The Clinical Advisor

The Clinical Advisor Stay in touch with the latest information about diagnosing, treating, managing, and preventing conditions seen in a typical office-based primary-care setting.
The Clinical Advisor is a monthly journal for nurse practitioners and physician assistants in primary care.

Elderly patients with #GERD can clinically present differently than younger patients and their management may therefore ...
01/10/2020
GERD and the Elderly Patient: Clinical Considerations - Clinical Advisor

Elderly patients with #GERD can clinically present differently than younger patients and their management may therefore vary. Learn more about managing older patients with GERD in our latest feature.

Elderly patients have a higher tolerance for GERD symptoms compared with younger patients; therefore, these symptoms may be under-reported.

The #holidays are arguably the most stressful time of year. Check out these 5 tips in order to manage the hustle and bus...
12/20/2019
5 Tips for Taming Stress During the Holidays - Clinical Advisor

The #holidays are arguably the most stressful time of year. Check out these 5 tips in order to manage the hustle and bustle and make the holidays a breeze!

The holidays can be the most stressful time of year, but these tips will help you manage the hustle and bustle with ease.

In this month's Legal Advisor feature, a nursing staff failed to diagnose a 7-year-old boy, leading to an amputation.
12/13/2019
An Issue of a Missed Diagnosis - Clinical Advisor

In this month's Legal Advisor feature, a nursing staff failed to diagnose a 7-year-old boy, leading to an amputation.

Three trips to the emergency department failed to diagnose compartment syndrome in a young boy following a trampoline injury.

To prevent the progression of CKD to end-stage renal disease, prompt identification and referral by primary care provide...
12/11/2019
How to Recognize Chronic Kidney Disease in Primary Care - Clinical Advisor

To prevent the progression of CKD to end-stage renal disease, prompt identification and referral by primary care providers is essential. Learn more about identifying #CKD in primary care in our latest feature.

Unchecked, CKD will progress to end-stage renal disease, an advanced form of CKD that necessitates renal replacement therapy.

12/01/2019

In honor of World Aids Day 2019, our latest feature discusses prevention methods for HIV infection among men who have sex with men #WAD2019 http://ow.ly/mAGz50xltk9

Pneumonia in older adults remains a leading cause of morbidity, mortality, and increased healthcare costs. Although #pne...
11/25/2019
Pneumococcal Vaccine in Older Adults: A Primary Care Approach to Increasing Uptake - Clinical Advisor

Pneumonia in older adults remains a leading cause of morbidity, mortality, and increased healthcare costs. Although #pneumonia is considered a vaccine-preventable disease, the annual incidence of the disease remains high because of low #vaccination rates. Read more about increasing vaccination rates in our latest feature.

Because of low vaccination rates, approximately 5.6 million cases of community-acquired pneumonia occur in the United States annually.

The holidays are around the corner which means food and drinks galore! For those of us with #IBS, the #low-FODMAP diet m...
11/20/2019
Low FODMAP Diet in Irritable Bowel Syndrome: Controversies and Practicality - Clinical Advisor

The holidays are around the corner which means food and drinks galore! For those of us with #IBS, the #low-FODMAP diet may show significant benefit although it may be challenging to maintain. Check out some of the latest research of the FODMAP diet for IBS here.

Further studies will need to look at different subtypes of IBS (IBS-diarrhea, IBS-constipation, IBS-mixed) and improved breath testing, as well as evaluating underlying gut microbiome profiles and how they may affect a response to a low FODMAP diet.

A nurse accesses a patient census list from her home, resulting a citation for violating the hospital's security code of...
11/15/2019
Privacy Violation Without a HIPAA Breach - Clinical Advisor

A nurse accesses a patient census list from her home, resulting a citation for violating the hospital's security code of conduct. Read more about this month's Legal Advisor case here.

Remotely accessing patients’ protected health information puts a nurse in a precarious position.

Within the past decade, #cannabidiol has become a fixture in the health supplement industry. CBD products are now easily...
11/07/2019
CBD: A Primer for the PCP - Clinical Advisor

Within the past decade, #cannabidiol has become a fixture in the health supplement industry. CBD products are now easily found in retail settings and are associated with health claims ranging from analgesia to cancer prevention, often without scientific evidence to support the claims. Read more about #CBD in this month's online first feature.

Clinicians are routinely asked by their patients if CBD products are safe and effective, but research is lagging behind public acceptance.

While it is known that the human microbiome has an impact on disease, this relationship has not been robustly studied un...
10/22/2019
Fecal Microbiota Transplant in the Treatment of Obesity - Clinical Advisor

While it is known that the human microbiome has an impact on disease, this relationship has not been robustly studied until recently. Learn more about microbiome's role in the treatment of #obesity in this month's online first clinical feature.

The human gut microbiota has been identified as a metabolic organ having a significant effect on host metabolism.

Is the gender wage gap among nurse practitioners and physician assistants narrowing, expanding, or remaining steady? We ...
09/24/2019
Gender Wage Gap: 2019 Salary Survey Takeaways - Clinical Advisor

Is the gender wage gap among nurse practitioners and physician assistants narrowing, expanding, or remaining steady? We analyzed recent salary survey findings to identify potential trends.

It's a question on the mind of NPs and PAs everywhere: is the gender wage gap narrowing? We explore takeaways from our 2019 survey.

Esophageal esophagitis is a chronic relapsing, remitting disease without cure requiring long-term, routine therapy to pr...
09/13/2019
Eosinophilic Esophagitis: A Chronic Allergic Disease - Clinical Advisor

Esophageal esophagitis is a chronic relapsing, remitting disease without cure requiring long-term, routine therapy to prevent recurrence. Read more about this allergic disease in our latest clinical feature:

Eosinophilic esophagitis is marked by an inflammatory cascade that leads to subepithelial fibrosis and esophageal dysmotility.

Chronic pancreatitis is a debilitating disease that is associated with approximately $150 million in healthcare expense ...
08/12/2019
Chronic Pancreatitis: Challenging to Diagnose, Difficult to Treat - Clinical Advisor

Chronic pancreatitis is a debilitating disease that is associated with approximately $150 million in healthcare expense annually. It is a complicated disease in that it is multifactorial, problematic to diagnose, and difficult to treat. Read more about this condition in our latest online first feature.

Chronic pancreatitis stems from a variety of pathogenic entities that result in chronic inflammation, fibrosis, and irreversible damage to the pancreas.

According to the CDC, an essential step in ending the HIV epidemic is routinely screening all patients for HIV and linki...
08/06/2019
Ending the HIV Epidemic Starts With HIV Screening - Clinical Advisor

According to the CDC, an essential step in ending the HIV epidemic is routinely screening all patients for HIV and linking people who test positive to treatment and people who test negative to prevention resources, including pre-exposure prophylaxis and syringe service programs. Read more about ending the #HIV epidemic in our August feature:

CDC report calls for increased HIV screening to reduce new infections.

In 2017, the National Institutes of Health (NIH) declared COPD one of the most urgent health care problems facing Americ...
07/15/2019
Chronic Obstructive Pulmonary Disease: Fighting for Each Breath - Clinical Advisor

In 2017, the National Institutes of Health (NIH) declared COPD one of the most urgent health care problems facing Americans. Since 1969, the death rate for COPD has doubled; however, that the number of deaths attributed to other chronic conditions has declined. Chronic lower respiratory disease, primarily COPD, is projected to be the third leading cause of death by 2020. Learn more about #COPD in our latest feature here:

As primary care clinicians are on the front lines of care for patients with COPD, they should educate them on the disease process, medication regimens, and nonpharmacologic treatments.

A nurse is fired after a social media post breaches a hospital's privacy policy. Read more in this month's Legal Advisor...
06/17/2019
Social Media Post Prompts Firing - Clinical Advisor

A nurse is fired after a social media post breaches a hospital's privacy policy. Read more in this month's Legal Advisor feature.

An RN’s post online violates a patient’s privacy, and she is fired.

Tickborne diseases in the United States are a significant public health problem, and in the past 50 years scientists hav...
06/07/2019
Emerging Tickborne Illnesses: Beyond Lyme Disease - Clinical Advisor

Tickborne diseases in the United States are a significant public health problem, and in the past 50 years scientists have detected at least a dozen new such infections. Learn more about the diagnosis and management of tickborne illnesses in our June feature article.

Although most providers are familiar with the symptoms of Lyme disease, coinfection with other tickborne illnesses such as babesiosis, human granulocytic anaplasmosis, and human monocytic ehrlichiosis is possible and becoming more prevalent.

Fournier gangrene is a rare and potentially fatal form of necrotizing fasciitis requiring rapid recognition and early su...
05/13/2019
Fournier Gangrene: A Rare Flesh-Eating Disease - Clinical Advisor

Fournier gangrene is a rare and potentially fatal form of necrotizing fasciitis requiring rapid recognition and early surgical intervention. Learn more about the condition in our online first feature inside:

Prompt identification of Fournier gangrene is essential, as the condition can have numerous life-threatening complications such as multi-organ failure and death.

Guideline Update: The #USPSTF has updates the guidelines for blood lead level screening in children and pregnant women. ...
04/25/2019
Blood Lead Level Screening in Children, Pregnant Women: Updated Guidelines From the USPSTF - Clinical Advisor

Guideline Update: The #USPSTF has updates the guidelines for blood lead level screening in children and pregnant women. We break down the recommendations here: http://ow.ly/eQrF50rr5NC

The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children and pregnant women.

According to a @ConsumerReports survey, approximately 64 million Americans have tried CBD in the past 2 years. As the po...
04/23/2019
CBD & Acne: 4 Questions Your Patients Might Ask - Clinical Advisor

According to a @ConsumerReports survey, approximately 64 million Americans have tried CBD in the past 2 years. As the popularity of CBD increases, so do the chances your patients will inquire about it. We review 4 questions about CBD and acne you might be asked.

CBD is gaining popularity in the United States, but should it be used to treat acne? We list 4 questions your patients may ask about CBD.

A recent survey of pharmacists show that drug shortages in the United States have become a widespread problem. The U.S. ...
04/08/2019
Drug Shortages Rampant in US: FDA Unveils Plan - Clinical Advisor

A recent survey of pharmacists show that drug shortages in the United States have become a widespread problem. The U.S. Food and Drug Administration has unveiled a response to this issue, detailing steps that the organization is taking to minimize the impact of #drugshortages and restore critical medicines.

Drug shortages are a widespread problem in the United States, according to a national survey. The FDA unveiled a plan to address the issue.

Amid the biggest measles outbreak in recent history, New York State lawmakers proposed legislation to combat anti-vax pa...
03/18/2019
Teens of Anti-Vax Parents Fighting to Get Vaccinated - Clinical Advisor

Amid the biggest measles outbreak in recent history, New York State lawmakers proposed legislation to combat anti-vax parents’ refusal to vaccinate their kids. Meanwhile, some teens are seeking information on how to vaccinate without parental consent. We break it all down.

Amid the anti-vaccine movement, some teens of anti-vax parents are taking matters into their own hands, seeking information on how to vaccinate.

For optimal results when treating patients with atopic dermatitis, a multifaceted approach should be used for management...
03/12/2019
The Practitioner’s Guide to Atopic Dermatitis - Clinical Advisor

For optimal results when treating patients with atopic dermatitis, a multifaceted approach should be used for management of patients with atopic dermatitis. Read more about diagnosis and treatment of patients presenting with atopic dermatitis in our online first feature!

For optimal results, a multifaceted approach should be used for management of patients with atopic dermatitis.

Because opioid-induced #constipation is one of the most frequently reported side effects of chronic #opioid therapy, and...
02/11/2019
Opioid-Induced Constipation: Insights Into Diagnosis and Effective Treatment

Because opioid-induced #constipation is one of the most frequently reported side effects of chronic #opioid therapy, and opioid use is so common, clinicians must be cognizant of this issue and be comfortable with its diagnosis and management. Read more about opioid-induced constipation in our latest feature!

Conventional approaches to treatment of opioid-induced constipation (OIC) include the use of treatment modalities that address non-opioid-related constipation as well as several relatively new medications that specifically target the OIC mechanism of action.

World Health Organization (WHO) listed #vaccine skepticism one of the top threats to global health in 2019. Researchers ...
01/24/2019
WHO Names Anti-Vax Top Health Threat: Hysteresis May Describe Movement

World Health Organization (WHO) listed #vaccine skepticism one of the top threats to global health in 2019. Researchers at Dartmouth explained that a certain phenomenon may describe persistent refusal to vaccinate. We explore the investigators’ findings and what they might mean from a public health perspective.

WHO named vaccine hesitancy a threat to global health. Hysteresis may describe persistent skepticism.

Early treatment of both visible AK lesions and nonvisible sun-damaged skin can eliminate the potential for malignant tra...
01/15/2019
Actinic Keratoses: Field Cancerization and Photodynamic Therapy

Early treatment of both visible AK lesions and nonvisible sun-damaged skin can eliminate the potential for malignant transformation and decrease the burden of cutaneous squamous cell carcinoma. Read our latest feature online ahead of print, and take the poll!

Early treatment of both visible AK lesions and nonvisible sun-damaged skin can eliminate the potential for malignant transformation and decrease the burden of cutaneous squamous cell carcinoma.

A visit to a primary care provider for routine evaluation uncovers an incidental finding of hypercalcemia. Read more abo...
01/04/2019
Hypercalcemia: An Incidental Finding in a Postmenopausal Woman

A visit to a primary care provider for routine evaluation uncovers an incidental finding of hypercalcemia. Read more about this patient's case in our January feature article:

A visit to a primary care provider for routine evaluation uncovers an incidental finding of hypercalcemia.

The National Commission on Certification of Physician Assistants (NCCPA) is launching a pilot program that will allow #P...
11/13/2018
Online PA Recertification Course Offers an Alternative to PANRE

The National Commission on Certification of Physician Assistants (NCCPA) is launching a pilot program that will allow #PhysicianAssistants to recertify online. What are some potential benefits of the program? How might it change the way PAs go about recertification? We break it all down.

The NCCPA is launching a pilot online recertification program that will offer physician assistants an alternative to PANRE.

Health officials are searching for answers regarding acute flaccid myelitis (AFM), a rare but serious polio-like disease...
11/05/2018
AFM: Outbreak of Polio-Like Disease Causing Paralysis in Children

Health officials are searching for answers regarding acute flaccid myelitis (AFM), a rare but serious polio-like disease that may lead to paralysis. We are in the midst of a surge in #AFM cases in the United States. In this article, we provide an update on the recent outbreak and present recent scientific theories about what causes the illness.

Health officials aren't sure what causes acute flaccid myelitis (AFM), a rare but serious polio-like disease that may lead to paralysis.

Although #ASCVD rates in the US and other developed countries have decreased by half in the past 30 years, rates in Sout...
10/25/2018
Risk Factors for Atherosclerotic Cardiovascular Disease in the South Asian Population

Although #ASCVD rates in the US and other developed countries have decreased by half in the past 30 years, rates in South Asians have doubled in the past 20 years. Read more about the risk of ASCVD in South Asians in our latest feature!

South Asians exhibit the highest rates of ASCVD among all ethnic groups, and the highest prevalence is in younger age groups; up to 25% of myocardial infarctions in India occur in individuals younger than 40 years of age.

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Re your article on the Opiate Epidemic, get a dose of Reality and see that it's the abusers who prevent honest people from getting the help they need.