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Transitioning from graduate school to independent practice for nurse practitioners (NPs) and physician assistants (PAs) is particularly challenging in high-acuity or specialty areas, where additional training, mentorship, and support are critical. Without such support, NPs and PAs often experience job dissatisfaction, burnout, and increased turnover, leading to substantial organizational costs. Postgraduate fellowship programs have emerged as a solution to these issues by providing structured education and mentorship that enhance clinical competence and professional development. This article explores an Acute Care Advanced Practice Provider Fellowship (ACAPPF), a postgraduate fellowship accredited by the American Nurses Credentialing Center Advanced Practice Provider Fellowship Accreditation. This accreditation recognizes transition-to-practice programs for NP and PA programs designed to support the development and management of novice NPs and PAs transitioning to independent practice. The ACAPPF program focuses on developing and implementing innovative educational strategies, including high-fidelity simulation, ultrasound training, professional development learning modalities, psychosocial support, and a unique partnership with medical education. The program emphasizes clinical competency, patient safety, provider resilience, and role integration, ensuring that new NPs and PAs can perform and deliver quality care in high-acuity situations while fostering personal and professional growth. Through its comprehensive curriculum, the ACAPPF helps to bridge the gap between academic preparation and independent clinical practice, contributing to the long-term success and satisfaction of NPs and PAs in complex health care environments.

Introduction: Studies have shown hyperoxemia in intubated patients is associated with poor outcomes including increased mortality. The location where trauma patients most often experience hyperoxemia has not been well studied. Understanding where in the hospital patients are mostly likely to be exposed to hyperoxemia can allow for targeted quality improvement initiatives to improve the incidence of hyperoxemia. Methods: This was an institutional review board approved single-institution retrospective review of mechanically ventilated trauma patients between January 1st, 2023 and December 31st, 2024. Patients who expired in the trauma bay or were admitted to the medical ICU were excluded. The primary aims of this study were to determine the incidence of hyperoxemia (defined as PaO2 >100mmHg) within the first 72 hours of admission and to determine the location where hyperoxemia most commonly occurred. Four areas were examined: Emergency Room (ER), Operating Room, (OR), Intensive Care Unit (ICU), and ICU Stepdown Unit. Results: We present data from 1081 individual ABG results. 638 represent the first ABGs taken after intubation. 188 patients were in OR and had a higher average PaO2 (294mmHg) and a 93% rate of hyperoxemia. 179 patients in the Emergency Room had a higher average PaO2 level (232mmHg) than the 252 patients in the Intensive Care Unit (171mmHg), but a similar percentage of both ICU and ER patients were hyperoxemic (65% and 69%). 19 patients in the ICU Stepdown unit were recorded and had the lowest average PaO2 (116mmHg) and rate of hyperoxia (32%). 443 data points from a third ABG drawn after intubation show similar findings with patients in the OR being more likely to be hyperoxemic (84%) and patients in the ER having higher average PaO2 than those in the ICU (218mmHg, 140mmHg), but similar rates of hyperoxemia (65%, 60%). Conclusions: The initial rate of hyperoxemia after intubation exceeds 65% in the ER, OR, and ICU and the average PaO2 level in each area is supratherapeutic. Subsequent ABG draws show that this rate is not improved as time passes. While particular focus should be made on patients going to the Operating Room, attention needs to be paid in every area of the hospital where intubated critically ill patients reside in order to mitigate the rate of hyperoxemia.

Introduction:Acetabular fractures in elderly patients are often the result of low-energy trauma and are complicated by osteopenia, comorbidities, and limited physiologic reserve. Minimally invasive approaches, such as percutaneous fixation have emerged as viable alternatives to open reduction in selected fracture patterns.Case Report:We report the case of a 76-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and osteopenia who sustained a comminuted right anterior column and posterior hemitransverse acetabular fracture following a ground-level fall. His hospital course was complicated by rhabdomyolysis and elevated troponin levels, necessitating cardiac evaluation, which demonstrated normal left ventricular function and no evidence of valvular disease. Given the fracture pattern and his polytrauma status, including an ipsilateral proximal humerus fracture and multiple rib fractures, he underwent navigated percutaneous screw fixation of the right acetabulum using O-arm-assisted guidance and iFuse TORQ TNT screws (SI-Bone, Santa Clara, California).Outcome:The patient recovered well without perioperative or post-operative complications. Radiographs at 6 months post-operatively demonstrated fracture healing and stable hardware. He achieved independent ambulation with full, pain-free, passive right hip range of motion.Conclusion:This case highlights the successful application of image-guided percutaneous fixation in an elderly patient with polytrauma and poor bone quality. The use of 3-dimensional navigation and larger-diameter porous screws may offer a biomechanical advantage with improved fixation in osteoporotic acetabulum fractures. Further studies are warranted to evaluate long-term outcomes in this patient population.

Introduction: Patients in the medical intensive care unit (MICU) with sepsis have a higher risk of developing new onset atrial fibrillation (NOAF). Several risk factors increase the risk of stroke in this population including activation of the coagulation cascade in sepsis. Simultaneously, critically ill patients often harbor increased risks for bleeding due to comorbidities in the setting of organ dysfunction. Existing risk stratification tools to evaluate the safety and efficacy of anticoagulation are not validated in critically ill patients. Methods: This was a descriptive, retrospective cohort study of MICU patients admitted to a 1,000-bed tertiary community teaching hospital between 1/1/2019 and 8/1/2024. Patients ≥ 18 years of age with a diagnosis of NOAF and sepsis during MICU admission were included. Patients were excluded for a history of anticoagulation use or cardiac surgery within 3 months. The primary aim was to compare the percentage of patients with NOAF and sepsis who were initiated on anticoagulation versus those not initiated on anticoagulation in the MICU. Secondary outcomes included the incidence of thromboembolic events, major bleeding, and death in the patients initiated on anticoagulation, and the clinical characteristics associated with anticoagulation. Results: A total of 320 patients were screened, and 44 patients met study inclusion criteria. The mean age of the patients was 69.5 (SD 14.9) years of age and 59% of patients were male. Of the 44 included patients, 29 were initiated on anticoagulation and 4 were continued on anticoagulation at discharge. Additionally, 62% of patients initiated on anticoagulation died in the MICU. The median CHA2DS2-VASc score was 5 (0-7) and the median HAS-BLED score was 4 (1-6). While no patients experienced pulmonary embolism, 2 patients had a deep vein thrombosis, and 3 patients experienced an embolic stroke. None of the patients experienced a major bleeding event. Conclusions: Due to the elevated risk of experiencing a stroke in this patient population coupled with the relatively low risk of bleeding illustrated in this study, it may be reasonable to initiate anticoagulation in patients with sepsis that develop NOAF. However, further research is warranted to improve understanding of the patients that would benefit most from anticoagulation.

BackgroundQuantitative coronary CT angiography plaque analysis (QCCTA) is a novel tool for atherosclerosis detection.ObjectivesThe authors examined utilization of a health plan offering of QCCTA to diabetic members and the impact of utilization on health plan costs.MethodsDiabetic health plan members ≥40 years without prior myocardial infarction were offered QCCTA as a pilot benefit. Benefit utilizers were compared to eligible nonutilizers for incident cardiovascular episodes of care post-notification of eligibility.ResultsOver 14 months, 2,064 of 38,079 health plan members were identified as eligible. Utilizers (19.1%) were predominantly White (76.4%) and female (72.6%) residing in communities with high census median household income ($54,321 [$54,321–$71,159]). Utilizers’ glycemic control was better (glycated hemoglobin 6.5% [6.0%-7.3%] vs 7.0% [6.4%-7.7%], P = 0.05), and 10-year atherosclerotic cardiovascular disease risk was lower (8.5% [4.2%-15.8%] vs 10.8% [5.7%-20.3%], P = 0.07). Detailed claims data from a matched cohort of 169 utilizers and 169 nonutilizers after a median of 19 months’ follow-up showed more incident cardiovascular episodes of care in utilizers (1 [1-3] vs 1 [1-1], P < 0.0001) and higher incremental per-member per-month health plan expenditure for cardiovascular episodes of care ($19.04/month [4.65-85.11] vs $0/month [0-0], P < 0.0001). Per-member per-month was similar after adjusting for baseline glycated hemoglobin and atherosclerotic cardiovascular disease risk score (P = 0.78).ConclusionsUtilization of QCCTA offered to an employed population with diabetes varies by demographics while increasing near-term health plan expenditure for cardiovascular care. Longer-term studies are warranted to evaluate QCCTA’s impact in value-based care models on diabetic members’ health outcomes and total health plan spend.

Treatment of hepatitis C virus (HCV) is slowly being adopted into primary care clinical practice as a result of curative treatment options with less frequent monitoring and fewer adverse effects.1-2 However, many primary care clinicians defer care to specialists because of administrative burdens

BackgroundComparing static postural stability between the involved and uninvolved legs in individuals 12 weeks after ACL reconstruction (ACLR), and against healthy controls, may provide insight into rehabilitation progression.PurposeTo compare static single-leg postural stability between the injured and uninjured legs of individuals 12 weeks post ACLR, and to a control group of healthy, physically active individuals.Study DesignCase-control studyMethodsTwenty-nine participants (17 male, 12 female; age = 20.9 ± 5.0) 12 weeks post ACLR and 87 healthy controls (51 male, 36 female; age = 19.4 ± 1.2) volunteered. Static single-leg postural stability was assessed using an AMTI force plate under eyes open (EO) and eyes closed (EC) conditions. Ground reaction force in three directions were recorded for each condition. Comparisons were made between the ACLR group and controls, as well as between the involved and uninvolved legs within the ACLR group. Descriptive statistics were calculated for each variable. Kruskal-Wallis and Wilcoxon signed rank tests identified significant differences, and effect sizes were computed.ResultsThere were no significant differences within the ACLR group or between the ACLR and control groups for any static postural stability variable.ConclusionsUnder the specific static postural stability test administered, individuals 12 weeks post ACLR did not show significant differences in static postural stability between their involved and uninvolved legs, or when compared to healthy controls. These findings suggest that static postural stability is either not significantly impacted by ACLR or that deficits resolve by 12 weeks post-surgery and may not need to be a primary focus of early rehabilitation. Alternatively, it is also possible that the challenge imposed in the current study was not sufficient to challenge the components required for postural stability and clinicians should consider integrating more difficult tasks.Level of Evidence3