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The first book to encompass adult-gerontology practice guidelines for primary care, this comprehensive resource is designed as a text and reference for health care practitioners specializing as adultgerontology nurse practitioners (A-GNP). It provides current national practice guidelines for delivering high-quality primary health care to adult, older adult, and pregnant patients in the outpatient setting. The book delivers chapters that focus on the older adult person, including a chapter describing the major effects of aging on each body system. For quick and easy access, practice guidelines are organized primarily by body system, disorders listed alphabetically within each body system, and each disorder presented in a consistent format throughout. With an emphasis on history taking, the physical exam, and key features of the aging population, each of the more than 240 disorder guidelines include definition, incidence, pathogenesis, predisposing factors, common complaints, other signs and symptoms, subjective data, physical exam, diagnostic tests, differential diagnoses, plan of care, health promotion including dietary recommendations, follow-up guidelines, and tips for consultation/referral. Particularly useful features include “Practice Pointers” highlighting crucial information for a disorder and bold-faced “Alerts” from experienced practitioners. The book also describes 19 procedures commonly used within the office or clinic setting. More than 140 Patient Teaching Guides are included (perforated for ease of use) as well as in digital format for customizing and printing. These include important information for patients about safety and medications. Appendices feature normal lab values and dietary guidelines.

Named a 2013 Doody's Core Title!\"This is a wonderful book for both novice and experienced physician assistants and nurse practitioners.This latest edition will see frequent use in your daily practice.\" Score: 100, 5 stars -- Doody's Medical Reviews \"This textbook provides comprehensive coverage of primary care disorders in an easy-to-read format.

Winner, Third Place, AJN Book of the Year Awards 2014, Advanced Practice Nursing ìBoth editors have done a wonderful job in building upon the previous versions of this book to create an exceptionally comprehensive resource.

The second edition of Family Practice Guidelines is a comprehensive resource for clinicians, presenting current national standard of care guidelines for practice, in addition to select 2011 guidelines. This clinical reference features detailed physical examination and diagnostic testing, information on health promotion, guidelines of care, dietary information, national resources for patient use, and patient education handouts all in one resource. This revised edition features guidelines for 246 disorders, each containing clearly outlined considerations for pediatric, pregnant, and geriatric patients. It also presents 18 procedures commonly performed in the clinical setting, including bedside cystometry, hernia reduction, neurological examination, and more. Patient Teaching Guides are also provided, and are designed to be given directly to patients as take home teaching supplements. Additionally, the book contains four appendices with guidelines on normal lab values, procedures, sexual maturity stages, and teeth.

In this study, we assess practice changes made in response to the threat of tort liability in the field of obstetrics, which has one of the highest levels of premiums, claim frequency, and mean dollar value of paid claims. There is much \"conventional wisdom\" about effects of tort liability risk on obstetrical practice based on obstetricians' perceptions of changes that have occurred. Our data comes from the Survey of Obstetrical Care in 1992, a survey of 963 women who had given birth in 1987 in 31 counties in Florida conducted for purposes of this study and related studies of medical malpractice and birth outcomes. Our results suggest that some antenatal testing is responsive to variation in the threat of being used. But for most measures included in our study, half of the antenatal testing variables, the decision to perform a cesarean section, and various dimensions of maternal satisfaction with care, our empirical analysis failed to reveal that obstetricians practice more \"defensively\" in areas with relatively high suit rates.

The SARS-CoV-2 omicron variant of concern was identified in South Africa in November, 2021, and was associated with an increase in COVID-19 cases. We aimed to assess the clinical severity of infections with the omicron variant using S gene target failure (SGTF) on the Thermo Fisher Scientific TaqPath COVID-19 PCR test as a proxy. We did data linkages for national, South African COVID-19 case data, SARS-CoV-2 laboratory test data, SARS-CoV-2 genome data, and COVID-19 hospital admissions data. For individuals diagnosed with COVID-19 via TaqPath PCR tests, infections were designated as either SGTF or non-SGTF. The delta variant was identified by genome sequencing. Using multivariable logistic regression models, we assessed disease severity and hospitalisations by comparing individuals with SGTF versus non-SGTF infections diagnosed between Oct 1 and Nov 30, 2021, and we further assessed disease severity by comparing SGTF-infected individuals diagnosed between Oct 1 and Nov 30, 2021, with delta variant-infected individuals diagnosed between April 1 and Nov 9, 2021. From Oct 1 (week 39), 2021, to Dec 6 (week 49), 2021, 161 328 cases of COVID-19 were reported in South Africa. 38 282 people were diagnosed via TaqPath PCR tests and 29 721 SGTF infections and 1412 non-SGTF infections were identified. The proportion of SGTF infections increased from two (3·2%) of 63 in week 39 to 21 978 (97·9%) of 22 455 in week 48. After controlling for factors associated with hospitalisation, individuals with SGTF infections had significantly lower odds of admission than did those with non-SGTF infections (256 [2·4%] of 10 547 vs 121 [12·8%] of 948; adjusted odds ratio [aOR] 0·2, 95% CI 0·1–0·3). After controlling for factors associated with disease severity, the odds of severe disease were similar between hospitalised individuals with SGTF versus non-SGTF infections (42 [21%] of 204 vs 45 [40%] of 113; aOR 0·7, 95% CI 0·3–1·4). Compared with individuals with earlier delta variant infections, SGTF-infected individuals had a significantly lower odds of severe disease (496 [62·5%] of 793 vs 57 [23·4%] of 244; aOR 0·3, 95% CI 0·2–0·5), after controlling for factors associated with disease severity. Our early analyses suggest a significantly reduced odds of hospitalisation among individuals with SGTF versus non-SGTF infections diagnosed during the same time period. SGTF-infected individuals had a significantly reduced odds of severe disease compared with individuals infected earlier with the delta variant. Some of this reduced severity is probably a result of previous immunity. The South African Medical Research Council, the South African National Department of Health, US Centers for Disease Control and Prevention, the African Society of Laboratory Medicine, Africa Centers for Disease Control and Prevention, the Bill & Melinda Gates Foundation, the Wellcome Trust, and the Fleming Fund.

Omicron lineages BA.4 and BA.5 drove a fifth wave of COVID-19 cases in South Africa. Here, we use the presence/absence of the S-gene target as a proxy for SARS-CoV-2 variant/lineage for infections diagnosed using the TaqPath PCR assay between 1 October 2021 and 26 April 2022. We link national COVID-19 individual-level data including case, laboratory test and hospitalisation data. We assess severity using multivariable logistic regression comparing the risk of hospitalisation and risk of severe disease, once hospitalised, for Delta, BA.1, BA.2 and BA.4/BA.5 infections. After controlling for factors associated with hospitalisation and severe outcome respectively, BA.4/BA.5-infected individuals had a similar odds of hospitalisation (aOR 1.24, 95% CI 0.98–1.55) and severe outcome (aOR 0.72, 95% CI 0.41–1.26) compared to BA.1-infected individuals. Newly emerged Omicron lineages BA.4/BA.5 showed similar severity to the BA.1 lineage and continued to show reduced clinical severity compared to the Delta variant. South Africa experienced a resurgence in COVID-19 in 2022 driven by Omicron subvariants BA.4 and BA.5. Here, the authors investigate the severity of infections caused by these subvariants, and find no difference in the risk of severe outcomes when compared to Omicron BA.1, whilst all Omicron subvariants were less severe than Delta.

Previous studies in adult mice indicate that the mGluR5 agonist 2-chloro-5-hydroxyphenyl glycine (CHPG), reduces cuprizone-elicited losses in myelin. This effect is partly mediated by CHPG binding to mGluR5 receptors on reactive astrocytes, triggering the release of brain derived neurotrophic factor (BDNF), which results in an increase in myelin. However, it remains unclear whether CHPG has similar beneficial effects on human oligodendrocytes. To address this issue, we examined effects of CHPG using both cultured human induced pluripotent stem cell (hiPSC)-derived oligodendrocytes and primary human fetal oligodendrocytes. We show that CHPG increases the proportion of MBP + mature oligodendrocytes without affecting survival. This effect is mediated by increasing the proliferation of oligodendrocyte precursor cells (OPCs) and enhancing differentiation in young oligodendrocytes. In contrast to observations in mice, mGluR5 expression in humans is localized on PDGFRα + OPCs and O4 + immature oligodendrocytes, but not astrocytes. Using purified human OPC cultures, we show a direct effect of CHPG in increasing the proportion of MBP + mature oligodendrocytes. To identify potential cellular targets of CHPG in demyelinating disease, we analyzed postmortem tissue from individuals with chronic active multiple sclerosis (MS) and healthy controls. In contrast to the hiPSCs or primary oligodendrocytes, demyelinated white matter from MS patients shows elevated mGluR5 mRNA expression in astrocytes. Taken together, our findings suggest that CHPG enhances the differentiation of human OPCs through a mechanism distinct from that observed in cuprizone-treated mice. Moreover, astrocytes in MS pathology upregulate mGluR5, suggesting mGluR5 expression changes dynamically under disease conditions.