Around the world, communities of faith are much more than a sanctuary. They provide a space for healing and hope. As religious exemptions for vaccination have taken on a new fervor, the critical role of faith-based institutions in implementing public health policies has become lost in the message.

 

In California, sympathetic and misguided clinicians face a great deal of scrutiny for falsifying medical exemptions for their COVID-19 vaccine-resistant patients. This op-ed explores one such attempt through the lens of standing one's ethical ground while still encouraging vaccination through empathy and compassion.

The nature of the Advanced Practice Provider (APP) and attending physician (MD) relationship is that of trust, mutual respect, and delegation. In U.S. territories where MD supervision or oversight of APP practice is required by law, MDs are left to trust and delegate patient care tasks and authority to their collaborating APPs while sharing medical liability. While effective collaborating relationships are of great importance for MD/APP hospitalist teams, there are few guidelines or evidence supporting ideal collaborative care. At our hospital, we undertook a process to better understand the ideal levels of autonomy and collaboration on MD/APP hospitalist teams across various domains of care.

This is a single case of a 65-year-old American woman who presented with substantial weight gain and insulin resistance (IR) post-Roux-en-Y gastric bypass (RYGB) surgery. Before RYGB, she had reached 340 lbs (155 kg) and a body mass index (BMI) of 56.6 kg/m². The surgery resulted in a 70 lbs (32 kg) weight loss, bringing her BMI, per cent total weight loss (%TWL) and per cent excess weight loss (%EWL) to 44.9 kg/m², 20.6% and 36.8%, respectively. Unfortunately, her BMI would return to 53.6 kg/m², nearly her pre-RYGB BMI. It was then she sought the guidance of a primary care physician with expertise in nutrition and medical management of obesity, who placed her on a ketogenic diet. One year later, she had lost 102 lbs (46.4 kg), resulting in a BMI, %TWL and %EWL of 36.6 kg/m², 31.7%, and 63.1%, respectively, also further resulting in significant improvements of her inflammatory biomarkers. This case presentation will explore current literature, covering the effects of obesity on IR, pre-diabetes and other disease-provoking inflammatory biomarkers.

Acute OE rarely requires systemic antibiotic therapy. However, early indentification of the causative pathogen and expedient care are needed for effective resolution.

Medi-spas (aka: medical spas) are currently under much crossfire due to many illegally operated facilities opening up all over the country and overseas. While there are many that operate legally under current law, there are others that continue to perform medical procedures without the supervision of physicians or other licensed providers, such as nurse practitioners and physician assistants. This constitutes a significant patient safety issue in the US and abroad. While there are no national standards for medi-spas, there is debate surrounding legislation in California, where lack of physician supervision is being addressed. However, this legislation is being met with much opposition. Implementation of this legislation will be met with great obstacles, such as, the sheer magnitude of the problem and financial limitations. With patient safety at its heart, this legislation is well worth the effort.

Cardiovascular disease is the leading cause of morbidity and mortality in the US. The exercise stress test (EST) remains the most widely used and cost-effective mode of cardiac testing available. Before performing an EST, the clinician must explore its indications, relative indications, and contraindications as well as identify other possible invasive and noninvasive alternatives. Indications for the exercise stress test can be subdivided into three classes: class 1, conditions for which there is general agreement that EST is justified; class II, conditions for which EST is frequently used but for which there is a divergence of opinion with respect to the value and appropriateness; and class III, conditions for which there is general agreement that EST is of little or no value, inappropriate, or contraindicated by risk. Some patients require alternative exercise testing modalities such as myocardial perfusion imaging, exercise radionucleotide angiography, exercise echocardiography, or pharmacologic stress testing.