Osteoporosis is described as a silent disease prior to fracture, and the sequelae of an osteoporotic fracture can be devastating. Primary care providers should routinely assess and remediate bone health during wellness visits for women aged at least 50 years. Assessment includes review of a variety of risk factors, bone density testing, and an online fracture risk assessment tool calculation. Diagnosis is based on bone density score and clinical risk factors. Evidence-based nonpharmacologic therapies are important adjuncts of care, and pharmacologic intervention may also be recommended. A variety of pharmacologic options are available for women with postmenopausal osteoporosis, and it is important to weigh benefits and risks. Pharmacologic indications, therapeutic variations among products, adverse effect profiles, administration considerations, and cost are addressed. Once pharmacotherapy is initiated, duration and drug holidays should also be considered. In general, medication benefits fade when treatment stops, so health care providers should be prepared to routinely revisit therapy indicators that will help define risk and guide treatment decisions. A comprehensive approach to bone health can make a valuable difference in the health of women.

Background Entrustable professional activities (EPAs) are used in medical education in the assessment of clinical competence, but consideration of EPAs in nurse practitioner (NP) education is emerging. Problem There are critical points in the NP educational trajectory when a student should demonstrate requisite knowledge and abilities. It can be challenging to assess and measure clinical proficiency in a way that can be clearly interpreted by students, faculty, and preceptors. Approach NP faculty reviewed a set of medical EPAs that were linked with physician competencies to determine if they related to national NP competency areas and learning activities in their curriculum. Conclusions Several NP competency areas (8 of 9) related to these EPAs, and the learning activities also related to multiple EPAs. Although further work would be needed to tailor EPAs to the NP role and link them specifically with NP competencies, EPAs may offer another valuable method for clinical evaluation of NP students.

Dizziness is a common patient complaint with multiple etiologies. Many causes are benign, but NPs should consider red flags for serious differential diagnoses. A systematic patient history and physical exam are crucial to accurately diagnosing conditions related to dizziness. This article reviews common etiologies of dizziness and vertigo, assessment techniques, and treatment options.

There has been an evolution in the care and survival of people living with human immunodeficiency virus (PLWH) and AIDS. Increased survival of PLWH is attributed to antiretroviral therapy. However, adverse effects of antiretroviral therapy increase the likelihood that PLWH may also be diagnosed with chronic conditions such as diabetes mellitus, hypertension, and dyslipidemia. Drug-drug interactions are common when coadministering human immunodeficiency virus drugs and therapies for common chronic conditions managed in primary care. To prevent adverse events, nurse practitioners should know about these interactions before prescribing new regimens or modifying a regimen.

In response to the need for increased access to primary care services for a low-income, at-risk community, two local universities partnered with a nonprofit Housing and Urban Development affiliated provider of affordable housing to launch a primary care clinic within an urban public housing community. Although the establishment of this clinic represented progress in meeting many healthcare needs of the target population, an interprofessional team also identified a need for the initiation of a new home-based service line. The goal of this project was to establish an innovative, sustainable, and cost-effective healthcare delivery method that would improve the health of this population. The project focused on a literature review, needs-assessment, and development of a comprehensive medical home visit program to serve the homebound, frail elderly, and other at-risk adults with complex medical conditions who reside in this community. The medical needs of potential recipients were assessed by conducting interviews with key support staff including a health service coordinator, health advocates, and housing provider service coordinators. Residents were also interviewed using a newly developed health perception and information survey. The data derived from the needs-assessment and pertinent literature were used to draft an initial program guideline. Because the needs-assessment indicated this population would not derive maximum benefit from a traditional house calls program, the project team developed a Home Healthcare Management service with an expanded scope to provide enhanced care coordination, house visits (medical and nonmedical), and community outreach.