Disease-a-month : DM
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Disease-a-month : DM · Jan 2021
ReviewA review of procedural skills performed by advanced practice providers in emergency department and critical care settings.
Advanced practice providers (physician assistants and nurse practitioners) are part of the interdisciplinary teams integral to successful care and improved outcomes for acutely ill patients in intensive care units and emergency departments. Between physician shortage and increased complexity of patients with often rapidly deteriorating conditions, the addition of advanced practice providers and expansion of acute care provider roles result in positive outcomes including decreased hospital length of stay, improved continuity of care, decreased hospital costs and increase inpatient, physician and staff nurses job satisfaction. This article attempts to examine the role that advanced practice providers (APPs) play in performing diagnostic and therapeutic procedures in acute care settings, education provided in physician assistant (PA) and nurse practitioner (NP) programs, and post-graduate training required to achieve competency and comfort in performing procedures. PA and NP training and credentialing often vary at the state level and by practice site. ⋯ Considering the healthcare system move towards team-based care, procedures performed by APPs align with the needs of the patient population served and correspond to the procedures done within the teams by physician providers. Independently billing under national provider identifier is cost effective but can be influenced by the current physician reimbursement system or lack of understanding of APP billing process by health care systems. Though there is limited research in this area, this article serves as a starting point to examining the current utilization and utility of APPs performing procedures in the emergency department and critical care settings.
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Disease-a-month : DM · Dec 2020
ReviewProcedures and pitfalls in incisional biopsies of oral squamous cell carcinoma with respect to histopathological diagnosis.
This review has addressed the issues faced by a diagnostic pathologist during routine assessment of haematoxylin and eosin stained incisional biopsies from oral squamous cell carcinoma patients. Herein, the pragmatic means undertaken, has highlighted routinely faced problems & encounters determined at various levels as clinical, laboratory and diagnostic pitfalls, when possible, tips offered towards procedures and guidance. Also, dealt with subtypes of oral squamous cell carcinoma, differential diagnosis, and relevant prognostic indicators that can navigate the surgeon to take quick decisions. ⋯ Although histopathological evaluation is a confirmatory tool for any clinically suspected lesion it mandates the co-operation of faculty from varied disciplines. The onus lies on a pathologist to establish standard protocols to oversee, audit the laboratory operating procedures from time and again. Technical errors and faults at the office desk doesn't come under the purview of this review.
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Oral cancer, a universal malady, has become a stumbling block over the years due to its significant morbidity and mortality rates. The greater morbidity associated with this deadly disease is attributed to delay in its diagnosis / its presentation in advanced stage. Being multifactorial, Oral squamous cell carcinoma (OSCC) is the outcome of genetic and epigenetic instability. ⋯ The saga of various diagnostic aids for OSCC has witnessed the so-called latest trends such as lab-on-chip, microfluidics, nano diagnostics, liquid biopsy, omics technology and synthetic biology in early detection of oral precancer and cancer. Oral cancer being multifactorial in origin with the chief participation of altered genetics and epigenetics would demand high-end diagnostics for designing personalized therapy. Hence, the present paper highlights the role of various advanced diagnostic aids including 'omics' technology and synthetic biology in oral precancer and cancer.