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UpRegulated last won the day on May 1 2016

UpRegulated had the most liked content!

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About UpRegulated

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    Nurse Practitioner

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  1. I wholeheartedly agree. But that's hard to pull off. Why? Because if you introduce a doctorate (wide spread) that adds something like a residency, or additional clinical hours, or more sciences, etc. then you simultaneously undercut and undermine all practicing PA's who have "only" a master's degree. It's sends the message, unintentionally or not, correct or not, that existing PA's aren't adequately trained. It could very well be perceived as an admission that existing PA training is inadequate, which, of course, is false.
  2. We didn't start the fire. But we've at least fanned it a little. By "we" I mean PA's and NP's. For years, one could be a PA with an AS. Now an MS is required. Is the training really that much different? For all the whining, moaning, and nashing of teeth that the DNP just adds "fluff" hours to the MS in nursing, the same can be said of the transition of AS to MS for PA's. It's just degree creep. A doctoral degree is becoming the norm in healthcare and there's no stopping that. The DNP is nursing's answer. PA's need one too.
  3. Not sure if you are replying to me or not, but good point. A POC test should be part of the data like ROS, PE. When an older adult presents with FUO, with only body aches, chills, malaise and fatigue with a clear UA and a + flu, you have a reasonable idea of what is going on. Or at least a reasonable management approach. Hx is 90% of your diagnosis. PE and labs are to help confirm, so long as limitations are understood.
  4. That's kind of my point too. But any test based on the prevalence of a disease in the community relies on some other measure/test to measure/test the prevalence of a disease in a community. I too am the nerd that likes to look at the statistical validity of a given test, but that only has so much utility in a real-world clinical setting. My point being that we can get too wrapped up in the stats/"research" of POC tests. To me, they are on a practical level just part of the history. Flu + or -, Tamiflu or other antivirals do practically nothing. Combine that with the fact that I have l
  5. The studies are based on predefined criteria, the patient is not. These studies are based on CDC criteria of ILI, but that in and of itself does not mean the patient does or does not have influenza. So...treat the patient not the test? Not being sarcastic at all, just that it's easy to tie onself in knots over a positive or a negative result of whatever POC test. I remind myself from time to time that there was a day when there were not rapid flu tests, rapid streps, POC mono's, etc. It forces me to rely more on my history, exam and clinical judgement. There are numerous studies
  6. Go to amazon.com, search for Botox, click on the product you want, then click "Add to Cart" then click "Proceed to Checkout." ;)
  7. $20K???? That's chump change over the life of a career and should have nothing to do with your decision. You are in school for 2-3 years. You are married for life. Your wife giving up seeing you for 2-3 years warrants listening to her opinion. She is making a greater sacrifice than you. If you pull your wife away from her family over a relatively minor school preference it will cost you. She will be left with no nearby family and no husband. The failure rate of marriages with students in medical professions is already extremely high. Taking her away from her family + you being in
  8. Wunderlist!!! It has nothing to do with medicine, but it rocks for groceries and what I need at Home Depot! Having said that...UpToDate is awesome in a desktop browser, kinda "meh" on a smart phone. Epocrates for smartphone (I know those were excluded from your question). Medscape is increasingly not my go-to, though I used to like them. Bugs+Drugs was great, but is no longer supported. MMIT is OK for getting a ballpark on insurance drug coverage, but only a ballpark. I've tried/used a few lab reference apps, but haven't been impressed and they don't offer anything Epocr
  9. In a year or two, when I rule the world, :) there will be three titles: MD, DO, MP. The latter being a "medical provider" and used by both PA's and NP's in areas of general medicine (family, peds, adult/IM, urgent care, women's health, ED) after 3-5 years of experience and passing a rigorous specialty national examination respective to each specialty. Physician Assistant does not accurately reflect the advanced training and abilities that PA's have. Too many patients see "Physician Assistant" as "nurse" or even worse, "medical assistant." How is a PA "assisting" a physician when they ha
  10. (1) Try to get some perspective on age. It cracks me up when people say something like "I'll be 25 before I finish my bachelors!" GASP. 25? Isn't that when you start getting letters from AARP? :) In your 20's, you are not even close to your peak abilities. You won't hit that until at least your 30's, 40's or 50's. That is why many change careers during those decades - it takes that long to learn who you are and what you are truly good at. In that regard, there is no difference in a 19 year old or a 29 year old. But in the mind of many 21 year olds, 27 year olds are old people. That's ver
  11. Extended fixation? Seems to me that my "fixation" is quite relevant to this back and forth discussion. Glad you are sorry the OP didn't mention edema. Me too. It seems like an important factor in light of the discussion. As previously mentioned, Homan's sign is pretty much useless, regardless of what vein(s) a potential thrombosis is in. Discounting the varied experiences of PA's? Hardly. A CNA with 3 months of experience prior to PA school matriculation needs to learn how to adequately take vital signs (they didn't get in CNA school, and likely just doubled down on bad habits in
  12. This coming from a poster that has NO profile pic? How would posting a real picture of me change anything? As for being "thin skinned," read my posts. I am quite complementary of and supportive of PA's, and I ignore most of the anti-NP posts that appear here from time to time.
  13. (1) The OP said NOTHING about edema. Venous blockages have no inherent effect on pulse amplitude. (2) Well aware of what and where the peroneal veins are. When I originally read the OP's post, I read it is as "perineal" instead of "peroneal" perhaps because he mentioned hip replacement and I was thinking regionally, so the whole post made no sense to me. I then (see my post edit done before anyone responded) mentioned that a peroneal, or any other venous blockage, does not inherently change pulse amplitude. Regardless, the points raised in my posts stand, regardless of switching an "i"
  14. The OP is either lying or confused. Period. Homan's sign is pretty much (no wait, IS) worthless regarding specificity and sensitivity and has NOTHING to do with the veins of the peritoneum, perineum or any other "neum" above the knee. IF the OP is telling the truth, then his "catch" is luck, not clinical acumen. But then, I am a stoopid NP that thanks that Homan's sign pertanes to them there vane thangs in the calf thang, rather than the crotch or belly thang. No wait, that's just the trooth. Homan's has NOTHING TO DO with thromboses in ANY vein other than those of the lower ex
  15. Dude, you seem really smart. And you seem to love anecdotes. I could probably own you own those. But let's no go there. Instead, let's do this: (1) As an ortho PA, how would you manage/treat a resistant HTN patient on a beta blocker, a CCB, and an ACEI who is allergic to several diuretics (who has normal renal function)? (2) As an ortho PA, how would you manage/treat the recurrent intermittent rash on the bottom of one's foot x 3 years that has not responded to topical or oral antifungals? And what is your ddx? (3) As an ortho PA, how would you manage/treat the otherwise health
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