interest in prescribing medication abortion, what barriers they face in adding this service, and what support they need.

Background:

Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization.

Introduction:

High-quality primary care can reduce avoidable emergency department visits and emergency hospitalizations. The availability of electronic medical record (EMR) data and capacities for data storage and processing have created opportunities for predictive analytics. This systematic review examines studies which predict emergency department visits, hospitalizations, and mortality using EMR data from primary care.

A prefilled syringe (PFS) should be able to be adequately and consistently extruded during injection for optimal safe drug delivery and accurate dosing. To facilitate appropriate break-loose and gliding forces (BLGFs) required during injection, certain primary packaging materials (PPMs) such as the syringe barrel and plunger are usually coated with silicone oil, which acts as a lubricant. Due to its direct contact with drug, silicone oil can increase the number of particles in the syringe, which could lead to adverse interactions. Compliance with regulatory-defined silicone oil quantities in certain drug products, such as ophthalmics, presents a trade-off with the necessity for desirable low and consistent BLGF. In addition to its siliconization, the dimensional accuracy of the PPM has an important role in controlling the BLGF. The dimensions of the PPM are individualized depending on the product and its design and have certain tolerances that must be met during manufacturing. Most studies on ophthalmics focused on the adverse interactions between silicone oil and the drug. To the authors' knowledge, there have been no public studies so far that have investigated the impact of the dimensional variability of the PPM on the BLGF in ophthalmic PFSs. In this study, we applied advanced optical shaft and tactile measuring technologies to investigate this impact. The syringes investigated were first sampled during aseptic production and tested for the BLGF. Subsequently, defined dimensions of the PPM were measured individually. The results showed that the dimensional variability of the PPM can have a negative impact on the BLGF, despite their conformity to specifications, which indicates that the currently available market quality of PPMs is improvable for critical drug products such as ophthalmics. This study could serve as an approach to define product-specific requirements for primary packaging combinations and thus appropriate specifications based on data during the development stage of drug products.

Extract

With a disproportionate burden of tuberculosis (TB) amongst migrants in Europe [1], Burman et al. [2] have highlighted the pressing need for alternative approaches to make TB infection (TBI) screening comprehensive and accessible. Across high-income Organisation for Economic Co-operation and development countries, a median of 52% of TB cases occur in foreign-born individuals, who are at their highest risk of developing TB disease within the first 5 years of migration [3]. Molecular epidemiological studies indicate that the majority of these cases occur as a result of TBI reactivation, often acquired overseas [4]. Within the UK, overseas-born migrants have a 14-fold higher TB incidence than UK-born individuals [5]. The World Health Organization therefore recommends that migrants from countries with a high TB burden may be prioritised for TBI screening [6, 7].

Background

Control of latent tuberculosis infection (LTBI) is a priority in the World Health Organization strategy to eliminate TB. Many high-income, low TB incidence countries have prioritised LTBI screening and treatment in recent migrants. We tested whether a novel model of care, based entirely within primary care, was effective and safe compared to secondary care.

ABSTRACTPolitics is one of the critical factors that influence health policy agendas. However, scholarly efforts, especially in low- and middle-income countries, rarely focus on how politics influence health policy agenda-setting. We conducted a qualitative document review to examine the factors that led to developing the free primary health care policy for maternal health in Papua New Guinea. We also discuss mechanisms through which national politics, as an overriding factor, influenced the development of the policy. The review draws on Kingdon’s multiple-stream model for agenda-setting and incorporates theoretical insights from Fox and Reich’s framework for analyzing the politics of health reform for universal health coverage in low- and middle-income countries.

Here, we highlight the case of a 31-yr-old man who had clinical features of primary hypertrophic osteoarthropathy (PHOAR) and harbored a homozygous variant (c.38C > A, p.Ala13Glu) in the HPGD gene, as indicated by whole-exome sequencing (WES). This variant has been previously classified by our laboratory as a variant of uncertain significance (VUS). However, another patient with the same phenotype and the same homozygous variant in HPGD was subsequently reported. In reassessing the variant, the absence of this variant in the gnomAD population database, supporting computational predictions, observation in homozygosity in two probands, and specificity of the phenotype for HPGD, all provide sufficient evidence to reclassify the HPGD c.38C > A, p.Ala13Glu variant as likely pathogenic.

BackgroundLong-term health conditions are major challenges for care systems. Social prescribing link workers have been introduced via primary care networks (PCNs) across England since 2019 to address the wider determinants of health by connecting individuals to activities, groups, or services within their local community.AimTo assess whether the rollout of social prescribing link workers was in areas with the highest need.Design and settingA retrospective study of social prescribing link workers in England from 2019 to 2023.MethodWorkforce, population, survey, and area-level data at the PCN-level from April 2020 to October 2023 were combined. Population need before the rollout of link workers was measured using reported lack of support from local services in the 2019 General Practice Patient Survey. To assess if rollout reflected need, linear regression was used to relate provision of link workers (measured by full-time equivalent [FTE] per 10 000 patients) in each quarter to population need for support.ResultsPopulations in urban, more deprived areas and with higher proportions of people from minority ethnic groups had the highest reported lack of support. Geographically these were in the North West and London. Initially, there was no association between need and provision; then from July 2022, this became negative and significant. By October 2023, a 10-percentage point higher need for support was associated with a 0.035 (95% confidence interval = −0.634 to −0.066) lower FTE per 10 000 patients.ConclusionRollout of link workers has not been sufficiently targeted at areas with the highest need. Future deployments should be targeted at those areas.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support.AimThis study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement.Design and settingCross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care.MethodThree interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software.ResultsData from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region – for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%).ConclusionElements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps.

BackgroundThere has been significant investment in pharmacists working in UK general practice to improve the effective and safe use of medicines. However, evidence of how to optimise collaboration between GPs and pharmacists in the context of polypharmacy (multiple medication) is lacking.AimTo explore GP and pharmacist views and experiences of in-person, interprofessional collaborative discussions (IPCDs) as part of a complex intervention to optimise medication use for patients with polypharmacy in general practice.Design and settingA mixed-method process evaluation embedded within the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial conducted in Bristol and the West Midlands, between February 2021 and September 2023.MethodAudio-recordings of IPCDs between GPs and pharmacists, along with individual semi-structured interviews to explore their reflections on these discussions, were used. All recordings were transcribed verbatim and analysed thematically.ResultsA total of 14 practices took part in the process evaluation from February 2022 to September 2023; 17 IPCD meetings were audio-recorded, discussing 30 patients (range 1–6 patients per meeting). In all, six GPs and 13 pharmacists were interviewed. The IPCD was highly valued by GPs and pharmacists who described benefits, including: strengthening their working relationship; gaining in confidence to manage more complex patients; and learning from each other. It was often challenging, however, to find time for the IPCDs.ConclusionThe model of IPCD used in this study provided protected time for GPs and pharmacists to work together to deliver whole-patient care, with both professions finding this beneficial. Protected time for interprofessional liaison and collaboration, and structured interventions may facilitate improved patient care.