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The Nurse Practitioner Blog

A forum for discussion on recent news and developments in healthcare and the NP field.

Monday, June 1, 2020

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely popular for managing type 2 diabetes in patients. This class of medications lowers blood glucose levels by increasing glucose-dependent insulin secretion. In addition to triggering insulin release, they inhibit production of glucagon—a hormone that induces the liver to release stored sugar into the bloodstream. Furthermore, they slow glucose absorption into the bloodstream by reducing the rate of gastric emptying and slowing the speed of nutrient absorption in the bloodstream, thus reducing appetite.

GLP-1 RAs were only available as injectable drugs until an oral tablet formulation was approved by the FDA in September 2019. Oral semaglutide, developed for oral administration for type 2 diabetes treatment, presents significant benefits to patients.

A study conducted by Novo Nordisk in collaboration with Ossian Health Economics and Communications found that semaglutide—both in injected form (1 mg) and oral form (14 mg)—was the most cost-effective GLP-1 RA in the US with regard to bringing patients to glycemic control targets.

The study compared the short-term cost effectiveness of oral and injectable semaglutide with several currently-available injectable drugs. The cost analysis was performed in terms of achieving glycemic control targets of HbA1c ≤6.5% and HbA1c <7.0%, as recommended by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists.

Cost of control assesses the value for money for each intervention simply and transparently. In order to analyze cost of control, the annual treatment cost associated with each aforementioned GLP-1 RA was divided by the ratio of patients accomplishing target treatment. This methodology is consistent with cost of control analysis previously published in peer-reviewed literature. Payment amounts were calculated in US dollars and based on wholesale acquisition charges for 2019. The calculations for cost of control were implemented using a cost of control model, which was programmed using Microsoft Excel. Projected outcomes were limited to a 1-year time horizon; this obviated the need to discount cost and clinical outcomes.

Two treatment targets were used to determine successful control: HbA1c <6.5% and HbA1c <7.0%. Seven GLP-1 RAs were evaluated: oral semaglutide 14 mg, once-weekly dulaglutide (1.5 mg), semaglutide (1 mg), and exenatide (2mg), once-daily liraglutide (1.8 mg) and lixisenatide (20 mg), and twice-daily exenatide (10 mg).

Once-weekly (injectable) semaglutide 1mg and oral semaglutide 14 mg were found to achieve the lowest costs of control among all drugs. For achieving a target of HbA1c <6.5%, semaglutide 1mg and oral semaglutide 14 mg respectively cost $15,430 and $17,383 per patient annually. For a target of HbA1c <7.0%, the cost of control was $12,627 with once-weekly semaglutide 1mg, and $13,493 with oral semaglutide 14mg per patient per year. All other drugs cost higher amounts.

In the base case analysis, for achieving HbA1c <6.5%, lixisenatide 20 µg was associated with the highest expense for control, at $36,552 per patient. And exenatide 10 µg had the highest cost of control, at $20,695 per patient achieving target, for the endpoint of HbA1c <7.0%.

The transparency of the cost-effectiveness analysis in the present study allows replication by other research groups and ease of updates with new clinical and cost data. The study also assesses cost-effectiveness over a 1-year period, thus reducing the uncertainty associated with traditional long-term cost modeling, which projects short-term trial data over long lifetimes.

Studies have shown a general preference for oral administration of drugs over injections. Oral semaglutide thus removes a barrier to medication adherence, which can improve outcomes with the exception of cases where patients may prefer a once-weekly injection to daily oral medications. The optimal medication route and dosage differs from patient to patient and should be determined based on physician discussions and ADA recommendations.

Saturday, November 10, 2018

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Did you know that one in three editors encounter plagiarism regularly?

We hear the stories every day. A number of television personalities, politicians, and writers have admitted to plagiarizing. Whether intentional or not, plagiarism has affected every industry, including scholarly communications, no doubt fueled by the easy access to information through the Internet.

The Nurse Practitioner is committed to delivering high-quality articles for its readers. Part of what that means, in addition to undergoing a rigorous peer review, is that content is free from plagiarism. Fortunately, plagiarism detection software has also become more advanced as of late. iThenticate is one type of software that can be used to ensure that a piece hasn't been plagiarized. It assists authors, editors, and publishers with monitoring for potential plagiarism or academic misconduct in articles. iThenticate boasts the largest scholarly comparison database and has checked over 50 million documents for plagiarism.

The process takes only three steps:

1. Content is uploaded via Editorial Manager, where it is screened using iThenticate prior to being routed for peer review. Authors' work is safe and will not be disseminated.

2. Uploaded documents are compared against those in a large database for plagiarism and attributes using iThenticate's software. The software crawls against documents in other publications and online to check for similarities.  

3. The compared document will be ready to review in just a few minutes. The report includes complete results including any unattributed sources and matched content. Editors of the journal use this report to examine whether plagiarism has occurred and decide how to address findings.

Authors, researchers, subscribers, and editors comprising The Nurse Practitioner's ecosystem can rest assured knowing that all manuscripts submitted for consideration are required to pass through iThenticate prior to being accepted for publication. Wolters Kluwer Health/Lippincott Williams & Wilkins journals are proud to take a strong stand behind integrity in scholarly publications and communications, especially knowing that the information you trust in The Nurse Practitioner informs the important work you do in caring for patients. 

Wednesday, October 10, 2018

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Peer review is a great experience for any researcher, as it provides opportunities to network with editors and fellow researchers, learn about new research, and earn recognition in the field. In addition, peer reviewers can earn CE credits by contributing to the community as a peer reviewer.

Many newer researchers feel deterred from becoming peer reviewers because they do not have the same level of experience in comparison with veteran researchers. However, journal editors tend to be accepting of new researchers, as they often have the time to dedicate to peer reviewing and are eager to prove themselves.

To help get started, Wolters Kluwer, in partnership with Editage, offers two different courses in peer reviewing for new and established peer reviewers. The basic course is free and offers a 3-hour interactive e-learning course with videos and quizzes. The course also has a forum for Q&A as well as a downloadable peer review report template. The advanced course offers everything that the basic course does but with additional features. With the advanced peer review kit, reviewers have access to a statistics guide curated by peer review experts, feedback from course faculty, and more. These kits are a great place for novice researchers to get started but are also great for veteran peer reviewers looking to brush up on their skills.

Becoming a peer reviewer designates a researcher as an expert in the field. It is for this reason that many peer reviewers say that peer reviewing for a publication is an honor. Peer reviewing is a great opportunity for novice and veteran researchers alike.

If this sounds like it might be for you, reach out to a journal editor and become a peer reviewer today!

Monday, September 10, 2018

Peer Review Week is celebrated around the world. Going into its fourth year, the event will be held the week of September 10-15. This year's theme is 'Diversity and Inclusion' in peer review. The organizers hope to promote diversity in the industry and generate discussion among peer reviewers as to what diversity looks like and how it can be achieved. The organizers are also looking to celebrate the diverse group of peer reviewers who have helped spur scientific discovery and communication via publication around the world. This year's theme will generate thoughtful discussion that is expected to touch on gender gaps in authorship and other issues focusing on gender, issues specific to early-career researchers, and country bias, to name a few.

Peer review is one of the most important components of scholarly publication, helping journal publishers ensure that research is correct, timely, necessary, and ethical. Through peer review, authors receive unbiased feedback from fellow subject-matter experts, and publishers are able to move forward with added confidence in knowing that articles are suitable for publication. Activities for Peer Review Week 2018 will be held around the globe. Keep an eye out for blogs, webinars, and lectures on subjects of interest to peer reviewers. 
Peer reviewers are an integral part of scientific publishing. Peer Review Week is set aside to honor those who volunteer their time and energy to helping improve the industry. Please join us in celebrating Peer Review Week 2018.

To get involved, e-mail ideas to using the subject line 'Peer Review Week.' For more information on this year's event, visit Keep up with all the latest on this year's event on Twitter by following @PeerRevWeek. Feel free to join in the conversation by using hashtags #PeerRevWk18 and #PeerRevDiversityInclusion.

f note, Wolters Kluwer Health has also partnered with Editage to provide free training resources for peer reviewers. A paid version of a course is also available. Visit to learn more. 

Thursday, July 26, 2018


With the rise of social media, sharing the output of published research has never been easier. But how do you track how many impressions an author's work garners?

AltMetric is a way to measure the impact of contributions to literature within the online community—via social media and beyond. The system tracks how many times a work has been read, cited, and shared across a variety of platforms. AltMetric takes these data and organizes it to show how much traction a piece has gained across different types of media.

How does it work?
AltMetric displays data with a visual showing whether an article has had impact as well as where it has had the most impact. Each article is accompanied by a rainbow-colored "donut" with different color stripes around it. The colors represent the type of media on which content has been shared and how frequently. For example, a red stripe represents how many times an article has been picked up by a news outlet, light blue represents how many times an article has been Tweeted about, and so on. The greater the variety of colors, the more platforms the work has been shared on.

What is an AltMetric Attention Score?
The AltMetric system uses a proprietary algorithm to score an article based on the total number of impressions an article attracts and the value for each of these impressions. The score is displayed in the center of the donut. An AltMetric Attention Score is based on three factors:

Volume: A part of the score is based on how many times the article is mentioned online.
2. Sources: Certain forms of media carry greater weight. Sources that reach a larger audience contribute more to an article's base score. For example, a newspaper contributes more points than a share on Twitter because a newspaper has a greater potential reach than most Twitter accounts.
3. Authors: The individual sharing an article can also impact an article's attention score. The person sharing the article might have a bias that could affect score. For this reason, a doctor sharing a medical article carries more clout than a publisher because a doctor is an expert in the field, whereas a publisher is sharing so the content gets more views.

These factors work together to create a picture of how much reach an article has had in the community. Still, no score can fully
represent the quality of an article, so do not avoid reading an article that does not have a score as high as another.

For more information on AltMetric, please visit:

​[Contributor: Helen Starrs