Mechanisms of action and therapeutic applications of GLP-1 and dual GIP/GLP-1 receptor agonists.

Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are two incretins that bind to their respective receptors and activate the downstream signaling in various tissues and organs. Both GIP and GLP-1 play roles in regulating food intake by stimulating neurons in the brain's satiety center. They also stimulate insulin secretion in pancreatic β-cells, but their effects on glucagon production in pancreatic α-cells differ, with GIP having a glucagonotropic effect during hypoglycemia and GLP-1 exhibiting glucagonostatic effect during hyperglycemia.

Vancomycin AUC-Based Dosing Practices in a Non-Teaching Community Hospital and Associated Outcomes: A One-Year Survey of Uniform Targets for Infections with or without MRSA.

Background: Intravenous (IV) vancomycin area under the curve (AUC)-based dosing is used uniformly for Gram-positive organisms in non-teaching community hospitals. However, evidence for using vancomycin AUC-based dosing for non-methicillin-resistant () and less serious infections is limited in the literature. A gap in the literature also exists with respect to comparisons between the outcomes that can be derived using the regimens suggested by Bayesian programs and target doses of the AUC of 400-499 and 500-600.

Characterization of B-cell receptor clonality and immunoglobulin gene usage at multiple time points during active SARS-CoV-2 infection.

Although monoclonal antibodies to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are known, B-cell receptor repertoire and its change in patients during coronavirus disease-2019 (COVID-19) progression is underreported. We aimed to study this molecularly. We used immunoglobulin heavy chain (IGH) variable region (IGHV) spectratyping and next-generation sequencing of peripheral blood B-cell genomic DNA collected at multiple time points during disease evolution to study B-cell response to SARS-CoV-2 infection in 14 individuals with acute COVID-19.

Racism: Eroding the health of Black communities.

Even in the context of major advances in medicine, racial minorities continue to suffer worse medical outcomes. Although race is defined as a social, nonscientific construct, researchers have continued to use it as proxy to explain genetic and evolutionary differences among patients. Poorer health outcomes among Black Americans are known to be related to the psychosocial and physiological stress of racism.

Critical Care Staffing in Pandemics and Disasters: A Consensus Report From a Subcommittee of the Task Force for Mass Critical Care - Systems Strategies to Sustain the Health Care Workforce.

Background: The COVID-19 pandemic has led to unprecedented mental health disturbances, burnout, and moral distress among health care workers, affecting their ability to care for themselves and their patients.

Research Question: In health care workers, what are key systemic factors and interventions impacting mental health and burnout?

Study Design And Methods: The Workforce Sustainment subcommittee of the Task Force for Mass Critical Care (TFMCC) utilized a consensus development process, incorporating evidence from literature review with expert opinion through a modified Delphi approach to determine factors affecting mental health, burnout, and moral distress in health care workers, to propose necessary actions to help prevent these issues and enhance workforce resilience, sustainment, and retention.

Results: Consolidation of evidence gathered from literature review and expert opinion resulted in 197 total statements that were synthesized into 14 major suggestions.

Role of the Advanced Practice Registered Nurse in Crisis Response.

As clinical leaders, advanced practice registered nurses are often called upon to respond to crises. Although frameworks for emergency preparedness and response have been established by the National Organization of Nurse Practitioner Faculties and the International Council of Nurses, the advanced practice registered nurse community is not consistently prepared to participate in crisis response. Merging of the previously established frameworks allows identification of additional opportunities for advanced practice registered nurses to be educated and engaged in emergency preparedness and all-hazards response, including preparation activities, communication, safety and security, incident management, assessment, intervention, and recovery.

Review of Autologous Fat Grafting in Postmastectomy Reconstruction Patients: Nonroutine Diagnostics and Oncologic Safety.

Unlabelled: Autologous fat grafting (FG) is increasingly used as an adjunctive reconstruction technique to augment volume, achieve symmetry, and improve contour deformities. This study aims to characterize the oncologic and surgical safety of FG in women undergoing autologous breast reconstruction (ABR) or implant-based reconstruction (IBR).

Methods: A retrospective chart review was performed for all patients undergoing FG at a multi-site single health system between 2015 to 2018.

Evaluating Medic Performance in Combat Casualty Care Simulation and Training: A Scoping Review of Prospective Research.

Introduction: Combat medics are required to perform highly technical medical procedures in austere environments with minimal error. Effective means to quantify medic performance in field and simulated environments are critical to optimize medic training procedures as well as to evaluate the influence of medical equipment and other supportive technologies on medic performance. Human performance evaluation in combat casualty care presents many unique challenges due to the unique environment (battlefields) and population (medics) that must be represented.

Structural racism, health disparities, and opportunities for PA practice.

Social determinants of health are rooted in structural racism. The healthcare community has long recognized the existence of significant race- and ethnicity-related health disparities. Yet pervasive disparities persist despite ongoing calls for institutions and healthcare professionals to promote health equity by addressing bias, discrimination, and social determinants of health.

Characteristics of Primary Care Providers' Consultations With a Statewide Child Psychiatry Access Program Regarding Autism Spectrum Disorder.

Background: Child Psychiatry Access Programs (CPAPs) provide consultative support for pediatric primary care providers (PCPs) to treat co-morbid mental health (MH) symptoms among patients with Autism Spectrum Disorder (ASD).

Objectives: We examined differences in illness severity, comorbidity, and psychotropic medication use between patients with and without ASD for whom primary care providers sought consultation from Maryland's CPAP.

Methods: We examined N = 3641 Maryland's CPAP consultations from 2012 to 2019; n = 311 were consultations for ASD.

Body-focused repetitive behaviors: Beyond bad habits.

Body-focused repetitive behavior (BFRB) is a significantly underrecognized phenomenon that can cause physical complications and marked mental distress. Understanding the condition and offering patients pharmacologic as well as psychotherapeutic support may effectively reduce adverse health outcomes. This article reviews BFRBs, which can present clinically in multiple settings.

Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies - A Preliminary Report of Findings From the Task Force for Mass Critical Care.

Background: After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world.

Research Question: A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality.

Triglyceride-lowering and anti-inflammatory mechanisms of omega-3 polyunsaturated fatty acids for atherosclerotic cardiovascular risk reduction.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death globally. Omega-3 polyunsaturated fatty acids (PUFAs) including eicosapentaenoic acid and docosahexaenoic acid have been extensively studied as both dietary supplement and pharmaceutical agent for the prevention of ASCVD. Epidemiological and retrospective studies have long shown the inverse relationship of omega-3 PUFA consumption and ASCVD event but results of previous large randomized controlled trials have not consistently shown the same effect.

Postoperative Rehabilitation of Posterior Glenohumeral Joint Instability Surgery: A Systematic Review.

Posterior glenohumeral (GH) joint instability is uncommon compared with anterior and multidirectional instability. A variety of surgical techniques are used to treat posterior GH instability. As a result, there are numerous rehabilitation protocols that vary greatly.

Factor VIII Inhibitor Bypassing Activity (FEIBA) Reversal for Apixaban and Rivaroxaban in Patients With Acute Intracranial and Nonintracranial Hemorrhage.

Background: The clinical use of factor VIII inhibitor bypassing activity (FEIBA) for factor Xa (FXa) inhibitor reversal is derived from small studies with notable variation in patient eligibility for use, dosage regimens, concurrent supportive care, and outcome measures. Consequently, additional effectiveness and safety data are warranted to expand the literature evaluating FEIBA for FXa inhibitor reversal.

Objective: This study sought to determine the incidence of observed effective hemostasis within 24 hours of post-FEIBA® administration as well as in-hospital and 30-day post-discharge incidences of thromboembolic event (TEE) and mortality between apixaban and rivaroxaban in the intracranial hemorrhage (ICH) and non-ICH populations.

The US Strategic National Stockpile Ventilators in Coronavirus Disease 2019: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices.

Background: Early in the coronavirus disease 2019 (COVID-19) pandemic, there was serious concern that the United States would encounter a shortfall of mechanical ventilators. In response, the US government, using the Defense Production Act, ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities, and whether all are able to support COVID-19 patients is not evident.

Battling Superstorm Sandy at Lenox Hill Hospital: When the Hospital Is Ground Zero.

In preparation for Superstorm Sandy, the emergency control center at Lenox Hill Hospital (LHH) was activated. Patients were evacuated safely to increase hospital capacity, including increased critical care beds, hospital equipment and supplies, including ventilators. A triage center was established in the emergency department at LHH.

Acute Tubular Necrosis Associated With High Serum Vancomycin and Tobramycin Levels After Revision of Total Knee Arthroplasty With Antibiotic-Containing Calcium Sulfate Beads.

We present the case of a 59-year-old male who developed acute tubular necrosis with a serum tobramycin level of 15.9 mg/L after instillation of tobramycin and vancomycin calcium sulfate beads for infected total knee arthroplasty. We emphasize standardizing surgical protocols to mitigate nephrotoxicity based on current efficacy and safety data.

Arthroscopic Untethering of the Fat Pad of the Knee: Release or Resection of the Infrapatellar Plica (Ligamentum Mucosum) and Related Structures for Anterior Knee Pain.

Anterior knee pain (AKP), a multifactorial symptom complex, can be successfully treated surgically. A specific diagnosis often cannot be made, but the pain is linked to an unrecognized common factor in most patients: the mechanical behavior of the non-isometric contents of the anterior compartment of the knee-the fat pad (FP) and infrapatellar plica (IPP). The objective of this presentation is to describe an effective arthroscopic technique that treats AKP by addressing this common factor.

Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper.

Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options.

Prevention of Pressure Ulcers Among People With Spinal Cord Injury: A Systematic Review.

Objectives: To evaluate the literature on the effectiveness of bed and wheelchair positioning and repositioning in the prevention of pressure ulcers (PUs) in both the spinal cord injury (SCI) and non-SCI populations.

Design: Systematic review.

Methods: PubMed, CINAHL, PsycINFO, and EMBASE were queried with the subject heading terms "pressure sore," "pressure ulcer," "position or turn in bed, wheelchair," "pressure relief," and "pressure release.