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Within each standard, specific indicators provide measurable action statements that illustrate how the RDN can apply the principles of sustainable food systems to a variety of practice settings. The indicators describe 3 skill levels (ie, competent, proficient, and expert) for RDNs in this focus area.In the aftermath of the killing of George Floyd and other Black Americans, the world has risen up in pain and anguish to condemn social injustice and racism that has systematically impacted the lives of people of color. Many of you have shared your outrage and impatience regarding lack of diversity in our profession, structural racism in our American culture that leads to inequities, and the need for a lasting systemic change. You have asked for implicit bias training, cultural humility, and frank conversations. You have asked us to look internally as individual members and as an organization. And you have asked us to listen.

Lower extremity bypass surgery remains an important treatment option for patients with critical limb ischemia (CLI), but is resource intensive. We sought to evaluate the cost and Medicare reimbursement for lower extremity bypass surgery in patients with CLI.

Hospital cost accounting systems were queried for total technical and professional costs incurred and reimbursement received for patients with CLI undergoing lower extremity bypass at our center between 2011 and 2017. Patients were identified by assignment to Diagnosis-Related Group (DRG) 252, 253, or 254 (other vascular procedure with major complication/comorbidity, with complication/comorbidity, and without complication/comorbidity, respectively). Additional clinical data were incorporated from the Vascular Quality Initiative clinical registry. For non-Medicare patients, reimbursement was indexed to Medicare rates. Contribution margins (reimbursement minus cost) from technical and professional services were analyzed for each patient and summarized bexity of DRG, there was insignificant variation in professional reimbursement as DRG complexity increased. On multivariable modeling, longer length of stay (-$2547 per additional day) and preoperative dialysis (-$5555) were significantly associated with negative margins.

For the majority of patients with CLI, current Medicare reimbursement does not adequately cover the cost of providing care after open bypass surgery. As commercial insurers move toward Medicare reimbursement rates, more granular risk stratification profiles are needed to ensure open surgical care for patients with CLI remains financially sustainable.

For the majority of patients with CLI, current Medicare reimbursement does not adequately cover the cost of providing care after open bypass surgery. As commercial insurers move toward Medicare reimbursement rates, more granular risk stratification profiles are needed to ensure open surgical care for patients with CLI remains financially sustainable.The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the first KDOQI nutrition guideline, there has been a great accumulation of new evidence regarding the management of nutritional aspects of kidney disease and sophistication in the guidelines process. The 2020 update to the KDOQI Clinical Practice Guideline for Nutrition in CKD was developed as a joint effort with the Academy of Nutrition and Dietetics (Academy). It provides comprehensive up-to-date information on the understanding and care of patients with chronic kidney disease (CKD), especially in terms of their metabolic and nutritional milieu for the practicing clinician and allied health care workers. The guideline was expanded to include not only patients with end-stage kidney disease or advanced CKD, but also patients with stages 1-5 CKD who are not receiving dialysis and patients with a functional kidney transplant. The updated guideline statements focus on 6 primary areas nutritional assessment, medical nutrition therapy (MNT), dietary protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. The guidelines primarily cover dietary management rather than all possible nutritional interventions. The evidence data and guideline statements were evaluated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.Alopecia totalis (AT) is characterised by extensive hair loss on the scalp, and common treatments are rarely effective. Janus kinase inhibitors represent a potentially new treatment modality in AT. In this case report, AT was successfully treated with tofacitinib in a 43-year-old male patient. MEK inhibitor After six months of treatment, the patient regained all his hair, and no relapse was seen after one year of treatment.A 12th nerve palsy with no or only few symptoms is rare due to its close location to other structures. The majority of 12th nerve palsies are due to malignancies. In this case report, a 45-year-old woman was admitted to neurological services with a right-sided 12th nerve palsy. An MRI of the brain and the carotid arteries with angiogram revealed an aneurysm in the extracranial part of the right internal carotid artery close to the hypoglossus canal. The aneurysm measuring 10 × 6 × 5 mm was stented and coiled. At telephone follow-up three weeks after coiling, the patient was asymptomatic.The sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin has been approved for the treatment of Type 1 diabetes (T1D) with significant reductions in HbA1c, weight, total daily insulin dose and significant increase in time in range without an increased risk of hypoglycaemia. The use of SGLT2i in T1D has, however, shown a significant increase from 1,9% to 4,0% in the risk of diabetic ketoacidosis (DKA), which may present as euglycaemic DKA. In this review we therefore find it important to know, that DKA may present with normal/near-normal blood glucose levels, if the patient is treated with an SGLT2i.