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Misleading at Best: A Critical Appraisal of "Nurse-Physician Substitution in Hospital Settings". 误导：对“医院环境中护士-医生替代”的批判性评价。
Missouri medicine Pub Date : 2026-07-01
Rebekah Bernard, Phillip Shaffer
{"title":"Misleading at Best: A Critical Appraisal of \"Nurse-Physician Substitution in Hospital Settings\".","authors":"Rebekah Bernard, Phillip Shaffer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A recent Cochrane review concluded that nurse-led care results in little to no difference in outcomes compared with physician-led care in hospital settings. These findings have been widely interpreted as evidence supporting substitution of nurses for physicians.</p><p><strong>Objective: </strong>To evaluate the studies included in the Cochrane review and determine whether the evidence supports independent nurse substitution for physicians in hospital settings.</p><p><strong>Methods: </strong>We conducted a structured analysis of the 82 randomized controlled trials included in the review, examining clinical setting, patient acuity, level of supervision, and type of intervention.</p><p><strong>Results: </strong>Only 10 of 82 studies evaluated inpatient hospital care, all involving stable or selected patient populations within physician-led or supervised systems. An additional 11 studies addressed low-acuity emergency or preoperative settings. The remaining majority consisted of outpatient, protocol-driven care for stable conditions, often with explicit physician oversight. No study evaluated independent nurse-led management of hospitalized patients or intensive care settings. Many studies assessed task-specific interventions, additional services, or structured follow-up rather than equivalent clinical roles.</p><p><strong>Conclusion: </strong>The evidence cited does not support independent substitution of nurses for physicians in hospital settings. Instead, it supports the effectiveness of protocolized, delegated care within physician-led teams. While addressing physician workforce shortages is important, maintaining quality and safety requires preserving physician-led models of care.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"284-287"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Not Just a Pediatric Condition: Down Syndrome Across the Lifespan. 不仅仅是儿科疾病：贯穿一生的唐氏综合症。
Missouri medicine Pub Date : 2026-07-01
Emily Haury, Jacqueline Kitchen, Brenda Rogers
{"title":"Not Just a Pediatric Condition: Down Syndrome Across the Lifespan.","authors":"Emily Haury, Jacqueline Kitchen, Brenda Rogers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>With increasing life expectancy for individuals with Down Syndrome (DS), there are growing numbers of adult DS patients needing care from primary care physicians who are knowledgeable regarding their health needs and risks. The Global Down Syndrome Foundation (GDSF) Medical Care Guidelines for Adults with Down Syndrome identify important areas of focus: mental health, dementia, diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, hypothyroidism and celiac disease. Additionally, there are unique considerations regarding cancer risk and screenings, as well as vaccination. Young adults with DS should have a structured transition from pediatric to adult care like any patient with chronic illness or intellectual disability. This article highlights several organizations and programs that provide social, vocational, legal, and family support for Missouri patients with Down Syndrome.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"327-330"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dangers of Injectable Peptides and Other Unregulated "Biohacking" Drugs. 注射肽和其他不受监管的“生物黑客”药物的危险。
Missouri medicine Pub Date : 2026-07-01
Areeba Moiz, Evan L O'Keefe, James H O'Keefe
{"title":"Dangers of Injectable Peptides and Other Unregulated \"Biohacking\" Drugs.","authors":"Areeba Moiz, Evan L O'Keefe, James H O'Keefe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Injectable peptides are increasingly used without prescriptions for cosmetic and athletic enhancement, driven by digital marketing and social media. While evidence-based, FDA-approved peptides like semaglutide and tirzepatide offer significant clinical benefits under medical supervision, an expanding illicit market provides easy access without a prescription to many unapproved experimental drugs. These unregulated substances-including the veterinary anabolic steroid trenbolone, investigational triple-agonists like retatrutide, and unapproved peptides such as BPC-157, TB-500, and melanotan-II-lack established human safety profiles. Their use introduces severe potential risks, including product contamination, manufacturing impurities, inaccurate dosing, pathological angiogenesis, carcinogenesis, cardiovascular stress, and supraphysiological hormonal signaling. This review differentiates evidence-based therapeutics from unproven, high-risk compounds and outlines the molecular mechanisms of toxicity associated with popular \"looksmaxxing\" injectables. Clinicians must recognize these trends, and counsel patients on potential long-term health hazards of these potent agents.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"337-343"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pills and Perils: Navigating Polypharmacy in Older Adults. 药片和危险：在老年人中使用多种药物。
Missouri medicine Pub Date : 2026-07-01
Jafar Ohiokpehai, Lina Toledo-Franco, Julie K Gammack
{"title":"Pills and Perils: Navigating Polypharmacy in Older Adults.","authors":"Jafar Ohiokpehai, Lina Toledo-Franco, Julie K Gammack","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Polypharmacy encompasses inappropriate prescribing, overprescribing, and underprescribing. Polypharmacy in older adults is quite common and contributes to adverse effects, drug interactions, hospital admissions, and functional and cognitive decline. Efforts to reduce polypharmacy include criterion-based management tools, deprescribing protocols, and the use of electronic clinical decision support tools.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"351-357"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Teen Vaping: Not Gone, But Forgotten: The harm associated with e-cigarettes or vaping products is not fully appreciated. 青少年吸电子烟：没有消失，而是被遗忘：电子烟或电子烟产品的危害尚未得到充分认识。
Missouri medicine Pub Date : 2026-07-01
Rebecca Sabates, Gary Salzman
{"title":"Teen Vaping: Not Gone, But Forgotten: The harm associated with e-cigarettes or vaping products is not fully appreciated.","authors":"Rebecca Sabates, Gary Salzman","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"288-291"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Critical Pediatric Obesity Window: Pre-Pubertal Metabolic Disease and the Fallacy of Delayed Intervention. 关键的儿童肥胖窗口：青春期前代谢疾病和延迟干预的谬误。
Missouri medicine Pub Date : 2026-07-01
Matthew Lindquist, Brooke Sweeney
{"title":"The Critical Pediatric Obesity Window: Pre-Pubertal Metabolic Disease and the Fallacy of Delayed Intervention.","authors":"Matthew Lindquist, Brooke Sweeney","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite increasing recognition of pediatric obesity as a chronic disease, many clinicians continue to rely on \"watchful waiting,\" assuming pubertal growth will mitigate excess weight and metabolic risk. Current evidence contradicts this approach. Children under 12 years of age with obesity frequently demonstrate clinically significant metabolic disease, including insulin resistance, dyslipidemia, dysglycemia, and metabolic dysfunction-associated steatotic liver disease (MASLD), often before symptoms emerge. Puberty does not reverse these processes; rather, physiologic pubertal insulin resistance amplifies preexisting metabolic dysfunction and accelerates disease progression. Delayed intervention allows potentially irreversible injury during a critical period of metabolic plasticity. This article reviews contemporary biologic and longitudinal data challenging the pubertal correction paradigm, highlights the concept of metabolic memory, and discusses limitations of lifestyle-only interventions. Drawing parallels to integrated pediatric mental health care, we propose a primary care- centered model emphasizing earlier metabolic screening, coordinated multidisciplinary care, and timely intervention to improve long-term cardiometabolic outcomes.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"314-321"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Report of the American Medical Association Annual Meeting. 美国医学协会年会报告。
Missouri medicine Pub Date : 2026-07-01
Charles W Van Way
{"title":"Report of the American Medical Association Annual Meeting.","authors":"Charles W Van Way","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"304-306"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Future of Care: Augmented Intelligence as a Partner in Patient Care. 护理的未来：增强智能作为患者护理的合作伙伴。
Missouri medicine Pub Date : 2026-07-01
Kevin D Weikart
{"title":"The Future of Care: Augmented Intelligence as a Partner in Patient Care.","authors":"Kevin D Weikart","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"303"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
AI in US Healthcare: Changing How, Not Why, We Practice. 人工智能在美国医疗保健：改变我们的实践方式，而不是为什么。
Missouri medicine Pub Date : 2026-07-01
Tina Quach, Farzana Hoque
{"title":"AI in US Healthcare: Changing How, Not Why, We Practice.","authors":"Tina Quach, Farzana Hoque","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"312-313"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Forgotten Few: Pediatric-to-Adult Healthcare Transitions. 被遗忘的少数人：从儿科到成人医疗保健的转变。
Missouri medicine Pub Date : 2026-07-01
Joanne Loethen, Amanda Sommerville
{"title":"The Forgotten Few: Pediatric-to-Adult Healthcare Transitions.","authors":"Joanne Loethen, Amanda Sommerville","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Healthcare transition is the period when an adolescent or young adult transitions from pediatric, family-centered care to an adult-oriented health care system. Effective transition processes are essential for all youth to promote continuity of care, health literacy, and long-term engagement with the healthcare system. Inadequate transition planning in clinical care can result in poor health outcomes and a young adult's disengagement from medical care. This article reviews the current evidence on healthcare transitions from pediatric to adult care, summarizes the core principles of effective transition, and identifies common barriers faced by those caring for adolescent and young adult populations.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"331-336"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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