A greater understanding of the conceptual basis of advanced practice nursing will help to gain clarity, internal cohesion, external legitimacy, and acceptance of APN roles by society and other healthcare professions.

Health care costs in the United States continue to increase, requiring solutions that permit safe, quality care with a lower financial investment. Utilization of the emergency department for nonemergent care is considered to be one of the costliest, and most preventable methods of health care delivery. This review seeks to demonstrate how advanced practice prehospital programs can potentially decrease the cost of health care without sacrificing quality or safety. Utilization of the emergency department for nonemergent care contributes to the escalating cost of health care as well as to emergency department overcrowding. Advanced practice prehospital programs are a novel approach to potentially decreasing health care costs and emergency department overcrowding. This review introduces the current state of health care costs, emergency department overcrowding, and advanced practice prehospital programs. Further research is needed to determine the actual fiscal impact of these programs.

Clostridium difficile, also called "C. diff," is a gram-positive bacillus associated with nosocomial infections involving diarrhea, most often seen in developing countries. The severity of C. diff-associated diarrhea varies tremendously from mild and self-limiting to fulminant and life-threatening. C. diff has become an extremely important pathogen in community health but can be minimized with attention to proper hygiene. This article presents a case study regarding the treatment and management options of C. diff infection using a recent update of clinical guidelines for patient management.

With health care costs continuing to rise, much attention has been focused on appropriate emergency department (ED) utilization, and nationwide interventions have been developed to support reduction in health care costs and ED use including primary care, community, and home health models. The following is a review of the current state of the evidence regarding patients receiving home health care nursing (HHN) services and impacts on ED utilization. There are significant gaps in the literature regarding the transition from home to ED in patients receiving HHN services; what tools are utilized by home health nurses for triage of patients at home in order to recommend transfer to the ED or other care sources; and what measures are in place for HHN patients regarding variables that are considered to have a higher impact on ED utilization. There is a substantial lack of evidence about whether the effects of HHN services have any relation to, in particular decreasing, ED utilization. There is increasing evidence of the impacts of nurse practitioner care within the community.

May-Thurner syndrome (MTS), or iliac vein compression syndrome, is a pelvic condition that involves compression of the iliac veins resulting in endothelial damage. This condition is typically asymptomatic and often missed in primary care. As progression occurs over time, symptoms related to venous hypertension may be present including acute extremity pain and swelling, pelvic pain, venous claudication, deep venous thrombosis, or chronic development of venous insufficiency. A case report is provided to enhance primary health care providers' knowledge of MTS and promote early detection and recognition to enhance positive and expedited outcomes.