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This online survey study examined the most frequently performed and most important clinical procedural skills (CPSs) and location of CPSs training in a sample of 102 primary care nurse practitioners across a 6 state/jurisdiction region of the United States. Results indicated that 7 CPSs were reported as being performed at least once a week by > 30% of participants, and the same 7 CPSs were reported as very important by > 50% of participants. Results facilitate formation of a list of core CPSs for primary care nurse practitioners for standardization of CPSs curricular requirements. •Deciding which clinical procedural skills to teach in nurse practitioner programs is garnering interest among educators and other stakeholders.•Limited literature addresses the types of clinical procedural skills taught in primary care nurse practitioner programs or performed in practice.•Results identified the 7 clinical procedural skills performed most often and rated as most important by participants.•Four of the most frequently performed and most important clinical procedural skills lie within a registered nurse or medical assistant scope of practice, which merits further investigation.

NP programs educate NPs in CPS commonly encountered in the care of specific populations. However, NPs transitioning to practice do so in a wide variety of settings and provide care to patients with a wide diversity of acuities whose care and management may require recognition of the need or performance of new CPS. Statement of the problem. With primary care NPs functioning in varied settings and roles requiring additional CPS knowledge and skills, NPs have expressed lack of preparedness regarding CPS. Although some evidence identified those CPS considered important to and frequently performed by NPs, the literature provides insufficient evidence to identify the CPS performed most frequently and rated as most important by primary care NPs in practice, and existing curricular standards lack clarity regarding which CPS to include in program curricula. This project aimed to conduct a practice analysis of the most frequently performed and most important CPS to primary care NPs in one region of the country to provide data to inform regional and national stakeholders regarding the current state of primary care NP CPS, and to guide standardization of primary care NP CPS curricular requirements. The Donabedian Model provided the theoretical underpinning for this project. The model component Structure represented academia and CCNE, individual state/jurisdiction boards of nursing, and the individual clinical practice settings. The model component Process represented the NP’s CPS knowledge and skills to diagnose and treat his patient in accordance with established practice standards. The model component Outcomes represented the patient’s receipt of high-quality care to facilitate improved health, and delivery of high-quality care also represented the outcome for the practice settings. Method. This project utilized a correlational design with a cross-sectional approach of a convenience sample, to recruit 102 NPs working in primary care in one multi-state/jurisdiction regions of the United States. Laustsen’s (2013) PCCSSI was modified and served as the data collection tool. The Catholic University of America IRB reviewed and approved the project before commencing to ensure the protection of human subjects. Data cleaning, frequency analysis to check for errors, outliers, and missing data, and Little MCARs test assessed for missing data patterns prior to analysis. This project answered five specific questions. Results. Question one: What is the frequency of individual CPS performance by primary care NPs? The results demonstrate of the 94 CPS surveyed, 62 were reported as performed “never” by > 50% of participants. Of the remaining 32 CPS, seven were reported as being performed “at least once a week” by > 30% of participants. Question two: What is the level of importance of individual CPS performed by primary care NPs? The results demonstrate of the 94 CPS surveyed, 43 were reported as “not important” by > 50% of participants. Of the remaining 51 CPS, eight were reported as “very important” by > 50% of participants. Question three: Does a relationship exist between the frequency and level of importance of CPS? The results demonstrated significant associations between frequency and importance in all 50 CPS examined, with effect sizes ranging from moderate to large. Question four: Does the level of importance and frequency of performance vary by geographic practice setting (urban vs. suburban vs. rural)? The results demonstrated significant associations between importance and location in 8 of the 50 CPS and demonstrated significant associations between frequency and location in 16 of the 50 CPS. Question five: For a CPS, does a relationship exist across performance of the CPS, importance of the CPS and receipt of CPS training in a NP program? Results across frequency, importance, and training demonstrated that the highest-order interaction (frequency x importance x training) was significant for three CPS: abscess- incision and drainage; splinting: wrist and hand; and eye irrigation. Summary of conclusions. Prior research from an exemplar study by Kennedy-Malone et al. (2008) supports this project’s finding that certain CPS are more likely to be performed more often by participants practicing in suburban or rural areas than by participants practicing in urban areas. As no prior literature examined a potential relationship between frequency and importance, the findings of this project and its use of inferential statistical tests constitutes a seminal appraisal of the current state of primary care NP CPS in one multistate/ jurisdiction region, providing information to NONPF for consideration of recommendations for curricular content. The identification of frequently performed CPS, which may lie within a RN or medical assistant scope of practice, merits further investigation. Examination of why NPs are performing CPS which can be performed by RNs or medical assistants needs to be addressed to facilitate clearer identification of actual CPS required in academic NP programs. In conclusion, this project advanced the examination of primary care NP CPS, furnishing data to facilitate the design of future studies exploring these topics, as well as to drive formation of a list of core CPS for primary care NPs for standardization of CPS curricular requirements.

We aimed to assess the efficacy and safety of two neutralising monoclonal antibody therapies (sotrovimab [Vir Biotechnology and GlaxoSmithKline] and BRII-196 plus BRII-198 [Brii Biosciences]) for adults admitted to hospital for COVID-19 (hereafter referred to as hospitalised) with COVID-19. In this multinational, double-blind, randomised, placebo-controlled, clinical trial (Therapeutics for Inpatients with COVID-19 [TICO]), adults (aged ≥18 years) hospitalised with COVID-19 at 43 hospitals in the USA, Denmark, Switzerland, and Poland were recruited. Patients were eligible if they had laboratory-confirmed SARS-CoV-2 infection and COVID-19 symptoms for up to 12 days. Using a web-based application, participants were randomly assigned (2:1:2:1), stratified by trial site pharmacy, to sotrovimab 500 mg, matching placebo for sotrovimab, BRII-196 1000 mg plus BRII-198 1000 mg, or matching placebo for BRII-196 plus BRII-198, in addition to standard of care. Each study product was administered as a single dose given intravenously over 60 min. The concurrent placebo groups were pooled for analyses. The primary outcome was time to sustained clinical recovery, defined as discharge from the hospital to home and remaining at home for 14 consecutive days, up to day 90 after randomisation. Interim futility analyses were based on two seven-category ordinal outcome scales on day 5 that measured pulmonary status and extrapulmonary complications of COVID-19. The safety outcome was a composite of death, serious adverse events, incident organ failure, and serious coinfection up to day 90 after randomisation. Efficacy and safety outcomes were assessed in the modified intention-to-treat population, defined as all patients randomly assigned to treatment who started the study infusion. This study is registered with ClinicalTrials.gov, NCT04501978. Between Dec 16, 2020, and March 1, 2021, 546 patients were enrolled and randomly assigned to sotrovimab (n=184), BRII-196 plus BRII-198 (n=183), or placebo (n=179), of whom 536 received part or all of their assigned study drug (sotrovimab n=182, BRII-196 plus BRII-198 n=176, or placebo n=178; median age of 60 years [IQR 50–72], 228 [43%] patients were female and 308 [57%] were male). At this point, enrolment was halted on the basis of the interim futility analysis. At day 5, neither the sotrovimab group nor the BRII-196 plus BRII-198 group had significantly higher odds of more favourable outcomes than the placebo group on either the pulmonary scale (adjusted odds ratio sotrovimab 1·07 [95% CI 0·74–1·56]; BRII-196 plus BRII-198 0·98 [95% CI 0·67–1·43]) or the pulmonary-plus complications scale (sotrovimab 1·08 [0·74–1·58]; BRII-196 plus BRII-198 1·00 [0·68–1·46]). By day 90, sustained clinical recovery was seen in 151 (85%) patients in the placebo group compared with 160 (88%) in the sotrovimab group (adjusted rate ratio 1·12 [95% CI 0·91–1·37]) and 155 (88%) in the BRII-196 plus BRII-198 group (1·08 [0·88–1·32]). The composite safety outcome up to day 90 was met by 48 (27%) patients in the placebo group, 42 (23%) in the sotrovimab group, and 45 (26%) in the BRII-196 plus BRII-198 group. 13 (7%) patients in the placebo group, 14 (8%) in the sotrovimab group, and 15 (9%) in the BRII-196 plus BRII-198 group died up to day 90. Neither sotrovimab nor BRII-196 plus BRII-198 showed efficacy for improving clinical outcomes among adults hospitalised with COVID-19. US National Institutes of Health and Operation Warp Speed

OBJECTIVE—To assess the effects of adjunctive treatment with pramlintide, an analog of the β-cell hormone amylin, on 24-h glucose fluctuations and postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion (CSII). RESEARCH DESIGN AND METHODS—In this study, 18 patients (16 of whom could be evaluated) with type 1 diabetes (age 44 ± 11 years, HbA1c 8.2 ± 1.3% [mean ± SD]) were given mealtime injections of 30 μg pramlintide t.i.d. for 4 weeks in addition to their preexisting CSII regimen (16 lispro, 2 regular insulin). Mealtime insulin boluses were reduced by a minimum of 10% during the first 3 days, and re-adjusted thereafter based on clinical judgment. At weeks 0 (baseline), 4 (on treatment), and 6 (2 weeks off treatment), 24-h interstitial glucose concentrations were measured using a continuous glucose monitoring system (CGMS), and postprandial plasma glucose, glucagon, and triglyceride concentrations were measured in response to a standardized test meal. RESULTS—At baseline, patients had excessive 24-h glucose fluctuations, with 59% of the CGMS measurements >140 mg/dl, 13% <80 mg/dl, and only 28% in the euglycemic range (80–140 mg/dl). After 4 weeks on pramlintide, measurements in the hyperglycemic range declined to 48% and measurements within the euglycemic range increased to 37%. This shift from the hyperglycemic to the euglycemic range occurred with a concomitant 17% reduction in mealtime insulin dosages and without relevant increases in measurements below the euglycemic range (15%) or any severe hypoglycemic events. After 4 weeks on pramlintide, postprandial glucose, glucagon, and triglyceride excursions were reduced by ∼86, ∼87, and ∼72%, respectively (incremental areas under the curve, all P < 0.05 vs. baseline). At week 6 (off treatment), the 24-h glucose profile and postprandial glucose, glucagon, and triglyceride excursions approached pretreatment values. CONCLUSIONS—In this study, the addition of pramlintide to insulin therapy reduced excessive 24-h glucose fluctuations as well as postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with insulin pumps.

The sensitivity of Haemophilus influenzae to penicillins in vitro, determined either by serial antibiotic dilution in broth or by the disc method on agar, is apparently profoundly influenced by inoculum size if the results are read by macroscopic inspection. Microscopic inspection of the growth, however, reveals that the turbidity in heavily inoculated broth containing concentrations higher than the minimal inhibitory concentration is the product of L forms which have failed to succumb to osmotic lysis. Similarly, minute colonies appearing in the ;inhibition zone' of disc tests are composed of L forms. In both broth and agar tests reduction of the osmolality of the medium from 340 to 144 mOsm per kg failed to bring about lysis of organisms exposed either to ampicillin or amoxycillin. The significance of this remarkable osmotic stability of haemophilus L forms is discussed in relation both to testing of sensitivity of this organism to penicillins and to persistence of chronic haemophilus infections of the lower respiratory tract.

As director of the District of Columbia Court Management Study which recommended the court executive provision in the new District of Columbia Court Reorganization bill, I should like to provide some background and understanding of what this section was designed to achieve.