4965 research outputs found
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Wilderness Therapy as an Intervention for Teens Who Are at the End of Their Rope
No full textAbstract
Wilderness therapy, treatment offered in a natural setting, is offered as an alternative to traditional treatment methods (Lodato, N., Blivas, R., & Blivas, N. L. and R., 2024). This model is often used as a last resort for teens who are unsuccessful in other environments. However, when used as a blanket treatment model for all mental health concerns, there is a risk for greater harm inflicted on participants. A case study approach provides evidence of a teen in one of these settings struggling with an eating disorder and self-harm. Although potentially helpful with some concerns, we learn from this study that those certain mental health diagnoses should not be addressed in a wilderness setting.
Key Words: troubled teen industry, wilderness therapy, therapeutic boarding schools, youth, case stud
Subcutaneous Insulin Use in Diabetic Ketoacidosis
No full textThe reviewed literature focuses on the clinical application of subcutaneous (SQ) insulin, particularly rapid-acting insulin analogs (RAIAs), in treating selected patients with mild to moderate diabetic ketoacidosis (DKA). The use of SQ insulin offers a viable alternative to traditional intravenous (IV) insulin infusions, enabling DKA management outside intensive care unit (ICU) settings and reducing healthcare resource utilization. Current DKA management protocols emphasize comprehensive fluid resuscitation and correction of electrolyte imbalances, with IV regular insulin administered at 0.1 units/kg/hour. This review synthesizes findings from multicenter cohort studies, meta-analyses, and randomized controlled trials (RCTs) available via PubMed, focusing on adult patients diagnosed with mild to moderate DKA. The primary outcome was time to DKA resolution, while secondary outcomes included hospital and ICU length of stay, rates of hypoglycemia, and operational efficiency.
Findings indicate that SQ insulin regimens using RAIAs demonstrate efficacy similar to IV regular insulin infusions, achieving comparable rates of DKA resolution, total insulin use, and hospital stay lengths. Notably, IV protocols were associated with higher hypoglycemia rates. Meta-analyses corroborate these findings, indicating that SQ RAIAs and IV regular insulin are equally effective and safe for resolving DKA, with no significant differences in hypoglycemia or recurrence rates. SQ insulin protocols also yield operational benefits, such as reduced emergency department length of stay and lowered ICU admission rates, marking a potential shift in DKA management strategies. The American Diabetes Association (ADA) endorses SQ RAIAs as a safe and effective option for treating mild to moderate DKA, stressing the necessity of proper patient selection and monitoring to optimize outcomes. While SQ regular insulin can be an option for select patients, RAIAs are the preferred choice according to most guidelines. Frequent patient monitoring and fluid management remain critical for successful treatment
Policy, Misinformation, and Mortality: The Effects of Abortion Restrictions on Maternal Outcomes
No full textThe objective of this review is to evaluate the effects of restrictive abortion laws on maternal mortality and morbidity in the United States. Even before the landmark reversal of Roe v. Wade, the US had one of the highest maternal mortality rates among other high-income countries, and rates are expected to continue to rise in states with restrictive abortion policies. Electronic databases and public health data were analyzed to assess clinical outcomes, access to care, and disparities associated with abortion restrictions nationally and internationally. The findings suggest that states with highly restrictive abortion policies experience higher rates of maternal morbidity and mortality and delayed or denied care for pregnancy-related complications. These laws disproportionately impact marginalized populations, including those with low income, people of color, and rural residents, exacerbating existing health disparities. Additionally, restrictive legislation creates legal and clinical uncertainty, hindering timely, evidence-based decision-making by clinicians and contributing to the criminalization of standard obstetric care in some cases. International comparisons support these trends; in countries enforcing strict abortion bans, similar outcomes were found. While this review highlights significant negative health outcomes associated with abortion restrictions, it also underscores the urgent need for evidence-based reproductive health policies that prioritize maternal safety and health equity and call for ongoing advocacy to protect access to comprehensive reproductive healthcare.
Keywords: abortion laws, maternal mortality, maternal morbidity, reproductive health policy, health disparities, health policy
Grover\u27s Disease: A Review of the Current Treatment Options
No full textGrover’s disease, also known as transient acantholytic dermatosis, is an uncommon dermatologic condition characterized by pruritic papulovesicular eruptions that predominantly affect the trunk of older adults. Although the disease is often self-limited, it may significantly impair quality of life. This review summarizes treatment options and emerging therapies for Grover’s disease reported in the literature since 2019. A comprehensive search of PubMed and MEDLINE identified 1,068 records, of which thirteen publications met inclusion criteria, including one systematic review, one narrative review, one nonrandomized controlled study, nine case reports, and one fact sheet, representing a total of 337 patients. The literature demonstrates the absence of a standardized treatment approach; however, several therapeutic classes show clinical benefit. First-line therapies commonly include topical corticosteroids, emollients, topical vitamin D analogs, and antihistamines, while second-line options include oral retinoids, systemic corticosteroids, phototherapy, and antibiotics, particularly tetracyclines. Emerging therapies, including biologic agents such as etanercept and dupilumab, have shown potential benefit in patients with severe or treatment-refractory disease. Overall, management of Grover’s disease remains largely symptom-directed. Additional research is needed to further understand disease mechanisms and to establish evidence-based treatment guidelines
Understanding Monoclonal Gammopathy of Undetermined Significance
No full textMonoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder characterized by serum monoclonal protein (M-protein) levels less than 3.0 g/dL, less than 10% plasma cells in the bone marrow, and absence of end-organ damage. It mainly affects older adults and is often an incidental finding. While most cases remain indolent, a subset progresses to malignancies such as multiple myeloma, smoldering myeloma, AL amyloidosis, lymphoproliferative disorders, macroglobulinemia, and monoclonal gammopathy of renal significance. This review summarizes current insights into MGUS pathophysiology, risk factors, molecular mechanisms, clinical features, diagnostic approaches, including laboratory assessments and imaging, and emphasizes early detection of progression. It explores management strategies and emerging therapies, such as celecoxib and glucagon-like peptide-1 receptor agonists (GLP-1 RA) aiming to delay or prevent transformation. Future directions focus on refining screening and developing personalized therapies to improve outcomes
Management of Difficult Patient Situations
No full textThe purpose of this paper is to provide strategies for clinicians to manage difficult patient interactions. A comprehensive search of PubMed was conducted, identifying articles that identified the root cause of difficult patient interactions and assessed methods for successfully navigating these situations. The term “difficult patient” reflects the interaction of patient behavior, clinician perception, and systemic constraints rather than an inherent patient flaw. Effective management involves reframing difficult behavior as an expression of unmet needs and responding with empathy, active listening, clear boundaries, and collaborative decision-making. System-level strategies reduce patient distress and clinician burnout. Ultimately, the difficult patient represents strained relationships within constrained healthcare systems, best addressed through communication and organizational support that foster trust and patient-centered care. Future research should investigate systemic and relational factors shaping perceptions of difficult patients, including clinician burnout and implicit bias. Studies should evaluate interventions such as communication training, empathy enhancement, and motivational interviewing on provider well-being and patient outcomes. Exploring patient perspectives may reveal structural inequities and support more equitable approaches to care. Developing validated tools to identify high-risk interactions could enable early intervention, helping healthcare systems prevent conflict and promote sustainable patient-centered care
Transcarotid Artery Revascularization Current Role and Outcomes
No full textThis paper aims to evaluate the role of transcarotid artery revascularization (TCAR) in the management of carotid artery stenosis. A comprehensive literature search was conducted using PubMed to identify the role and current outcomes of TCAR compared to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Carotid artery stenosis accounts for a significant portion of ischemic strokes. The global burden of stroke includes permanent disability and death. Medical and surgical interventions following ischemic stroke are aimed at reducing the future incidence of ischemic stroke based on the underlying etiology. Symptomatic carotid artery stenosis management includes optimal medical management and carotid artery revascularization with CEA or carotid artery stenting (CAS). Historically, CAS has been performed from the transfemoral route, requiring manipulation of the aortic arch, resulting in an increased risk of periprocedural stroke compared to CEA. As a result, CEA has been considered the gold standard for treating carotid artery stenosis. TCAR offers an alternative approach to carotid artery revascularization. The TCAR procedure utilizes a neck incision to access the common carotid artery, avoiding the aortic arch, and a flow reversal system for neuroprotection. This article aims to evaluate the role and outcomes of TCAR in carotid artery revascularization, primarily in high-risk symptomatic patients. Further research is needed to determine the role of TCAR in managing both standard-risk and high-risk patients with asymptomatic and symptomatic carotid artery stenosis, as well as to assess the long-term outcomes of TCAR.
Keywords: carotid artery stenosis, carotid endarterectomy, transfemoral carotid artery stenting, transcarotid artery revascularization, ischemic stroke
Genetic Adaptations and Malaria Prophylaxis in Sickle Cell Disease: Reducing Morbidity and Mortality
No full textThis study examines the relationship between sickle cell disease (SCD) and malaria, focusing on the benefits and risks of the sickle cell trait, complications associated with SCD, and the impact of malaria infection in endemic regions. The paper emphasizes the importance of antimalarial prophylaxis for patients with SCD living in these areas. Evidence suggests a genetic adaptation in populations exposed to malaria, where a β-globin mutation provides partial protection against infection in individuals with the sickle cell trait. Studies consistently show that heterozygous carriers are largely protected from severe malaria, whereas individuals with homozygous SCD remain highly susceptible, resulting in malaria-related complications and, in severe cases, death. These findings underscore the need for malaria chemoprophylaxis to reduce morbidity and mortality in SCD.
Given malaria’s global health burden, integrating prophylaxis into SCD management is crucial to lowering morbidity and mortality. Sickle cell–related complications, such as painful crises, significantly affect quality of life, and minimizing these through preventive strategies offers a clear benefit. Future research should focus on identifying biomarkers for prophylaxis and vaccine development, predicting malaria severity in SCD, and clarifying the role of malaria parasites in triggering sickling. Further investigation is also warranted to determine whether hydroxyurea—currently the cornerstone of SCD therapy—affects malaria infection rates in individuals affected by SCD.
Keywords: sickle cell trait, sickle cell disease, genetic mutation, malaria, malaria chemoprophylaxi
Physician Assistants and the Medical Science Liaison Role: Expanding Career Pathways Beyond Clinical Practice
No full textABSTRACT
The purpose of this article is to examine how physician assistants can transition into Medical Science Liaison roles within the pharmaceutical and biotechnology industries. Growing interest in nonclinical career pathways has prompted more physician assistants to explore opportunities in medical affairs, yet many remain uncertain about the qualifications, expectations, and academic preparation associated with these positions. A focused literature review was conducted to evaluate the competencies required for Medical Science Liaison roles, the barriers clinician applicants often encounter, and the strategies that may support successful transition into industry-based careers. Findings show that physician assistants possess relevant strengths such as clinical reasoning, scientific literacy, and communication ability, but face obstacles that include limited exposure to pharmaceutical industry functions and longstanding assumptions about preferred academic backgrounds. Engagement in research, scientific communication, networking, and continuing professional development can support readiness for industry roles, while doctoral education may provide structured scholarly preparation that enhances academic credibility and competitiveness for physician assistants pursuing medical affairs positions. Increasing awareness of medical affairs within PA education and professional development may help broaden career opportunities for the profession, and this article highlights the need for further research, mentorship, and structured pathways to support physician assistants seeking non-clinical roles within the pharmaceutical and biotechnology sectors
Circulating Tumor DNA: Reducing Burden in HPV+ Oropharyngeal Cancer Surveillance
No full textThis review examines the rising prevalence of human papillomavirus-related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) and evaluates the role of circulating tumor HPV DNA (ctHPVDNA) in diagnosis and post-treatment surveillance. A comprehensive literature search of electronic databases, including PubMed, Medline, Cochrane Library, and Google Scholar, identified studies that validated ctHPVDNA as a biomarker with high sensitivity and specificity, assessed its cost-effectiveness, and explored patient and provider perceptions. Clinical evidence supports that plasma-based ctHPVDNA is the most accurate method for detecting disease recurrence and quantifying tumor burden. Patient perception studies reported high confidence in ctHPVDNA testing, while providers viewed it as broadly beneficial, advocating for judicious utilization and further investigation into false negative results. Limitations included variability in test sensitivity for specific patients and the need for standardization of testing intervals. Ultimately, ctHPVDNA shows promise to supplement or replace current surveillance methods, which rely heavily on costly imaging and exams. Incorporating ctHPVDNA into routine surveillance could enhance early recurrence detection, expand access to care in rural populations, promote health equity, and reduce the economic burden of HPV+ OPSCC care