« Back

Open Thread – NPs and PAs are Handling Primary Care Visits

Angry Bear | September 23, 2023 7:30 am

Healthcare

Hot Topics

Open Thread: NPs and PAs are Handling Increasingly More Primary Care Visits, Medscape, Avery Hurt

“Healthcare Primary Care visits to NPs and PAs, also known as advanced practice providers, have been rising in recent years compared to doctor visits, according to the latest studies. The proportion of Medicare visits that NPs and PAs delivered nearly doubled in the 7-year period 2013-2019 (14% in 2013 to 26% in 2019), according to research published this month in the BMJ. “

Open Thread September 15, 2023, Will Union Auto Workers Strike? Angry Bear.

9 Comments

Fred C. Dobbs says:

September 23, 2023 at 11:02 am

My last hospitalization (and I have had several in recent years) was life-threatening and it was largely managed by a nurse-practitioner/’hospitalist’who happens to be one of my library patrons at the hospital where I volunteer. She was excellent. I expect not just because she knows me and depends on me to some extent.

Not all ‘hospitalists’ (who are licensed physicians but hospital employees) are that good.

But much physician-care at hospitals these days is provided by hospitalists. Perhaps somewhat like being treated by a resident.
- Fred C. Dobbs says:
  
  September 23, 2023 at 7:04 pm
  
  I should say that all hospitalists are licensed but not necessarily MDs.
  
  Obviously some are NPs and others are PAs I expect, still others are DOs.
  
  A hospitalist can be a doctor of medicine (MD), a doctor of osteopathic medicine (DO), or a physician’s assistant (PA) or an advanced nurse practitioner (APRN). A hospitalist engages and specializes in the care of patients, teaching, research and leadership in the field of hospital medicine. …
  - Bill Haskell says:
    
    September 23, 2023 at 9:10 pm
    
    Fred:
    
    The PAs and nurses took care of me after open heart surgery (yes, they found one). They remove the tubes from my belly in another room. The PA had his hands on the tubes. gripped them, yanked on them, and ducked. The liquids spattered the wall behind him. Very scientific removal . . .
    
    This is an open thread, you know? It is there for you and ltr. I like to have a subject on it, just in case.
JaneE says:

September 23, 2023 at 3:57 pm

For years my primary provider was a nurse practitioner. She was the one who found out I was pre-diabetic and got me into an education program that gave me a leg up on treating the disease before it got out of control. Once I went to full blown diabetic, they assigned me to a doctor because of their rules, not because my care was any less than excellent. Even now some of the routine stuff is actually overseen by practitioners not doctors.
- Bill Haskell says:
  
  September 23, 2023 at 9:07 pm
  
  Jane:
  
  I go to a Nurse Practitioner now. It is easier and she is just down the road from us. I have too many things going on right now. Working on my teeth (broke one on an onion ring). Gums are good, just old teeth. Cataract removed from one eye and retinal surgery on it. The other eye on the 4th and an easier fix. Those are the recent issues. Next Hematologist and Cardiologist.
  
  The general practice care is excellent.
Fred C. Dobbs says:

September 25, 2023 at 2:20 pm

This being an Open Thread…

Mammals’ Time on Earth Is Half Over, Scientists Predict

NY Times – Sep 25

A new model suggests that in 250 million years, all land will collide into a supercontinent that boosts warming and pushes mammals to extinction.

It’s been about 250 million years since reptile-like animals evolved into mammals. Now a team of scientists is predicting that mammals may have only another 250 million years left.

The researchers built a virtual simulation of our future world, similar to the models that have projected human-caused global warming over the next century. Using data on the movement of the continents across the planet, as well as fluctuations in the chemical makeup of atmosphere, the new study projected much further into the future.

Alexander Farnsworth, a paleoclimate scientist at the University of Bristol who led the team, said that the planet might become too hot for any mammals — ourselves included — to survive on land. The researchers found that the climate will turn deadly thanks to three factors: a brighter sun, a change in the geography of the continents and increases in carbon dioxide.

“It’s a triple whammy that becomes unsurvivable,” Dr. Farnsworth said. He and his colleagues published their study on Monday in the journal Nature Geoscience. …
- Fred C. Dobbs says:
  
  September 25, 2023 at 2:24 pm
  
  Climate extremes likely to drive land mammal extinction during next supercontinent assembly
  
  Nature Geoscience – Sep 25 – PDF available
rjs says:

September 25, 2023 at 8:38 pm

being that this is a health care open thread,

Potential link found between Merck antiviral and mutated COVID strains

A new study published Monday links COVID-19 antiviral created by Merck with new mutations of the virus that have been sequenced around the world.

Molnupiravir, known commercially as Lagevrio, is one of two COVID-19 antivirals authorized for treating coronavirus infections along with Paxlovid from Pfizer. The drug works by inducing mutations in the virus’s cells as it replicates, resulting in random mutations that are harmful to the virus and cuts down on its viral load.

Researchers from the U.K. and South African delved into the question of where some mutated variants may have occurred, given that some have been found with seemingly random mutations, and whether molnupiravir may have contributed to the rise of some strains.

In the study published in the Nature science journal, researchers looked at available data from patients who were treated with molnupiravir and those who were not. Their findings confirmed the drug’s ability to cause high rates of mutations in the virus, and they noted that a “high proportion” of these mutations are likely to be hazardous to the virus.

They also looked at sequenced COVID-19 genomes from global databases and narrowed down mutations that were only sequenced in 2022, after molnupiravir became available, and found that many of the sequences were consistent with mutations that were found in patients treated with the antiviral.

They cited a specific type of mutation that rarely occurs in natural SARS-CoV-2 evolution but which they note is induced through the use of molnupiravir. High rates of the specific mutation which researchers associated with molnupiravir use were found in populations of countries where use of the treatment was higher, such as in seniors in Australia where retirement homes were stocked with the drug.

The study put forward that molnupiravir may increase genomic diversity in the viral cells that survive the hazardous mutations brought on by the drug, expanding the variety from which SARS-CoV-2 can select from for future changes.

“Importantly, the divergence of the molnupiravir mutation spectrum from standard SARS-CoV-2 mutational dynamics might allow the virus to explore the fitness of distinctive parts of the possible genomic landscape to those it is already widely exploring in the general population,” the study stated.

“Molnupiravir-induced mutation could also potentially allow infections to persist for longer by creating a more varied target for the immune system.”
rjs says:

September 25, 2023 at 8:45 pm

while i’m at it, here’s the update on Covid i included with a couple of the newsletters i sent out yesterday:

briefly, the CDC reported 20,538 new hospital admissions for Covid for the week ending September 9th, a 7.7% increase from the prior week, and 95.6% higher than five weeks ago…they also report that Covid accounted for 2.7% of US deaths during the week ending September 16th, which is up from an upwardly revised 2.4% of all deaths the prior week, and up 170% from 6 weeks ago, when Covid was only accounting for 1.0% of US deaths…confirmed deaths due to Covid, as pulled from their deaths by week graph, shows there were 959 deaths due to Covid during the week ending August 26th, up from 887 during the week ending August 19th, which was previously reported at 844…

meanwhile, Biobot’s most recent data on Covid in US wastewater appears to have been revised upward, but it is still trending lower…it now shows there were 608 copies of the Covid virus per ml of US wastewater during the week of September 13th, down 4.9% from 639 copies per ml during the week ending September 6th, but well up from the 165 copies per ml of wastewater shown for the week ending June 21st…a drop in the virus concentration in the South, from 633 copies per ml for the week ending September 6th to 518 per ml for the week ending September 13th, is driving the national totals lower; virus concentrations elsewhere are still rising slowly, led by the Northeast, where virus levels have risen to 739 copies per ml of wastewater, up from 722 per ml the prior week… Biobot should be updating its data for the week ending September 20th soon, so you might want to check it later today or tomorrow..