Knowledgeable Provider

Updates on current medical news, Jody's Epocrates exodus, and a review of hepatitis B pathophysiology, diagnosis, and treatment.References:Lok. A. S. F. Hepatitis B virus: Screening and diagnosis in adults. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-screening-and-diagnosis-in-adultsLok. A. S. F., Hepatitis B virus: Overview of management. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-overview-of-managementCDC ACIP Presentation: https://www.cdc.gov/acip/downloads/slides-2025-09-18-19/03-su-mmrv-508.pdfACIP Recommendation Statement: https://www.hhs.gov/press-room/acip-recommends-chickenpox-vaccine-for-toddlers.htmlTang LSY, Covert E, Wilson E, Kottilil S. Chronic Hepatitis B Infection: A Review. JAMA. 2018;319(17):1802–1813. doi:10.1001/jama.2018.3795. https://jamanetwork.com/journals/jama/fullarticle/2679946OpenEvidence Conversation: https://www.openevidence.com/ask/4dde6fd5-1bca-4a86-a6f3-3a335f0334a1AAP Recommended Vaccine Schedule for Children & Adolescents: https://publications.aap.org/redbook/resources/15585/AAP-Immunization-ScheduleVaccine History (Hep B Foundation): https://www.hepb.org/prevention-and-diagnosis/vaccination/history-of-hepatitis-b-vaccine/Vaccine History (CDC): https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a3.htm

Jody reviews recent developments in the US healthcare dystopia, then discusses pathophysiology, diagnosis, and treatment of gout.References:1) Merriman, T. Gout: Pathophysiology. UpToDate. https://www.uptodate.com/contents/gout-pathophysiology2) Gaffo, A. L. Gout: Clinical Manifestations and diagnosis. UpToDate. https://www.uptodate.com/contents/gout-clinical-manifestations-and-diagnosis3) Gaffo, A. L. Gout: Treatment of Flares. UpToDate. https://www.uptodate.com/contents/gout-treatment-of-flares4) Perez-Ruiz, F. Gout: Pharmacologic urate-lowering therapy and treatment of tophi. UpToDate. https://www.uptodate.com/contents/gout-pharmacologic-urate-lowering-therapy-and-treatment-of-tophi5) Neogi, T. Gout: Nonpharmacologic strategies for prevention and treatment. UpToDate. https://www.uptodate.com/contents/gout-nonpharmacologic-strategies-for-prevention-and-treatment6) https://www.science.org/content/article/attempt-oust-cdc-director-sparks-key-resignations-agency-officials7) The CDC's Vaccine Chief on Why Quitting Was His Only Option (The Daily via Spotify)Music:https://youtu.be/8GliyDgAGQI?si=F8NBaxJeaezO9V2Y

In a spin-off of last week's episode, Jody discusses making life and death decisions as a healthcare professional.

Lieutenant Colonel Rick Caniglia, U.S. Army, Retired, shares medical stories from his long military career.

Links:ACIP WebsiteHHS Statement on ACIP ReconstitutionRestoring Gold Standard Science Executive OrderExperts Sound Alarm After ACIP Members Removed (NFID)NPR Article on New ACIP Members

F is for Fournier! Jody reviews pathophysiology, diagnosis, and treatment of this (thankfully) uncommon condition.References:1) Stevens, D.L., & Baddour, L.M. Necrotizing soft tissue infections. UpToDate. https://www.uptodate.com/contents/ necrotizing-soft-tissue-infections2) Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter C, Chong WH. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019 Jun 4;170(11):764-769. doi: 10.7326/M19-0085. Epub 2019 May 7. PMID: 31060053.3) Jean Alfred Fournier. Wikipedia. https://en.wikipedia.org/ wiki/Jean_Alfred_Fournier

Jody reviews pathophysiology, assessment, and treatment of erectile dysfunction.References:1) Raymond, R.C., & Khera, M. Epidemiology and etiologies of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/epidemiology-and-etiologies-of-male-sexual-dysfunction2) Khera, M. Evaluation of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/evaluation-of-male-sexual-dysfunction3) Khera, M. Treatment of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction

Jody went to a conference! Here's what he learned...

Jody's CHD lecture for nursing students.Case study links:Case Study 1Case Study 2Case Study 3

Jody responds to the American College of Physicians' Annals On Call Podcast episode released on May 19th, 2025.Links:Advanced Practice Clinicians Cannot Replace Primary Care Physicians. Annals On Call Podcast, 5-29-25Physician Assistant and Former PA-Turned-Physician Discuss the State of the Profession. Patients At Risk Podcast, 7-25-21 (Spotify)New Workforce Model Suggests Continued Physician Shortages In Nonprimary Care Specialties (AAMC Article)Christin Giordano McAuliffe. There Is No Substitute for Primary Care Physicians: A Response to the Association of American Medical Colleges’ Workforce Model. Ann Intern Med.2025;178:590-591. [Epub 4 March 2025]. doi:10.7326/ANNALS-24-03806University of South Alabama Dual Role NP CurriculumRazavi, Moaven PhD*; O’Reilly-Jacob, Monica RN, PhD, FNP-BC†; Perloff, Jennifer PhD*; Buerhaus, Peter RN, PhD, FAAN, FAANP(h)‡. Drivers of Cost Differences Between Nurse Practitioner and Physician Attributed Medicare Beneficiaries. Medical Care 59(2):p 177-184, February 2021. | DOI: 10.1097/MLR.0000000000001477 McMenamin A, Turi E, Schlak A, Poghosyan L. A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions. Medical Care Research and Review. 2023;80(6):563-581. doi:10.1177/10775587231186720Kippenbrock T, Emory J, Lee P, Odell E, Buron B, Morrison B. A national survey of nurse practitioners' patient satisfaction outcomes. Nurs Outlook. 2019 Nov-Dec;67(6):707-712. doi: 10.1016/j.outlook.2019.04.010. Epub 2019 May 4. PMID: 31607371.Haas, D., Pozehl, B., Alonso, W. W., & Diederich, T. (2023). Patient Satisfaction With a Nurse Practitioner–Led Heart Failure Clinic. Journal for Nurse Practitioners, 19(4), Article 104496. https://doi.org/10.1016/j.nurpra.2022.11.006https://www.techtarget.com/patientengagement/news/366584669/Nurse-Practitioners-Boost-Patient-Satisfaction-Quality-Outcomeshttps://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practicehttps://www.aacnnursing.org/news-data/all-news/rounds-with-leadership-focusing-on-the-outcomes-of-np-practiceStanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson, R., Fountain, L., Steinwachs, D. M., Heindel, L., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500.e13. https://doi.org/10.1016/j.nurpra.2013.07.004Savard I, Al Hakim G, Kilpatrick K. The added value of the nurse practitioner: An evolutionary concept analysis. Nurs Open. 2023 Apr;10(4):2540-2551. doi: 10.1002/nop2.1512. Epub 2022 Dec 17. PMID: 36527435; PMCID: PMC10006655.

D is for deprescribing! Jody wrestles with this very complicated and grey area of medical practice.Resources:Beers Criteria (AGS)STOPP/START CriteriaDeprescribing.orgMedStopperNO TEARSNICE Medicines Optimization GuidelinesEMPOWER BrochuresThe list of deprescribing resources was generated by ChatGPT.

Jody is joined by one of the world's foremost AI experts, ChatGPT itself, to discuss how AI is impacting healthcare currently and how it might change the medical field in the future.

C is for constipation! Jody discuss pathogenesis, diagnosis, and treatment of this surprisingly common problem.References:American College of Gastroenterology GuidelinesRome FoundationChronic Constipation in Adults: Management (UpToDate)NIDDK on ConstipationMayo Clinic Constipation ArticleMerck Manual Constipation ArticleDiagnosis & Management of Constipation (AAFP)The outline for this episode was created in part by chatGPT.

In this final episode of the #NephMadness 2025 series, Jody summarizes each region in detail. Remember, it's about LEARNING, not WINNING...Links:Shells & Tails 2025Herbal Supplements & Kidney Disease (NKF)National Center for Complementary & Integrative Health

Jody reviews the changes to healthcare policy made by the Trump administration so far.References:1) Grossi, G. et al. Health policy in flux: Trump administration updates. AJMC. Published online March 28, 2025. https://www.ajmc.com/view/health-policy-in-flux-trump-administration-updates2) Kates, J., Michaud, J., Moss, K., & Dawson, L. Overview of President Trump's executive actions on global health. KFF. Published online January 28, 2025. https://www.kff.org/global-health-policy/fact-sheet/overview-of-president-trumps-executive-actions-on-global-health/Whitehouse.gov fact sheets:https://www.whitehouse.gov/fact-sheets/2025/02/fact-sheet-president-donald-j-trump-establishes-the-make-america-healthy-again-commission/https://www.whitehouse.gov/fact-sheets/2025/02/fact-sheet-president-donald-j-trump-announces-actions-to-make-healthcare-prices-transparent/

Jody submits his bracket for #NephMadness 2025 at the last minute! A true buzzer beater!

B is for Brugada! Jody reviews this important cause of ventricular arrhythmias and sudden cardiac arrest.References & Resources:1) Medications to Avoid (Brugadadrugs.org)2) Brugada Syndrome (Life In The Fastlane)3) Wylie, J. V. Brugada syndrome: Epidemiology and pathogenesis. UpToDate. https://www.uptodate.com/ contents/brugada-syndrome-epidemiology-and-pathogenesis4) Wylie, J. V. Brugada syndrome: Clinical presentation, diagnosis, and evaluation. UpToDate. https://www. uptodate.com/contents/brugada-syndrome-clinical-presentation-diagnosis-and-evaluation5) Wyle, J. V. Brugada syndrome or pattern: Management and approach to screening of relatives. UpToDate. https://www. uptodate.com/contents/brugada-syndrome-or-pattern-management-and-approach-to-screening-of-relatives

A is for alpha-1-antitrypsin! Jody reviews this maybe-not-so-rare genetic disorder that is an important and often overlooked cause of mostly lung and liver disease.References:1) Stoller, J.K. Clinical manifestations, diagnosis, and natural history of alpha-1-antitrypsin deficiency. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-natural-history-of-alpha-1-antitrypsin-deficiency2) Hogarth, D. K. Alpha-1-antitrypsin deficiency. Epocrates. https://www.epocrates.com/online/diseases/1075/alpha-1-antitrypsin-deficiency#highlights-basics3) Alpha-1-antitrypsin level test. Lippincott Advisor. https://advisor.lww.com/lna/document.do?bid=5&did=1336317&searchTerm=alpha-1-antitrypsin&hits=antitrypsin,alpha4) Endobronchial Valve Therapy (American Lung Association)

Jody reviews a recent Special Communication from JAMA about a 2024 update of medical malpractice standards from the American Law Institute.Reference:Aaron DG, Robertson CT, King LP, Sage WM. A New Legal Standard for Medical Malpractice. JAMA. Published online February 26, 2025. doi:10.1001/jama.2025.0097

Jody shares what he learned at this year's Huntsville Hospital Cardiology Update, held on Saturday, February 8th, 2025 at the UA Huntsville College of Nursing.Links:1) UA Huntsville CON Golden Gala2) WHO 2003 Pulmonary Hypertension Guidelines3) BMPR2 Gene Mutations4) 2022 ESC/ERS 3 Strata Risk Score Calculator for Pulmonary Hypertension