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ANP-BC questions - ANCC Adult Nurse Practitioner Updated: 2024

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Exam Code: ANP-BC ANCC Adult Nurse Practitioner questions January 2024 by team

ANP-BC ANCC Adult Nurse Practitioner

Category Content Domain Number of Questions Percentage

I Assessment 31 21%

II Diagnosis 39 26%

III Clinical Management 65 43%

IV Professional Role 15 10%

TOTAL 150 100%

Body Systems Drug Agents Age Group

1. Cardiovascular 1. Analgesic 1. Infant

2. Endocrine 2. Anti-Infective 2. Preschool

3. Gastrointestinal 3. Cardiovascular 3. School-Age

4. Genitourinary and Renal 4. Endocrine 4. Adolescent

5. Head, Eyes, Ears, Nose, and Throat 5. Eye, Ear, Nose and Skin 5. Young Adult (including late adolescent and emancipated minors)

6. Hematopoietic* 6. Gastrointestinal 6. Adult

7. Immune* 7. Genitourologic 7. Older Adult

8. Integumentary 8. Musculoskeletal 8. Frail Elderly

9. Musculoskeletal 9. Neurological

10. Neurological 10. Psychiatric

11. Psychiatric 11. Reproductive

12. Reproductive 12. Respiratory

13. Respiratory


A. Knowledge

1. Evidence-based population health promotion and screening

B. Skill

1. Comprehensive history and physical assessment

2. Focused history and physical assessment

3. Risk assessment (e.g., genetic, behavioral, lifestyle)

4. Functional assessment (e.g., cognitive, developmental, physical capacity)

II Diagnosis

A. Knowledge

1. Pathogenesis and clinical manifestations of disease states

B. Skill

1. Differentiating between normal and abnormal physiologic or psychiatric changes

2. Diagnostic test selection and evaluation

III Clinical Management

A. Knowledge

1. Pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and pharmacogenetics

2. Anticipatory guidance (e.g., developmental, behavioral, disease progression, crisis management, end-of-life care)

3. Age-appropriate primary, secondary, and tertiary prevention interventions

B. Skill

1. Pharmacotherapeutic intervention selection (e.g., interactions, contraindications)

2. Pharmacotherapeutic intervention evaluation (e.g., monitoring, side/adverse effects, patient outcomes)

3. Non-pharmacologic intervention selection and evaluation

4. Therapeutic communication (e.g., motivational interviewing, shared decision making)

5. Culturally congruent practice

6. Resource management (e.g., accessibility, coordination, cost effectiveness)

IV Professional Role

A. Knowledge

1. Legal and ethical considerations for health care informatics and technology (e.g., confidentiality, accessibility)

2. Scope and standards for advanced practice registered nurses

3. Regulatory guidelines (e.g., reportable diseases, abuse reporting)

4. Evidence-based clinical guidelines and standards of care

5. Ethical and legal principles and issues for patients, populations, and systems (e.g., justice, consent, guardianship, bioethics)

B. Skill

1. Research appraisal (e.g., design, results, clinical applicability)

The ANCC Family Nurse Practitioner board certification examination is a competency based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of nurse practitioners. This certification aligns with the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Once you complete eligibility requirements to take the certification examination and successfully pass the exam, you are awarded the credential: Family Nurse Practitioner-Board Certified (FNP-BC). This credential is valid for 5 years. You can continue to use this credential by maintaining your license to practice and meeting the renewal requirements in place at the time of your certification renewal. The Accreditation Board for Specialty Nursing Certification accredits this ANCC certification.

The ANCC certification examinations are developed consistent with the technical guidelines recommended by the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education (AERA, APA, NCME; 1999). Additionally, the ANCC certification examinations meet accreditation standards of the Accreditation Board for Specialty Nursing Certification(ABSNC) and the National Commission for Certifying Agencies (NCCA).
Each examination is developed by ANCC in cooperation with a Content Expert Panel (CEP) composed ofcarefully selected experts in the field. CEPs analyze the professional skills and abilities from role delineationstudies, which provide the evidence for the test content outline (also called the test blueprint).

Test questions or “items” are written by certified nurses and interprofessional content experts in their discipline who have received training by ANCC staff in writing items. The items are then reviewed by the CEP with the ANCC staff and pilot-tested to ensure validity and psychometric quality before being used as scored items on the actual examinations. ANCC adheres to a variety of guidelines during the development of items to ensure that the items are appropriate for the specialty and certification level (e.g., APRN vs. RN). This includes editing and coding items, referencing items to the approved test
content outlines and reference books, and screening items for bias and stereotypes.
Items for the examinations are selected that reflect the test content outline and item distributions.
The validity and reliability of the exams are monitored by ANCC staff. Certification examinations are updated approximately every three to five years.

ANCC reports its examinees test score results as pass or fail. If an examinee fails, the score report includes diagnostic feedback for each of the major content areas covered on the examination.

ANCC examinations are criterion-referenced tests, which means that an examinees performance on the examination is not compared to that of other examinees in determining the examinees pass/fail status.

In a criterion-referenced test, an examinee must achieve a score equal to or greater than the minimum passing score for the examination. The minimum passing score represents the absolute minimum standards that the examinee must achieve to demonstrate the ability to practice the profession safely and competently. With the guidance of a measurement expert (e.g., a psychometrician), a panel of subject matter experts in the nursing specialty sets the minimum passing score for each ANCC
examination. In setting the minimum passing score, ANCC uses the Modified Angoff Method, which is well-recognized within the measurement field.

Each exam contains between 150 to 175 scored test items plus 25 pilot test items that do not count towards the final score. For specific information on the number of items each exam contains, please refer to the test content outline associated with that exam.

Scores on ANCC examinations are reported on a scale with a maximum possible score of 500. To pass the ANCC examination, an examinee must achieve a scale score of 350 or higher. Prior to conversion of an examinees score to this scale, the examinees raw score on the examination is determined, which is simplythe number of test items that the examinee answered correctly (e.g., 105 out of 150). The raw score is then converted to a scale score, using a conversion formula.

For examinees who do not achieve a scale score of at least 350, the score report will show the scale score achieved, “fail” status, and diagnostic feedback for each of the content areas covered by the examination
ANCC Adult Nurse Practitioner
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ANCC Adult Nurse Practitioner
Question: 64
Which is the most significant procedure in screening for benign prostatic
D. Prostate biopsy
Answer: B - PSA, or Protein Specific Antigen, is a tool for detecting prostate
disease; however, digital rectal examination, where the prostate can be palpated
through the rectal wall, would be a more definitive diagnosis. Hard nodule or
benign enlargement of the prostate can be felt through DRE. An increasing PSA
may indicate prostate cancer.
Question: 65
A patient is diagnosed with diabetes insipidus after a series of diagnostic tests.
Which of the following signs and symptoms is indicative of this disorder?
A. Polydipsia
B. Weight gain
C. Hypertension
D. Changes in level of consciousness
Answer: A
Diabetes insipidus is hyposecretion of aldosterone, a hormone that increases the
absorption of sodium and water. This disorder is manifested by signs of fluid
deficit. Diabetes insipidus is manifested by polydipsia, polyuria, dehydration,
fatigue, inability to concentrate urine, and postural hypotension. Options B, C,
and D are common signs of syndrome of inappropriate antidiuretic hormone.
Question: 66
You suspect a patient has Type I Diabetes. The following statements are true
about Type I Diabetes except:
A. May be linked to autoimmunity
B. Onset usually prior to age 20
C. Beta islet cells destroyed
D. Does not require insulin injections
Answer: D
Type 1 Diabetes Mellitus is caused by the destruction of Beta islet cells in the
pancreas, which ensue a deficiency of insulin. Type 1 DM is formerly known as
juvenile-onset DM since it afflicts the younger population, usually prior to the age
of 20. The recommended treatment for this condition is insulin replacement (thru
injection) therapy.
Question: 67
A female patient complains of an enlarged thyroid gland, and protruding eye ball.
Further evaluation reveals that the patient has hypertension, nervousness, and fine
tremors of the hands. Which of the following medications should be ordered for
the patient?
A. Propylthiouracil (PTU)
B. Levothyroxine (Synthroid)
C. Liotrix (Thyrolar)
D. Liothyronine (Cytomel)
Answer: B
Propylthiouraciis an anti-thyroid medication that inhibits the synthesis of thyroid
hormones. The other medications are thyroid hormones that control the metabolic
balance rate of tissues.
Question: 68
A newly diagnosed client is prescribed with insulin. The patient is taught to rotate
injection sites when administering insulin to prevent which of the following
reasons complications?
A. Increased resistance to insulin
B. Insulin lipodystrophy
C. Hypersensitivity
D. Increased bleeding and bruises
Answer: B
Rotating injection sites are essential to prevent insulin lipodystrophy, which may
result in decreased or altered absorption of insulin. The other options are not
Question: 69
The following statements are true regarding Burkitts lymphoma, except:
A. Close association with Epstein Barr virus
B. High-grade T-cell malignancy
C. Cytogenic chromosomal change is seen
D. It is a form of non-Hodgkin lymphoma
Answer: B
Burkitts lymphoma is a rare and highly aggressive type of Non-Hodgkins
lymphoma that usually affects children. It is a rapid-growing B-cell lymphoma
that involves parts of the body other than the lymph nodes. Burkitts lymphoma is
highly associated with the chromosomal translocation of the c-myc gene.
Numerous cases of this lymphoma have decreased resistance to EBV (Epstein-
Barr virus).
Question: 70
The following are characteristics of nephrogenic diabetes insipidus, except:
A. Sensitized kidney tubules to ADH
B. A genetic (sex-linked) predilection in men
C. Normal ADH production and secretion
D. Large volumes of dilute urine are produced
Answer: A
Unlike Central Diabetes Insipidus, Nephrogenic diabetes insipidus is caused by
the kidneys resistance to ADH rather than a deficiency of this hormone. This
results in a decreased ability of the kidneys to concentrate the urine. The disease
is rare, but 90% of the known cases are believed to be X-linked, which causes the
vasopressing receptor to not function properly. The primary symptom of NDI is
excessive thirst and excretion of large amount of urine. Dehydration is a common
complication of the disease.
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Medical Practitioner questions - BingNews Search results Medical Practitioner questions - BingNews Help on call for medical professionals

Introduced during the pandemic, this support service became an invaluable resource for health care workers.

A rapid response line for medical professionals with workplace-related health and safety questions and concerns has apparently been a long time coming, according to Vancouver Coastal Health Research Institute researcher Dr. Annalee Yassi. Together with other health care workers and researchers, Yassi led the medical Practitioner Occupational Safety and Health (mPOSH) initiative, which provides prompt dedicated support and guidance to medical professionals.

“Physicians are largely independent contractors and, before mPOSH was launched, they did not have a dedicated resource within the health care system where they could ask occupational health and safety questions with complete confidentiality,” says Yassi. 

“Being able to connect with a human being who can help answer workplace questions and concerns allows physicians and other medical staff to feel cared for.”

Innovation, community partnerships and a growing portfolio of services and patients have led to incredible advances in medicine, as well as added layers of complexity within the profession. This was particularly true during the COVID-19 pandemic, when there was a high frequency of new health care policies that could sometimes raise further questions among health practitioners. 

“There was a lack of consistent information surrounding workplace occupational health and safety concerns that may have impeded knowledge acquisition and understanding of policy changes in health care settings,” notes Yassi. 

Rapid peer support for medical practitioners in the workplace

mPOSH was launched at Vancouver Coastal Health (VCH) during the early days of the pandemic. It offered a confidential resource to medical practitioners who had questions related to exposures, had to be reached for contact tracing or wanted information on what to do if infected with COVID-19, along with return-to-work protocols following illness or exposure to a communicable disease. 

Emails to mPOSH are triaged by medically trained individuals, including medical students, physicians and specialists, who would then aim to reply with a phone call or email within two hours.

Below is a sample of questions posed by mPOSH users:

• “My partner has concerns about implications for our kids, etc. What do you recommend?”

• “I am a general practitioner working in the community. I have a question regarding the risk of exposure outside of work.”

• “I may have been exposed at work. Can I still go out to Costco? Thank you for your hard work. This is very stressful.” 

mPOSH is well-integrated with VCH’s People Team, which supports prevention efforts and return-to-work plans for health practitioners, states Yassi. The mPOSH team also provides resources and collaborates with other B.C. health authorities, including Interior Health and Providence Health Care. 

In addition to these services, mPOSH promotes and offers important information about COVID-19 vaccination, monitors exposures to other infectious diseases, including tuberculosis, and connects health care professionals with workplace violence supports. 

Another significant mPOSH mandate is to analyze anonymised data and do research to develop resources and guides that can address identified gaps in health care settings. For example, mPOSH tracks violent incidents, as well as addresses the need among medical staff for respirator fit-testing to reduce the risk of exposure to transmissible diseases in the workplace.

“We see the role of mPOSH as one of advocating for medical staff,” says Yassi. “So long as it continues to be beneficial to medical practitioners and the health sector, our hope is to continue offering this service long into the future.” 

Thu, 28 Dec 2023 04:59:00 -0600 en-US text/html
ChatGPT struggles to answer medical questions, new research finds

CNN  — 

ChatGPT might not be a cure-all for answers to medical questions, a new study suggests.

Researchers at Long Island University posed 39 medication-related queries to the free version of the artificial intelligence chatbot, all of which were real questions from the university’s College of Pharmacy drug information service. The software’s answers were then compared with responses written and reviewed by trained pharmacists.

The study found that ChatGPT provided accurate responses to only about 10 of the questions, or about a quarter of the total. For the other 29 prompts, the answers were incomplete or inaccurate, or they did not address the questions.

The findings were presented Tuesday at the annual meeting of the American Society for Health-Systems Pharmacists in Anaheim, California.

ChatGPT, OpenAI’s experimental AI chatbot, was released in November 2022 and became the fastest-growing consumer application in history, with nearly 100 million people registering within two months.

Given that popularity, the researchers’ interest was sparked by concern that their students, other pharmacists and ordinary consumers would turn to resources like ChatGPT to explore questions about their health and medication plans, said Sara Grossman, an associate professor of pharmacy practice at Long Island University and one of the study’s authors.

Those queries, they found, often yielded inaccurate – or even dangerous – responses.

In one question, for example, researchers asked ChatGPT whether the Covid-19 antiviral medication Paxlovid and the blood-pressure lowering medication verapamil would react with each other in the body. ChatGPT responded that taking the two medications together would yield no adverse effects.

In reality, people who take both medications might have a large drop in blood pressure, which can cause dizziness and fainting. For patients taking both, clinicians often create patient-specific plans, including lowering the dose of verapamil or cautioning the person to get up slowly from a sitting position, Grossman said.

ChatGPT’s guidance, she added, would have put people in harm’s way.

“Using ChatGPT to address this question would put a patient at risk for an unwanted and preventable drug interaction,” Grossman wrote in an email to CNN.

When the researchers asked the chatbot for scientific references to support each of its responses, they found that the software could provide them for only eight of the questions they asked. And in each case, they were surprised to find that ChatGPT was fabricating references.

At first glance, the citations looked legitimate: They were often formatted appropriately, provided URLs and were listed under legitimate scientific journals. But when the team attempted to find the referenced articles, they realized that ChatGPT had given them fictional citations.

In one case, the researchers asked ChatGPT how to convert spinal injection doses of the muscle spasm medication baclofen to corresponding oral doses. Grossman’s team could not find a scientifically established dose conversion ratio, but ChatGPT put forth a single conversion rate and cited two medical organizations’ guidance, she said.

However, neither organization provides any official guidance on the dose conversion rate. In fact, the conversion factor that ChatGPT suggested had never been scientifically established. The software also provided an example calculation for the dose conversion but with a critical mistake: It mixed up units when calculating the oral dose, throwing off the dose recommendation by a factor of 1,000.

If that guidance was followed by a health care professional, Grossman said, they might deliver a patient an oral baclofen dose 1,000 times lower than required, which could cause withdrawal symptoms like hallucinations and seizures.

“There were numerous errors and “problems’ with this response and ultimately, it could have a profound impact on patient care,” she wrote.

The Long Island University study is not the first to raise concerns about ChatGPT’s fictional citations. Previous research has also documented that, when asked medical questions, ChatGPT can create deceptive forgeries of scientific references, even listing the names of real authors with previous publications in scientific journals.

Grossman, who had worked little with the software before the study, was surprised by how confidently ChatGPT was able to synthesize information nearly instantaneously, answers that would take trained professionals hours to compile.

“The responses were phrased in a very professional and sophisticated manner, and it just seemed it can contribute to a sense of confidence in the accuracy of the tool,” she said. “A user, a consumer, or others that may not be able to discern can be swayed by the appearance of authority.”

A spokesperson for OpenAI, the organization that develops ChatGPT, said it advises users not to rely on responses as a substitute for professional medical advice or treatment.

The spokesperson pointed to ChatGPT’s usage policies, which indicate that “OpenAI’s models are not fine-tuned to provide medical information.” The policy also states that the models should never be used to provide “diagnostic or treatment services for serious medical conditions.”

Although Grossman was unsure of how many people use ChatGPT to address medication questions, she raised concerns that they could use the chatbot like they would search for medical advice on search engines like Google.

“People are always looking for instantaneous responses when they have this at their fingertips,” Grossman said. “I think that this is just another approach of using ‘Dr. Google’ and other seemingly easy methods of obtaining information.”

For online medical information, she recommended that consumers use governmental websites that provide reputable information, like the National Institutes of Health’s MedlinePlus page.

Still, Grossman doesn’t believe that online answers can replace the advice of a health care professional.

“[Websites are] maybe one starting point, but they can take their providers out of the picture when looking for information about medications that are directly applicable to them,” she said. “But it may not be applicable to the patients themselves because of their personal case, and every patient is different. So the authority here should not be removed from the picture: the healthcare professional, the prescriber, the patient’s physicians.”

Sat, 09 Dec 2023 23:49:00 -0600 en text/html
More questions than answers in code of conduct revisions

The new year provides an opportunity to cast our eyes ahead to what’s on the tax and superannuation horizon for 2024. This second part of a two-part series discusses some of the key developments expected to command our attention this year.

Proposed legislative measures that did not complete their passage through Parliament by the last sitting day of 2023 (7 December) are likely to be progressed following the resumption of parliamentary sittings on 6 February.

Tax profession ethical and professional conduct

The focus on the tax profession and ethical and professional conduct dominated the headlines in 2023, attracting the attention of senators, the government, and various government agencies. The significant reform package announced on 6 August 2023 aims to restore public confidence and faith in the tax profession by covering three priority areas:

  • Strengthening the integrity of the tax system.
  • Increasing the powers of the regulators.
  • Strengthening regulatory arrangements to ensure they are fit for purpose.

Enacted law

Following the announcement, we saw the passage of the Treasury Laws Amendment (2023 Measures No. 1) Act 2023, which amended the Tax Agent Services Act 2009 to:

  1. Insert new Code of Professional Conduct items 15 (and 16) that require a registered tax or BAS agent to seek approval before employing, or using the services of, an entity to provide tax agent services on their behalf if they know, or ought reasonably to know, that the entity is a disqualified entity – from 1 January 2024. A transitional rule applies to disqualified entities employed or used to provide tax agent services immediately before 1 January 2024.
  2. Reduce the registration period from every three years to annually – from 1 July 2024.
  3. Enable the minister to specify in a legislative instrument additional obligations that registered agents must comply with – from 1 January 2024.

A draft determination, the Tax Agent Services (Code of Professional Conduct) Determination 2023, was released by the Treasury for comment by 21 January 2024 and will supplement the code. It proposes that, among other things, registered agents:

  • Will need to protect public trust and confidence in the integrity of the tax profession and the tax system.
  • Must not disclose any information they receive, directly or indirectly, from an Australian government agency in connection with any activities undertaken with the agency in their capacity as a registered agent.
  • Must keep complete and accurate records relating to the tax agent services they have provided to each of their clients, including former clients.
  • Must advise all current and prospective clients of various matters that could be reasonably relevant and material to a decision by a client to engage, or to continue to engage, the agent.
  1. Prevent a partner in a partnership or an executive officer of a company (and certain former partners and executives who continue to receive financial benefits within the six-month period preceding their possible appointment to the board) from being appointed a board member of the TPB where the firm has more than 100 employees – from 1 October 2024.
  2. Introduce new breach reporting requiring registered agents to “dob in” themselves and other registered agents to the TPB where they have reasonable grounds to believe that they or the other agent has breached the code and the breach is a “significant breach”.

The disqualified entity provisions and dob-in provisions in particular have many in the tax profession nervous about what this means for them. How will registered agents efficiently manage the increased compliance burden (in the form of additional costs and time) to ensure they comply with the disqualified entity provisions? What will be the effect on the relationships between registered agents of a positive obligation imposed on one agent to dob in another agent where they reasonably believe the code has been breached and the breach is a significant breach? What effect will this have on interactions between partners of the same firm or on practitioners in smaller regional communities? How will this operate when gaining or losing a client from or to another agent who you reasonably believe has breached the code? The dust is far from settled on these substantial changes in the regulation of the tax profession.

Proposed law

Newly introduced legislation, the Treasury Laws Amendment (Tax Accountability and Fairness) Bill 2023, proposes to further amend the TASA to increase obligations imposed on registered agents and increase the powers of the regulators. On 30 November 2023, the Senate referred this bill to the Senate committee for inquiry and report by 18 April 2024.

The measures in this bill propose to:

  • Increase the maximum promoter penalties by 100-fold (see below).
  • Expand whistleblower protection when evidence of agent misconduct is provided to the TPB.
  • Give the TPB more time to complete investigations (up to 24 months).
  • Enable the ATO and the TPB to refer ethical misconduct by advisers to “prescribed disciplinary bodies” (broadly include, but are not limited to, prescribed professional associations) for disciplinary action.

The previously touted maximum promoter penalty of $782.5 million will instead be $825 million due to the separately proposed increase in the amount of a penalty unit from $313 to $330. A Treasury consultation paper released on 10 December 2023 seeks feedback on enhancing the TPB’s sanctions regime.

MYEFO measures

The Mid-Year Economic and Fiscal Outlook 2023–24 was released on 13 December 2023 and the following significant measures were announced:

  • A further increase in the amount of the Commonwealth penalty unit from $313 to $330. The increase is proposed to commence four weeks after the passage of the enabling legislation, with indexation expected to continue in line with the existing three-year schedule. This follows an increase from $222 to $275 on 1 January 2023 and indexation from $275 to $313 on 1 July 2023.
  • Providing superannuation trustees with the ability to pay advice fees agreed between a member and their financial adviser from the member’s superannuation account – retroactively applying from the 2019–20 income year.
  • Denying deductions for amounts charged under the general interest charge (GIC) and shortfall interest charge (SIC) provisions – from income years starting on or after 1 July 2025. The Commissioner will continue to retain the discretion to remit the GIC and SIC.
  • Changing the foreign resident capital gains withholding tax regime by increasing the rate from 12.5 per cent to 15 per cent and reducing the withholding threshold from $750,000 to zero – this will affect real property disposals where the contract is entered into from 1 January 2025.
  • Tripling foreign investment fees for foreign investors who apply to purchase established dwellings – from the day after the date of royal assent of the enabling legislation.
  • Amending the definition of a fuel-efficient vehicle for luxury car tax purposes by reducing the maximum fuel consumption limit from 7 litres per 100 kilometres to 3.5 litres per 100 kilometres  from 1 July 2025.
  • Allowing victims and survivors of child sexual abuse to seek access, via a court order, to additional personal or salary sacrifice superannuation contributions made by the offender this would apply retrospectively and only to identifiable additional superannuation contributions starting from the 2002–03 income year.

Of these, the move to remove the deductibility of the GIC and SIC will be felt most by taxpayers. Many are accustomed to being able to manage their tax debts through the lessened impact of the post-tax amount of these interest charges. Once the charges become non-deductible, will the settings of the GIC still be appropriate or should they be reviewed as part of this measure? The GIC is already uplifted by a factor of 7 per cent and the SIC by a factor of 3 per cent. Notably, as the deductions will be denied, any GIC or SIC that is later remitted will no longer need to be included as assessable income.

State taxes

Significant payroll tax changes affecting general medical practitioners have been made in several states. While the changes apply retrospectively, Queensland and South Australia have each provided an amnesty to affected medical practices.

In the recent High Court decision in Vanderstock & Anor v State of Victoria [2023] HCA 30, it was held that subsection 7(1) of the Zero and Low Emission Vehicle Distance-based Charge Act 2021 (Vic) is invalid on the basis that it imposes a duty of excise within the meaning of section 90 of the constitution (which grants exclusive power to the federal Parliament to impose duties of customs and excise). This decision is likely to have significant implications for states’ ability to collect revenue from these sources.

On 1 December 2023, the federal Treasurer announced that the Commonwealth and the states and territories will work together on long-term options for zero-emission vehicles user charging in light of the Vanderstock decision and develop options in response to the implications of the decision on sources of state revenue.

Looking ahead

We expect to see progression, finalisation, and enactment of the various measures announced or released for consultation in 2023. The government’s approach to tackling the list of announced but unenacted measures, such as the corporate tax residency amendments, the individual tax residency rules, and Division 7A reforms remains uncertain.

On the administrative front, registered agents will continue to grasp the expanded application of client-agent linking, navigate the new beta version of the ATO website, and work with clients to manage their outstanding tax debts against the backdrop of the ATO’s firmer approach to debt collection.

Robyn Jacobson is the senior advocate at the Tax Institute.

Thu, 04 Jan 2024 06:53:00 -0600 en text/html
‘RHOBH’ star Annemarie Wiley fires back at ‘clout-chasing’ Dr. Nicole Martin for ‘hurtful’ medical critique No result found, try new keyword!Tea” podcast, the Bravo rookie questions whether the “RHOM” star’s defense of Sutton Stracke was sincere — or merely an attention ... Thu, 04 Jan 2024 09:38:16 -0600 en-us text/html Experts advocate for a digital shift in medical education

Continuing COVID-19 research, other emerging disease threats, and questions about just when the next pandemic may strike as well as concern over the nation's preparedness for it are still top of mind for many healthcare professionals. But in a field where emergencies happen daily, and drastic changes can occur overnight, will these unceasing aspects translate into medical education curriculums fast enough? 

Artificial intelligence is one way to help, some experts say. The technology's use is booming across several industry sectors including healthcare, where it holds promise of improving workflows, diagnoses, educational simulations and more. 

To keep pace with the continually evolving field and new technology supporting it, medical leaders told Becker's that it is imperative for medical education to keep pace. 

Here's what curriculums should prioritize in 2024, according to experts:

Cristy Page, MD. Executive Dean at the University of North Carolina School of Medicine and chief academic officer of UNC Health (Chapel Hill): We are living in a time of rapid scientific discovery and technological advancement. Students need to learn to embrace and lead through change to better the health of our patients and to enable a fulfilling career in medicine. One current example is the use of AI in medicine. As educators, we must ensure that our students understand how to utilize it most effectively in practice and are aware of the latest trends in this area. At the same time, we are actively working with counterparts across our university to establish policies and protocols for the use of AI by students in their coursework.

Adele Webb, PhD, RN. Executive Dean of Healthcare Initiatives for Strategic Education (Herndon, Va.):: As we move into the future, medical education must adjust training to the rapid changes in healthcare. There must be increased focus on how augmented intelligence and virtual reality can be used to safely support health care delivery and train practitioners. As more care is shifting into home and outpatient settings, clinical experiences must adapt to the new realities. And given concerns for the future of general practitioners, students should be educated on the value, satisfaction and importance of a general practitioner role.

Janelle Sokolowich, PhD, MSN. Academic Vice President and Dean of the Leavitt School of Health at Western Governors University (Salt Lake City): In the future, I think nursing will continue to have more integration of virtual reality simulations. So far, with [the implementation of] our simulation experience, we've found that one part of simulation that does really well is building the self-confidence in students' abilities. … We know that we have to continue to build confidence in order to build clinical decision-making ability.

Keith Mueller, PhD. Director of the Rural Policy Research Institute and the Health Management Policy Department at the University of Iowa (Iowa City): There are models in some programs that could be more widely adopted. These are changes in both the content and modality of education that would better prepare physicians as co-leaders of person-centered medical homes functioning under new payment models.

  1. Including instructional material focused on the evolution of payment from volume-based to value-based methodologies will better prepare physicians to understand reasons for pressures to understand patient needs for services beyond those offered in the clinic. I’m thinking of asking physicians to refer patients to other services, sometimes with a formal prescription… Training in public health, changes in delivery modalities (including hospital-at-home), and finance (increased income for the clinic or other healthcare organization related to measures of health) will be needed as part of the medical curriculum.
  2. Increase contact hours during medical education that are undertaking in interprofessional training. Physicians need to collaborate with other members of patient-centered teams (including social workers, public health workers, and administrators) in order to optimize results for the persons (patients) they serve.
  3. Include a variety of opportunities in experiential learning that include serving different population groups (including historically underserved) and in different settings (including rural clinics and hospitals). The degree to which institutions move learning sites out of the immediate environment of the medical school can, and should, vary given the mission of the institution. Having said that, we should encourage those institutions with missions to serve entire states to develop site-specific training to meet the needs of all residents of their states.

Responses have been edited for clarity and length.

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Fri, 29 Dec 2023 01:51:00 -0600 en-gb text/html
A student’s death sparks questions about support services at Middlebury College
People stand outside a building with protest signs.
A group of students held a silent protest at Middlebury College during the Fall Family Weekend in September for Evelyn Sorensen, a 20-year-old transgender student who died suddenly. Courtesy photo by Corinne Lowmanstone

Megan Sorensen sleeps with her daughter’s ashes so that she can be close to her at the end and the start of each day. 

Three months after 20-year-old student Evelyn Mae Sorensen died from an accidental overdose on the Middlebury College campus, her mother is still seeking answers. Megan Sorensen has become increasingly frustrated with the response of college administrators and alleges that the school failed to support her daughter, a transgender woman who struggled with mental illness and substance use.

Faculty members and friends of Evelyn have also been demanding answers from college officials. In a letter to the administration weeks after Evelyn’s death, 11 faculty members asked a series of pointed questions — about the circumstances of the third-year student’s death and the state of on-campus support services for mental health and substance use disorders, especially for marginalized groups such as LGBTQ+ people. Through a protest and social media posts, students have also been calling on the college to do more.

Middlebury spokespeople declined to discuss details of Evelyn’s case, citing privacy laws, and did not respond to repeated requests for interviews with college leaders. But they have disputed allegations that the school doesn’t provide enough support to students.

As she grieves at home in Oregon, Megan Sorensen has grappled with regret. She said she wishes her daughter had pursued higher education elsewhere — somewhere less elite and closer to home. 

“You don’t expect to send your kid to college to come home in a coffin,” Sorensen said, through tears, during an interview with VTDigger earlier this month. “You expect (school officials) to be supportive if they are depressed. You expect them to be supportive if there is drug involvement. You expect that the college is going to take care of them.”

A difficult summer 

Sorensen and other people close to Evelyn described her as a bright, caring student who was active in the mountaineering, bicycling and queer communities on campus. She enjoyed photography, nature and working at local cafes.

The summer, her mother said, was full of opportunity — but also significant challenges. Evelyn was earning straight A’s in her pursuit of a double major in geology and gender, sexuality and feminist studies. She was also looking forward to working as a research assistant in earth and climate sciences, collaborating on projects with NASA’s Goddard Space Flight Center. And as a person who struggled with mental health issues and substance use disorder, Evelyn had achieved “an extended period of sobriety,” Sorensen said. 

But Evelyn was also “struggling with the possibility of relapse,” her mother said, as is common among people in recovery, and had been “open to her providers at the college about her use.” She was working to stay healthy through an opioid treatment program, a local addiction support group and services through the college’s Disability Resource Center, Sorensen said. She said Evelyn disclosed to her medical providers on campus that she was “looking at ordering a package of fentanyl.”

According to Sorensen, Evelyn told her mother she bought the fentanyl, having it delivered to herself on campus sometime in late May, but threw it away without using it because she was on suboxone, which is used to treat opioid dependence. 

In messages Evelyn sent her mother and a faculty advisor, Evelyn said that Derek Doucet, the associate vice president and dean of students, showed up at her summer dorm room days later, early in the morning of May 30. She said in the messages that Doucet gave her a short period to pack up and vacate her room, and handed her a plane ticket to fly home to Oregon later in the day.

In an email sent to a professor, Lizz Ultee, on May 30, Evelyn wrote, “I am so sorry but I’m not going to make our 11am meeting and don’t even know if I will continue with the plans of having me as a research assistant. Derek Doucet told me this morning at 8:30am that I am being kicked off of campus effective at 1pm today so I need to pack and get on a flight back to Oregon. I don’t know if I could still continue my research remotely and would be incredibly thankful if I could.”

Ultee, an assistant professor in earth and climate sciences who had hired Evelyn for the summer, said in an interview that Evelyn told her the school wanted to put her on a forced medical leave of absence because of “a substance use disorder for which she was already in treatment, with a program overseen by a medical doctor.” According to Ultee, Evelyn “said that the dean of students did not understand medication-assisted treatment and wanted her to go to inpatient rehab.”

Ultee emailed Doucet the same day and Doucet confirmed to her via email that Evelyn had been required to depart campus but had access to telemedicine services. He said he could not share more because of “significant privacy considerations.”

Evelyn chose to stay in Vermont because, she said in texts to Sorensen, her health care team thought it would be the most stable option, given that she was on medication-assisted treatment for substance use. 

Despite a severe shortage of options, Evelyn found temporary housing at a Middlebury homeless shelter. There, she told friends and family, other residents, mostly older men, encouraged her to take drugs.

Evelyn appealed Doucet’s decision, according to Sorensen and faculty. Emails shared by Sorensen show at least two concerned faculty members agreed that the college had put her in “grave danger” during a housing crisis in Vermont with very few emergency beds available.

“I honestly feel like we’re fighting for her life,” Sorensen wrote in a June 8 email in response to the faculty. “(Homelessness) is a death sentence either by drugs or suicide. Coming home is better than that, but it would just be prolonging the struggle, and there would be great doubts of whether she would ever return to Middlebury. The college holds her life and future literally in their hands.”

Evelyn sent her mother a series of texts outlining her condition during that time. One, sent from the homeless shelter in June, reads: “I haven’t slept a whole night since Derek kicked me out. I’m sick, weak, lost so much weight my ribs are showing. My mental health is the worst it’s ever been.”

“Every day I get more depressed and closer to wanting to die,” Evelyn wrote in another text to her mother on June 11.

Following the appeal, Evelyn was allowed back into a dorm room on June 16, according to Ultee.

Even as she struggled, Evelyn was open about mental health and substance use challenges evidently related to depression, anxiety and other issues. In a July TikTok post, she wrote, “Over 5 weeks without f3nt, c0ke, and x@ns,” referring to fentanyl, cocaine and xanax. “I know I have a long way to go and everyday is difficult but I finally feel like I have my life back.” The post logged more than 800 likes and 65 comments.

On Sept. 11 — a couple months after she was readmitted on campus and days before her death — Evelyn suffered a bicycle accident that totaled the beloved bike she had saved up to buy, according to Sorensen and a Middlebury Police Department report. She was hospitalized at Porter Medical Center with a concussion and a broken tooth. 

Sorensen, faculty members and friends of Evelyn said they were upset that no one from the college administration checked in on her after she returned to her dorm. 

A single mother of three, Sorensen said she became worried when, a few days after the bike accident, she stopped hearing back from her daughter. On Sept. 19, she called the college’s public safety department, asking it to check on her daughter. The call was logged at 10:05 p.m., according to a Middlebury Police Department report.

Within a few minutes, a security officer from the college’s public safety department conducted a wellness check at the Forrest Hall dorm room, found no response and forced entry at 10:13 p.m., according to the report.

Evelyn’s body, already in rigor mortis, was found lying on the bed, face down, according to the report. There was drug paraphernalia around the room, including needles, snorting straws, a spoon, Narcan and drug testing kits. Seven minutes later, Middlebury police responded and declared Evelyn dead.

College authorities confirmed that she had last entered the building three days earlier, at 10:21 p.m. on Sept. 16, according to the police report.

The 20-year-old’s death certificate showed she died from an accidental fentanyl overdose after using cocaine. 

A demand for information

On Oct. 11, a group of 11 faculty members sent a letter to the Faculty Council to request “crucial information about Evelyn’s treatment at Middlebury and the handling of her death.” 

In the letter they ask why she was asked to leave campus in May, whether there was a reentry plan in place, why no wellness checks occurred between the bike accident and her death, and what systems failures occurred to allow her to die and not be found for as many as three days.

The letter also poses broader questions about the availability of in-person mental health support, caseloads for resident assistants, whether health care staff are trained in dealing with substance use disorder and when a psychiatrist will be made available to students.

“We ask this not only because we know demand is high, but also because some of Evelyn’s friends heard from her that she was not able to access the resources she needed,” the letter states.

The Faculty Council, an elected executive committee representing faculty, backed the letter with a note to the administration on Nov. 1 encouraging it to respond to the concerns. (The council also voted in November to extend academic deadlines in light of two student deaths on campus, including Evelyn’s, The Middlebury Campus newspaper reported.)

Michelle McCauley, interim executive vice president and provost, emailed a response to the faculty letter-writers on Dec. 12 that did not answer the questions. “Middlebury cannot share students’ confidential health, medication or counseling information with the faculty as a whole, or a subset that requests it,” she stated.

McCauley further wrote, “Our colleagues have consistently gone above and beyond for our students and our community. To suggest otherwise is simply inaccurate.”

“We have had a horrific, sad fall semester,” McCauley wrote. “Many of us will have questions that are never fully answered around why two amazing young adults are gone. I have two children approximately the ages of Evelyn and Ivan and I am personally struggling to understand the challenges these young adults are balancing.”

Not enough support?

When families visited Middlebury College during Fall Family Weekend, which took place Sept. 27-29, a small group of students with black tape across their mouths held up black and white handmade signs outside the chapel with various slogans referring to Evelyn and the questions surrounding her death.

“How long until you find the next kid dead?” read one. 

After Evelyn was found deceased on Sept. 19, another student died on campus. Ivan Valerio, a 19-year-old Filipino American from Florida, died by suicide on Nov. 7, according to a death certificate obtained by VTDigger.

A November editorial in the The Middlebury Campus, titled “Student death is now part of the routine at Middlebury,” cited these deaths, as well as that of a third student — Yan Zhou from China — who died of an apparent suicide in 2021, according to the student newspaper. Another student, William Nash, died after drug use in 2020. Middlebury Police confirmed that four deaths have been investigated on campus since 2019. The causes were accidental asphyxiation, accidental drug overdose and two suicides.

Middlebury Police Chief Jason Covey said in an email this week that the mental health struggles evident from these incidents are reflective of society at large. The school and the town “are not immune to the state and nationwide impacts of mental health and drug use. As a police department, we find ourselves routinely dealing with related matters.”

The department, Covey said, recognizes “the evolving nature of the law enforcement profession to one where officers serve many functions,” including filling gaps to act as social workers.  

Students recently created an Instagram page — No More Dead Kids at Middlebury — in which they anonymously share their experiences and thoughts.

“I believe that if the college was better equipped to meet the needs of marginalized students in this rural, socially isolating, elitist pwi (predominately white institution), student death might not be normal as it is now,” one person identifying themselves as a current student wrote in November. They added that they had “tried and failed to find a counselor on this campus.”

“If I were to speak, I would say that addiction is terrifying, and that this school does not put enough attention to mental health and providing resources for students to have access to regular therapy,” Annika Raiha Vikstrom, one of Evelyn’s friends, told VTDigger in an email.

Sorensen said it took almost a year for Evelyn to get set up with a local doctor, counselor and psychiatrist. Instead, the school repeatedly referred her to online therapy modules that involved short conversations with a new person every time, Sorensen said.

“As a professional, I’m disgusted,” said Sorensen, who is a nurse practitioner in child and adolescent psychiatry in Oregon. “The college has not adapted to the mental health needs of their students, especially in the pandemic.” 

Nationwide, rates of anxiety, stress and depression among young people have skyrocketed since the onset of Covid-19, with suicide rates of people ages 10-24 climbing, according to a 2021 advisory from U.S. Surgeon General Vivek Murthy. LGBTQ+ and other marginalized populations are particularly affected.

In an email to VTDigger, Julia Ferrante, associate vice president for public affairs, wrote, “While we can’t share information about any specific student’s use of campus supports and resources, we can confirm that Middlebury takes a comprehensive approach to student support and identifying students with needs.” 

Ferrante declined to answer specific questions about Evelyn’s situation but shared general information outlining Middlebury’s approach to “harm reduction resources and educational programming about the risks of opioids.”

In a section about opioids, Ferrante said there are harm reduction stations that stock Narcan. She pointed to the availability of a 30-minute online course on “other drugs” and how students can access four 60-minute sessions “with a provider from Health and Wellness Education to explore your personal relationship with substance use, get individualized feedback, and learn about support services.”

And she said that the college was planning to open a LGBTQIA+ resource called the Prism Center for Queer and Trans Life at Middlebury that “will focus particularly on student empowerment and center on the experiences of queer and trans people of color.”

It was slated to open in 2021, according to a press release on the college website.

Speech censored?

Sorensen’s criticism of Middlebury extends to how it handled the aftermath of her daughter’s death. Sorensen flew in for an Oct. 5 vigil and ceremonial bicycle ride in honor of her daughter, she said. But before her speech, Sorensen said, the chaplain told her she couldn’t include comments about the administration and how it had treated her.

“He said, you can’t say this stuff at a vigil and if you’re going to say that stuff we are not holding a vigil for everyone tonight,” she said. “So I had to completely rewrite my vigil remarks 45 minutes before the vigil occurred to align with what Middlebury wanted me to say.”

More than 300 people showed up at the vigil, which she said was beautiful.

Smita Ruzicka, the vice president for student affairs at Middlebury College, informed Sorensen the next day that Evelyn’s room had been packed up and sanitized, Sorensen said. “So we didn’t get the chance to say goodbye to her in her room or to pack up any of her belongings,” she said.

Sorensen was directed to the Scott Center, a religious and spiritual building on campus, to pick up Evelyn’s things, she said. Many of the items were damaged, she alleged, and several were missing, including some of Evelyn’s journals, a roller suitcase, and two fish fossils that Sorensen had given her daughter when she went home last year.

After she followed up with Middlebury again this week about the missing items, the school’s general counsel, Hannah S. Ross, invited her to a phone meeting. 

Sorensen responded to say she was too upset for another meeting and had lost all faith in the college after three months of waiting.

“I want my daughter’s belongings back, and I want to know what happened to them. I don’t need to go through another traumatic experience of the College giving me no answers, and a bunch of excuses of why they have not been sent to me,” she wrote back.

‘A terrible tragedy’

Yumna Siddiqi, associate professor of English, said in an email that Evelyn was in one of her advanced classes as a first year student. “She was extraordinarily thoughtful and bright, and pushed herself very hard,” Siddiqi said.

Evelyn also worked part time at local cafes. Caroline Corrente of Haymaker Buns said Evelyn worked on and off there since her first year at Middlebury. Corrente described Evelyn as “a quiet, kind individual who was a talented barista and a hard worker.”

“She shared her dislike of the college from year one, which I do remember at one point sparked a conversation between us where I asked her why she didn’t think about transferring because it was so much money to spend on something that she did not like. She said she was going to deliver it some more time,” Corrente said in an email. “I unfortunately think her time at Middlebury never improved and she did not or could not get to a school that was a better fit.”

Though Evelyn endured many challenges, Corrente said, Evelyn came to work with a positive attitude every day and described Haymaker “as a safe space where she felt the environment and her co-workers were really supportive.”

Corrente attended the vigil and bike ride. She said she felt very sad and was still in the dark about what actually happened.

Sorensen has created a Facebook page called The Evelyn Project that focuses on mental health and substance use struggles on the Middlebury College campus. It is modeled after the Elis for Rachel nonprofit formed by students and alumni at Yale University after first-year Rachael Shaw-Rosenbaum died by suicide in 2021. 

The nonprofit claimed in a class-action lawsuit that the university limited her access to care and discriminated against students with mental health disabilities. This August it won a historic settlement that has set off a series of reforms to better serve students with mental health needs. 

Sorensen said she hopes The Evelyn Project will force similar changes on campus for students struggling with mental health and substance use disorders.

Grieving has been “lonely and exhausting” for Sorensen, who has two younger kids at home. Between digging for information and her exchanges with Middlebury College, she’s studying books about grief, connecting online with other parents who have faced similar situations, and poring over the ways in which she thinks she somehow failed Evelyn — a trauma faced by many parents of youth lost to suicide or overdose.

“I cope by trying to keep Evelyn’s legacy alive,” she said. “I can only hope I can make her proud and find how to honor her in the time I have left here on earth, if only for my kids so they will go on the remainder of their lives remembering her.”

Fri, 22 Dec 2023 13:30:00 -0600 en-US text/html
Matthew Perry’s ketamine OD prompts questions about its use for mental illness

The death of actor Matthew Perry in October from ketamine has prompted new concerns and scrutiny focused on unapproved uses of the drug.

Ketamine is used as an anesthetic in hospitals, where it has a long history of safe usage. It also has been abused as a recreational drug. Most recently, it has shown promise as an alternative treatment for unusually difficult cases of mental illnesses, including depression, anxiety, post-traumatic stress disorder and obsessive-compulsive disorder.

Although it’s not FDA-approved for psychiatric illnesses, doctors can legally prescribe it as an off-label treatment.

Meanwhile, a pandemic-era waiver allows doctors to prescribe ketamine via telemedicine without an in-person exam. Some patients receive ketamine at clinics or at home in the presence of a therapist, and some use it unsupervised at home.

Perry battled alcohol and drug addiction for all of his adult life. He was open about his struggles, detailing his dozens of treatment stays and the profound toll of addiction on his health.

Perry, 54, had been getting ketamine infusions legally from a clinic to treat depression. However, an autopsy determined the ketamine found in his body after his death on Oct. 28 couldn’t have been from his most recent known treatment, because too much time had passed, according to The New York Times, which reviewed the autopsy report.

While the Los Angeles medical examiner ruled that ketamine was the primary cause of his accidental drowning in a hot tub, other contributors included heart disease and buprenorphine, which is commonly used to treat opioid addiction and sometimes as a painkiller. The ketamine would have accelerated his heart rate while slowing his breathing, according to the medical examiner.

In October — several weeks before Perry’s death — the FDA published a warning about ketamine, citing risks including abuse, increased blood pressure and bladder problems, and risks of using it at home without a health care provider being present.

The U.S. Drug Enforcement Administration was already working on new rules that would limit use of telemedicine to prescribe drugs including ketamine.

Deaths such as Perry’s are considered rare. Still, it has prompted new discussion and concern. The American Society of Ketamine Physicians, Psychotherapists and Practitioners called the star’s death “a wake-up call for ketamine practitioners and the wider medical community to put clear and unified guardrails in place guided by real-world data and medicine,” the Washington Post reported. The non-profit group said it would devise guidelines for using ketamine at home.

According to MedPage Today, psychiatrist Drew Ramsey of Spruce Mental Health in Jackson, Wyoming, wrote on social media: “In clinical settings, ketamine is known for its safety profile. That doesn’t mean it is safe.” Ramsey also “cited celebrity, substance use disorders, character pathology, psychedelic medicine, and concierge medicine” as possible factors in Perry’s death.

Adam Kaplin, chief scientific officer for Mira Pharmaceuticals, cited by The Washington Post, believes ketamine has great potential to help people with psychiatric illnesses said Perry’s death shows “it is a very potentially dangerous practice to deliver patients access to this at home.”

At the same time, assorted start-ups are working to increase access to ketamine for people with hard-to-treat depression and other mental illnesses.

One point of contention centers on those who believe the drug should be used only in the presence of a trained therapist, and others who say the treatment will be unaffordable for many patients if they aren’t allowed to use it at home, according to the Post.

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Thu, 28 Dec 2023 08:55:00 -0600 en text/html

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