dissent

I agree, you should defer to the cardiologist especially if he/she is the one who started the med. I think calling someone who is an expert in the field a cowboy when they do off-label stuff may not be completely right. Now I don't know what he/she was doing (and it may have been outright wrong) but in more than a few circumstances, the label just isn't right. For instance, nifedipine XL is a labeled as a once daily med with a supposed max of 120 daily. For refractory hypertension it is given BID (especially in renal patients) and frequently 120mg BID (so double the supposed max daily dose). Lisinopril by label is again once daily and rarely given with an ARB since they end in the same common pathway. However, in patients with a highly active Renin-angiotensin-aldo axes it is often given BID or with an ARB. So, I guess what I am saying is perhaps he/she had a reason since he/she is the expert in the field.

I think the OP is asking why someone would prescribe flovent and flonase to the same patient

Everyone makes mistakes. Live and learn. In the end I think you learned a valuable lesson without having any harm come to anyone: don't prescribe a medicine you are not comfortable prescribing.

It would probably be similar to the PA to MD bridge- a 3 year program followed by residency.

At least in the past, the hopkins guide was free if you used it online. You just had to sign up for it. The PDA/smartphone version always cost money. I don't know if they started charging for the online version or not b/c it is obviously free on the Hopkins intranet. I think the hopkins guide is much easier to use and overall more robust than the sanford guide

Yup. For most drips you need to bolus to get to steady state prior to initiation of a drip (ie SL NTG or 400mcg prior to a nitro drip). For a GI bleed it is a standard initial dose (80 mg IV) and a standard drip dose 8mg per hour. It is the doctor's fault for not putting in an order for the initial order. Good for you and the pharmacist for catching it.

So actually the data aren't exactly a slam dunk and they definitely aren't strongly in favor. I would say they are overall, weakly in favor. Unfortunately there aren't any meta-analyses. Here are the RCTs. L-albuterol is WORSE than racemic albuterol- http://www.ncbi.nlm.nih.gov/pubmed/21275850 They are the same http://www.ncbi.nlm.nih.gov/pubmed/18044102 http://www.ncbi.nlm.nih.gov/pubmed/15988423 http://www.ncbi.nlm.nih.gov/pubmed/11742271 http://www.ncbi.nlm.nih.gov/pubmed/10200010 L-albuterol is BETTER than racemic albuterol http://www.ncbi.nlm.nih.gov/pubmed/16635694 http://www.ncbi.nlm.nih.gov/pubmed/15709454 http://www.ncbi.nlm.nih.gov/pubmed/14657817 Albuterol and L-albuterol are the same for hyperkalemia- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726786/pdf/v022p00366a.pdf

Oh and to answer the original question, you are probably not going to find a large percentage of the Canadian population that come to the US. Only those who are wealthy and are waiting for cancer tx or ortho surgery are likely to come.

Controlling for lifestyle choices (obesity, smoking) and heterogeneity of the US population (ie with infant mortality) you do not see the same difference in life expectancy. These things are not health care system related- they are population/lifestyle related. This is not to say the US system is perfect but it is academically dishonest to compare dissiimilar populations. Think about what would happen if a new cardiovascular drug showed improved mortality yet the they had 10% fewer obese people than control? Answer- it wouldn't pass peer review unless it controlled for these.

It's not.

Belittling or truthful? Quite frankly, anyone who pushes the DNP as much as you do without realizing its massive flaws has ulterior motives or a conflict of interest. So which is it?

I would highly recommend not going to this school. Foreign schools have a lot of problems compared to their US counterparts. There are those that are highly regarded (the UK, german and most australian schools), those that are accepted but with hurdles the graduates have to endure (SGU, Ross), and those where it is difficult for graduates to get residencies. This is the latter. Foreign, Non-european schools tend to have major problems compared to the US: 1) Attrition- they tend to have a high drop-out/fail-out rate 2) Their USMLE pass rate is miserable 3) Their rotations are very subpar 4) Their ability to get residencies is very limited From this school, it would be near impossible to get pretty much anything other than a family medicine residency, and even then, you would probably have difficulty getting an FM program to accept you. Do not underestimate the difficulty to get a residency in the US. No residency and all that money you spent means nothing.

I mean how bad of an error are we talking about? Was this HCTZ 50mg instead of 25 (ie no big deal)?

How long will it take you to finish the BSN and then the DNP? In terms of time to degree and practice I expect the DNP is going to be much much quicker: Medical school route: Peds: total of 9 years- 2 years for post-bac, 4 years for medical school, 3 of peds Peds ICU- total of 11-12 years (add 2-3 years for peds ICU) Peds onc or med onc: total of 12 years- 2post back, 4 med school, 3 of peds or medicine, 3 of peds-onc or med onc NPs do not do as much as a doctor does but as above there is a big difference in the length and depth of training and that explains the difference. Technically after a year of internship after medical school you can LEGALLY do whatever you want (onc/ICU/surgery) but no hospital is going to hire you and you'd be a fool to try. That means to work in an ICU or oncology you must do the extra training as an MD. Think about it this way, at the end of that internship, a physician-in-training will have roughly 7000-8000 clinical hours under their belt with a minimum of 500 of those spent in an ICU while most DNPs require only 1000 hours and not many of those will be spent in an ICU. The post-internship resident isn't going to be allowed to run an ICU alone and will have limited autonomy. Obviously the case is going to be similar for the DNP. The autonomy is going to be hospital dependent. Many ICUs will give NPs a lot of autonomy but there are definitely limitations. Where I have been, NPs dont put in central lines (with exception of PICCs which often aren't that useful in an ICU) or A-lines as well as various other major ICU procedures. These places have been teaching hospitals where there is a lot of cheap labor (residents) so the need for NPs is less. Oncology is a bit of a different bag. NPs tend to have less autonomy overall and in my experience have acted more as physician extenders. In the end I think the decision will hinge on whether the time is worth it and how much knowledge and independence you want. Add to that the knowledge that residency is very tough and you will be working 80 hours a week for 6 years to get into peds-critical care or peds-oncology during your 20s and 30s. Good luck

I think of it as expecting more from an extra year or so of loans. If it is supposed to be a clinical doctorate, it should have more clinical courses and vastly more clinical hours than a masters. Otherwise why have a doctorate? Milk it's students for more money? Try to compete with physicians (ie all political)? The research/statistic courses are somewhat helpful for reading literature but not at the expense a better foundation. I realize people like the idea of having a doctorate for entry but if it's adding little to a clinical practice, what is the use? I think students should speak up and expect more. Purely self directed learning is not the answer but without more basis in disease that is what it is coming down to. If self directed learning were adequate, we wouldn't need teachers and schools.