Advanced practice providers (APPs) are uniquely positioned to identify and manage immune-related adverse events (irAE's) through frequent patient interactions, comprehensive assessments, and continuity of care. Their role may be particularly important in early-phase oncology clinical trials, where timely toxicity recognition is essential. Despite their critical role in oncology care, APPs remain underrepresented in clinical trial leadership and decision-making. This commentary examines the implications of APP underutilization for patient safety and trial quality and proposes strategies to enhance APP integration in clinical research through expanded roles, policy changes, and targeted clinical research training.
Opioids are not first-line treatment for chronic noncancer pain. Older adults receiving opioids have an increased risk for respiratory depression, sedation, falls, cognitive decline, and medication interactions. However, poorly planned deprescribing may worsen pain and distress. This clinical practice–oriented paper introduces a decision aid for clinicians in ambulatory care managing opioid therapy for older adults. Guided by the age-friendly Medication, Mentation, Mobility, and What Matters framework and overall clinical complexity, the tool helps identify patients appropriate for structured deprescribing while directing those with acute pain, end-of-life needs, psychiatric instability, or untreated opioid use disorder toward stabilization first.
Transition-age youth face significant challenges accessing mental health care. The purpose of this study was to compare the characteristics of youth (12-26 years) receiving mental health care from nurses or nurse practitioners (NPs) vs psychiatrists using data on outpatient mental health visits from the Medical Expenditure Panel Survey (2000-2019). Among 10,916 mental health visits during this period (weighted N = 114,788,891), 93.6% of visits were by psychiatrists and 6.4% were by nurses or NPs. In adjusted models, nurses and NPs were less likely to care for younger patients (adjusted odds ratio = 0.07, 95% CI = 0.02-0.28), college-educated patients (adjusted odds ratio = 0.04, 95% CI = 0.01-0.26), and patients from the Midwest, West, and South. Nurses and NPs are an important source of mental health care for vulnerable youth, especially older youth and those with socioeconomic vulnerability.
Genitourinary syndrome of menopause (GSM) is a common but frequently underrecognized consequence of estrogen deficiency that affects the vulvovaginal tissues and lower urinary tract. Women presenting to primary care with persistent dysuria, urinary urgency, or frequency after treatment for a urinary tract infection may have GSM rather than recurrent infection, contributing to unnecessary antibiotic use and delayed diagnosis. This clinical practice review uses a de-identified illustrative vignette to highlight the evaluation and management of persistent urinary symptoms in a postmenopausal woman. Current evidence, guideline recommendations, and emerging literature are reviewed to support a structured diagnostic approach, appropriate use of low-dose vaginal estrogen, and antibiotic stewardship. Earlier recognition of GSM may improve diagnostic accuracy, reduce unnecessary antibiotic exposure, and enhance quality of life for affected women.
Insulin is indicated for the treatment of type 2 diabetes when patients do not achieve glycemic targets or experience metabolic decompensation on oral or injectable pharmacotherapy. This overview supports nurse practitioners in prescribing insulin icodec, a once-weekly basal insulin analog. The once-weekly dosing schedule offers advantages for patients with concerns about injection frequency, needle anxiety, or pain. Insulin icodec has a favorable safety profile and can be used in patients with mild to moderate renal or hepatic impairment, older adults, during illness, or during the perioperative period. It is compatible with most noninsulin antihyperglycemic medications and offers enhanced glycemic control when used concurrently.
Falls among older adults represent a public health crisis with increasing death rates. Nurse practitioners face a dual challenge: managing acute postfall injuries and preventing future occurrences. While immediate assessment for hidden injuries using advanced imaging is critical, long-term prevention is paramount. The key to reducing fall-related morbidity lies in applying the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries framework. By utilizing this screening tool and performance-based tests, including the Timed Up and Go, 30-second chair stand, and 4-stage balance tests, nurse practitioners can identify and address modifiable risk factors, shifting care toward proactive prevention.
Background Community clinics serving low-income individuals are key in addressing social needs and holistic well-being. Purpose To implement social needs screenings and referrals and well-being initiatives using a plan-do-study-act approach. Design and Intervention Social needs screening and referrals and well-being initiatives were implemented. Data on number of patients screened and referred for social needs and patient engagement in well-being initiatives were collected and analyzed descriptively. Results One hundred one adult patients were screened and 40 patients received social resources; 14 patients participated in well-being activities. Conclusions Study reveals a high number of social needs and low uptake of well-being initiatives.
Rural communities in the Philippines face ongoing health care access challenges driven by workforce shortages and socioeconomic constraints. This cross-sectional survey examined healthcare professionals' understanding of advanced practice nursing roles and their contributions in rural settings. Results showed increased familiarity with APN roles following interprofessional education and collaborative medical outreach. Respondents’ perceived impact of advanced practice nurses includes improved access to primary care, enhanced patient education, reduced travel burden, chronic disease management, and culturally responsive care. Physician collaborators noted improved workflow efficiency and optimized task distribution. Overall, the findings support formal recognition and nationwide integration of advanced practice nurses into the Philippine health care system.
Extreme heat is an immediate, predictable hazard to mental health, psychiatric stability, and medication safety, and it is intensifying with climate change. Population studies link hot weather to increased psychiatric morbidity and suicide, and people with serious mental illness face markedly higher mortality during extreme heat events. Nurse practitioners (NPs) across primary care, psychiatric-mental health, emergency, geriatric, pediatric, and community settings are well positioned to identify and reduce this risk; however, practical, evidence-based guidance for NPs remains limited. Synthesizing peer-reviewed literature, this clinical review offers NPs a concise framework for climate-informed mental health care: recognizing why heat warrants clinical attention, identifying higher-risk populations, reviewing heat-sensitive psychotropic and medical treatments, applying place-based screening, delivering tailored anticipatory guidance, documenting vulnerability, and coordinating community resources. A medication considerations table and an integrated screening and workflow table support implementation. Climate-ready NP practice does not require a separate clinic; it requires adding heat, place, and medication safety to routine clinical reasoning to prevent avoidable harm and address inequities in environmental exposure.
Polypharmacy is highly prevalent among older adults and is associated with increased risks of adverse drug events, hospitalization, functional decline, and mortality. Age-related changes in pharmacokinetics and pharmacodynamics, multimorbidity, and fragmented care further complicate medication management in this population. Nurse practitioners are uniquely positioned to identify polypharmacy and potentially inappropriate medications through comprehensive medication reconciliation and evidence-based prescribing guidance. This clinical feature reviews key risks and consequences of polypharmacy and presents a stepwise deprescribing framework, illustrated through a case vignette demonstrating practical, patient-centered implementation, to support safe medication optimization in older adults.
Rural primary care practices in Health Professional Shortage Areas often have limited behavioral health services, and newly board-certified nurse practitioners may enter practice with limited transition support. This 12-month postgraduate model combined mentored clinical training, protected learning time, and telehealth-enabled consultation. From 2020 to 2025, 25 residents were recruited, 22 completed the program, 14 were hired by their training site, and 15 remained in rural and/or Health Professional Shortage Area settings. This model may offer a feasible approach for strengthening integrated care capacity and supporting workforce retention in rural settings.
Separation anxiety in children may present with behavioral dysregulation, particularly in the context of psychosocial stressors, such as immigration-related trauma. This case describes an 8-year-old Hispanic boy presenting with escalating school refusal and aggressive outbursts, ultimately resulting in juvenile court involvement. Comprehensive evaluation, including validated screening tools, revealed underlying separation anxiety associated with prior traumatic family separation. Treatment with cognitive behavioral therapy and sertraline resulted in symptom remission. This case highlights the importance of trauma-informed, culturally responsive assessment in pediatric behavioral presentations.
Despite being introduced 25 years ago, the scope of practice for emergency nurse practitioners remains poorly benchmarked. An integrative review of the national literature identified 27 articles and 3 position statements which provided an overview of the role. While some commonalities were observed, the evidence base was limited by age and narrow focus, which prevented meaningful insights into current practice. Nationally focused research is required to define, standardize, and benchmark contemporary Australian scope to support role clarity, consistency of application, and enhance recognition of emergency nurse practitioner practice.
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual symptoms that may include physical, behavioral, or mood indicators significantly impacting the lives of people who menstruate. Since symptomology intersects women’s health and psychiatric domains, patients can present with PMDD symptoms to a variety of healthcare providers, but all should be prepared to provide evidence-based care to identify, diagnose, and treat PMDD. This case report explores the journey of identification and treatment of PMDD for a deidentified adult patient using a multidisciplinary approach.
